Experimental investigation and Monte Carlo simulations of radionuclide production inside the Uranium spallation target QUINTA irradiated with a 660-MeV proton beam

The accelerator-Driven-System (ADS) is very important to study the neutron field and radionuclide production inside simple-geometry uranium subcritical setups irradiated with high energy particle beams. A subcritical setup QUINTA was irradiated with the 660-MeV proton beam from Phasotron accelerator at the Joint Institute for Nuclear Research (JINR). The radionuclide production in the region along the beam axis was investigated by the activation technique. The aim was to compare (n,x) with (p,x) reactions using activation detectors of 59Co and natPb, and compare experimental results with the calculated results using Monte Carlo simulation code MCNPX 2.7.

^{7}Be(n,p)^{7}Li Reaction and the Cosmological Lithium Problem: Measurement of the Cross Section in a Wide Energy Range at n_TOF at CERN

We report on the measurement of the ^{7}Be(n,p)^{7}Li cross section from thermal to approximately 325 keV neutron energy, performed in the high-flux experimental area (EAR2) of the n_TOF facility at CERN. This reaction plays a key role in the lithium yield of the big bang nucleosynthesis (BBN) for standard cosmology. The only two previous time-of-flight measurements performed on this reaction did not cover the energy window of interest for BBN, and they showed a large discrepancy between each other. The measurement was performed with a Si telescope and a high-purity sample produced by implantation of a ^{7}Be ion beam at the ISOLDE facility at CERN. While a significantly higher cross section is found at low energy, relative to current evaluations, in the region of BBN interest, the present results are consistent with the values inferred from the time-reversal ^{7}Li(p,n)^{7}Be reaction, thus yielding only a relatively minor improvement on the so-called cosmological lithium problem. The relevance of these results on the near-threshold neutron production in the p+^{7}Li reaction is also discussed.

^{7}Be(n,α)^{4}He Reaction and the Cosmological Lithium Problem: Measurement of the Cross Section in a Wide Energy Range at n_TOF at CERN

The energy-dependent cross section of the ^{7}Be(n,α)^{4}He reaction, of interest for the so-called cosmological lithium problem in big bang nucleosynthesis, has been measured for the first time from 10 meV to 10 keV neutron energy. The challenges posed by the short half-life of ^{7}Be and by the low reaction cross section have been overcome at n_TOF thanks to an unprecedented combination of the extremely high luminosity and good resolution of the neutron beam in the new experimental area (EAR2) of the n_TOF facility at CERN, the availability of a sufficient amount of chemically pure ^{7}Be, and a specifically designed experimental setup. Coincidences between the two alpha particles have been recorded in two Si-^{7}Be-Si arrays placed directly in the neutron beam. The present results are consistent, at thermal neutron energy, with the only previous measurement performed in the 1960s at a nuclear reactor. The energy dependence reported here clearly indicates the inadequacy of the cross section estimates currently used in BBN calculations. Although new measurements at higher neutron energy may still be needed, the n_TOF results hint at a minor role of this reaction in BBN, leaving the long-standing cosmological lithium problem unsolved.

Neutron capture cross section measurement of 151Sm at the CERN neutron time of flight facility (n_TOF)

The151Sm(n,gamma)152Sm cross section has been measured at the spallation neutron facility n_TOF at CERN in the energy range from 1 eV to 1 MeV. The new facility combines excellent resolution in neutron time-of-flight, low repetition rates, and an unsurpassed instantaneous luminosity, resulting in rather favorable signal/background ratios. The 151Sm cross section is of importance for characterizing neutron capture nucleosynthesis in asymptotic giant branch stars. At a thermal energy of kT=30 keV the Maxwellian averaged cross section of this unstable isotope (t(1/2)=93 yr) was determined to be 3100+/-160 mb, significantly larger than theoretical predictions.

