This new approach, called the ��specially-designed multiple imputation�Cbased fuzzy clustering method�� (s-FCM), can be used even when there are missing values. Using inhibitor Pazopanib this method, Fang et al. (2011) detected a graded exposure effect on neonatal birth weight and neurobehavioral outcome in a sample of 361 women in the Midwest Infant Development Study (MIDS, R01 “type”:”entrez-nucleotide”,”attrs”:”text”:”DA014661″,”term_id”:”78308928″DA014661; Espy, PI). The MIDS dataset has four types of exposure data (22 exposure variables, where 9 had missing value rates ranging from 0.6% to 18.3%): self-reported smoking, maternal urine cotinine levels, nicotine by cigarette brand, and nicotine dependence scores.

Using the s-FCM, three subgroups with distinct smoking behavior patterns across pregnancy resulted, which were labeled: nonexposed (NE, N = 172), lighter tobacco-exposed (lTE, N = 140), and heavier tobacco-exposed (hTE, N = 40). Differences in birth weight were observed between the hTE (M = 3,277.7 g) and NE (M = 3,431.6 g) groups but not between the lTE (M = 3,400.3 g) and NE groups. Furthermore, on a standardized neonatal behavioral assessment (Riese, 1982) administered at birth, 2-, and 4 weeks of age, the s-FCM identified differences in the pattern of developmental change in irritable reactivity, again, with significant differences between hTE and NE but not between lTE and NE. The predictive power increased by at least 13% over the nonsignificant comparisons of exposure groups defined by traditional binary cut-score groupings (Espy et al., 2011).

These findings suggest that s-FCM may facilitate the detection of subtle exposure effects on a variety of smoking-related outcomes. To understand whether s-FCM has this utility, we need to test it further on known exposure-related outcomes (e.g., birth weight). Thus, the purpose of the present study is to examine if a similar number of exposure subgroups and a graded exposure effect can again be detected on perinatal growth outcomes by applying the s-FCM method to a study cohort, the Maternal Infant Smoking Study of East Boston (MISSEB, now followed as the East Boston Family Study; Pickett, Kasza, Biesecker, Wright, & Wakschlag, 2009; Wakschlag et al., 2011), with different exposure variables and participant characteristics (Pickett et al., 2008).

Specifically, we hypothesize that as in MIDS, three subgroups will be identified: (a) heavier, (b) lighter, and (c) nonexposed and that these groups, particularly the heavier versus nonexposed groups, will differ in fetal growth outcomes. Since mixed results exist in the literature as to the significance of exposure effects on neonatal Carfilzomib body length and head circumference (e.g., Conter, Cortinovis, Rogari, & Riva, 1995; Espy et al., 2011; Hardy & Mellits, 1972; Nelson, Jodscheit, & Guo, 1999), these effects may differ in MISSEB and MIDS.

, 2003, 2009; Sargent et al., 2002, 2005; see also DiFranza et al., 2006; National Cancer Institute [NCI], 2008; Wellman, Sugarman, DiFranza, & Winkoff, 2006). An emerging literature has begun to shed light on psychosocial mechanisms (e.g., positive expectancies) selleck chemicals Nilotinib that mediate these exposure effects (Sargent et al., 2002; Wills, Sargent, Stoolmiller, Gibbons, & Gerrard, 2008; Wills et al., 2007). In addition to understanding meditational mechanisms, it is important to understand whether character motives for smoking influence the impact of these portrayals. For example, movie smoking that is portrayed as having a motive (e.g., as a way to relax, to facilitate socializing, or to appear rebellious; Dalton et al., 2002; Worth, Duke, Green, & Sargent, 2007) may affect adolescents differently than that portrayed as having no motive.

These portrayals may then foster vicarious learning of associations between smoking and positive outcomes (e.g., relaxation) which in turn could prompt adolescent smoking (see Johnson et al., 2003; Piko, Wills, & Walker, 2007; Wills, Sandy, & Shinar, 1999; see also Bandura, 2006). However, research has yet to examine associations between exposure to different motives for movie smoking and adolescent smoking. This preliminary laboratory study examined whether exposure to movie smoking that is portrayed as having a clear motive (i.e., as helping characters to socialize, to relax, or to appear rebellious) has a different association with desire to smoke compared with smoking that is portrayed as having no clear motive.

