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Background: Cancer rehabilitation is an integral part of the continuum of care for survivors. Due to the increasing number of survivors, physiatrists commonly see cancer patients in their general practices. Essential to guiding the field is to understand the current training and practice patterns of cancer rehabilitation physicians.Objectives: To assess current trends in training and practice for cancer rehabilitation physicians, including the level of burnout among providers in this field.Design: Cross-sectional descriptive survey study.Setting: Online survey.Participants: American physicians who are affiliated with the Cancer Rehabilitation Physician Consortium (CRPC) of the American Academy of Physical Medicine and Rehabilitation (AAPM&R). The CRPC is a group of cancer rehabilitation providers (both fellowship-trained and not fellowship-trained) with the mission of furthering cancer rehabilitation medicine through education, research, and networking.Methods: All CRPC physicians were invited to complete a voluntary and anonymous 43-question online survey. The survey was conceived by a group of eight experts interested in providing additional information to the current literature regarding the training and practice in the cancer rehabilitation field.Main Outcome Measurements: Training, practice, opioid prescribing, and professional support.Results: Thirty-seven of 50 physicians participated (response rate = 74%). Respondents were from various states, the three most common being New York (16%, n = 6), Texas (16%, n = 6), and Massachusetts (11%, n = 4). About 57% (n = 21) of the respondents were employed in an academic medical center and 73% (n = 27) reported their primary departmental affiliation was Physical Medicine and Rehabilitation (PM&R). Approximately 78% (n = 29) credited mentorship early in training for their interest in the field. More than half (54%, n = 20) either strongly agreed or agreed that cancer rehabilitation fellowship training is necessary for graduating physiatrists who plan to treat oncology patients/survivors. National PM&R meetings were the primary source of continuing education for 86% (n = 31). Sixty-five percent (n = 24), strongly agreed or agreed that cancer rehabilitation physiatrists should know how to prescribe opioids, and 35% (n = 13) reported prescribing them when appropriate. About 54% (n = 20) rated their level of burnout as low or very low, and more than half (51%, n = 19) believed their burnout level was lower than physiatrists treating other rehabilitation populations.Conclusions: Cancer rehabilitation is a growing subspecialty in PM&R, and most physiatrists in general practice will treat many survivors-often for neurologic or musculoskeletal impairments related to cancer or its treatment. Cancer rehabilitation physicians perceive that they have relatively low levels of burnout, and early mentorship and fellowship training is beneficial. Professional conferences and mentorship are a primary source for continuing education.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Background: Gout continues to be underdiagnosed and poorly managed despite the potential for cure. US and European management guidelines recommend treating to target serum urate (sUA) levels of <6 mg/dL (or <5 mg/dL to durably improve severe symptoms), with use of regular sUA monitoring, but studies suggest relatively poor adherence to these recommendations. This study investigates the real-world state of gout management in the United States by describing the characteristics of a large patient population treated in primary care and rheumatology settings.Methods: A retrospective chart audit, conducted among 124 primary care physicians and 125 rheumatologists, included 1245 patients with gout. Physicians completed structured case report forms capturing 12 months of sUA laboratory values, flare counts, comorbidities, types and doses of treatment, treatment duration, diagnosis date, physician specialty and socio-demographic factors. Focusing on the xanthine oxidase inhibitors (n = 858), descriptive statistics and multivariate models characterized relationships between patient characteristics, disease control, and treatment.Results: Only 83 (11%) patients achieved disease control, defined as a 12-month average sUA ≤6 mg/dL, no flares, and no tophi. Patients with greatest disease severity (defined as sUA >6 mg/dL, ≥2 flares per year, and tophi) were more likely to have kidney disease and other comorbidities. In a multivariate model, predictors of more severe gout were rheumatologist (vs primary care) management, febuxostat (vs allopurinol) use and presence of comorbid conditions.Conclusion: Our findings confirm the inadequacy of gout management in the real-world setting. Regular monitoring, including sUA measurement as recommended in guidelines, is important to assess gout control. Our analyses also demonstrate that patients with more severe gout are more likely to have comorbid conditions, be treated by a specialist and use newer therapies. [ABSTRACT FROM AUTHOR]

