Administering selected subscales of patient-reported outcome questionnaires to reduce patient burden and increase relevance: a position statement on a modular approach

Patient-reported outcome (PRO) questionnaires considered in this paper contain multiple subscales, although not all subscales are equally relevant for administration in all target patient populations. A group of measurement experts, developers, license holders, and other scientific-, regulatory-, payer-, and patient-focused stakeholders participated in a panel to discuss the benefits and challenges of a modular approach, defined here as administering a subset of subscales out of a multi-scaled PRO measure. This paper supports the position that it is acceptable, and sometimes preferable, to take a modular approach when administering PRO questionnaires, provided that certain conditions have been met and a rigorous selection process performed. Based on the experiences and perspectives of all stakeholders, using a modular approach can reduce patient burden and increase the relevancy of the items administered, and thereby improve measurement precision and eliminate wasted data without sacrificing the scientific validity and utility of the instrument. The panelists agreed that implementing a modular approach is not expected to have a meaningful impact on item responses, subscale scores, variability, reliability, validity, and effect size estimates; however, collecting additional evidence for the impact of context may be desirable. It is also important to recognize that adequate rationale and evidence (e.g., of fit-for-purpose status and relevance to patients) and a robust consensus process that includes patient perspectives are required to inform selection of subscales, as in any other measurement circumstance, is expected. We believe that the considerations discussed within (content validity, administration context, and psychometric factors) are relevant across multiple therapeutic areas.

Evaluation of breast tumor morphologies from African American and Caucasian patients

The primary aim of this research was to investigate potential differences of breast tumor morphologies across African American and Caucasian racial groups by utilizing machine learning (ML) and artificial intelligence (AI) methods. While breast cancer disparities can partially be attributed to social determinants of health, tumor biology also contributes to survival outcomes. The rate of breast tumor growth is largely dependent on the extracellular matrix (ECM). Current research suggests the cellular components of the ECM may vary among racial and ethnic populations, and this may contribute to the incidence of cancer in African Americans. We utilized a supervised AI method to evaluate morphological differences between African American and Caucasian breast cancer tumors. Images used for analysis were downloaded from the Cancer Genome Atlas (TCGA) biorepository stored in the NIH Genomic Data Commons (GDC) data portal. We designed an ML classifier using the AlexNet model provided in PyTorch's torchvision package. The model was pre-trained and adapted via transfer learning resulting in a classification accuracy of 92.1% when using our breast cancer tumor image database split into 80% of training set and 20% of testing set. We interpreted the results of the AlexNet and ResNet50 models using LIME and saliency mapping as the explainers. Based on the images from our bi-racial testing set, this study confirmed significant variations of tumor and ECM regions in the different racial groups evaluated. Based on these findings, further analysis and characterization may provide new insight into disparities associated with the incidence of breast cancer.

Adaptations to water stress and pastoralism in the Turkana of northwest Kenya

The Turkana people inhabit arid regions of east Africa-where temperatures are high and water is scarce-and they practice subsistence pastoralism, such that their diet is primarily composed of animal products. Working with Turkana communities, we sequenced 367 genomes and identified 8 regions putatively involved in adaptation to water stress and pastoralism. One of these regions includes a putative enhancer for STC1-a kidney-expressed gene involved in the response to dehydration and the metabolism of purine-rich foods such as red meat. We show that STC1 is induced by antidiuretic hormone in humans, is associated with urea levels in the Turkana themselves, and is under strong selection in this population (s∼0.041). This work highlights that partnerships with subsistence-level groups can lead to new models of human physiology with biomedical relevance.

Elbow arthroplasty in trauma-current concepts review

Introduction

Despite advancements in modern locking plate technology, distal humerus fractures in the elderly remain difficult to treat. A subset of fractures in this osteoporotic bone includes multiple, shallow articular fragments that renders fixation unreliable, precluding early motion and acceptable functional outcomes. Arthroplasty, in the form of either Total Elbow Arthroplasty (TEA) or Distal Humeral Hemiarthroplasty (DHH) are alternative treatment options in this cohort and are being increasingly used.

Methods

This article reviews the use of TEA or DHH for acute distal humerus fracture, including patient selection, pre-operative planning, surgical approach, implant positioning, rehabilitation, outcomes and complications.

Results

Arthroplasties are being increasingly used for acute distal humerus fractures, however they introduce potential complications not seen with fixation. Due care must be employed to correct implant positioning which is a function of implant rotation, implant length and implant sizing. We describe a robust technique for epicondyle repair in DHH and unlinked TEA to avoid instability. Outcomes of DHH and TEA for acute distal humerus fracture are encouraging, however further long-term outcome and comparative data regarding arthroplasty is required.