End-of-life decision making by adolescents, parents, and healthcare providers in pediatric oncology: research to evidence-based practice guidelines

Participating in end-of-life decisions is life altering for adolescents with incurable cancer, their families, and their healthcare providers. However, no empirically developed and validated guidelines to assist patients, parents, and healthcare providers in making these decisions exist. The purpose of the work reported here was to use three sources (the findings of three studies on decision making in pediatric oncology, published literature, and recommendations from professional associations) to develop guidelines for end-of-life decision making in pediatric oncology. The study designs include a retrospective, descriptive design (Study 1); a prospective, descriptive design (Study 2); and a cross-sectional, descriptive design (Study 3). Settings for the pediatric oncology studies included a pediatric catastrophic illness research hospital located in the Midsouth (Studies 1 and 2); and that setting plus a children's hospital in Australia and one in Hong Kong (Study 3). Study samples included 39 guardians and 21 healthcare providers (Study 1); 52 parents, 10 adolescents, and 22 physicians (Study 2); and 43 parents (Study 3). All participants in the studies responded to six open-ended questions. A semantic content analysis technique was used to analyze all interview data. Four nurses independently coded each interview; interrater reliability per code ranged from 68% to 100% across studies. The most frequently reported influencing factors were "information on the health and disease status of the patient," "all curative options having been attempted," "trusting the healthcare team," and "feeling support from the healthcare provider." The agreement across studies regarding influencing factors provides the basis for the research-based guidelines for end-of-life decision making in pediatric oncology. The guidelines offer assistance with end-of-life decision making in a structured manner that can be formally evaluated and individualized to meet patient and family needs.

Clinical use of topoisomerase I inhibitors in anticancer treatment

The camptothecin analogs topotecan and irinotecan have shown to be among the most effective anticancer agents and, as S-phase specific agents, their antitumor effect is maximized when they are administered in protracted schedules. The documented activity as single agents in many adult and pediatric malignancies has been followed by their use in combination with other anticancer agents. These studies have shown promising results, and have placed topotecan and irinotecan in the first line treatment for some malignancies. However, studies to better determine the optimal schedules and sequence of combinations are needed.

The role of peers in the emergence of heterosexual romantic relationships in adolescence

Adolescents' peer structures and the quality of their friendships were explored as antecedents of romantic relationships. Longitudinal data were gathered in a sample of 180 high school students over a 3-year period from grade 9 to grade 11. Consistent with Dunphy (1963), small groups of close friends were predictive of other-sex peer networks which were, in turn predictive of the emergence of future romantic relationships. Indirect effects were found for same-sex groups of close friends and same-sex networks. Consistent with Furman and Wehner (1994), the qualitative features of relationships with both friends and romantic partners were predictive of the qualitative features of subsequent romantic experiences. These linkages suggest ways in which peer relationships may support romantic development at this stage of the life cycle.

An international feasibility study of parental decision making in pediatric oncology

PURPOSE/OBJECTIVES

To describe parental decision making about treatment options for children with cancer and determine the feasibility of a similar but larger international study.

DESIGN

Exploratory.

SETTINGS

A pediatric catastrophic illness research hospital in the United States and children's hospitals in Australia and Hong Kong.

SAMPLE

A convenience sample of 43 parents (5 fathers and 38 mothers ages 23-59 years).

METHODS

Six open-ended interview questions posed to parents during private individual interviews. Content analysis techniques were used.

MAIN RESEARCH VARIABLES

Parental perceptions of (a) factors considered in the decision-making process, (b) behaviors of healthcare professionals that affected the process, and (c) satisfaction with the process. Feasibility of a larger study was estimated by considering ease of access to parents, number of refusals to participate, understanding of the interview questions, and level of interest at each setting.

FINDINGS

Access to parents was possible at all sites. Refusal to participate was reported only at the U.S. site. Certain factors (e.g., getting information from the healthcare team, trusting staff) were important to all parents considering end-of-life decisions. Site-specific factors included considering alternative therapies (at the Australian site) and strengthening faith (at the U.S. site).

CONCLUSIONS

A larger international study of parental decision making is feasible. Sufficient similarities in parental decision making exist across these sites to justify future efforts to identify universal decision-making factors that, in conjunction with site-specific differences, could be helpful in developing guidelines for healthcare professionals who assist parents in making treatment-related decisions for a sick child.

