College Health as a Partner in the Care of Pediatric Cancer Survivors

Abstract

Objective: This study reviews an initiative to educate providers on pediatric cancer survivor care and to establish a cancer survivor registry in a college health center. Participants: Participants were University of Georgia (UGA) college health providers. Methods: Providers attended lectures on survivor care and were encouraged to register on Cancer SurvivorLink. Changes in provider familiarity and practice were measured using baseline and follow-up surveys. A survivor registry was created using health entrance forms and medical records abstraction. Results: Twenty-four providers registered on SurvivorLink, and 16 completed both surveys. Familiarity with survivor care (p = .003) and a survivor health care plan (p = .016) increased. Likelihood to deliver survivor care increased (p = .01). UGA follows 95 survivors; 71 diagnosed at < 21 years. Among survivors diagnosed at < 21 years, 91% reported their diagnosis on entrance forms. Conclusions: Through education and optimization of health informatics, college health centers can identify and provide survivor care to this medically vulnerable population.     

Lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction: from physiology to clinical aspects

Abstract

Erectile dysfunction, prostatic hyperplasia and lower urinary tract symptoms hare important pathogenetic links. Endothelial dysfunction and hormonal alterations represent the main aspects. The present article examines the anatomical, physiological, and pathophysiological characteristics of this association, finalizing the text to an interpretation of the clinical management of these patients based on these functional considerations.     

Treatment of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction

Abstract

This article summarizes years of challenging research on erectile dysfunction (ED), a condition that has an important social and cultural relevance. Preclinical and clinical research progress has led to new therapeutic approaches to ED in patients with different comorbidities and particularly in those with low urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). These goals were possible only by combined work of specialists and researchers of different and intertwined medical disciplines. Currently, tadalafil (5?mg/d) is the best choice; other phosphodiesterase-5 inhibitors (PDE5i) are not included among options, despite the growing evidence of therapeutic effects. Different regimens of tadalafil may be prescribed based on patient needs, severity of LUTS/BPH – ED profile, and clinical experience. An integrated approach is necessary to choose for a combined therapy with PDE5i and α-blockers following urological and cardiac counseling in terms of outcomes and adverse effects.     

LEGAL STANDARDS,ENFORCEMENT, AND CORRUPTION

Stricter laws require more incisive and costlier enforcement. Because enforcement activity depends both on available tax revenue and the honesty of officials, the optimal legal standard of a benevolent government is increasing in per capita income and decreasing in officials' corruption. In contrast to the “tollbooth view” of regulation, the standard chosen by a self‐interested government is a non‐monotonic function of officials' corruption, and can be either lower or higher than that chosen by a benevolent regulator. International evidence on environmental regulation shows that standards correlate positively with per‐capita income, and negatively with corruption, consistent with the model's predictions for benevolent governments. (JEL: D73, K42, L51)     

Comparing and generating Latin Hypercube designs in Kriging models

In Computer Experiments (CE), a careful selection of the design points is essential for predicting the system response at untried points, based on the values observed at tried points. In physical experiments, the protocol is based on Design of Experiments, a methodology whose basic principles are questioned in CE. When the responses of a CE are modeled as jointly Gaussian random variables with their covariance depending on the distance between points, the use of the so called space-filling designs (random designs, stratified designs and Latin Hypercube designs) is a common choice, because it is expected that the nearer the untried point is to the design points, the better is the prediction. In this paper we focus on the class of Latin Hypercube (LH) designs. The behavior of various LH designs is examined according to the Gaussian assumption with exponential correlation, in order to minimize the total prediction error at the points of a regular lattice. In such a special case, the problem is reduced to an algebraic statistical model, which is solved using both symbolic algebraic software and statistical software. We provide closed-form computation of the variance of the Gaussian linear predictor as a function of the design, in order to make a comparison between LH designs. In principle, the method applies to any number of factors and any number of levels, and also to classes of designs other than LHs. In our current implementation, the applicability is limited by the high computational complexity of the algorithms involved.     

Estimating percentile-specific treatment effects in counterfactual models: a case-study of micronutrient supplementation, birth weight and infant mortality

Summary.  Clinical trials of micronutrient supplementation are aimed at reducing the risk of infant mortality by increasing birth weight. Because infant mortality is greatest among the low birth weight (LBW) infants (2500 g or under), an effective intervention increases the birth weight among the smallest babies. The paper defines population and counterfactual parameters for estimating the treatment effects on birth weight and on survival as functions of the percentiles of the birth weight distribution. We use a Bayesian approach with data augmentation to approximate the posterior distributions of the parameters, taking into account uncertainty that is associated with the imputation of the counterfactuals. This approach is particularly suitable for exploring the sensitivity of the results to unverifiable modelling assumptions and other prior beliefs. We estimate that the average causal effect of the treatment on birth weight is 72 g (95% posterior regions 33–110 g) and that this causal effect is largest among the LBW infants. Posterior inferences about average causal effects of the treatment on birth weight are robust to modelling assumptions. However, inferences about causal effects for babies at the tails of the birth weight distribution can be highly sensitive to the unverifiable assumption about the correl-ation between the observed and the counterfactuals birth weights. Among the LBW infants who have a large causal effect of the treatment on birth weight, we estimate that a baby receiving the treatment has 5% less chance of death than if the same baby had received the control. Among the LBW infants, we found weak evidence supporting an additional beneficial effect of the treatment on mortality independent of birth weight.     

Regional foods and rural development: The role of product qualification

Qualification schemes have become popular tools for supporting regional foods, yet little is understood about the impacts they have on the rural development contribution of such foods. Qualification processes may stimulate new networks and community actions, but they may also be incompatible with strategies of extended territorial development because of their foundation in theories of competitive advantage. To explore these issues, the evolution is traced of three cases of regional food production, where local actors pursue the opportunity to qualify products under EEC Regulation 2081/92. The results reveal, in practice, the different experiences that can evolve under the same qualification mechanism, and also how the consequences for rural development can vary. The paper concludes with analysis of factors influencing the involvement and behaviour of actors in regional food qualification, and what these infer for the rural development approach pursued.     

CONGESTION MODELS AND WEIGHTED BAYESIAN POTENTIAL GAMES

Games associated with congestion situations à la Rosenthal (1973) have pure Nash equilibria. This result implicitly relies on the existence of a potential function. In this paper we provide a characterization of potential games in terms of coordination games and dummy games. Second, we extend Rosenthal's congestion model to an incomplete information setting, and show that the related Bayesian games are potential games and therefore have pure Bayesian equilibria.     

A test of concordance based on Gini’s mean difference

A new rank correlation index, which can be used to measure the extent of concordance or discordance between two rankings, is proposed. This index is based on Gini’s mean difference computed on the totals ranks corresponding to each unit and it turns out to be a special case of a more general measure of the agreement of m rankings. The proposed index can be used in a test for the independence of two criteria used to rank the units of a sample, against their concordance/discordance. It can then be regarded as a competitor of other classical methods, such as Kendall’s tau. The exact distribution of the proposed test-statistic under the null hypothesis of independence is studied and its expectation and variance are determined; moreover, the asymptotic distribution of the test-statistic is derived. Finally, the implementation of the proposed test and its performance are discussed. Both the authors contributed equally to this work; however, the actual writing of the paper was as follows: Sects. 2 and 3 are due to C. G. Borroni, Sects. 1 and 4 are due to M. Zenga.