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BackgroundUnrelieved chemotherapy-induced nausea (CIN) occurs 48% of patients undergoing chemotherapy and is one of the most debilitating symptoms that patients report.ObjectiveThe aims of this study were to identify subgroups of patients with distinct CIN profiles and determine how these subgroups differed on demographic and clinical characteristics; severity, frequency, and distress of CIN; and the co-occurrence of common gastrointestinal symptoms.MethodsPatients (n = 1343) completed demographic questionnaire and Memorial Symptom Assessment Scale 6 times over 2 cycles of chemotherapy. Latent class analysis was used to identify subgroups of patients with distinct CIN profiles. Differences among these subgroups were evaluated using parametric and nonparametric statistics.ResultsFour distinct CIN profiles were identified: none (40.8%), increasing-decreasing (21.5%), decreasing (8.9%), and high (28.8%). Compared with the none class, patients in the high class were younger, had a lower annual household income, had child care responsibilities, had a lower Karnofsky Performance Status score and a higher Self-administered Comorbidity Questionnaire score, and were more likely to have received chemotherapy on a 14-day cycle and a highly emetogenic chemotherapy regimen. In addition, patients in the high class reported high occurrence rates for dry mouth, feeling bloated, diarrhea, lack of appetite, abdominal cramps, difficulty swallowing, mouth sores, weight loss, and change in the way food tastes.ConclusionsThat 60% of the patients reported moderate to high CIN occurrence rates confirms that this unrelieved symptom is a significant clinical problem.Implications for practiceNurses need to evaluate patients' level of adherence to their antiemetic regimen and make appropriate referrals for physical therapy, psychological services, and dietary counseling.

When data for multiple outcomes are collected in a multilevel design, researchers can select a univariate or multivariate analysis to examine group-mean differences. When correlated outcomes are incomplete, a multivariate multilevel model (MVMM) may provide greater power than univariate multilevel models (MLMs). For a two-group multilevel design with two correlated outcomes, a simulation study was conducted to compare the performance of MVMM to MLMs. The results showed that MVMM and MLM performed similarly when data were complete or missing completely at random. However, when outcome data were missing at random, MVMM continued to provide unbiased estimates, whereas MLM produced grossly biased estimates and severely inflated Type I error rates. As such, this study provides further support for using MVMM rather than univariate analyses, particularly when outcome data are incomplete.

Women remain underrepresented in physical science, engineering, and computer science college majors and careers. Prior research has suggested that motivational beliefs and experiences in high school play a critical role in girls' persistence in science fields. We hypothesized that compared to male students, female high school students may experience less daily autonomy support from teachers and lower psychological need satisfaction in physics, chemistry, and engineering courses. In turn, we expected that these differences would explain girls' lower daily engagement in these courses compared to boys. In line with current trends indicating gender parity in biology and biomedical fields, we did not expect to find gender differences in biology courses. Results from a six-week intensive longitudinal study in which high school students reported their daily experiences of teacher autonomy support, need satisfaction, and engagement during science class supported our hypotheses. The implications of the results for theory and practice are discussed.

This diary study provided the first classroom-based empirical test of the relations between student perceptions of high school science teachers' various autonomy supporting and thwarting practices and students' motivation and engagement on a daily basis over the course of an instructional unit. Perceived autonomy supporting practices were hypothesized to predict autonomous motivation and engagement outcomes, while perceived autonomy thwarting practices were hypothesized to predict controlled motivation and disaffection outcomes. In line with this prediction, multilevel modeling results based on regular reports of 208 high school students in 41 science classes across 6 weeks suggested that 4 perceived daily supports (choice provision, consideration for student preferences and interests, rationales for importance, and question opportunities) and 1 daily thwart (use of uninteresting activities) predicted changes in daily autonomous motivation and engagement. In contrast, changes in students' daily controlled motivation and disaffection were predicted primarily by 3 perceived daily thwarts (controlling messages, suppression of student perspectives, and use of uninteresting activities). Results also suggested that practices interacted such that the perception of thwarts generally bolstered desirable daily relationships between perceived supports and students' motivation and the perception of supports generally mitigated undesirable daily relationships between thwarts and motivation. Supplemental exploratory results suggested that the effects of choice and suppression of student perspectives may be heterogeneous and depend on the outcome and/or the presence of other practices. Implications of the findings are discussed.

