Early Findings on the Use of Clinical Pathways for Management of Unwarranted Variation in Cancer Care.

Clinical pathways have the potential to improve complex clinical decision-making in cancer care. The authors implemented pathways with customized content to assist oncologists to select treatments, aiming for an on-pathway rate of 70%-85%. Treatment decisions were captured as on or off pathway, and metrics were shared monthly with users. Oncologists were categorized into quintiles based on on-pathway performance during the first 90 days of use. On-pathway rates were then calculated for days 91-360 (N = 121). Median on-pathway quintile rates varied from 50% to 100% in the initial 90-day period. During follow-up, median on-pathway rates shifted into the prespecified goal range for all groups. Clinical pathways resulted in greater uniformity in medical oncology practice. Monthly feedback about usage, familiarity with the electronic platform, and regular content updates are some factors that may influence on-pathway rates. Clinical pathways hold promise to manage unwarranted variation in cancer care.

Temporal and spatial variability of trace volatile organic compounds in rainwater.

This study presents the first detailed concentration profile of trace VOCs in atmospheric waters. Analytes were detected and quantified in 111 unique rain events in Wilmington, NC, USA over a one-year period. Headspace solid phase microextraction was optimized for detection of these compounds at sub-nanomolar levels. Distinct seasonality in both the occurrence and concentration of compounds was observed with the lowest abundance occurring during low irradiance winter months. In contrast to other rainwater components studied at this location, VOCs did not show any correlation between rainfall amount and concentrations. There was significant spatial variation with regards to air-mass back-trajectory for methyfuran with higher concentrations observed in terrestrial events during the growing season. Air mass back trajectory also impacted CCl4 concentrations in rainwater with evidence of a possible oceanic input. However there was no significant impact of air-mass back-trajectory on the concentration of BTEX observed in rain indicating that storm origin is not the controlling factor driving concentrations of these analytes in precipitation. Members of the BTEX family did, however, have significant correlations with each other occurring in ratios aligned closely with ratios reported in the literature for gas-phase BTEX. Using available gas-phase data from locations with similar anthropogenic sources and Henry's Law constants, calculated concentrations agreed with VOC levels found in Wilmington rain. Results of this study indicate local gas-phase scavenging is the major source of VOCs in rain and wet deposition is not an efficient removal mechanism (<0.1%) of VOCs from the atmosphere.

Simulation of traumatic brain injury symptoms on the Personality Assessment Inventory: an analogue study.

The purpose of this study was to characterize the operating characteristics of the Personality Assessment Inventory (PAI) validity scales in distinguishing simulators feigning symptoms of traumatic brain injury (TBI) while completing the PAI (n = 84) from a clinical sample of patients with TBI who achieved adequate scores on performance validity tests (n = 112). The simulators were divided into two groups: (a) Specific Simulators feigning cognitive and somatic symptoms only or (b) Global Simulators feigning cognitive, somatic, and psychiatric symptoms. The PAI overreporting scales were indeed sensitive to the simulation of TBI symptoms in this analogue design. However, these scales were less sensitive to the feigning of somatic and cognitive TBI symptoms than the feigning of a broad range of cognitive, somatic, and emotional symptoms often associated with TBI. The relationships of TBI simulation to consistency and underreporting scales are also explored.

Complexation of metal ions, including alkali-earth and lanthanide(III) ions, in aqueous solution by the ligand 2,2',6',2''-terpyridyl.