We had no specific hypotheses about which motive would be more strongly associated with desire to smoke in this exploratory study. Methods Participants This study was approved by the Institutional Review Board at RAND. A total of 77 never-smoking adolescents, recruited using media advertising, participated (62% male; 60% Caucasian; 14% Black; and 25% multiethnic). Their mean age was 12.8 years (SD = 1.0). A majority of the sample reported that both parents worked (more than 77%). Procedures Smoking and non�Csmoking clips were selected from 28 wide-release movies (rated PG to R). The smoking scenes were initially sorted by study team consensus into four smoking motives categories (see Worth et al.

, 2007; categorizations used for the final analyses were determined by examining participant data; see Results section below): (a) characters smoking to relax, (b) characters smoking to facilitate social interaction, (c) characters smoking to appear rebellious, or (d) characters smoking where no motive was apparent. A Cilengitide total of 32 smoking scenes (8 per motive category) were selected. Next, non�Csmoking scenes were selected from the same movies where the same characters that appeared in the smoking scenes were present and where the tone of the scene was similar to that of the identified smoking clip, yielding 32 non�Csmoking clips.

s well (e.g., Article 6.2b). The existence of a substantial illicit market, or the threat that illicit trade will increase, can jeopardize future excise tax increases. This can be both real in that it undermines www.selleckchem.com/products/carfilzomib-pr-171.html the effect of the tax or latent in that the threat of increases in illicit trade prevents increases in tax from taking place. TRENDS IN CIGARETTE TAXATION, PRICING, AND CONSUMPTION The FCTC encourages Parties to raise the excise tax on tobacco products, but does not set specific targets. The targeted level of excise tax (expressed either in a common currency or as a percentage of the retail price) and/or the rate at which the excise tax should increase from year to year is necessarily arbitrary. However, some organizations have set benchmarks or targets.

For example, the World Bank recommends that excise and sales taxes combined should comprise between 67% and 80% of the retail price of cigarettes (Jha & Chaloupka, 1999). The WHO recommends that excise taxes should account for at least 70% of the retail price (WHO, 2010). The latter recommendation sets a particularly high bar, and according to WHO data (WHO, 2011) is currently met by only five countries (Cuba, San Marino, Fiji, Egypt, and the United Kingdom). The European Union sets a minimum excise tax burden of 57% of the retail price (with a minimum tax floor of �64 per 1,000 cigarettes), to be increased to 60% (with a minimum �90 per 1,000 cigarettes) as of January 1, 2014 (Council Directive 2010/12/EU). None of the international organizations have set specific targets for the retail price of cigarettes.

Comparable price and tax data over long periods of time exist for a limited number of countries, mainly HICs. Based on a sample of 31 HICs and 21 LMICs, van Walbeek et al. (forthcoming) found that real, inflation adjusted cigarettes prices increased in nearly all HICs between 1990 and 2008, but that they decreased in more than half of the LMICs during the same period. These trends, together with rapid economic growth in LMICs can explain the divergence in cigarette consumption trends between the HICs and the LMICs. Cigarette consumption in HICs decreased from 1.8 trillion to 1.4 trillion cigarettes between 2000 and 2009, while cigarette consumption in LMICs increased from 3.4 trillion to 4.5 trillion cigarettes over the same period (van Walbeek et al., forthcoming).

As a result, global aggregate cigarette consumption increased from around 5.2 trillion cigarettes in 2000 to 5.9 trillion cigarettes in 2009. WHAT IS KNOWN IN THE SCIENTIFIC LITERATURE? Price and Consumption Many studies have investigated the determinants of cigarette demand. Until the 1980s, these studies used time Entinostat series data focusing exclusively on HICs (Baltagi & Goel, 1987; Warner, 1977). Chapman and Richardson��s study of cigarette demand in Papua New Guinea in 1990 was the first time series�Cbased tobacco demand study using LMICs data. Despite differences in the individual countries, the quality of data, and the met