Alzheimer's disease (AD) affects Latinos disproportionately. One of the reasons underlying this disparity may be type 2 diabetes (T2D) that is a risk factor for AD. The purpose of this study was to examine the associations of T2D and AD blood biomarkers and the differences in these associations between Mexican Americans and non-Hispanic Whites. This study was a secondary analysis of baseline data from the observational Health and Aging Brain Study: Health Disparities (HABS-HD) that investigated factors underlying health disparities in AD in Mexican Americans in comparison to non-Hispanic Whites. HABS-HD participants were excluded if they had missing data or were large outliers (z-scores >|4|) on a given AD biomarker. Fasting blood glucose and glycosylated hemoglobin (HbA1c) levels were measured from clinical labs. T2D was diagnosed by licensed clinicians. Plasma amyloid-beta 42 and 40 (Aβ42/42) ratio, total tau (t-tau), and neurofilament light (NfL) were measured via ultra-sensitive Simoa assays. The sample sizes were 1,552 for Aβ42/40 ratio, 1,570 for t-tau, and 1,553 for NfL. Mexican Americans were younger (66.6±8.7 vs. 69.5±8.6) and had more female (64.9% female vs. 55.1%) and fewer years of schooling (9.5±4.6 vs. 15.6±2.5) than non-Hispanic Whites. Mexican Americans differed significantly from non-Hispanic Whites in blood glucose (113.5±36.6 vs. 99.2±17.0) and HbA1c (6.33±1.4 vs. 5.51±0.6) levels, T2D diagnosis (35.3% vs. 11.1%), as well as blood Aβ42/40 ratio (.051±.012 vs..047±.011), t-tau (2.56±.95 vs. 2.33±.90), and NfL levels (16.3±9.5 vs. 20.3±10.3). Blood glucose, blood HbA1c, and T2D diagnosis were not related to Aβ42/40 ratio and t-tau but explained 3.7% of the variation in NfL (p <.001). Blood glucose and T2D diagnosis were not, while HbA1c was positively (b = 2.31, p <.001, β = 0.26), associated with NfL among Mexican Americans. In contrast, blood glucose, HbA1c, and T2D diagnosis were negatively (b = -0.09, p <.01, β = -0.26), not (b = 0.34, p =.71, β = 0.04), and positively (b = 3.32, p <.01, β = 0.33) associated with NfL, respectively in non-Hispanic Whites. To conclude, blood glucose and HbA1c levels and T2D diagnosis are associated with plasma NfL levels, but not plasma Aβ and t-tau levels. These associations differ in an ethnicity-specific manner and need to be further studied as a potential mechanism underlying AD disparities. [ABSTRACT FROM AUTHOR]

This investigation examined relations between adolescent students' daily and cumulative perceptions of teachers' practice and their experience of autonomy. Two-hundred and eighteen high school science students in 43 classes participated in a 6-week diary study. Multilevel modeling results suggested that perceptions of 8 out of 9 practices predicted a change in students' daily autonomy. Results also revealed that autonomy-relevant practices interacted with time, each other, and characteristics of students and classrooms. Implications are discussed.

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Use of multivariate analysis (e.g., multivariate analysis of variance) is common when normally distributed outcomes are collected in intervention research. However, when mixed responses--a set of normal and binary outcomes--are collected, standard multivariate analyses are no longer suitable. While mixed responses are often obtained in intervention studies and analysis models that can simultaneously include such outcomes are available, we found very limited use of these models in intervention research. To encourage greater use of multivariate analysis for mixed outcomes, this article highlights the benefits and describes important features of models that can incorporate a mix of normal and binary outcomes. Models for intervention research are then fit using Mplus and results interpreted using data from an evaluation of the Early Head Start program, a randomized trial designed to improve child outcomes for an at-risk population. The models illustrated estimate treatment effects for mixed responses in standard and multilevel experimental designs.

This article presents 3 standardized effect size measures to use when sharing results of an analysis of mediation of treatment effects for cluster-randomized trials. The authors discuss 3 examples of mediation analysis (upper-level mediation, cross-level mediation, and cross-level mediation with a contextual effect) with demonstration of the calculation and interpretation of the effect size measures using a simulated dataset and an empirical dataset from a cluster-randomized trial of peer tutoring. SAS syntax is provided for parametric percentile bootstrapped confidence intervals of the effect sizes. The use of any of the 3 standardized effect size measures depends on the nature of the inference the researcher wishes to make within a single site, across the broad population, or at the site level.

Cultural stereotypes that equate aging with decreased competence and increased forgetfulness have persisted for decades. Stereotype threat (ST) refers to the psychological discomfort people experience when confronted by a negative, self-relevant stereotype in a situation where their behavior could be construed as confirming that belief. The purpose of this study was to examine the relationships of ST on memory performance in older adults over 24 months. The ST levels on average significantly declined, or improved in the memory training, but not the health training group. Although not significant at the.01 level, the bivariate correlation indicated that change in ST was moderately related to change in verbal memory, suggesting the possibility that improvements (or reductions) in ST may be related to increases in verbal memory scores. We discovered that the unique contribution of ST into the memory performance of healthy older adults offers a possible malleable trait. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has been a source of worry for many, but older adults have been identified as more vulnerable to serious cases and may therefore feel more concerned about the virus. We assessed whether COVID-19 worry was related to indicators of mental health and preparedness for future care, in an adult lifespan sample. An online study (n = 485; age 18–82, M = 49.31, SD = 15.39) included measures of COVID-19 worry, depression, general anxiety, health anxiety, hostile and benevolent ageism, preparedness for future care, and demographic information. Age and living alone were positively associated with greater COVID-19 worry, as were health anxiety, general anxiety, benevolent ageism, and preparedness for future care needs via gathering information. A significant interaction indicated that among individuals reporting lower health anxiety, greater preference for gathering information was positively associated with greater COVID-19 worry; however, for individuals having high health anxiety, gathering information about future care was not related to COVID-19 worry, as their COVID-19 worry levels were moderately high. Older age was associated with greater COVID-19 worry, perhaps in response to the much publicized greater risk for negative outcomes in this population. In spite of this specific concern, indicators of older adults' continued mental health emerged. Preparedness for future care is also highlighted, as well as clinical implications. [ABSTRACT FROM AUTHOR]