Phase I therapy trials in children with cancer

PURPOSE

This study examined the response and toxicity rates of antineoplastic drugs evaluated in phase I clinical trials in children to identify trends in response and toxicity over time.

PATIENTS AND METHODS

Full length, peer-reviewed articles describing the results of single agent phase I therapy trials in children younger than 21 years with cancer were reviewed. Tumor-specific response data and doses of drugs that resulted in objective responses were noted. Deaths that occurred on study caused by drug toxicity, progressive disease (PD), or complications of marrow aplasia were identified, along with drug doses that resulted in toxic death. Temporal trends in response rates, toxicity, and number of patients entered in trials were examined.

RESULTS

A total of 1,606 patients with cancer were enrolled in 56 single-agent pediatric phase I therapy trials published between 1978 and 1996. Of these, 1,257 were evaluated for response by tumor type. The overall objective response rate was 7.9%. Response rates were highest for patients with neuroblastoma (17.7%) and acute myelogenous leukemia (11.6%). Patients with osteosarcoma and rhabdomyosarcoma had response rates of < 3%. Sixty percent of responses in patients with solid tumors occurred at 81 to 100% of the maximum tolerated dose (MTD), although 42% of responses in patients with leukemia occurred at > 100% of the MTD. Death on study was noted in 7.0% of all patients entered in trials. Only 0.7% of patients experienced a death related to drug toxicity. PD accounted for the death of 5.6% of study participants. A trend of increasing response rate despite smaller trial size was noted over the last 7 years of this period.

CONCLUSION

Phase I trials in children with cancer represent a safe mechanism to determine the MTD, toxicity profile, and pharmacokinetics of new agents for use in children with cancer.

Decision making by parents and healthcare professionals when considering continued care for pediatric patients with cancer

PURPOSE/OBJECTIVES

To better define the treatment-related decisions considered most difficult by parents of pediatric patients with cancer and the factors that influenced their final decisions.

DESIGN

Retrospective-descriptive design.

SETTING

Pediatric oncology institution in the mid-southern region on the United States.

SAMPLE

39 parents representing 37 of 83 eligible families, 16 attending physicians, three nurses, and two chaplains.

METHODS

Parent participants responded by telephone to six open-ended interview questions and a 15-item questionnaire about factors that were important when making the decision to continue care. Healthcare professionals were interviewed face-to-face.

MAIN RESEARCH VARIABLES

Most difficult treatment-related decisions; factors influencing decision making.

FINDINGS

Parents reported 15 types of difficult decisions, the majority of which were made late in the course of treatment. Deciding between a phase I drug study or no further treatment (n = 14), maintaining or withdrawing life support (n = 11), and giving more chemotherapy or giving no further treatment (n = 8) were the most frequently reported difficult decisions. Parents rated "recommendations received from healthcare professionals" as the questionnaire factor most important in their decision making, and healthcare professionals rated "discussion with the family of the patient" as the most important factor.

CONCLUSION

Parents of children or adolescents with cancer and their healthcare providers face difficult treatment-related decisions, many of which occur late in the course of treatment. Parents and healthcare professionals cite similar factors in their decision making but differ in their ratings of the factors' importance. For parents, the information and recommendations they receive from healthcare professionals figure most frequently and most importantly in their decision making. For healthcare professionals, the certainty that the patient will not get better and discussions with the patient's family figure most importantly in their decision making. Once parents conclude that their child can not get better, they are more likely to choose noncurative options such as choosing no further treatment or withdrawing life support.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can help determine what information parents need in their decision making. Particular attention must be given to ways to communicate the likelihood of the their child's survival.

