Journal of Clinical Oncology Official Journal of the American Society of Clinical Oncology, Apr 20, 2007
Osteonecrosis of the capital femoral epiphysis is a significant late toxicity of treatment for ch... more Osteonecrosis of the capital femoral epiphysis is a significant late toxicity of treatment for childhood leukemia and lymphoma. We determined clinical and imaging risk factors predicting clinical joint outcomes of femoral head osteonecrosis in pediatric patients with leukemia or lymphoma.
Communications in Statistics Theory and Methods, Sep 2, 2006
An application of the pseudo maximum likelihood method to estimation of a multilevel linear model... more An application of the pseudo maximum likelihood method to estimation of a multilevel linear model fitted to the dependent observations coming from a finite population is demonstrated. The proposed approach provides a closed form solution for estimating of the model parameters. It is computationally simpler than the iterative procedures suggested in the literature (e.g., the iterative probability weighted least squares method of Pfeffermann et al. (Pfeffermann, D., Skinner, C.J., Holmes, D.J., Goldstein, H., Rasbash, J. (1998). Weighting for unequal selection probabilities in multilevel models. Journal of Royal Statistical Society B 60:23–40)). Issues related to model and sample design hierarchies and their impact on estimation are discussed. A problem of weighting at different levels is addressed. A small simulation study showed that the proposed procedure is efficient even for small within group sample sizes.
Up to 38% of children receiving treatment for acute lymphoblastic leukemia (ALL) develop osteonec... more Up to 38% of children receiving treatment for acute lymphoblastic leukemia (ALL) develop osteonecrosis, often without symptoms. Little is known about the association between the degree of osteonecrosis and functional mobility in this population. The purpose of this study was to examine relationships among the degree of osteonecrosis, pain, range of motion (ROM), and functional mobility in people with ALL.
There has been little empirical documentation of the acute effects of bone marrow or stem cell tr... more There has been little empirical documentation of the acute effects of bone marrow or stem cell transplant (BMT) on children. In the present study, the responses of 153 children undergoing BMT were assessed in a prospective, longitudinal design. Children were assessed at the time of admission for transplant, then underwent weekly assessments to week +6, followed by monthly assessment to month +6. Data were obtained both by parent report and patient report (for patients age 5 and up) using the BASES scales. The major findings are: (1) children undergoing BMT enter the hospital with an already heightened level of distress (defined by high levels of somatic symptoms and mood disturbance, and low levels of activity) that increases dramatically following conditioning, reaching a peak approximately 1 week following transplant; (2) this increased distress is transient, declining rapidly back to admission levels by week +4 to week +5, followed by a further decline to presumed basal levels by months 4-6; and (3) the trajectories of distress depicted by both parent and child report are remarkably similar, each providing confirmatory support for the validity of the findings. These findings confirm a number of widely held clinical impressions that had not previously been documented empirically, and point to the need for new interventions or more intensive approaches to supportive care aimed at reducing levels of distress during the acute phase of transplant.
A growing body of literature suggests that there is an optimal size for software components. This... more A growing body of literature suggests that there is an optimal size for software components. This means that components that are too small or too big will have a higher defect content (i.e., there is a U-shaped curve relating defect content to size). The U-shaped curve has become known as the "Goldilocks Conjecture". Recently, a cognitive theory has been proposed to explain this phenomenon, and it has been expanded to characterize object-oriented software. This conjecture has wide implications for software engineering practice. It suggests (1) that designers should deliberately strive to design classes that are of the optimal size, (2) that program decomposition is harmful, and that there exists a maximum (threshold) class size that should not be exceeded to ensure fewer faults in the software. The purpose of the current paper is to evaluate this conjecture for object-oriented systems. We first demonstrate that the claims of an optimal component/class size (1 above) and of smaller components/classes having a greater defect content (2 above) are due to a mathematical artifact in the analyses performed previously. We then empirically test the threshold effect claims of this conjecture (3 above). To our knowledge, the empirical test of size threshold effects for object-oriented systems has not been performed thus far. We perform an initial study with an industrial C++ system, and replicated it twice on another C++ system and on a commercial Java application. Our results provide unambiguous evidence that there is no threshold effect of class size. We obtained the same result for three systems using 4 different size measures. These findings suggest that there is a simple continuous relationship between class size and faults, and that optimal class size, smaller classes are better, and threshold effects conjectures have no sound theoretical nor empirical basis.