Human recombinant activated MMP-1 and -2 were used for calibration. Extraction procedures were performed in the presence of EDTA-free concerning complete protease inhibitor (Roche) to prevent ex vivo MMP activation (37). Substrate gel zymography. Substrate gel zymography was performed as outlined (37). Briefly, liver extracts (see above) or cell lysates at 20 ��g protein/lane were separated on 10% polyacrylamide gels copolymerized with 1 mg/ml gelatin, incubated in activity buffer for 24 h, stained with 0.25% Coomassie Blue, and destained in acetic acid/methanol/H2O (10:1:89). Proteolytic bands corresponding to MMP-2 and MMP-9 were identified and quantified as described (37). Substrate in situ zymography. Substrate in situ zymography was performed as detailed (37). Briefly, liver sections were dried and overlaid with 0.

1 mg/ml DQ-gelatin in MMP activity buffer supplemented with 0.5% low-melt agarose, covered with coverslips, gelled at 4��C for 1 h, and incubated at room temperature for 2�C16 h. Images were documented on a Nikon E800 photodocumentation microscope. Live cell matrix-degrading activities. Live cell matrix-degrading activities were determined as follows. Freshly isolated rat peritoneal macrophages or cell lines representing other liver cell types were plated in 96-well culture plates at constant density (3 �� 104 cells/well) in phenol red and serum-free DMEM (1% penicillin/streptomycin). Gelatinase and collagenase activities were measured as an absolute increase in fluorescence after addition of self-quenched fluorogenic substrates DQ-gelatin or DQ-collagen (0.

02 mg/ml), respectively, as previously described (37). These substrates were added to cells for 1�C16 h, either alone or immediately before addition of the apoptotic cholangiocytes prepared as described above. Statistical Analyses Data are expressed as means �� SE, and statistical analyses were performed using Microsoft excel and GraphPad Prism version 5.00 (GraphPad Software, San Diego, CA). Multiple comparisons were performed by one-way ANOVA. Two planned comparisons were performed to each of the control groups, healthy nonfibrotic rats (sham) and rats at peak of fibrosis (BDL) using the Dunnett’s posttest. Differences among selected experimental groups were compared using the Tukey posttest. P values >0.05 Dacomitinib were considered significant. RESULTS Advanced Secondary Biliary Fibrosis Reverses After Bilio-digestive Anastomosis At week 4 after BDL (peak of fibrosis), serum markers of cholestasis and inflammation were significantly increased (Supplemental Table S2). After RY-anastomosis these parameters rapidly decreased to near normal on day 3 and remained at this level throughout the following 12 wk (Supplemental Table S2).

Binding buffer (400 ��L) was added to dilute the samples before analysis on a flow cytometer. The cells positively labeled for Annexin V were considered apoptotic. These experiments were conducted three times at least. Statistical Analysis Data are expressed as mean �� standard error of at least three independent ref 3 experiments. Groups were compared using a one-way analysis of variance with Bonferroni��s correction (SPSS, Chicago, IL). Statistical significance was assumed at P<0.05. Results Effect of KRG on Pancreatic Function in CsA-induced Pancreatic Injury Table 1 shows the effects of 4 weeks of CsA and KRG (K) treatment on the basic parameters of the experimental groups. Both CsA+K groups (one treated daily with 0.2 g/kg and one with 0.4 g/kg of KRG) showed lower serum creatinine (Scr) and blood urea nitrogen (BUN) than the CsA only group.

KRG cotreatment did not affect the CsA level in either whole blood or pancreatic tissues, indicating that drug interactions did not occur at these doses. Baseline blood glucose levels did not differ among the four groups (Figure 1A and B). However, the blood glucose level after intraperitoneal glucose loading was significantly higher in the CsA group than in the VH group, but cotreatment with KRG significantly decreased the blood glucose level at 30 and 60 min after glucose loading compared with the CsA group. KRG cotreatment with CsA decreased the calculated area under the curve for glucose (AUCg) compared with the CsA group (Figure 1C: VH, 1229��55 mg/dL/min; VH+K0.2, 1174��49 mg/dL/min; VH+K0.4, 1360��35 mg/dL/min; CsA, 1563��39 mg/dL/min; CsA+K0.