Adolescent girls' relationships with mothers and best friends

The present study examined factors associated with harmony in adolescent girls' relationships with their mothers and their best friends. A framework was proposed in which relationship harmony was expected to be related to individual characteristics of each partner and the match between the individual characteristics of each partner. 60 adolescent girls, their mothers, and their best friends participated in self-report and observational tasks. Harmonious mother-daughter partners (vs. disharmonious ones) had more similar needs, felt their needs were better met, perceived their partners as more socially skilled, and had more similar interests. Harmonious friends (vs. disharmonious ones) had more similar needs, and target adolescents perceived partners to be more socially skilled and better at meeting their needs. Observational ratings of attunement, positive affect, and power negotiation were greater in harmonious relationships with both mothers and friends. Discussion focuses on the value of a common framework for studying different relationships.

Phase I study of escalating targeted doses of carboplatin combined with ifosfamide and etoposide in treatment of newly diagnosed pediatric solid tumors

BACKGROUND

The combination of carboplatin, ifosfamide, and etoposide has shown promising activity in a variety of relapsed childhood solid tumors but has not been studied in newly diagnosed patients.

PURPOSE

The tolerance for and activity of escalating targeted doses of carboplatin combined with ifosfamide and etoposide (ICE) were assessed in children with advanced germ cell tumors or other rare solid tumors for which no standard therapy exists.

METHODS

Fifteen children with newly diagnosed solid tumors received ICE chemotherapy. Individualized carboplatin doses were calculated to achieve a target area under the concentration x time curve (AUC) and adjusted for the glomerular filtration rate (estimated by 99mTc-labeled diethylene-triamine pentaacetic acid clearance). Cohorts of at least three patients received carboplatin at an initial target AUC of 6 mg.min/mL, with escalations of 2 mg.min/mL in subsequent cohorts. Carboplatin was given on day 1, followed by ifosfamide at 2 g/m2 per day and etoposide at 100 mg/m2 per day on days 2 through 4. All patients received at least two courses of therapy in the absence of progressive disease, and as many as eight courses could be given.

RESULTS

The 15 patients received a total of 46 assessable courses of ICE. Myelosuppression was the dominant toxicity; 30 courses (67%) resulted in hospitalization for febrile neutropenia. Neutropenia was dose limiting at the carboplatin target AUC of 12 mg.min/mL. One complete and eight partial responses were seen in the 14 assessable patients; two additional patients had at least partial responses documented at surgery or autopsy. Six patients are without evidence of disease at a median of 548 days after diagnosis.

CONCLUSION

ICE chemotherapy, with the carboplatin dose based on a target AUC of 10 mg.min/mL, is tolerable and has significant activity in a variety of rare malignancies, including extragonadal germ cell tumors.

IMPLICATIONS

The combination of carboplatin, etoposide, and ifosfamide holds promise in the treatment of rare pediatric malignancies.

Phase I study of topotecan for pediatric patients with malignant solid tumors

PURPOSE

To determine the dose-limiting toxicity and potential efficacy of topotecan in pediatric patients with refractory malignant solid tumors.

PATIENTS AND METHODS

In this phase I clinical trial, 27 patients received topotecan 0.75-1.9 mg/m2 by continuous intravenous infusion daily for 3 days. Fifty-three treatment courses were given to these patients.

RESULTS

Myelosuppression was the dose-limiting toxicity at levels of 1.3 to 1.9 mg/m2 for 3 days, requiring significant support with transfused packed RBCs and platelets. Myelosuppression was variable in severity at the 1.0-mg/m2 dosage level; thus, additional patients were treated with this dosage, followed by human recombinant granulocyte-colony stimulating factor (G-CSF). Other toxicities were not significant. One patient with neuroblastoma had a complete response that lasted for 8 months. Stable disease activity was recorded for other patients with neuroblastoma, rhabdomyosarcoma, and islet cell carcinoma. Pharmacokinetic studies showed that topotecan plasma concentrations ranged from 1.6 to 7.5 ng/mL during infusions of 1.0 mg/m2/d, and that there was a biphasic plasma distribution with a mean terminal half-life of 2.9 +2- 1.0 hours.

CONCLUSION

Topotecan is a promising anticancer agent that deserves phase II testing in pediatric solid tumors. We recommend that pediatric phase II topotecan trials use 1.0 mg/m2/d for 3 days as a constant intravenous infusion, followed by G-CSF for 14 days, and that these treatment courses be repeated every 21 days.