Sixth International Conference of Information Fusion, 2003. Proceedings of the, 2003
Using human immune system mechanisms, an artificial immune algorithm used for minimizing cost of ... more Using human immune system mechanisms, an artificial immune algorithm used for minimizing cost of redundant multi-sensor systems is presented in this paper. The search surface for finding the minimal cost of the sensor system while insuring system dependability has many local minima. The heuristic methods must be used to solve the problem. The artificial immune algorithm uses hyper-mutation to search local areas and receptor editing to escape from local minima. It is more suitable than simulated annealing and genetic algorithms for solving this problem. The results produced by the method are compared with results of simulated annealing and genetic algorithm.
Advances in energy harvesting, low-power radios, and biometric sensing have enabled new applicati... more Advances in energy harvesting, low-power radios, and biometric sensing have enabled new applications in medical and scientific monitoring. In medicine, unobtrusive biosensors promise to wirelessly relay critical patient information including temperature, heart rate, or blood pressure. This paper describes key technologies needed to integrate complex, wirelessly-powered health monitors.
2006 IEEE International Conference on Reconfigurable Computing and FPGA's (ReConFig 2006), 2006
... 2. Compression Formats The FBI uses the wavelet scalar quantization (WSQ) method for encoding... more ... 2. Compression Formats The FBI uses the wavelet scalar quantization (WSQ) method for encoding/decoding fingerprint images [1]. Each image is firstnormalized with zero mean and pixel value range (-128,128). ...
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2009
Efficient, miniaturized wireless recording is critical for both existing and emerging health-moni... more Efficient, miniaturized wireless recording is critical for both existing and emerging health-monitoring applications. One important example of this is in the brain interface community, where new technologies allow improved observation and understanding of brain functions. This, in turn, drives the need for ever smaller, lower power, and higher performance circuitry for chronic recording. This paper describes circuit and system techniques for low power wireless brain interfaces. Active and passive architectures are described and compared, and measured in-vivo data from both are presented.
Many object-oriented metrics have been proposed, and at least fourteen empirical validations of t... more Many object-oriented metrics have been proposed, and at least fourteen empirical validations of thesemetrics have been performed. However, recently it was noted that without controlling for the effect ofclass size in a validation study, the impact of a metric may be exaggerated. It thus becomes necessaryto re-validate contemporary object-oriented metrics after controlling for size. In this paper we perform avalidation
Proceedings 11th International Symposium on Software Reliability Engineering. ISSRE 2000, 2000
A practical application of object-oriented measures is to predict which classes are likely to con... more A practical application of object-oriented measures is to predict which classes are likely to contain a fault. This is contended to be meaningful because object-oriented measures are believed to be indicators of psychological complexity, and classes that are more complex are likely to be faulty Recently, a cognitive theory has been proposed suggesting that there are threshold effects for many object-oriented measures. This means that objectoriented classes are easy to understand as long as their complexity is below a threshold. Above that threshold their understandability decreases rapidly, leading to an increased probability of a fault. This occurs, according to the theory, due to an overflow of short-term human memory. If this theory is confirmed, then it would provide a mechanism that would explain the introduction of faults into objectoriented systems, and would also provide some practical guidance on how to design object-oriented programs. In this paper we empirically test this theory on two C++ telecommunications systems. We test for threshold effects in a subset of the Chidamber and Kemerer (CK) suite of measures. The dependent variable was the incidence of faults that lead to field failures. Our results indicate that there are no threshold effects for any of the measures studied. This means that there is no value for the studied CK measures where the faultproneness changes from being steady to rapidly increasing. The results are consistent across the two systems. Therefore, we can provide no support to the posited cognitive theory.
Biomedical Engineering: Applications, Basis and Communications, 2015
Warfarin is a frequently used oral anticoagulant for long-term prevention and treatment of thromb... more Warfarin is a frequently used oral anticoagulant for long-term prevention and treatment of thromboembolic events. Due to its narrow therapeutic range and large inter-individual dose-response variability, it is highly desirable to personalize warfarin dosing. However, the complexity of the conventional kinetic-pharmacodynamic (K-PD) models hampers the development of the personalized dose management. To avert this challenge, we propose simplified PD models for warfarin dose-response relationship, which is motivated by ideas from control theory. The simplified models were further applied to longitudinal data of 37 patients undergoing anticoagulation treatment using the standard two-stage approach and then compared with the conventional K-PD models. Data analysis shows that all models have a similar predictive ability, but the simplified models are most parsimonious.