The residential sector is responsible for 22% of U.S. primary energy consumption and CO 2 emissions, annually, stressing the importance of building energy efficiency. Energy audits and assessments are commonly incorporated into energy conservation strategies. However, heterogeneity of homeowner behaviors and motivators has accompanied ambiguous conclusions on the effectiveness of energy audits. In response, the National Energy Leadership Corps (NELC), developed a holistic energy assessment approach tailoring information to homeowner motivators, with the goal of stimulating energy investments through informative personalized energy reports. A post-assessment survey, focusing on implementation, barriers to investment, and catalytic impact from the energy assessment, was developed and distributed to 82 houses that received an energy assessment. Statistical analysis of survey responses indicate homeowners’ perception of skill and/or abilities and building envelope improvements are correlated to implementation rates. Homeowner prioritization of home improvements may also be related to energy improvements. Results from the survey and recommendations are presented including implications for energy education and energy service professionals in the design, engineering, and construction industry. [ABSTRACT FROM AUTHOR]

The article presents information on the official report approved and published by the House Republican Study Committee (RSC), which recommends several reforms to the U.S. Copyright system for increasing the efficiency of the copyright protection. Topics discussed include the trade association Motion Picture Association of America (MPAA), Affordable Care Act and the Copyright infringement. It also discusses legislative reforms Digital Millennium Copyright Act (DMCA).

The article offers information on objective and purpose of the U.S. copyright law, which is to compensate the creator or the developer of the content in the U.S. Topics discussed include effectiveness and myths on copyright law, legal regimes of copyright protection and the U.S. Copyright Act. It also discusses legislative reforms to the existing copyright law.

Objective: Independent review boards can provide an objective appraisal of investigators' decisions and may be useful for determining complex primary outcomes, such as bipolar disorder relapse, in cross-national studies. This article describes the use of an independent, blinded relapse monitoring board to assess the primary outcome (relapse) in an international clinical trial of risperidone long-acting therapy adjunctive to standard-care pharmacotherapy for patients with bipolar disorder. Design: The fully autonomous relapse monitoring board was composed of a chair and two additional members-all psychiatrists and experts in the diagnostic, clinical, and therapeutic management of bipolar disorder. The relapse monitoring board met six times during the study to review patient relapse data and was charged with the responsibility of determining if the events described by investigators qualified as relapses. Additionally, the relapse monitoring board reviewed data for all randomized patients to identify any relapse events not recognized by investigators. Results: Primary efficacy results were similar and significant for investigator- and relapse monitoring board-determined relapses. Ten discrepancies were noted: two of the 42 investigator-determined relapses did not meet the intended clinical relapse threshold as determined by the relapse monitoring board; conversely, the relapse monitoring board confirmed eight relapse events not identified by investigators. The relapse monitoring board had no direct interactions with patients and had to rely on the accuracy of investigator assessments. Also, once an investigator determined a relapse and the patients discontinued the study, less information was available to the relapse monitoring board for relapse assessment. Conclusions: Use of the relapse monitoring board supported the validity of the study by incorporating a level of standardization to mitigate the risk that local practice in different cultures and medical systems at the sites would confound study results. [ABSTRACT FROM AUTHOR]

The article presents an economic analysis of the land use and greenhouse gas mitigation effects of federal biofuel incentive schemes in the U.S. Such policies include the Renewable Fuel Standard (RFS), the Biomass Crop Assistance Program (BCAP), and the biofuel tax credits. It analyzes the significance of the subsidies for fuel prices and consumption and investigates the effects undermining the energy security and greenhouse gases reduction benefits.