Conclusions

Short to medium term outcomes demonstrate that both DHH and TEA are valuable options for selected patients, although attention to technique is required to minimise potential complications.

Changes in Momentary Experience Were Associated With the Onset of the COVID Pandemic

We explored the COVID-19 pandemic’s effects on daily experience using momentary recordings of affect, activities, locations, and social interactions, documenting changes in the pandemic’s early stages. 123 individuals 50 years or older from an ongoing panel study completed 1-week bursts of Ecological Momentary Assessment (6/day) in March, May, and July. A pronounced spike in negative affect and decrease in positive affect was observed in late March compared with early March, which in May and June returned to early March levels. Levels of fatigue, however, did not follow this pattern. Being with one’s spouse/significant other and family also increased, then decreased. Working and interacting with others dropped from early to late March and then remained steady; doing chores had the opposite pattern. Regarding location, being at the workplace dropped from early to late March and remained steady, and being at home had the opposite pattern. Additional analyses explored these patterns.

Influence of ecological momentary assessment study design features on reported willingness to participate and perceptions of potential research studies: an experimental study

OBJECTIVE

Intensive ambulatory assessment, such as ecological momentary assessment (EMA), is increasingly used to capture naturalistic patient-reported outcomes. EMA design features (eg, study duration, prompt frequency) vary widely between studies, but it is not known if such design decisions influence potential subjects' willingness to participate in a study. We hypothesise that intentions to participate will be higher in studies that are less burdensome and have higher reward (eg, compensation).

DESIGN

This experimental study examined if four EMA study design features (study duration, prompt frequency, prompt length, compensation) affected intentions to participate in a hypothetical EMA study and participation appraisals (eg, participation effort). Participants were randomly assigned to conditions (reflecting a fully crossed design of the four features, each with two levels). Each condition presented a vignette describing a study (each a unique combination of design features) and asked them to report on likelihood of participating and study appraisals.

PARTICIPANTS

A convenience sample of participants (n=600; 46% female, Mage=40.39) were recruited using an online service.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcomes were willingness to participate (No/Yes) and reported participation likelihood (0-100 scale). Secondary outcomes included appraisals of interest, enjoyment, effort, and if the study makes a valuable contribution to science.

RESULTS

We examined main effects, and two-way interactions for participation likelihood, across study design features. Overall, reported willingness to participate and participation likelihood were high (89%, M=83.90, respectively). Shorter study duration, fewer prompts, shorter prompts and higher compensation increased willingness to participate and elicited higher participation likelihood (each associated with ~6%-8% increases). Findings suggested that more intensive studies were judged as somewhat less interesting and enjoyable, and requiring more effort.

CONCLUSION

Hypotheses were generally supported. Design features influence behavioural intentions to participate in, and appraisals of, EMA studies. Implications for participant recruitment and generalisability, and remaining research questions, are discussed.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Exaggeration of PFS by blinded, independent, central review (BICR)

BACKGROUND

Recent published studies have shown meaningful discrepancies between local investigator and blinded, independent, central review (BICR) assessed median progression-free survival (PFS). When the local review but not BICR shows progression, generally, no further assessments are carried out and patients are censored in the BICR analysis, leading to violation of the statistical assumptions of independence between censoring and outcome used in survival analysis methods.

METHODS

We carried out a simulation study to assess methodological reasons behind these discrepancies and corroborated our findings in a case study of three BRCA-mutated ovarian cancer trials. We briefly outline possible methodological solutions that may lead to improved estimation of the BICR medians.

RESULTS

The Kaplan-Meier (KM) curve for the BICR PFS can often be exaggerated. The degree of bias is largest when there is reasonably strong correlation between BICR and local PFS, especially when PFS is long compared with assessment frequency. This can result in an exaggeration of the medians and their difference; however, the hazard ratio (HR) is much less susceptible to bias. Our simulation shows that when the true BICR median PFS was 19 months, and patients assessed every 12 weeks, the estimated KM curves were materially biased whenever the correlation between BICR and local PFS was 0.4 or greater. This was corroborated by case studies where, in the active arm, the BICR median PFS was between 6 and 11 months greater than the local median PFS. Further research is required to find improved methods for estimating BICR survival curves.

CONCLUSIONS

In general, when there is a difference between local and BICR medians, the true BICR KM curve is likely to be exaggerated and its true median will probably lie somewhere between the observed local and BICR medians. Presentation of data should always include both BICR and local results whenever a BICR is carried out.