63rd Device Research Conference Digest, 2005. DRC '05., 2005
We describe novel AlGaN-GaN metal-oxide-semiconductor heterostructure field-effect transistors (M... more We describe novel AlGaN-GaN metal-oxide-semiconductor heterostructure field-effect transistors (MOSHFETs) with record high power-voltage efficiencies (PVE = RF power/Drain bias), up to 0.43W/V-mm at 2 GHz. The RF powers of 15 W/mm at 35 V (PVE=0.43 W/V-mm) and 20 W/mm at 55 V (PVE= 0.36W/V-mm) were measured, which are approximately 50% higher than the previously reported values of PVE=0.25 W/V-mm (30
Purpose Childhood acute lymphoblastic leukemia (ALL) is treated with potentially neurotoxic drugs... more Purpose Childhood acute lymphoblastic leukemia (ALL) is treated with potentially neurotoxic drugs and neurologic complications in long-term survivors are inadequately studied. This study investigated neurologic morbidity and its effect on quality of life in long-term survivors of childhood ALL. Methods Prospective, single institution, cross-sectional, institutional review board-approved study of long-term ALL survivors. Participants were recruited from institutional clinics. Participants answered an investigator-administered questionnaire followed by evaluation by a neurologist. Quality of life (QOL) was also assessed. Results Of the 162 participants recruited over a 3-year period, 83.3 % reported at least one neurologic symptom of interest, 16.7 % had single symptom, 11.1 % had two symptoms, and 55.6 % had three or more symptoms. Symptoms were mild and disability was low in the majority of participants with neurologic symptoms. Median age at ALL diagnosis was 3.9 years (0.4-18.6), median age at study enrollment was 15.7 years (6.9-28.9), and median time from completion of ALL therapy was 7.4 years (1.9-20.3). On multivariable analyses, female sex correlated with presence of dizziness, urinary incontinence, constipation, and neuropathy; use of≥10 doses of triple intrathecal chemotherapy correlated with urinary incontinence, back pain, and neuropathy; cranial radiation with ataxia; history of ALL relapse with fatigue; and CNS leukemia at diagnosis with seizures. Decline in mental QOL was associated with migraine and tension type headaches, while physical QOL was impaired by presence of dizziness and falls. Overall, good QOL and physical function was maintained by a majority of participants. Conclusions Neurologic symptoms were present in 83 % long-term ALL survivors. Symptoms related morbidity and QOL impairment is low in majority of survivors. Female sex, ≥10 doses of intrathecal chemotherapy, and history of ALL relapse predispose to impaired QOL. Implications for Cancer Survivors This study will educate survivors and their care providers regarding cancer or treatment-related neurologic symptoms and morbidity. This study will help them understand factors contributing to impaired QOL when present.
The user has requested enhancement of the downloaded file. All in-text references underlined in b... more The user has requested enhancement of the downloaded file. All in-text references underlined in blue are linked to publications on ResearchGate, letting you access and read them immediately. SUMMARY: Athanassiadou F, Tragiannidis A, Rousso I, Katzos G, Sidi V, Papageorgiou T, Papastergiou C, Tsituridis I, Koliouskas D. Bone mineral density in survivors of childhood acute lymphoblastic leukemia. Turk J Pediatr 2006; 48: 101-104.