This paper focuses on Engineering and Education faculty and students, and middle and high school science and mathematics teachers who collaborated on a project to investigate strategies to infuse engineering design into the Grade 7-12 curriculum using hands-on design projects. The experience in the design and classroom testing of two projects is reported. It was found that students liked the hands-on exemplars, but resisted the design aspects of the task, such as working under constraints. Boys generally reported higher self-efficacy than girls and showed different patterns of interest than girls. Projects that were not directly relevant to improving test scores were difficult to implement because of resistance from teachers and administrators. [ABSTRACT FROM AUTHOR]

Objectives: Study the role of highly active antiretroviral therapy (HAART) in cervical disease in women with human immunodeficiency virus (HIV) and human papillomavirus (HPV) infections.Materials and Methods: A systematic review of current literature and the results summarized in the following headings: HIV and cytological evidence of disease, HIV and HPV, and HAART and HIV in women with HPV-associated cervical disease.Results: Limited data is available to study the influence of HAART on HPV-related cervical disease in women with HIV. There is evidence that the use of HAART may lead to immune restoration and thereby prevent severe recurrent HPV disease, thus influencing associated cervical disease.Conclusions: Little data is available on HAART and its role in HPV-associated cervical disease in women with HIV. Immune restoration may decrease the severity and recurrence of HPV infection and potentially impact cervical disease. Population-based studies are needed to further evaluate the role of HAART in HPV associated cervical disease. [ABSTRACT FROM AUTHOR]

[In this post-hegemonic analysis, Parag Khanna, Director of the Global Governance Initiative of the New American Foundation, posits a tripolar world pivoting around three poles: China, Europe and the US, each of which will be required to pay growing attention to what he describes as "swing states" and emerging "anti-imperialist belts". The author is particularly upbeat on the possible merger of European and swing state interests: … nothing has brought about the erosion of American primacy faster than globalization. While European nations redistribute wealth to secure or maintain first-world living standards, on the battlefield of globalization second-world countries' state-backed firms either outhustle or snap up American companies, leaving their workers to fend for themselves. The second world's first priority is not to become America but to succeed by any means necessary. Of particular interest to Japan Focus readers may be the fact that Japan appears at best as an afterthought, and whereas the author pays close attention to the significance of the possible emergence of Europe, he virtually ignores both the deepening interdependence and continuing conflicts within the Asia Pacific region with China, Japan and Korea at its center.] [ABSTRACT FROM AUTHOR]

The cumulative irritation test (CIT) is an accepted method used to evaluate the skin irritation potential and safety of individual ingredients and formulas of leave-on skin care and cosmetic compounds. Here, we report the results of CITs collected by JOHNSON & JOHNSON Consumer Companies, Inc. (Skillman, NJ), part of an extensive tiered program to evaluate product safety. In the CIT, test formulations were applied to the skin of adults (18-70 years) with no known skin disease or allergies, 3 times per week for 2 weeks using semi-occlusive clinical patches. Preservatives were 1 of up to 16 components of test formulas, and included ethylenediaminetetraacetic acid, diazolidinyl urea, 1,3-Bis(hydroxymethyl)-5,5-dimethylimidazolidine-2,4-dione, parabens, isothiazolinone, phenoxyethanol, sorbates, or benzoates. Skin sites were scored after each patch removal using a 5-point scale, with 0 = no visible reaction and 4 = erythema, marked edema, or substantial vesiculation. Scores were reported as percentage of maximal irritation score. Data were analyzed from 1363 CIT studies (over 45 000 subjects). There were no significant differences in percentage of maximal scores between formulas grouped by preservative types (p > .1). Median score across the entire dataset was 0.44, with most formulas showing none or mild irritation. Although seasonal variations were observed, no correlation was noted between score and preservative concentration. In conclusion, in a large, normal subject dataset, preservatives at typical in-use concentrations did not appear to contribute to skin irritation., (© The Author 2015. Published by Oxford University Press on behalf of the Society of Toxicology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Background: To assess whether an objective performance criterion for in vitro fertilization (IVF) centers can be established., Methods: A retrospective analysis of 2011 National ART Surveillance System data for 451 U.S. IVF centers, 137 of which were included in the analysis since they performed >20 fresh embryo transfers per age group and >20 fresh oocyte donor transfers. The analysis of autologous cycles was restricted to women under age 40. The main outcome measure was correlation between center-specific live birth rates (LBR) in autologous and donor oocyte cycles., Results: 55.6% donor and 46.7%, 39.1% and 28.7% (for ages <35, 35-37 and 38-40 years) autologous cycles resulted in live births per fresh embryo transfer. Donor LBR predicted autologous LBR (< 35 years, P < 0.001; 35 - 38 years, P < 0.001; 38 - 40 years, P = 0.015). Clinics with high prevalence of patients with diminished ovarian reserve had lower autologous LBR per age group (P = 0.015). Every 10% increase in donor LBR increased odds of autologous LBR above the age-adjusted national average by 68% (OR 1.68; 95% CI 1.36 - 2.07; P < 0.001)., Conclusions: Since center-specific donor and autologous IVF cycle outcomes correlate, and as donor cycles reflect fewer patient covariates, they represent a first comparable performance measure between centers, allowing for internal as well as external quality control.