Practitioner review: problems in children's peer relations: what can the clinician do?

This paper describes the assessment and treatment of children with peer relationship problems. The first part of the paper is organized around five topics: peer rejection, peer neglect, the absence of friendships, reputation in the peer group, and peer group affiliations. Next, a series of assessment methods is delineated, including peer, teacher, parent and self reports, as well as direct observational procedures. Finally, we suggest a number of treatment options, including social skills training, social cognitive interventions, and co-operative group interventions.

Progress in the treatment of adolescents with acute lymphoblastic leukemia

BACKGROUND AND METHODS. The authors studied the clinical and biologic features and treatment response of 358 children with acute lymphoblastic leukemia (ALL), including 90 adolescents, treated on a single multiagent protocol (St. Jude Total Study XI, 1984-1988). This was done to clarify whether the disease differed in adolescents and to determine the degree of improvement in treatment outcome produced by this modern intense chemotherapy.

RESULTS

Compared with the younger children (1-9 years of age; infants 1 year old or younger excluded; n = 257), adolescents (10-18 years of age; n = 90) were significantly more likely to have adverse prognostic features, including T-cell phenotype, L2 blast cell morphologic characteristics, blasts with negative findings for common ALL antigen, and ploidy other than hyperdiploidy greater than 50. Eighty-six of the 90 (96%) adolescents achieved a complete remission, a rate similar to that of the children (97%). Although the event-free survival (EFS) of adolescents was shorter than that of younger children (5-year EFS of 66 +/- 8% versus 75 +/- 5%, respectively; P = 0.04), in this analysis of consecutively treated patients with ALL it showed a significant statistical and clinical improvement as compared with that in our previous study (St. Jude Total Study X, 1979-1983; 5-year EFS rate of 66 +/- 8% versus 37 +/- 5%, respectively; P < 0.001). Within the adolescent group treated on Total Study XI, the EFS was worse for those older than 15 years of age than for those 10-14 years old (46 +/- 15% versus 75 +/- 8%, respectively; P = 0.007). Toxic effects primarily included myelosuppression without severe sequelae. Approximately 96% of the therapy was administered in the outpatient setting.

CONCLUSIONS

The increased frequency of unfavorable clinical and biologic features undoubtedly accounts for the poorer prognosis of adolescents with ALL, a conclusion supported by the lack of independent prognostic importance of age in this study. The authors conclude that approximately two-thirds of adolescents can be cured when treated with this intensive but tolerable therapy, showing that this form of treatment significantly has changed the prognosis of adolescents with ALL.

Phase I study of escalating targeted doses of carboplatin combined with ifosfamide and etoposide in children with relapsed solid tumors

PURPOSE

The tolerance of escalating targeted doses of carboplatin combined with ifosfamide (IFOS)/etoposide (VP-16) (ICE) was assessed in children with recurrent solid tumors.

PATIENTS AND METHODS

To reduce interpatient variability in carboplatin systemic exposure, 45 children were treated with doses individualized to a target area under the serum concentration versus time curve (AUC) based on renal function, using technetium 99-diethyl-enetriamine pentaacetic acid (99mTc-DTPA) clearance to estimate glomerular filtration rate (GFR). Cohorts of at least three patients received carboplatin at an initial target AUC of 2 mg/mL x min, with escalations of 1 mg/mL x min in subsequent cohorts. Courses consisted of carboplatin on day 1 followed by IFOS 2 g/m2 plus VP-16 100 mg/m2 on days 2 and 3. Patients received at least two courses, with a maximum of eight courses possible in the absence of progressive disease. When only moderate toxicity occurred after escalation to 5 mg/mL x min, a third dose of IFOS plus VP-16 was added. After three patients were treated at this level, carboplatin escalation proceeded.