Studies on the behaviour and control of phlebotomine sandflies using experimental houses

Programmes for the control of phlebotomine sandflies (Diptera: Psychodidae), the vectors of leishmaniases, mainly target adults because larval breeding sites are generally unknown or inaccessible. To determine how blood-questing sandfly females enter homes and to develop means for their control, an experimental house (EH) was constructed in a village endemic for cutaneous leishmaniasis. Initially, carbon dioxide (CO₂ )-baited suction traps were installed inside the EH to attract and capture sandflies. For other experiments, the windows of the EH were fitted with CO₂ -baited window entrance traps (WETs) that allow each window to be considered as a separate unit. The majority of captures inside the EH and in WETs consisted of Phlebotomus sergenti, a species that enters inhabited houses relatively infrequently. Analyses of collections in WETs and in sticky traps on external walls showed that sandflies entered windows having landed previously on the wall below or either side of the window. Shelves constructed below windows significantly reduced the numbers of sandflies that entered both the EH and inhabited houses. The lining of internal walls with insecticide-impregnated fabric significantly increased mortality rates of sandflies captured inside the EH. To reduce the biting burden imposed by phlebotomine sandflies, several control measures must be integrated and sustained.

CRP polymorphisms and DNA methylation of the AIM2 gene influence associations between trauma exposure, PTSD, and C-reactive protein

BACKGROUND

Recent studies have implicated inflammatory processes in the pathophysiology of posttraumatic stress disorder (PTSD). C-reactive protein (CRP) is a widely-used measure of peripheral inflammation, but little is known about the genetic and epigenetic factors that influence blood levels of C-reactive protein (CRP) in individuals with PTSD.

METHODS

Participants were 286 U.S. military veterans of post-9/11 conflicts (57% with current PTSD). Analyses focused on single nucleotide polymorphisms (SNPs) in the CRP gene and DNA methylation at cg10636246 in AIM2-a locus recently linked to CRP levels through results from a large-scale epigenome-wide association study.

RESULTS

PTSD was positively correlated with serum CRP levels with PTSD cases more likely to have CRP levels in the clinically-elevated range compared to those without a PTSD diagnosis. Multivariate analyses that controlled for white blood cell proportions, genetic principal components, age and sex, showed this association to be mediated by methylation at the AIM2 locus. rs3091244, a functional SNP in the CRP promoter region, moderated the association between lifetime trauma exposure and current PTSD severity. Analyses also revealed that the top SNPs from the largest genome-wide association study of CRP conducted to date (rs1205 and rs2794520) significantly interacted with PTSD to influence CRP levels.

CONCLUSIONS

These findings provide new insights into genetic and epigenetic mechanisms of inflammatory processes in the pathophysiology of PTSD and point to new directions for biomarker identification and treatment development for patients with PTSD.

BDNF genotype is associated with hippocampal volume in mild traumatic brain injury

The negative long-term effects of mild traumatic brain injury (mTBI) have been a growing concern in recent years, with accumulating evidence suggesting that mTBI combined with additional vulnerability factors may induce neurodegenerative-type changes in the brain. However, the factors instantiating risk for neurodegenerative disease following mTBI are unknown. This study examined the link between mTBI and brain-derived neurotrophic factor (BDNF) genotype, which has previously been shown to regulate processes involved in neurodegeneration including synaptic plasticity and facilitation of neural survival through its expression. Specifically, we examined nine BDNF single-nucleotide polymorphisms (SNPs; rs908867, rs11030094, rs6265, rs10501087, rs1157659, rs1491850, rs11030107, rs7127507 and rs12273363) previously associated with brain atrophy or memory deficits in mTBI. Participants were 165 white, non-Hispanic Iraq and Afghanistan war veterans between the ages of 19 and 58, 110 of whom had at least one mTBI in their lifetime. Results showed that the BDNF SNP rs1157659 interacted with mTBI to predict hippocampal volume. Furthermore, exploratory analysis of functional resting state data showed that rs1157659 minor allele homozygotes with a history of mTBI had reduced functional connectivity in the default mode network compared to major allele homozygotes and heterozygotes. Apolipoprotein E (APOE) was not a significant predictor of hippocampal volume or functional connectivity. These results suggest that rs1157659 minor allele homozygotes may be at greater risk for neurodegeneration after exposure to mTBI and provide further evidence for a potential role for BDNF in regulating neural processes following mTBI.