Post-traumatic stress disorder (PTSD) has been put forth as a model for understanding the adjustm... more Post-traumatic stress disorder (PTSD) has been put forth as a model for understanding the adjustment of children with cancer and their parents, but findings in the literature regarding the prevalence of post-traumatic stress symptoms (PTSS) have been mixed. This study examined PTSS levels in both patients and parents as a function of time elapsed from diagnosis, and by use of parent versus child reports for assessing patient PTSS. Four groups of patients (total N = 162) differing in time elapsed since diagnosis were assessed with standardized measures of PTSS. Patients reported on their own symptoms, while parents reported on their symptoms as well as symptoms in their child. Significant differences between groups were observed on all patient PTSS measures. Recently diagnosed patients obtained higher PTSS scores than survivors more than 5 years from diagnosis. Likewise, parents of recently diagnosed patients self-reported significantly higher levels of PTSS than parents of long-term survivors. Parent-child correlations were high and no differences were observed between parent and patient report of patient PTSS. Comparison with historical control data suggests that levels of PTSS in patients are very low. Concordance between parent and child reports of child PTSS suggests that data may be obtained with reasonable confidence from either if only one informant is available. Higher levels of PTSS in patients who are recently diagnosed (and their parents) in comparison to long-term survivors, suggest that the symptoms reported reflect primarily a concurrent response to ongoing acute stressors, rather than a post-traumatic re-experiencing of past traumas. This, in combination with the low levels of patient PTSS raise questions regarding the utility of PTSD as a model for understanding patient and parent adjustment to childhood cancer.
Parents (N = 151) of children undergoing bone marrow or stem cell transplantation (BMT) were asse... more Parents (N = 151) of children undergoing bone marrow or stem cell transplantation (BMT) were assessed in a prospective, longitudinal design with repeated measures of distress (mood disturbance, perceived stress, caregiver burden). Parents were assessed weekly from admission for BMT (week-1) through week +6 post-BMT, followed by monthly assessments through month +6. Concurrent measures of child distress (somatic distress, mood disturbance) were also obtained by parent and child report. Parents demonstrate modest, but significant elevations in distress, particularly during the early period from admission through week +3. Elevations in parental distress are transient, and appear to be largely resolved by 4-6 months post-BMT. Parental distress was unrelated to child age, gender, diagnosis, or type of transplant, but was significantly related to parental socioeconomic status (SES). Parents from lower SES backgrounds reported greater levels of distress throughout the BMT process. Moderate correlations were observed between measures of parent and child distress, and level of child distress at the time of admission for BMT was predictive parental distress trajectories across the acute phase of BMT. These findings point to appropriate targets for intervention to reduce transplant-related distress.
Journal of Clinical Oncology Official Journal of the American Society of Clinical Oncology, Apr 20, 2007
Osteonecrosis of the capital femoral epiphysis is a significant late toxicity of treatment for ch... more Osteonecrosis of the capital femoral epiphysis is a significant late toxicity of treatment for childhood leukemia and lymphoma. We determined clinical and imaging risk factors predicting clinical joint outcomes of femoral head osteonecrosis in pediatric patients with leukemia or lymphoma.
Communications in Statistics Theory and Methods, Sep 2, 2006
An application of the pseudo maximum likelihood method to estimation of a multilevel linear model... more An application of the pseudo maximum likelihood method to estimation of a multilevel linear model fitted to the dependent observations coming from a finite population is demonstrated. The proposed approach provides a closed form solution for estimating of the model parameters. It is computationally simpler than the iterative procedures suggested in the literature (e.g., the iterative probability weighted least squares method of Pfeffermann et al. (Pfeffermann, D., Skinner, C.J., Holmes, D.J., Goldstein, H., Rasbash, J. (1998). Weighting for unequal selection probabilities in multilevel models. Journal of Royal Statistical Society B 60:23–40)). Issues related to model and sample design hierarchies and their impact on estimation are discussed. A problem of weighting at different levels is addressed. A small simulation study showed that the proposed procedure is efficient even for small within group sample sizes.
Up to 38% of children receiving treatment for acute lymphoblastic leukemia (ALL) develop osteonec... more Up to 38% of children receiving treatment for acute lymphoblastic leukemia (ALL) develop osteonecrosis, often without symptoms. Little is known about the association between the degree of osteonecrosis and functional mobility in this population. The purpose of this study was to examine relationships among the degree of osteonecrosis, pain, range of motion (ROM), and functional mobility in people with ALL.