Some metal-ion-complexing properties of the ligand 2,2',6',2''-terpyridyl (terpy) in aqueous solution are determined by following the π-π* transitions of 2 × 10(-5) M terpy by UV-visible spectroscopy. It is found that terpy forms precipitates when present as the neutral ligand above pH ∼5, in the presence of electrolytes such as NaClO(4) or NaCl added to control the ionic strength, as evidenced by large light-scattering peaks. The protonation constants of terpy are thus determined at the ionic strength (µ) = 0 to avoid precipitation and found to be 4.32(3) and 3.27(3). The log K(1) values were determined for terpy with alkali-earth metal ions Mg(II), Ca(II), Sr(II), and Ba(II) and Ln(III) (Ln = lanthanide) ions La(III), Gd(III), and Lu(III) by titration of 2 × 10(-5) M free terpy at pH >5.0 with solutions of the metal ion. Log K(1)(terpy) was determined for Zn(II), Cd(II), and Pb(II) by following the competition between the metal ions and protons as a function of the pH. Complex formation for all of these metal ions was accompanied by marked sharpening of the broad π-π* transitions of free terpy, which was attributed to complex formation affecting ligand vibrations, which in the free ligand are coupled to the π-π* transitions and thus broaden them. It is shown that log K(1)(terpy) for a wide variety of metal ions correlates well with log K(1)(NH(3)) values for the metal ions. The latter include both experimental log K(1)(NH(3)) values and log K(1)(NH(3)) values predicted previously by density functional theory calculation. The structure of [Ni(terpy)(2)][Ni(CN)(4)]·CH(3)CH(2)OH·H(2)O (1) is reported as follows: triclinic, P1, a = 8.644(3) Å, b = 9.840(3) Å, c = 20.162(6) Å, α = 97.355(5)°, ß = 97.100(5)°, γ = 98.606(5)°, V = 1663.8(9) Å(3), Z = 4, and final R = 0.0319. The two Ni-N bonds to the central N donors of the terpy ligands in 1 average 1.990(2) Å, while the four peripheral Ni-N bonds average 2.107(10) Å. This difference in the M-N bond length for terpy complexes is typical of the complexes of smaller metal ions, while for larger metal ions, the difference is reversed. The significance of the metal-ion size dependence of the selectivity of polypyridyl ligands, and the greater rigidity of ligands based on aromatic groups such as pyridyl groups, is discussed.

Metal ion complexing properties of dipyridoacridine, a highly preorganized tridentate homologue of 1,10-phenanthroline.

DPA (dipyrido[4,3-b;5,6-b]acridine) may be considered as a tridentate homologue of phen (1,10-phenanthroline). In this paper some of the metal ion complexing properties of DPA in aqueous solution are reported. Using UV-visible spectroscopy to follow the intense π-π* transitions of DPA as a function of pH gave protonation constants at ionic strength (µ) = 0 and 25 °C of pK(1) = 4.57(3) and pK(2) = 2.90(3). Titration of 10(-5) M solutions of DPA with a variety of metal ions gave log K(1) values as follows: Zn(II), 7.9(1); Cd(II), 8.1(1); Pb(II), 8.3(1); La(III), 5.23(7); Gd(III), 5.7(1); Ca(II), 3.68; all at 25 °C and µ = 0. Log K(1) values at µ = 0.1 were obtained for Mg(II), 0.7(1); Sr(II), 2.20(1); Ba(II), 1.5(1). The log K(1) values show that the high level of preorganization of DPA leads to complexes 3 log units more stable than the corresponding terpyridyl complexes for large metal ions such as La(III) or Ca(II), but that for small metal ions such as Mg(II) and Zn(II) such stabilization is minimal. Molecular mechanics calculations (MM) are used to show that the best-fit M-N length for coordination with DPA is 2.60 Å, accounting for the high stability of Ca(II) or La(III) complexes of DPA, which are found to have close to this M-N bond length in their phen complexes.

The role of depression in verbal memory following traumatic brain injury.

The purpose of this study was to characterize the relationship between verbal memory and depression scores on the Personality Assessment Inventory following traumatic brain injury. Depression was associated with diminished delayed recall and recognition on the California Verbal Learning Test-II (CVLT-II), even after controlling for a neuropsychological composite score and/or a measure of motivation (i.e., the TOMM). There was no relationship between depression and recall on Verbal Paired Associates or Logical Memory when controlling for the same covariates. The findings were most consistent with depressed subjects failing to utilize the semantic organization of the CVLT-II list to enhance their learning.