The Measure Matters: An Investigation of Evaluative and Experience-Based Measures of Wellbeing in Time Use Data

Measures of subjective wellbeing (SWB) are used to understand how people think and feel about their lives and experiences. But the measure used matters to conclusions about how well people's lives are going. This research compares life evaluations and experienced SWB using nationally representative time use diaries, advancing previous research because diaries are less subject to recall biases than other, more popular methods. Analyses of over 20,000 US residents in 2012-2013 show life evaluations are more closely associated with positive and negative affect than experienced meaningfulness. Women have higher SWB than men except for negative affect, older age groups have higher SWB than middle age groups except for experienced meaningfulness, and younger age groups report the lowest experienced meaning. The unemployed have low life evaluations but experiences of SWB are similar across employment groups. A complete picture of SWB requires a complete set of measures.

Visual sign phonology: insights into human reading and language from a natural soundless phonology

Among the most prevailing assumptions in science and society about the human reading process is that sound and sound-based phonology are critical to young readers. The child's sound-to-letter decoding is viewed as universal and vital to deriving meaning from print. We offer a different view. The crucial link for early reading success is not between segmental sounds and print. Instead the human brain's capacity to segment, categorize, and discern linguistic patterning makes possible the capacity to segment all languages. This biological process includes the segmentation of languages on the hands in signed languages. Exposure to natural sign language in early life equally affords the child's discovery of silent segmental units in visual sign phonology (VSP) that can also facilitate segmental decoding of print. We consider powerful biological evidence about the brain, how it builds sound and sign phonology, and why sound and sign phonology are equally important in language learning and reading. We offer a testable theoretical account, reading model, and predictions about how VSP can facilitate segmentation and mapping between print and meaning. We explain how VSP can be a powerful facilitator of all children's reading success (deaf and hearing)-an account with profound transformative impact on learning to read in deaf children with different language backgrounds. The existence of VSP has important implications for understanding core properties of all human language and reading, challenges assumptions about language and reading as being tied to sound, and provides novel insight into a remarkable biological equivalence in signed and spoken languages. WIREs Cogn Sci 2016, 7:366-381. doi: 10.1002/wcs.1404 For further resources related to this article, please visit the WIREs website.

A Summary of the First HIV Microbiome Workshop 2015

The role of microbiota in the pathogenesis of HIV infection has become the subject of intense research in recent years. A rapidly growing amount of data suggest that microbial dysbiosis-in the gut or the genital tract-can influence HIV transmission and/or disease progression; however, a deeper understanding of the mechanisms involved is lacking. To better understand the relationship between the microbiome and HIV infection, investigators from a wide variety of disciplines, including those working in basic and clinical HIV studies, cardiovascular disease, reproductive health, and bioinformatics, gathered at the first International Workshop on Microbiome in HIV Pathogenesis, Prevention and Treatment, at NIH on 7 and 8 April, 2015.

Relaxation Training and Cortisol Secretion in Adult Asthmatics

Relaxation techniques can lead to symptom reduction and improved pulmonary functioning in asthmatics, although the mechanism is not clear. One possibility is by influencing cortisol secretion, as cortisol is implicated in inflammatory processes and relaxation has been shown to alter cortisol secretion in healthy individuals. This study explored the effect of relaxation training on cortisol levels and cortisol reactivity to stress in asthmatics. Twenty adult asthmatics participated for 21 days in their natural environment, and received relaxation training halfway through the study. Cortisol was assessed from saliva five times per day for three weeks. Relaxation training was successful, but did not lead to the hypothesized reduction in overall cortisol levels. Participants using corticosteroid medication showed increases in cortisol after relaxation, whereas those not using corticosteroids showed decreases in cortisol ( p< .05). Relaxation altered the cortisol reactivity to stress ( p= .007); before relaxation training cortisol levels increased after a stressor, whereas following relaxation training cortisol levels decreased after a stressor. This study suggests that relaxation training can influence cortisol secretion in asthmatics, but that these effects differ from those observed in healthy individuals and may be influenced by corticosteroid medication use.

Linking fatigue measures on a common reporting metric

CONTEXT

Fatigue is one of the most common and debilitating symptoms experienced by patients living with chronic conditions and is also commonly experienced in the general U.S. population. Linking fatigue scores from some of the most widely used measure of fatigue to the same metric will facilitate interpretation of fatigue outcomes.

OBJECTIVES

The goal of this study is to report the methods used to develop linking (crosswalk) tables to enable the direct comparison of Patient-Reported Outcomes Measurement Information System-Fatigue with fatigue scores on the Functional Assessment of Chronic Illness Therapy-Fatigue Scale, the Medical Outcomes Study Short Form-36 four-item Vitality Scale, and the Quality of Life in Neurological Disorders Fatigue Scale.

METHODS

Participants were recruited from two data sets (n=1120 and n=803). Two item response theory-based linking methods, the Stocking-Lord calibration and fixed-parameter calibration, were used to establish linking between measures. The item response theory calibrations were derived using the graded response model.