2, 1447��32 mg/dL/min; CsA+K0.4, 1368��44 mg/dL/min; VH vs. CsA, CsA vs. CsA+K0.2 or CsA+K0.4, P<0.05). The fasting insulin level was significantly lower in the CsA group than in the VH group. It was significantly increased in both CsA+K groups compared with the CsA group (Figure 1D: VH, 0.30��0.05 ng/mL; VH+K0.2, 0.33��0.05 ng/mL; VH+K0.4, 0.30��0.04 ng/mL; CsA, 0.15��0.01 ng/mL; CsA+K0.2, 0.19��0.01 ng/mL; CsA+K0.4, 0.30��0.06 ng/mL; VH vs. CsA, CsA vs. CsA+K0.2 or CsA+K0.4, P<0.05). Thus, oral KRG administration during CsA-induced pancreatic dysfunction in mice improved glucose tolerance and restored defective insulin secretion, suggesting that KRG has an antihyperglycemic effect. Figure 1 Effect of KRG on pancreatic function in CsA-induced pancreatic injury. Table 1 Effect of KRG on basic parameters. Effect of KRG on Pancreatic �� Cell Area in CsA-induced Pancreatic Injury Double immunofluorescence for insulin (red fluorescence) and glucagon (green fluorescence) in the VH group and Carfilzomib VH+K groups showed a strong and uniform pattern of staining in a large proportion of the islet �� cells (Figure 2A).

10, p = .15; see Figure 3). Finally, age of onset of khat use was inversely correlated with frequency of khat use (hours per session: r = ?.31, p < .01; times per week: r = ?.34, p < .001; selleck catalog years of khat use: r = ?.28, p < .01). Figure 3. A gender �� smoking status interaction in the number of khat sessions held per week. Smoking status (occasional or daily) was associated with khat use among women while this was not the case with men as found by simple effects tests. DISCUSSION More than 70% of khat users in the current sample of Yemeni adults reported that they consume khat on a regular basis. The average age of onset of khat use was 17, and these individuals spend 5hr a day chewing almost every day. These confirm previous studies (Al-Motarreb et al., 2002; The World Bank, 2007).

Also as expected, men reported that they consume khat and tobacco more intensely and frequently than women, supporting that these substances are more widely accepted among men as compared with women in Middle Eastern countries (Maziak, 2002; The World Bank, 2007). The current study found that men and women use different tobacco products during a khat session. Men were more likely to smoke cigarettes, whereas women tended to smoke waterpipe. Studies have reported gender differences in social perception of cigarette and waterpipe smoking. For example, cigarette smoking is generally considered ��men��s thing�� and viewed as unfavorable behavior for women in Middle Eastern countries (Maziak, 2002). In contrast, waterpipe smoking is generally viewed as more socially positive and trendy as compared with cigarette smoking (Hammal, Mock, Ward, Eissenberg, & Maziak, 2008; Maziak et al.

, 2004). Family attitude toward the use of waterpipe by women is more lenient than its use by men (Maziak et al., 2004). These findings suggest that waterpipe smoking is more culturally accepted than cigarette smoking for women. Another possibility is gender differences in taste perception of khat. Epidemiological data report that female nonusers do not chew khat because of its bitter taste more so than men (The World Bank, 2007). Because aroma and taste are often attributed to the use of waterpipe (Maziak et al., 2004), it is possible that women khat users consume flavored waterpipe to manage the bitterness of the leaves. The findings that 87% of women cited that they smoke only when they chewed khat (vs.

30% of men), while the majority of men (>55%) endorsed that they smoke their first cigarette after Cilengitide breakfast and smoke before going to bed (compared with less than 30% of women) may further suggest that tobacco use among women may be situation specific. Taken together, social, motivational, and psychopharmacological processes may be associated with different patterns of tobacco use between male and female khat users. Our findings extend previous work by pointing out the need to take into account gender differences when examining concurrent use of khat and tobacco.

