Patient Expectations of Benefit from Phase I Clinical Trials: Linguistic Considerations in Diagnosing a Therapeutic Misconception

The ethical treatment of cancer patientsparticipating in clinical trials requiresthat patients are well-informed about thepotential benefits and risks associated withparticipation. When patients enrolled in phaseI clinical trials report that their chance ofbenefit is very high, this is often taken as evidence of a failure of the informed consent process. We argue, however, that some simple themes from the philosophy of language may make such a conclusion less certain. First, the patient may receive conflicting statements from multiple speakers about the expected outcome of the trial. Patients may be reporting the message they like best. Second, there is a potential problem of multivocality. Expressions of uncertainty of the frequency type(e.g., ``On average, 5 out of every 100 patientswill benefit') can be confused with expressionsof uncertainty of the belief type (e.g.,``The chance that I will benefit is about80%'). Patients may be informed using frequency-type statements and respond using belief-type statements. Third, each speech episode involving the investigator and the patient regarding outcomes may subservemultiple speech acts, some of which may beindirect. For example, a patient reporting ahigh expected benefit may be reporting a beliefabout the future, reassuring family members,and/or attempting to improve his or her outcome by apublic assertion of optimism. These sources oflinguistic confusion should be considered injudging whether the patient's reported expectation isgrounds for a bioethical concern that there hasbeen a failure in the informed consent process.     

Effect of different knee starting angles on intersegmental coordination and performance in vertical jumps

This study aimed to analyze the effect of different knee starting angles on jump performance, kinetic parameters, and intersegmental coupling coordination during a squat jump (SJ) and a countermovement jump (CMJ). Twenty male volleyball and basketball players volunteered to participate in this study. The CMJ was performed with knee flexion at the end of the countermovement phase smaller than 90° (CMJ_<90), greater than 90° (CMJ_>90), and in a preferred position (CMJ_PREF), while the SJ was performed from a knee angle of 70° (SJ₇₀), 90° (SJ₉₀), 110° (SJ₁₁₀), and in a preferred position (SJ_PREF). The best jump performance was observed in jumps that started from a higher squat depth (CMJ_<90–SJ₇₀) and in the preferred positions (CMJ and SJ), while peak power was observed in the SJ₁₁₀ and CMJ_>90. Analysis of continuous relative phase showed that thigh–trunk coupling was more in-phase in the jumps (CMJ and SJ) performed with a higher squat depth, while the leg–thigh coupling was more in-phase in the CMJ_>90 and SJ_PREF. Jumping from a position with knees more flexed seems to be the best strategy to achieve the best performance. Intersegmental coordination and jump performance (CMJ and SJ) were affected by different knee starting angles.     

NiTi superelasticity via atomistic simulations

The NiTi shape memory alloys (SMAs) are promising candidates for the next-generation multifunctional materials. These materials are superelastic i.e. they can fully recover their original shape even after fairly large inelastic deformations once the mechanical forces are removed. The superelasticity reportedly stems from atomic scale crystal transformations. However, very few computer simulations have emerged, elucidating the transformation mechanisms at the discrete lattice level, which underlie the extraordinary strain recoverability. Here, we conduct breakthrough molecular dynamics modelling on the superelastic behaviour of the NiTi single crystals, and unravel the atomistic genesis thereof. The deformation recovery is clearly traced to the reversible transformation between austenite and martensite crystals through simulations. We examine the mechanistic origin of the tension–compression asymmetries and the effects of pressure/temperature/strain rate variation isolatedly. Hence, this work essentially brings a new dimension to probing the NiTi performance based on the mesoscale physics under more complicated thermo-mechanical loading scenarios.     

Novel long-period stacking-ordered structure of martensite in zirconium–cobalt–palladium alloys

A novel long-period stacking-ordered (LPSO) structure of a martensitic phase in a Zr–Co–Pd alloy was discovered and characterized by means of conventional transmission electron microscopy and high-angle annular dark-field scanning transmission electron microscopy. The new phase had a 6O structure and its lattice parameters were estimated to be a = 0.34, b = 0.45 and c = 1.53 nm. The formation mechanism and the space group of the LPSO structure are described.     

