The development and initial validation of the narrative foreclosure scale

Objectives: As people grow older, identity development in later life becomes a more and more relevant topic. Studying processes that hinder or promote identity development in later life is of importance. Within this broader field, there has been a growing interest in narrative foreclosure. Our goal was to develop a short, reliable and easy–to-use instrument measuring narrative foreclosure and to validate this instrument in two samples.Methods: The narrative foreclosure scale (NFS) was validated in two studies with a sample of middle-aged adults (n = 319) and a sample with older adults (n = 174). Several analyses were conducted to assess the psychometric properties, the factor-structure and incremental validity of the scale.Results: Confirmatory factor analyses generally showed an acceptable fit of the two-factor (NF-Future and NF-Past) model to the data in both samples. Both factors of the NFS demonstrated adequate to good internal consistency, with alpha coefficients ranging from .79 for NF-Past in study 2 to .88 for NF-Future in study 1. Construct validity was good as shown by moderate to large correlations to related constructs. The scale adds a unique portion of explained variance to positive mental health, thereby showing the incremental validity of the NFS.Conclusion: A reliable scale is now available that allows to study the premature hindering of identity development in older populations. The use of the NFS as a process measure in studies on the effectiveness of interventions aiming at meaning making and identity development, such as life-review therapy and narrative therapy, is also recommended.     

EGFR related mutational status and association to clinical outcome of third-line cetuximab-irinotecan in metastatic colorectal cancer

Background  

As supplement to KRAS mutational analysis, BRAF and PIK3CA mutations as well as expression of PTEN may account for additional non-responders to anti-EGFR-MoAbs treatment. The aim of the present study was to investigate the utility as biomarkers of these mutations in a uniform cohort of patients with metastatic colorectal cancer treated with third-line cetuximab/irinotecan.     

Treatment of advanced seminoma with cyclophosphamide, vincristine and carboplatin on an outpatient basis.

This study describes the efficacy and toxicity of a combination regimen consisting of cyclophosphamide, vincristine (oncovin) and carboplatin (COC) for advanced seminoma on an outpatient basis. Twenty-seven patients (mean age 43 years, range 28-63 years) were classified as stage IIC (n = 5), stage IID (n = 12), stage III (n = 9) or stage IV (n = 1). Six had been treated with prior radiotherapy; elevated beta-HCG and elevated LDH serum levels were observed in 15 and 25 patients respectively. Patients were treated with four cycles of 750 mg m-2 cyclophosphamide intravenously (i.v.), 1.4 mg m-2 vincristine i.v. (maximum 2 mg) and carboplatin adjusted to creatinine clearance. Cycles were given at 3 week intervals. The median dose of carboplatin administered was 400 mg m-2 (range 300-450 mg m-2). Six patients [22%; 95% confidence interval (CI), 6-38%] achieved a complete response (CR), 19 (70%; 95% CI, 51-88%) a partial response and two (8%; 95% CI, 0 18%) showed only a response in tumour markers but not a reduction of retroperitoneal mass (NR). Post-chemotherapeutic masses were not removed surgically or irradiated. After a median follow-up of 26 months (range 5-69 months), two patients have died, one from cardiac arrest 2 years after achieving CR, the other with relapsed seminoma 5 months after therapy. None of the other patients relapsed. Main toxicity was haematological, with 22 patients (81%) experiencing thrombocytopenia WHO grade III/IV and 27 (100%) leucocytopenia WHO grade III/IV, requiring dose reduction in five patients. Seven patients experienced granulocytopenic fever. Non-haematological toxicity was rare. Peripheral neuropathy grade I was observed in four patients and grade III in one. Haemorrhagic cystitis occurred once. In conclusion, despite considerable haematological toxicity, COC is feasible on an outpatient basis, even after prior radiotherapy, and is an effective regimen for advanced seminoma with only 1/27 treatment failures after a median follow-up of 26 months.     