The use of poly(I:C) as an innate immune response activator is advantageous because it avoids the use of infectious agents within the working environment, and treatments can towards be standardized, facilitating comparisons between experiments and between laboratories. However, it should be noted that i.v. or i.p. injection of poly(I:C) do not exactly reproduce a natural viral infection, as viruses most commonly infect epithelial cells of the respiratory and digestive tracts, and very rarely infect and replicate in the blood stream or in the peritoneum. Therefore, the immune cells activated by i.v. or i.p. administration of poly(I:C) are likely to be different than the ones activated during an ordinary viral infection. Activation of immune cells in different tissues may lead to the generation of an innate immune response with different profiles of cytokine production.

Thus, the profile IRSF in maternal serum observed in the present study after i.p. administration of poly(I:C) may not be exactly the same as the profile observed after an i.v. injection of poly(I:C) or after a common viral infection. Nevertheless, the profile of IRSF detected in fetal brain homogenates did not correlate with the profile observed in maternal serum, indicating that IRSF production was regulated within the fetus or in the placenta. This suggests that, regardless of the route of administration, the effect of poly(I:C) on IRSF expression levels in fetal brains is expected to be similar to the effect caused by a natural viral infection.

Maternal exposure to poly(I:C) close to the end of the mouse pregnancy (GD16 to GD17) impairs associative and reversal learning, exploration in open field and social behavior of the offspring. In addition, an increase in anxiety and a decrease in pre-pulse inhibition have been observed in post-pubertal animals exposed to poly(I:C) during pregnancy, indicating that innate immune activation by poly(I:C) during the final period of the pregnancy affects CNS development and causes long-lasting impairments of animal behaviors associated with psychiatric symptoms [28,40-42]. The developmental stage of the mouse CNS at GD16 correlates with GD68 to GD94 of human brain development, depending on whether cortical (GD93.3), limbic (GD68.4) or non-cortical/limbic events (GD73.7) are compared [34-36]. At this developmental stage, neurogenesis is
fatty acids and glucose can compete as oxidative fuels within muscle [for review, see Randle (37)]. Additionally, increased triglyceride (TG) content has been associated with insulin resistance in various insulin-sensitive tissues (21, 24, 29, 31, 41, 43), and accumulation of lipid species within Entinostat cells might directly affect cell insulin signaling (42).

The aim of this study selleck Olaparib was to examine abstinence rates among GB compared with HT smokers in a smoking cessation treatment study that did not specifically recruit GB smokers or use a therapeutic approach targeted to any special group of smoker. The 8-week open treatment phase that preceded a maintenance treatment study (Covey et al., 2007) provided an opportunity to compare short-term cessation outcome by sexual orientation. Methods At the baseline visit, participants completed a self-administered form that included the following question: ��Do you think of yourself as: (a) heterosexual or straight, (b) homosexual or gay or lesbian, or (c) bisexual?�� Based on responses to this question, we categorized study participants as HT versus GB.

Using advertisements without reference to participants�� sexual orientation, our study drew 1,859 respondents, of whom 1,047 met study eligibility criteria during telephone screen and 588 met enrollment criteria at the initial clinic visit (Covey et al., 2007). Of the enrolled group, 11.6% (68/588) self-reported LGB orientation, a percentage similar to the recent 10.6% estimate of the LGB population in the New York City metropolitan area (Gates, 2006), where our smoking cessation program is located. Among 305 males, 54 (19%) self-identified as GB, 243 (80%) as HT, and 8 (2.6%) did not answer. Among 283 female study participants, only a small number (n = 14) self-identified as LGB; this led us to restrict the present study to the sample of 297 males who answered the sexual orientation question.

The study outcome was abstinence status at Weeks 1, 2, 4, 6, and 8 (the end of treatment) following the target quit day, verified by expired carbon monoxide ��8 parts per million (Jarvis, Tunstall-Pedoe, Feyerabend, Vesey, & Saloojee, 1987). Dropouts were considered nonabstainers. The main predictor was sexual orientation (GB vs. HT). Potential covariates selected for their putative influence on smoking cessation outcome were demographics, smoking history, body mass index (BMI), psychological variables, and psychiatric history (see Table 1). Table 1. Baseline characteristics of heterosexual and gay/bisexual male smokers To test differences by sexual orientation, we used the chi-square test for categorical variables and the two-sample t test for continuous variables.