RESULTS

Neutropenia and thrombocytopenia were the dominant toxicities in the 43 assessable patients. At the target AUC of 8 mg/mL x min, 13 of 20 cycles were associated with febrile neutropenia. For phase II trials, we recommend a carboplatin target AUC of 6 mg/mL x min with three doses of IFOS and VP-16 for patients with prior craniospinal irradiation or high-dose cisplatin (CDDP)/VP-16, or 7 mg/mL x min for patients without such histories. There were two complete responses (CRs), 13 partial responses (PRs), and 17 objective responses (ORs).

CONCLUSION

The ICE regimen shows promising activity in pediatric solid tumors. The clear relationship between hematologic toxicity and carboplatin systemic exposure supports the use of targeted dosing in further trials of ICE chemotherapy.

Age and sex differences in perceptions of networks of personal relationships

In this study, 549 youths in the fourth grade, seventh grade, tenth grade, and college completed Network of Relationship Inventories assessing their perceptions of their relationships with significant others. The findings were largely consistent with 7 propositions derived from major theories of the developmental courses of personal relationships. In particular, mothers and fathers were seen as the most frequent providers of support in the fourth grade. Same-sex friends were perceived to be as supportive as parents in the seventh grade, and were the most frequent providers of support in the tenth grade. Romantic partners moved up in rank with age until college, where they, along with friends and mothers, received the highest ratings for support. Age differences were also observed in perceptions of relationships with grandparents, teachers, and siblings. Finally, age differences in perceived conflict, punishment, and relative power suggested that there was a peak in tension in parent-child relationships in early and middle adolescence. Discussion centers around the role various relationships are perceived as playing at different points in development.

Perceptions of sibling relationships during middle childhood and adolescence

Children in grades 3, 6, 9, and 12 were administered the Sibling Relationship Questionnaire. Relationships were rated as progressively more egalitarian across the 4 grade groups, with adolescents reporting less dominance and nurturance by their older siblings than younger participants. Adolescents also reported less companionship, intimacy, and affection with siblings than younger participants reported. Levels of perceived conflict with younger siblings were moderately high across all 4 grades, whereas ratings of conflict with older siblings were progressively lower across the 4 grades. The findings suggested that sibling relationships: (a) become more egalitarian and less asymmetrical with age, (b) become less intense with age, and (c) encompass experiences that are partially determined by the child's standing in the family constellation.

Positive, negative, and neutral peer interactions as indicators of children's social competency: the issue of concurrent validity

Many studies examining the effects of treatments for socially isolated/withdrawn children have used behavioral measures to assess children's peer relations. In an attempt to examine the concurrent validity of these measures, we observed 258 preschool children during free play and coded their interactions into the categories of positive, negative, and neutral behaviors. We also interviewed these children individually, using a sociometric nomination procedure, and asked them to indicate liked and disliked peers. Our examination of the results revealed that, consistent with other research, the correlation between the sociometric measures and the children's total rate of interaction with peers was low. In addition, measures of positive, negative, and neutral behaviors were also only weakly correlated with the children's sociometric scores. We agree with others in concluding that multiple methods of assessment are needed to properly assess the adequacy of children's peer relations.

Five domains of interpersonal competence in peer relationships

In three studies we investigated the utility of distinguishing among different domains of interpersonal competence in college students' peer relationships. In Study 1 we developed a questionnaire to assess five dimensions of competence: initiating relationships, self-disclosure, asserting displeasure with others' actions, providing emotional support, and managing interpersonal conflicts. Initial validation evidence was gathered. We found that self-perceptions of competence varied as a function of sex of subject, sex of interaction partner, and competence domain. In Study 2 we found moderate levels of agreement between ratings of competence by subjects and their roommates. Interpersonal competence scores were also related in predictable ways to subject and roommate reports of masculinity and femininity, social self-esteem, loneliness, and social desirability. In Study 3 we obtained ratings of subjects' competence from their close friends and new acquaintances. Relationship satisfaction among new acquaintances was predicted best by initiation competence, whereas satisfaction in friendships was most strongly related to emotional support competence. The findings provide strong evidence of the usefulness of distinguishing among domains of interpersonal competence.