RESULTS

Both the Stocking-Lord calibration and fixed-parameter calibration linking methods produced comparable results. Final crosswalk tables are reported for the fixed-parameter calibration.

CONCLUSION

Findings can facilitate comparison of scores across some of the most widely used fatigue measures and assist in comparing patient-reported fatigue outcomes in clinical trials, comparative effectiveness research, and clinical practice.

Abstract P6-08-06: Use of an NIH PROMIS® instrument to identify predictors of fatigue in breast cancer patients receiving adjuvant chemotherapy

Background: Fatigue is one of the most common side effects of treatment for breast cancer (BC). This study used a daily diary approach to investigate the course of fatigue in BC patients receiving adjuvant chemotherapy. We examined clinical (BSA, menopausal status, stage, hemoglobin levels) and self-reported biopsychosocial factors (anxiety, depression, pain, physical and social functioning) as predictors of fatigue after chemotherapy infusion.

Methods: We enrolled 28 stage I (39%), II (50%), and III (11%) BC patients (mean age = 48.9 years, SD = 9.7) receiving standard adjuvant chemotherapy. Fatigue was assessed over 14 consecutive days (day −2 to +11) using a modified version of the NIH Patient-Reported Outcomes Measurement Information System (PROMIS®) fatigue short-form. Putative predictors of fatigue were assessed in the week prior to infusion. Anxiety and depression were measured with computerized adaptive testing. Pain, physical functioning, and social functioning were assessed using PROMIS global health items. Clinical variables were abstracted from patients' medical records. Analyses used individual growth curve modeling to examine overall levels of post-infusion fatigue and rates of change (amplitude) in daily fatigue over a 14-day period prior to the next infusion.

Results: Daily fatigue varied considerably over the 14 day study period, following a sinusoidal pattern. Fatigue T-scores increased from near-normal values (mean = 53) by about 1 SD (p &lt; .001) during the first 3 days post-infusion (mean = 62), peaked on days 3–6, and decreased to near-normal (mean = 53) by day 11. Higher baseline anxiety, depression, pain and problems with physical functioning independently predicted higher overall fatigue levels during the post-infusion period (p &lt; .001). In addition, baseline pain and physical functioning predicted distinct patterns of change in fatigue scores (p &lt; .05). Fatigue showed a steep rise and fall in patients with less pain and better physical functioning at baseline, rapidly returning to pre-infusion levels. Fatigue was more constant in patients with greater pain and worse physical functioning at baseline. These patients reported higher fatigue scores prior to infusion but experienced fewer dynamic changes in response to chemotherapy. Medical variables and social functioning were not associated with baseline fatigue levels or changes in fatigue.

Conclusions: This study demonstrates that BC patients with greater anxiety, depression, pain or poor physical functioning at baseline are at risk for prolonged and severe fatigue during treatment with chemotherapy. Patients with low pain and high physical functioning experience sharper changes in fatigue after infusion with quick return to baseline. The NIH PROMIS questionnaire provides a powerful quantitative method to identify predictors of chemotherapy-related fatigue. Identification of these predictors is critical for effective management of patient expectations and the development of targeted interventions to improve tolerance and functioning during adjuvant chemotherapy for breast cancer.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-08-06.

Self-reported fatigue: one dimension or more? Lessons from the Functional Assessment of Chronic Illness Therapy--Fatigue (FACIT-F) questionnaire

Across two general population (total n=1,878) and two cancer (total n=3,140) samples, we evaluated the dimensionality of self-reported fatigue as measured by the Functional Assessment of Chronic Illness Therapy--Fatigue (FACIT-F) instrument. After evaluating dimensionality of the FACIT-F, we compared the conceptually distinct fatigue experience versus fatigue impact scores in each sample. Confirmatory factor analysis of the 13-item scale showed very good fit to a single dimension ("unidimensional") model for each sample (comparative fit index range=0.92-0.97). Using a bifactor model to compare the loading of each item with the general fatigue factor versus the identified sub-domain (experience or impact), we found the item-general loading to be higher than that of the item-sub-domain factor in 52 of 52 comparisons (13 items; four samples). When scored separately, experience and impact scores were correlated highly (range=0.80-0.88), yet their difference relative to one another was significant (p<0.001). Consistently across samples, experience scores were systematically higher (more endorsement) than impact scores, by a margin of 0.21-0.46 SD units. This suggests that the fatigue experience and the impact of fatigue upon function are reported along a single dimensional continuum, but that experience is more likely than impact upon function to be endorsed at lower levels of fatigue. Fatigue as an outcome or trial endpoint can be expressed as a single number, and the experience of the symptom is more likely to be endorsed at mild levels of fatigue, presumably before the symptom exerts an adverse impact upon function.