There has been little empirical documentation of the acute effects of bone marrow or stem cell tr... more There has been little empirical documentation of the acute effects of bone marrow or stem cell transplant (BMT) on children. In the present study, the responses of 153 children undergoing BMT were assessed in a prospective, longitudinal design. Children were assessed at the time of admission for transplant, then underwent weekly assessments to week +6, followed by monthly assessment to month +6. Data were obtained both by parent report and patient report (for patients age 5 and up) using the BASES scales. The major findings are: (1) children undergoing BMT enter the hospital with an already heightened level of distress (defined by high levels of somatic symptoms and mood disturbance, and low levels of activity) that increases dramatically following conditioning, reaching a peak approximately 1 week following transplant; (2) this increased distress is transient, declining rapidly back to admission levels by week +4 to week +5, followed by a further decline to presumed basal levels by months 4-6; and (3) the trajectories of distress depicted by both parent and child report are remarkably similar, each providing confirmatory support for the validity of the findings. These findings confirm a number of widely held clinical impressions that had not previously been documented empirically, and point to the need for new interventions or more intensive approaches to supportive care aimed at reducing levels of distress during the acute phase of transplant.
A growing body of literature suggests that there is an optimal size for software components. This... more A growing body of literature suggests that there is an optimal size for software components. This means that components that are too small or too big will have a higher defect content (i.e., there is a U-shaped curve relating defect content to size). The U-shaped curve has become known as the "Goldilocks Conjecture". Recently, a cognitive theory has been proposed to explain this phenomenon, and it has been expanded to characterize object-oriented software. This conjecture has wide implications for software engineering practice. It suggests (1) that designers should deliberately strive to design classes that are of the optimal size, (2) that program decomposition is harmful, and that there exists a maximum (threshold) class size that should not be exceeded to ensure fewer faults in the software. The purpose of the current paper is to evaluate this conjecture for object-oriented systems. We first demonstrate that the claims of an optimal component/class size (1 above) and of smaller components/classes having a greater defect content (2 above) are due to a mathematical artifact in the analyses performed previously. We then empirically test the threshold effect claims of this conjecture (3 above). To our knowledge, the empirical test of size threshold effects for object-oriented systems has not been performed thus far. We perform an initial study with an industrial C++ system, and replicated it twice on another C++ system and on a commercial Java application. Our results provide unambiguous evidence that there is no threshold effect of class size. We obtained the same result for three systems using 4 different size measures. These findings suggest that there is a simple continuous relationship between class size and faults, and that optimal class size, smaller classes are better, and threshold effects conjectures have no sound theoretical nor empirical basis.
Sixth International Conference of Information Fusion, 2003. Proceedings of the, 2003
Using human immune system mechanisms, an artificial immune algorithm used for minimizing cost of ... more Using human immune system mechanisms, an artificial immune algorithm used for minimizing cost of redundant multi-sensor systems is presented in this paper. The search surface for finding the minimal cost of the sensor system while insuring system dependability has many local minima. The heuristic methods must be used to solve the problem. The artificial immune algorithm uses hyper-mutation to search local areas and receptor editing to escape from local minima. It is more suitable than simulated annealing and genetic algorithms for solving this problem. The results produced by the method are compared with results of simulated annealing and genetic algorithm.
Advances in energy harvesting, low-power radios, and biometric sensing have enabled new applicati... more Advances in energy harvesting, low-power radios, and biometric sensing have enabled new applications in medical and scientific monitoring. In medicine, unobtrusive biosensors promise to wirelessly relay critical patient information including temperature, heart rate, or blood pressure. This paper describes key technologies needed to integrate complex, wirelessly-powered health monitors.
2006 IEEE International Conference on Reconfigurable Computing and FPGA's (ReConFig 2006), 2006
... 2. Compression Formats The FBI uses the wavelet scalar quantization (WSQ) method for encoding... more ... 2. Compression Formats The FBI uses the wavelet scalar quantization (WSQ) method for encoding/decoding fingerprint images [1]. Each image is firstnormalized with zero mean and pixel value range (-128,128). ...
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2009
Efficient, miniaturized wireless recording is critical for both existing and emerging health-moni... more Efficient, miniaturized wireless recording is critical for both existing and emerging health-monitoring applications. One important example of this is in the brain interface community, where new technologies allow improved observation and understanding of brain functions. This, in turn, drives the need for ever smaller, lower power, and higher performance circuitry for chronic recording. This paper describes circuit and system techniques for low power wireless brain interfaces. Active and passive architectures are described and compared, and measured in-vivo data from both are presented.