Clinical and biological features predict relapse hazard in childhood acute lymphoid leukemia

Remarkable progress has been made in understanding the immunobiology, cytogenetic features and potential molecular pathogenetic mechanisms of childhood acute lymphoid leukemias (ALL). Studies of the expression of certain lineage restricted molecules on the surface of or within normal lymphoid cells and their malignant counterparts have been largely responsible for this advance, which has markedly improved the classification of ALL. These studies have disclosed previously unrecognized biologic heterogeneity and have shown that there are several different immunophenotypic subsets of ALL. Some of these subsets differ in their clinical and cytogenetic features, as well as in their responsiveness to modern therapy, underscoring the clinical relevance of such studies. A consideration of all of these features of ALL permits a more accurate assessment of prognosis for children with newly diagnosed disease and has permitted tailoring therapy based on expected relapse hazard. Recent cytogenetic studies have disclosed that clonal abnormalities are present in the blast cells of most children with ALL. Furthermore, such studies have demonstrated increasing numbers of non-random structural anomalies of chromosomes, some of which are specific for certain immunophenotypic species of ALL. Finally, molecular studies of some of these particularly informative cytogenetic anomalies in leukemic cells have suggested that proto-oncogenes are altered and/or activated as a consequence of chromosomal rearrangements.(ABSTRACT TRUNCATED AT 250 WORDS)

Intensified chemotherapy for childhood lymphoblastic leukemia: modifications and results of induction treatment in St. Jude Study XI

The value of intensified chemotherapy for improving event-free survival rates in childhood lymphoblastic leukemia (ALL) is now widely accepted among leukemia therapists. Still to be determined are (1) the optimal method of intensification, (2) the subset or subsets of patients for whom such treatment may be excessive, and (3) whether or not cure rates in ALL can be further improved by alternative approaches to intensification. St. Jude Total Therapy Study XI, based on predictions of the Goldie-Coldmand model of drug resistance, addresses some of these questions by use of rotational "non-cross-resistant" drug pairs throughout the course of therapy. A new method of risk classification has been developed to refine distinctions among prognostic subgroups, especially to identify patients with biologically unfavorable ALL. Unacceptable toxicity noted in the first 134 children enrolled in this study led to two protocol modifications. One hundred thirty-two patients have been treated subsequently without undue toxicity. The treatment is now being delivered safely. Our early experience with this regimen demonstrates some of the hazards of intensive multidrug combination treatment, but gains in leukemia control appear to justify this approach.

A new algorithm for calculation of blood loss in excisional burn surgery

One hundred and two patients who sustained thermal injury and who underwent 155 excisional procedures were prospectively studied in order to determine an accurate blood loss formula. Blood loss (mean +/- S.D.) is expressed as the percentage of the total blood volume lost for each per cent of body surface area excised and autografted. There was no significant difference between the blood loss for the overall group of procedures (4.1 +/- 0.24) and the various subgroups indicating that the outcome was not influenced by the method, extent or timing of excision or by the use of tourniquets. From the authors' calculations, approximately 196 ml of blood is required for each per cent of body surface area excised and autografted.

Five domains of interpersonal competence in peer relationships

In three studies we investigated the utility of distinguishing among different domains of interpersonal competence in college students' peer relationships. In Study 1 we developed a questionnaire to assess five dimensions of competence: initiating relationships, self-disclosure, asserting displeasure with others' actions, providing emotional support, and managing interpersonal conflicts. Initial validation evidence was gathered. We found that self-perceptions of competence varied as a function of sex of subject, sex of interaction partner, and competence domain. In Study 2 we found moderate levels of agreement between ratings of competence by subjects and their roommates. Interpersonal competence scores were also related in predictable ways to subject and roommate reports of masculinity and femininity, social self-esteem, loneliness, and social desirability. In Study 3 we obtained ratings of subjects' competence from their close friends and new acquaintances. Relationship satisfaction among new acquaintances was predicted best by initiation competence, whereas satisfaction in friendships was most strongly related to emotional support competence. The findings provide strong evidence of the usefulness of distinguishing among domains of interpersonal competence.