The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008

OBJECTIVES

Patient-reported outcomes (PROs) are essential when evaluating many new treatments in health care; yet, current measures have been limited by a lack of precision, standardization, and comparability of scores across studies and diseases. The Patient-Reported Outcomes Measurement Information System (PROMIS) provides item banks that offer the potential for efficient (minimizes item number without compromising reliability), flexible (enables optional use of interchangeable items), and precise (has minimal error in estimate) measurement of commonly studied PROs. We report results from the first large-scale testing of PROMIS items.

STUDY DESIGN AND SETTING

Fourteen item pools were tested in the U.S. general population and clinical groups using an online panel and clinic recruitment. A scale-setting subsample was created reflecting demographics proportional to the 2000 U.S. census.

RESULTS

Using item-response theory (graded response model), 11 item banks were calibrated on a sample of 21,133, measuring components of self-reported physical, mental, and social health, along with a 10-item Global Health Scale. Short forms from each bank were developed and compared with the overall bank and with other well-validated and widely accepted ("legacy") measures. All item banks demonstrated good reliability across most of the score distributions. Construct validity was supported by moderate to strong correlations with legacy measures.

CONCLUSION

PROMIS item banks and their short forms provide evidence that they are reliable and precise measures of generic symptoms and functional reports comparable to legacy instruments. Further testing will continue to validate and test PROMIS items and banks in diverse clinical populations.

Memories of yesterday's emotions: does the valence of experience affect the memory-experience gap?

Intense pain is often exaggerated in retrospective evaluations, indicating a possible divergence between experience and memory. However, little is known regarding how people retrospectively evaluate experiences with both pleasant and unpleasant aspects. The Day Reconstruction Method (DRM; Kahneman. Krueger, Schkade, Schwarz, & Stone, 2004b) provides a unique opportunity to examine memory-experience gaps in recollections of individual days, which elicit a wide gamut of emotions. We asked female participants (N = 810, Study 1, and N = 615, Study 2) to reconstruct episodes of the previous day using the DRM and demonstrated that memory and experience diverge for both pleasant and unpleasant emotions. When they rated their day overall in a retrospectively evaluative frame of mind, the participants recalled more unpleasant and pleasant emotions than they reported feeling during the individual episodes, with a larger gap for unpleasant emotions than for pleasant emotions. The findings suggest that separate processes are used for committing positive and negative events to memory and that, especially when unpleasant emotions are involved, prudence is favored over accuracy.

Drink a little; take a few drugs: do nurses have knowledge to identify and manage in-patients at risk of drugs and alcohol?

INTRODUCTION AND AIMS

The widespread use of alcohol and other drugs poses particular problems during hospitalisation. Although nurses have been identified as an appropriate group to screen patients and provide acute and ongoing management to people with drug and alcohol-related problems, rates of screening are low. The aims of this study were to identify current practices for screening by nurses working in medical and surgical wards, determine their knowledge relating to problems associated with substance use and identify their self-reported skills in managing patients with drug- and alcohol-related problems.

DESIGN AND METHODS

A chart audit of medical records was completed and a survey was distributed to nurses working in the study wards.

RESULTS

Screening for alcohol and drug use was documented on only 22/79 medical records, and detailed information about quantity and duration of use was recorded in only nine. Overall, the nurses reported that they had little knowledge about substance use problems, and felt that they lacked skills to care adequately for these patients.

DISCUSSION AND CONCLUSIONS

The results of this study suggest a need for a comprehensive training and education to ensure that nurses are familiar with policies and protocols for management of patients and to assist nurses to provide evidence-based care and make appropriate referrals to specialist services.

Classical test theory and item response theory/Rasch model to assess differences between patient-reported fatigue using 7-day and 4-week recall periods

OBJECTIVE

This study compared self-reported fatigue between 7-day and 4-week time frames and explored factors that affect patients' responses.

STUDY DESIGN AND SETTING

Two hundred and sixteen cancer patients completed either 7-day or 4-week version of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). Cochran-Mantel-Haenszel statistics and Cochran-Armitage trend tests were used to assess the association between time frame and item scores. Information function curves at both item and scale levels were depicted to evaluate the precision along the fatigue continuum. Differential item functioning (DIF) was used to examine the stability of the psychometric properties between time frames.

RESULTS

Time frame did not influence patients' item responses. Examination of information function curves at item level did not clearly favor either time frame. At the scale level, the 7-day time frame was slightly more precise overall than the 4-week time frame. No item demonstrated DIF between time frames. Neither gender nor fatigue severity had an impact on above results.