Timing and antecedents of intracranial hemorrhage in the newborn

Fifty newborn infants of less than 33 weeks' gestation were followed prospectively from birth to evaluate the temporal relationships of various clinical factors to the onset and progression of intracranial hemorrhage (ICH) in an inborn population given maximal support. ICH was diagnosed and followed with bedside ultrasound every eight hours. The incidence of intraventricular hemorrhage was 30% and of any ICH was 40% with onset from less than 2 hours to 8 days of age. Grades 2, 3, and 4 ICH correlated with Apgar scores of less than 5 at five minutes, vaginal delivery, longer labors, and intrapartum hemorrhage. There was a significant correlation between ICH and both blood pressure fluctuations of greater than 100% and rapid colloid infusions. Slow transfusions of packed red cells did not appear to precipitate episodes of ICH. In a setting of optimal care, ICH appears to be more related to prenatal stresses than to specific postnatal complications.     

Behavioral and neuroanatomical characterization of the Fmr1 knockout mouse

Previous studies showed the Fmr1 knockout (KO) mouse to be an excellent animal model for human fragile-X syndrome. The aim of this study was to further characterize the phenotype of these animals. Neuroanatomically, KO male mice were compared to wild-types (littermates) with respect to their sizes of hippocampal intra- and infrapyramidal mossy fiber (IIPMF) terminal fields. Behaviorally, they were tested in four different paradigms, each measuring different aspects of cognitive and emotional behavior: elevated plus maze (anxiety), neutral cage (aggression), open field (exploration), and radial maze (spatial memory). The results showed a diminished ability for radial maze learning associated with smaller sizes of IIPMF terminal fields. In addition, Fmr1 knockout animals exhibited increased locomotor activity, while no differences were found for aggression and anxiety. These data suggest the involvement of FMRP protein in the development of spatial learning and the sprouting of IIPMF terminal fields.     

Cognitive dysfunction and chemotherapy: neuropsychological findings in perspective

Currently, the interest in cognitive functioning following chemotherapy is rapidly expanding as is reflected in a growing number of published studies on this topic. Although most studies are indicative of cognitive deficits after chemotherapy, definite conclusions on the role of chemotherapy on cognitive function can often not be drawn due to methodological problems. On the basis of the studies on cognitive functioning after chemotherapy that are conducted in The Netherlands Cancer Institute, the current article describes a number of such methodological topics that obscure straightforward interpretation of neuropsychological findings in toxicity research. Measurement issues that diverge from usual assessment issues encountered in psychosocial oncology will be described, and factors that might play a role in the cause of cognitive impairment will be evaluated. Also, future developments necessary to gain more insight into the prevalence, the pattern, and the impact of cognitive problems following chemotherapy are discussed     

Accidental firearm fatalities

Out of a total of 624 consecutive gunshot autopsies from Münster and Hamburg, Germany, 32 cases (5.1%) were accidental. The accidents were self-inflicted in 3 cases while another person fired the gun in the remaining 29 cases. More than half of the victims were younger than 25 years and 75% were male. A single gunshot injury was present in all cases and the head was struck in 47% but a detailed analysis of the entrance wound sites did not show any preferential anatomical sites. A surprising finding was the presence of five contact or near contact gunshots (16%). The reasons for these and most other accidents were extreme carelessness when handling a firearm, the involvement of children or adolescents or a foolish behaviour with a gun intended to impress others. Gun-cleaning accidents occurred rarely and there were no major technical defects of the weapons. Preventive measures should concentrate on strict inaccessibility of guns to children and on increased educational efforts to subgroups at risk such as hunters and members of the armed forces. A single non-contact gunshot injury from a long-barrelled firearm can be considered typical for an accident but the great variety and the possible presence of "disguised" suicides and homicides requires a careful forensic investigation including inspection of the scene and reconstruction of the events. It is recommended that a case should always be considered to be non-accidental in the beginning of an investigation.