Many object-oriented metrics have been proposed, and at least fourteen empirical validations of t... more Many object-oriented metrics have been proposed, and at least fourteen empirical validations of thesemetrics have been performed. However, recently it was noted that without controlling for the effect ofclass size in a validation study, the impact of a metric may be exaggerated. It thus becomes necessaryto re-validate contemporary object-oriented metrics after controlling for size. In this paper we perform avalidation
Proceedings 11th International Symposium on Software Reliability Engineering. ISSRE 2000, 2000
A practical application of object-oriented measures is to predict which classes are likely to con... more A practical application of object-oriented measures is to predict which classes are likely to contain a fault. This is contended to be meaningful because object-oriented measures are believed to be indicators of psychological complexity, and classes that are more complex are likely to be faulty Recently, a cognitive theory has been proposed suggesting that there are threshold effects for many object-oriented measures. This means that objectoriented classes are easy to understand as long as their complexity is below a threshold. Above that threshold their understandability decreases rapidly, leading to an increased probability of a fault. This occurs, according to the theory, due to an overflow of short-term human memory. If this theory is confirmed, then it would provide a mechanism that would explain the introduction of faults into objectoriented systems, and would also provide some practical guidance on how to design object-oriented programs. In this paper we empirically test this theory on two C++ telecommunications systems. We test for threshold effects in a subset of the Chidamber and Kemerer (CK) suite of measures. The dependent variable was the incidence of faults that lead to field failures. Our results indicate that there are no threshold effects for any of the measures studied. This means that there is no value for the studied CK measures where the faultproneness changes from being steady to rapidly increasing. The results are consistent across the two systems. Therefore, we can provide no support to the posited cognitive theory.
Biomedical Engineering: Applications, Basis and Communications, 2015
Warfarin is a frequently used oral anticoagulant for long-term prevention and treatment of thromb... more Warfarin is a frequently used oral anticoagulant for long-term prevention and treatment of thromboembolic events. Due to its narrow therapeutic range and large inter-individual dose-response variability, it is highly desirable to personalize warfarin dosing. However, the complexity of the conventional kinetic-pharmacodynamic (K-PD) models hampers the development of the personalized dose management. To avert this challenge, we propose simplified PD models for warfarin dose-response relationship, which is motivated by ideas from control theory. The simplified models were further applied to longitudinal data of 37 patients undergoing anticoagulation treatment using the standard two-stage approach and then compared with the conventional K-PD models. Data analysis shows that all models have a similar predictive ability, but the simplified models are most parsimonious.
63rd Device Research Conference Digest, 2005. DRC '05., 2005
We describe novel AlGaN-GaN metal-oxide-semiconductor heterostructure field-effect transistors (M... more We describe novel AlGaN-GaN metal-oxide-semiconductor heterostructure field-effect transistors (MOSHFETs) with record high power-voltage efficiencies (PVE = RF power/Drain bias), up to 0.43W/V-mm at 2 GHz. The RF powers of 15 W/mm at 35 V (PVE=0.43 W/V-mm) and 20 W/mm at 55 V (PVE= 0.36W/V-mm) were measured, which are approximately 50% higher than the previously reported values of PVE=0.25 W/V-mm (30
Purpose Childhood acute lymphoblastic leukemia (ALL) is treated with potentially neurotoxic drugs... more Purpose Childhood acute lymphoblastic leukemia (ALL) is treated with potentially neurotoxic drugs and neurologic complications in long-term survivors are inadequately studied. This study investigated neurologic morbidity and its effect on quality of life in long-term survivors of childhood ALL. Methods Prospective, single institution, cross-sectional, institutional review board-approved study of long-term ALL survivors. Participants were recruited from institutional clinics. Participants answered an investigator-administered questionnaire followed by evaluation by a neurologist. Quality of life (QOL) was also assessed. Results Of the 162 participants recruited over a 3-year period, 83.3 % reported at least one neurologic symptom of interest, 16.7 % had single symptom, 11.1 % had two symptoms, and 55.6 % had three or more symptoms. Symptoms were mild and disability was low in the majority of participants with neurologic symptoms. Median age at ALL diagnosis was 3.9 years (0.4-18.6), median age at study enrollment was 15.7 years (6.9-28.9), and median time from completion of ALL therapy was 7.4 years (1.9-20.3). On multivariable analyses, female sex correlated with presence of dizziness, urinary incontinence, constipation, and neuropathy; use of≥10 doses of triple intrathecal chemotherapy correlated with urinary incontinence, back pain, and neuropathy; cranial radiation with ataxia; history of ALL relapse with fatigue; and CNS leukemia at diagnosis with seizures. Decline in mental QOL was associated with migraine and tension type headaches, while physical QOL was impaired by presence of dizziness and falls. Overall, good QOL and physical function was maintained by a majority of participants. Conclusions Neurologic symptoms were present in 83 % long-term ALL survivors. Symptoms related morbidity and QOL impairment is low in majority of survivors. Female sex, ≥10 doses of intrathecal chemotherapy, and history of ALL relapse predispose to impaired QOL. Implications for Cancer Survivors This study will educate survivors and their care providers regarding cancer or treatment-related neurologic symptoms and morbidity. This study will help them understand factors contributing to impaired QOL when present.