CONCLUSION

This study suggests 7-day and 4-week time frame are equally appropriate in measuring fatigue, preference might be given to the more informative 7-day time frame. However, substantive considerations regarding the appropriate time frame should outweigh statistical ones.

Search for flavor-changing-neutral-current d meson decays

We study the flavor-changing-neutral-current process c-->u micro(+) micro(-) using 1.3 fb(-1) of pp[over ] collisions at square root s = 1.96 TeV recorded by the D0 detector operating at the Fermilab Tevatron Collider. We see clear indications of the charged-current mediated D(s)(+) and D(+)-->phipi(+) --> micro(+)micro(-)pi(+) final states with significance greater than 4 standard deviations above background for the D(+) state. We search for the continuum neutral-current decay of D(+)-->pi(+) micro(+) micro(-) in the dimuon invariant mass spectrum away from the phi resonance. We see no evidence of signal above background and set a limit of B(D(+) --> pi(+) micro(+) micro(-))<3.9 x 10(-6) at the 90% C.L. This limit places the most stringent constraint on new phenomena in the c--> u micro(+) micro(-) transition.

Use of treatment records and lung lesion scoring to estimate the effect of respiratory disease on growth during early and late finishing periods in South African feedlot cattle

Growth, morbidity, and slaughter data from 2,036 calves in 2 South African feedlots were used to estimate the effect of bovine respiratory disease (BRD) and of lung lesion type and extent on growth during the early (processing to d 35) and late (d 35 to slaughter) finishing periods. Calves were weighed at processing (d 5 after arrival), on d 35, and at slaughter after a mean of 137 d on feed. All calves were monitored twice daily and were treated for BRD if rectal temperature was > 40 degrees C or if other specific signs of BRD were present. After slaughter, the occurrence and extent of parenchymal bronchopneumonic lesions and pleural adhesions were recorded. Subclinical BRD (never treated but with lung lesions at slaughter) occurred in 29.7% and clinical BRD in 22.6% of calves. Lung lesions were present in 43% of calves at slaughter; 8.6% had parenchymal lesions and 38.8% had pleural adhesions. Using a combined case definition (treated for BRD and/or lung lesions present at slaughter), the incidence of BRD was 52.5%. During the early finishing period, clinical BRD reduced ADG by 216 g (P < 0.001), subclinical BRD reduced ADG by 91 g (P < 0.001), and the combined effect of BRD was a 143 g reduction in ADG (P < 0.001). After d 35, animals treated for BRD tended to grow faster than those with subclinical BRD (P = 0.11), indicating that treatment was generally successful in reducing economic losses. The extent of bronchopneumonic lesions at slaughter was not associated with reduced growth during the early finishing period (P = 0.27), but extensive lesions reduced ADG by 88 g during the late period (P = 0.02). In contrast, the extent of pleural adhesions was not associated with reduced growth rate during the late finishing period (P = 0.37) but was strongly associated with reduced ADG before d 35; there was a 101 g reduction (P < 0.001) and a 220 g reduction (P = 0.01) for adhesions involving < 50% and > 50% of the pleural surfaces, respectively. Thus, although the presence of bronchopneumonic lesions and pleural adhesions at slaughter were both associated with reductions in overall ADG, they were indicative of production losses having occurred at different times during the finishing period. The overall effect of BRD was a 24 g reduction in ADG (P = 0.02) and a 5.1 d increase in days on feed (P < 0.001). The hidden cost of reduced growth rate due to BRD amounted to $3.41 per calf with clinical or subclinical BRD, or $1.79 per animal entering the feedlot.

Search for production of single top quarks via tcg and tug flavor-changing-neutral-current couplings

We search for the production of single top quarks via flavor-changing-neutral-current couplings of a gluon to the top quark and a charm (c) or up (u) quark. We analyze 230 pb{-1} of lepton+jets data from pp[over] collisions at a center of mass energy of 1.96 TeV collected by the D0 detector at the Fermilab Tevatron Collider. We observe no significant deviation from standard model predictions, and hence set upper limits on the anomalous coupling parameters kappa{g}{c}/Lambda and kappa{g}{u}/Lambda, where kappa{g} define the strength of tcg and tug couplings, and Lambda defines the scale of new physics. The limits at 95% C.L. are kappa{g}{c}/Lambda<0.15 TeV-1 and kappa{g}{u}/Lambda<0.037 TeV-1.