The development of companionship and intimacy

This study is concerned with the development of companionship and intimacy. Subjects in the second, fifth, and eighth grades (mean ages, respectively, 7.5, 10.4, and 13.4) rated the importance and extent of companionship and intimate disclosure experienced in social life in general and in each of 8 types of relationships. Companionship was perceived as a desired social provision at all 3 grade levels. Family members were important providers of companionship for children in the second and fifth grades, but they became significantly less so in the eighth grade. Same-sex peers were important providers across all 3 grades, and they became increasingly important as children grew older. Opposite-sex peers did not become important as companions until the eighth grade. Counter to expectations, there were no age differences in the global desire for intimacy. Parents were important providers of intimate disclosure for the youngest children, but they were less important among the younger adolescents. There was mixed support for the hypothesis that same-sex friends become important providers of intimacy during preadolescence. Findings were different for boys and girls, suggesting that girls seek intimate disclosure in friendship at younger ages than boys do.

Acute lymphocytic leukemia in childhood: immunologic marker, cytogenetic, and molecular studies

Remarkable progress has been achieved in our understanding of the biology of acute lymphoblastic leukemias (ALL) occurring in childhood. Morphologic, immunologic, and cytogenetic studies of ALL have resulted in more accurate classification and risk assessment, permitting tailoring of therapy in this heterogeneous group of diseases. Studies of tumor cell biology have begun to pinpoint genes whose altered functions may be etiologically linked to cancer, and have provided insights into the biochemical processes involved in leukemogenesis.

Children's perceptions of the qualities of sibling relationships

Although many studies of family constellations exist, only recently have investigators begun to examine the qualities of sibling relationships. The purpose of the present investigation was to develop a systematic framework for describing and assessing such relationship qualities. In the first study, upper elementary school children were interviewed about their perceptions of the qualities of their sibling relationships. These interviews yielded a list of 15 salient qualities. In the second study, a self-report questionnaire that assessed their perceptions of these qualities was administered to a sample of 198 fifth- and sixth-grade children. A principal components analysis yielded 4 underlying factors: (a) Warmth/Closeness, (b) Relative Status/Power, (c) Conflict, and (d) Rivalry. Relative Status/Power was found to be strongly related to the relative ages of the child and sibling. The other 3 factors were also related to various family constellation variables, but these relations were modest in size. Because family constellation variables and the qualities of sibling relationships are not isomorphic with one another, it is important to study relationship qualities directly, rather than simply examining family constellation variables. Some of the determinants of such qualities are discussed.

The effects of social skills training and peer involvement on the social adjustment of preadolescents

This study examined the effects of social skills training and peer involvement on the peer acceptance of disliked preadolescents. 56 fifth- and sixth-grade children were identified as unaccepted by their peers and deficient in conversational skills. These children were then randomly assigned to 1 of 4 treatment conditions: (1) conversational skills training (individual coaching), (2) peer involvement under superordinate goals (group experience), (3) conversational skills training combined with peer involvement (group experience with coaching), and (4) a no-treatment control. Differential treatment effects were observed at both a posttreatment and follow-up assessment. As predicted, conversational skills training promoted skill acquisition and increased skillful social interaction. Peer involvement increased peer acceptance and children's self-perceptions of their social efficacy. The results were interpreted in terms of a developmentally based multidimensional model of social competence.

Rehabilitation of socially withdrawn preschool children through mixed-age and same-age socialization

24 socially withdrawn preschool children were located through classroom observations and assigned to 3 conditions: (a) socialization with a younger child during 10 play sessions, (b) socialization with an age mate during a similar series of sessions, and (c) no treatment. The socialization sessions, particularly those with a younger partner, were found to increase the sociability of the withdrawn children in their classrooms. Significant increases occurred mainly in the rate with which positive social reinforcement was emitted. Generally, the results support a leadership deficit theory of social isolation. Possible mechanisms responsible for the observed changes are discussed.