Developing a cognitive behavioral therapy manual for delayed sleep–wake phase disorder

This article reports the development of a treatment protocol, based on cognitive behavioral therapy (CBT) principles, for delayed sleep–wake phase disorder (DSWPD). The protocol consists of psycho-education, presenting a CBT model for DSWPD, case formulation, motivational interviewing, registering sleep in a diary, strategies to improve the rhythm of sleep and wakefulness, relaxation training, cognitive restructuring, strategies to cope with daytime symptoms, constructing an individualized CBT program, and learning how to deal with relapses. Qualitative data, focusing on how the patients perceived the protocol, were collected within the realm of a trial exploring the efficacy of the protocol. These findings highlighted several advantages but also disadvantages of the therapy. It is our hope that this paper might act as a platform for further clinical work and future research efforts in patients with DSWPD.     

Divergence Behaviour of the Successive Geometric Mean Method of Pairwise Comparison Matrix Generation for a Multiple Stage,Multiple Objective Optimization Problem

This paper focuses on the divergence behaviour of the successive geometric mean (SGM) method used to generate pairwise comparison matrices while solving a multiple stage, multiple objective (MSMO) optimization problem. The SGM method can be used in the matrix generation phase of our three‐phase methodology to obtain pairwise comparison matrix at each stage of an MSMO optimization problem, which can be subsequently used to obtain the weight vector at the corresponding stage. The weight vectors across the stages can be used to convert an MSMO problem into a multiple stage, single objective (MSSO) problem, which can be solved using dynamic programming‐based approaches. To obtain a practical set of non‐dominated solutions (also referred to as Pareto optimal solutions) to the MSMO optimization problem, it is important to use a solution approach that has the potential to allow for a better exploration of the Pareto optimal solution space. To accomplish a more exhaustive exploration of the Pareto optimal solution space, the weight vectors that are used to scalarize the MSMO optimization problem into its corresponding MSSO optimization problem should vary across the stages. Distinct weight vectors across the stages are tied directly with distinct pairwise comparison matrices across the stages. A pairwise comparison matrix generation method is said to diverge if it can generate distinct pairwise comparison matrices across the stages of an MSMO optimization problem. In this paper, we demonstrate the SGM method's divergence behaviour when the three‐phase methodology is used in conjunction with an augmented high‐dimensional, continuous‐state stochastic dynamic programming method to solve a large‐scale MSMO optimization problem. Copyright © 2013 John Wiley & Sons, Ltd.     

Effects of experimentally increased trunk stiffness on thorax and pelvis rotations during walking

Patients with non-specific low back pain, or a similar disorder, may stiffen their trunk, which probably alters their walking coordination. To study the direct effects of increasing trunk stiffness, we experimentally increased trunk stiffness during walking, and compared the results with what is known from the literature about gait coordination with, e.g., low back pain. Healthy subjects walked on a treadmill at 3 speeds (0.5, 1.0 and 1.5 m/s), in three conditions (normal, while contracting their abdominal muscles, or wearing an orthopedic brace that limits trunk motions). Kinematics of the legs, thorax and pelvis were recorded, and relative Fourier phases and amplitudes of segment motions were calculated. Increasing trunk stiffness led to a lower thorax–pelvis relative phase, with both a decrease in thorax–leg relative phase, and an increase in pelvis–leg relative phase, as well as reduced rotational amplitude of thorax relative to pelvis. While lower thorax–pelvis relative phase was also found in patients with low back pain, higher pelvis–leg relative phase has never been reported in patients with low back pain or related disorders. These results suggest that increasing trunk stiffness in healthy subjects causes short-term gait coordination changes which are different from those seen in patients with back pain.     

编码和检索阶段的异质情境流畅性对再认的影响

研究采用经典的R/K范式，通过两个实验分别探讨编码阶段和检索阶段的异质情境流畅性对再认的影响。实验1为2（异质情境：高流畅性预期情境和低流畅性预期情境）×2（测试词类型：目标词和分心词）的混合实验设计，异质情境发生在编码阶段；实验2与实验1设计相同，不同之处在于异质情境发生在检索阶段。结果发现：异质情境发生在检索阶段时只对K反应产生影响，目标词在高流畅性情境中比低流畅性情境中的K反应率更高，而分心词在低流畅性情境中比高流畅性情境中的K反应率更高。研究表明，检索阶段的异质情境流畅性只影响熟悉性再认，支持双系统加工理论。