Measurement of the Lambdab0 lifetime using semileptonic decays

We report a measurement of the Lambda(b)(0) lifetime using a sample corresponding to 1.3 fb(-1) of data collected by the D0 experiment in 2002-2006 during run II of the Fermilab Tevatron collider. The Lambda(b)(0) baryon is reconstructed via the decay Lambda(b)(0)-->micronuLambda(c)(+)X. Using 4437+/-329 signal candidates, we measure the Lambda(b)(0) lifetime to be tau(Lambda(b)(0))=1.290(-0.110)(+0.119)(stat)(-0.091)(+0.087)(syst) ps, which is among the most precise measurements in semileptonic Lambda(b)(0) decays. This result is in good agreement with the world average value.

Properties of L=1 B(1) and B(2)* mesons

This Letter presents the first strong evidence for the resolution of the excited B mesons B(1) and B(2)* as two separate states in fully reconstructed decays to B(+)(*)pi(-). The mass of B(1) is measured to be 5720.6+/-2.4+/-1.4 MeV/c(2) and the mass difference DeltaM between B(2)* and B(1) is 26.2+/-3.1+/-0.9 MeV/c;{2}, giving the mass of the B(2)* as 5746.8+/-2.4+/-1.7 MeV/c(2). The production rate for B(1) and B(2)* mesons is determined to be a fraction (13.9+/-1.9+/-3.2)% of the production rate of the B+ meson.

Measurement of the Lambda b lifetime in the exclusive decay Lambda b --> J/psi Lambda

We have measured the Lambda b lifetime using the exclusive decay Lambda b --> J/psi Lambda, based on 1.2 fb(-1) of data collected with the D0 detector during 2002-2006. From 171 reconstructed Lambda b decays, where the J/psi and Lambda are identified via the decays J/psi --> mu+ mu- and Lambda --> ppi, we measured the Lambda b lifetime to be tau(Lambda b)=1.218 (+0.130)/(-0.115) (stat) +/- 0.042(syst) ps. We also measured the B0 lifetime in the decay B0 --> J/psi(mu+ mu-)K(0)/(S)(pi+ pi-) to be tau(B0)=1.501 (+0.078)/(-0.074) (stat) +/- 0.050(syst) ps, yielding a lifetime ratio of tau(Lambda b)/tau(B0)=0.811 (+0.096)/(-0.087) (stat) +/- 0.034(syst).

Search for stopped gluinos from pp collisions at square root s = 1.96 TeV

Long-lived, heavy particles are predicted in a number of models beyond the standard model of particle physics. We present the first direct search for such particles' decays, occurring up to 100 h after their production and not synchronized with an accelerator bunch crossing. We apply the analysis to the gluino (g), predicted in split supersymmetry, which after hadronization can become charged and lose enough momentum through ionization to come to rest in dense particle detectors. Approximately 410 pb(-1) of pp collisions at square root(s) = 1.96 TeV collected with the D0 detector during Run II of the Fermilab Tevatron collider are analyzed in search of such "stopped gluinos" decaying into a gluon and a neutralino (chi(1)(0)). Limits are placed on the (gluino cross section) x (probability to stop) x [BR(g --> g chi(1)(0))] as a function of the gluino and chi(1)(0) masses, for gluino lifetimes from 30 micros-100 h.

Search for third-generation scalar leptoquarks in pp at square root s=1.96 TeV

We report on a search for charge-1/3 third-generation leptoquarks (LQ) produced in pp collisions at square root s =1.96 TeV using the D0 detector at Fermilab. Third-generation leptoquarks are assumed to be produced in pairs and to decay to a tau neutrino and a b quark with branching fraction B. We place upper limits on sigma(pp --> LQLQ)B2 as a function of the leptoquark mass M(LQ). Assuming B=1, we exclude at the 95% confidence level third-generation scalar leptoquarks with M(LQ)<229 GeV.

Direct observation of the strange b baryon Xib-

We report the first direct observation of the strange b baryon Xi(b)- (Xi(b)+). We reconstruct the decay Xi(b)- -->J/psiXi-, with J/psi-->mu+mu-, and Xi--->Lambdapi--->ppi-pi- in pp collisions at square root of s =1.96 TeV. Using 1.3 fb(-1) of data collected by the D0 detector, we observe 15.2 +/- 4.4(stat)(-0.4)(+1.9)(syst) Xi(b)- candidates at a mass of 5.774 +/- 0.011(stat) +/- 0.015(syst) GeV. The significance of the observed signal is 5.5 sigma, equivalent to a probability of 3.3 x 10(-8) of it arising from a background fluctuation. Normalizing to the decay Lambda(b)-->J/psiLambda, we measure the relative rate sigma(Xi(b-) x B(Xi)b})- -->J/psiXi-)/sigma(Lambda(b)) x B(Lambda(b)-->J/psiLambda) = 0.28+/-0.09(stat)(-0.08)(+0.09)(syst).