The user has requested enhancement of the downloaded file. All in-text references underlined in b... more The user has requested enhancement of the downloaded file. All in-text references underlined in blue are linked to publications on ResearchGate, letting you access and read them immediately. SUMMARY: Athanassiadou F, Tragiannidis A, Rousso I, Katzos G, Sidi V, Papageorgiou T, Papastergiou C, Tsituridis I, Koliouskas D. Bone mineral density in survivors of childhood acute lymphoblastic leukemia. Turk J Pediatr 2006; 48: 101-104.
Post-traumatic stress disorder (PTSD) has been put forth as a model for understanding the adjustm... more Post-traumatic stress disorder (PTSD) has been put forth as a model for understanding the adjustment of children with cancer and their parents, but findings in the literature regarding the prevalence of post-traumatic stress symptoms (PTSS) have been mixed. This study examined PTSS levels in both patients and parents as a function of time elapsed from diagnosis, and by use of parent versus child reports for assessing patient PTSS. Four groups of patients (total N = 162) differing in time elapsed since diagnosis were assessed with standardized measures of PTSS. Patients reported on their own symptoms, while parents reported on their symptoms as well as symptoms in their child. Significant differences between groups were observed on all patient PTSS measures. Recently diagnosed patients obtained higher PTSS scores than survivors more than 5 years from diagnosis. Likewise, parents of recently diagnosed patients self-reported significantly higher levels of PTSS than parents of long-term survivors. Parent-child correlations were high and no differences were observed between parent and patient report of patient PTSS. Comparison with historical control data suggests that levels of PTSS in patients are very low. Concordance between parent and child reports of child PTSS suggests that data may be obtained with reasonable confidence from either if only one informant is available. Higher levels of PTSS in patients who are recently diagnosed (and their parents) in comparison to long-term survivors, suggest that the symptoms reported reflect primarily a concurrent response to ongoing acute stressors, rather than a post-traumatic re-experiencing of past traumas. This, in combination with the low levels of patient PTSS raise questions regarding the utility of PTSD as a model for understanding patient and parent adjustment to childhood cancer.
Parents (N = 151) of children undergoing bone marrow or stem cell transplantation (BMT) were asse... more Parents (N = 151) of children undergoing bone marrow or stem cell transplantation (BMT) were assessed in a prospective, longitudinal design with repeated measures of distress (mood disturbance, perceived stress, caregiver burden). Parents were assessed weekly from admission for BMT (week-1) through week +6 post-BMT, followed by monthly assessments through month +6. Concurrent measures of child distress (somatic distress, mood disturbance) were also obtained by parent and child report. Parents demonstrate modest, but significant elevations in distress, particularly during the early period from admission through week +3. Elevations in parental distress are transient, and appear to be largely resolved by 4-6 months post-BMT. Parental distress was unrelated to child age, gender, diagnosis, or type of transplant, but was significantly related to parental socioeconomic status (SES). Parents from lower SES backgrounds reported greater levels of distress throughout the BMT process. Moderate correlations were observed between measures of parent and child distress, and level of child distress at the time of admission for BMT was predictive parental distress trajectories across the acute phase of BMT. These findings point to appropriate targets for intervention to reduce transplant-related distress.
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Papers by Shesh Rai