Background: Prior estimates suggest that up to 40% of the US general population (GP) report symptoms of gastroesophageal reflux disease (GERD). However, symptoms in the GP versus patients seeking care for gastrointestinal (GI) complaints have not been compared. We estimated the prevalence and severity of GERD symptoms in the GP versus GI patients, and identified predictors of GERD severity. We hypothesized that similar to functional GI disorders, psychosocial factors would predict symptom severity in GERD as much, or perhaps more, than care-seeking behavior alone., Methods: We compared the prevalence of heartburn and regurgitation between a sample from the US GP and patients seeking GI specialty care. We compared GERD severity between groups using the NIH PROMIS(®) GERD scale. We then performed multivariable regression to identify predictors of GERD severity., Results: There was no difference in the prevalence of heartburn between the GP and patient groups (59 vs. 59%), but regurgitation was more common in patients versus GP (46 vs. 39%; p = 0.004). In multivariable regression, having high visceral anxiety (p < 0.001) and being divorced or separated (p = 0.006) were associated with higher GERD severity., Conclusions: More than half of a GP sample reports heartburn-higher than previous series and no different from GI patients. Although regurgitation was more prevalent in patients versus the GP, there was no difference in GERD severity between groups after adjusting for other factors; care seeking in GERD appears related to factors beyond symptoms, including visceral anxiety.

Objectives: Because gastrointestinal (GI) illnesses can cause physical, emotional, and social distress, patient-reported outcomes (PROs) are used to guide clinical decision making, conduct research, and seek drug approval. It is important to develop a mechanism for identifying, categorizing, and evaluating the over 100 GI PROs that exist. Here we describe a new, National Institutes of Health (NIH)-supported, online PRO clearinghouse-the GI-PRO database., Methods: Using a protocol developed by the NIH Patient-Reported Outcome Measurement Information System (PROMIS(®)), we performed a systematic review to identify English-language GI PROs. We abstracted PRO items and developed an online searchable item database. We categorized symptoms into content "bins" to evaluate a framework for GI symptom reporting. Finally, we assigned a score for the methodological quality of each PRO represented in the published literature (0-20 range; higher indicates better)., Results: We reviewed 15,697 titles (κ>0.6 for title and abstract selection), from which we identified 126 PROs. Review of the PROs revealed eight GI symptom "bins": (i) abdominal pain, (ii) bloat/gas, (iii) diarrhea, (iv) constipation, (v) bowel incontinence/soilage, (vi) heartburn/reflux, (vii) swallowing, and (viii) nausea/vomiting. In addition to these symptoms, the PROs covered four psychosocial domains: (i) behaviors, (ii) cognitions, (iii) emotions, and (iv) psychosocial impact. The quality scores were generally low (mean 8.88 ± 4.19; 0 (min)-20 (max). In addition, 51% did not include patient input in developing the PRO, and 41% provided no information on score interpretation., Conclusions: GI PROs cover a wide range of biopsychosocial symptoms. Although plentiful, GI PROs are limited by low methodological quality. Our online PRO library (www.researchcore.org/gipro/) can help in selecting PROs for clinical and research purposes.