To evaluate moderation of cessation outcome by sexual orientation during the 8-week treatment, we applied a generalized linear mixed model (GLMM) for categorical repeated measures using a logit link function, fitted with Brefeldin_A PROC GLIMMIX in SAS, with weekly abstinence status (Weeks 1, 2, 4, 6, 8) modeled as a function of sexual orientation, time (weeks since target cessation day), age, occupational level, and BMI (baseline characteristics that significantly differentiated GB from HT smokers in the study).

The recurrence, present in around 10% of hernia surgeries, encourages the research of new techniques and materials that can be utilized selleckbio in the hernia correction (2�C4). After many experiences from ancient times, the hernia surgery begins in Italy with Bassini (1844�C1924) with the reinforcement of the posterior plan of the inguinal canal. Bassini was followed by many surgeons with changes and adaptations of his technique, always aiming at reducing the recurrence (1,2,5). The mesh prosthesis use, from Shouldice (1890�C1965) with steel, silver and actually with polypropylene shows good results, although there is a big incidence of rejection and infection, aside from the price of prosthesis never always accessible to the patient (2�C6).

Halsted (1852�C1922) said: ��If we can be able to find a material with the same characteristics of a fascia or tendon we would arrive at the radical hernia cure�� (1,2). From 1971 with Alcino L��zaro, the hernia sac has been studied in regards of its constitution and his utilization for reinforcement of abdominal wall defect with very good result. The hernia sac is removed from the patient, doesn��t show rejection, inflammation and it��s a tissue of great resistance on account of smooth muscular fibers and collagen (1,2,7). The aim of this study is show the use of the hernia sac in the correction of the inguinal hernia. Patients and methods This study was authorized by the ��Conselho de ��tica e Pesquisa em Seres Humanos�� of the ��Universidade Federal de Juiz de Fora �C UFJF �C MG��. The data had been collected from March 2003 to December 2006 in the ��Hospital Municipal Dr.

Mozar Geraldo Teixeira�� of Juiz de Fora with 200 patients who had undergone inguinal hernia surgery. Of these patients, 147 (73,5%) were male and 53 (26,5%) female. The age varied from 13 to 89 years (average: 41,85; DPad: 16,8). The patients were chosen randomly and the factors of inclusion in this technique were the thickness and size of the hernia sac. Among the patients, 133 (66,5%) showed right inguinal hernia, 53 (23,5%) left inguinal hernia and 14 (7%) bilateral inguinal hernia. The transverse incision was used following the force line of the skin �C called the Felizet incision �C with exposition of the spermatic cord after incision of the External Oblique Muscle (EOM) aponeurosis. After the identification of the hernia sac (Fig.

1), a string Cilengitide in its basis was made with absorbable thread (cromade Cat-Gut 2-0) and then resected. Hernia sac was put in physiological solution. The reinforcement of the inguinal wall is done with the approximation of the conjoint tendon to the inguinal ligament with Prolene 0 continuous suture. The hernia sac is cut and adapted on the previous suture. It is fixed with separated stitches of Nylon 3-0 and left loose serous with surface standing above.

However, given that the vast majority of smokers smoke within a few days of their quit date (Hughes, Keely, and Naud, 2004), it might be particularly important to have a measure that can identify Carfilzomib those at risk for relapse early in their attempt to quit. Also, it is possible that the analyses of predictive bias could have been nonsignificant due to low power. However, the effect size estimates conducted for these analyses indicated that the current sample size could detect moderate effects, and the confidence intervals of the resulting analyses are relatively narrow, indicating reasonable precision of effect estimates. Finally, the current study is the first, to our knowledge, to identify the WSWS as an acceptable instrument for assessing the smoking withdrawal syndrome across racial/ethnic groups, but further research in this area is needed.

Funding National Institute on Drug Abuse (R01 DA014818); National Cancer Institute (K07 CA121037, a CURE Minority Supplement to R25 CA57730); National Institutes of Health through The University of Texas MD Anderson Cancer Center’s Cancer Center Support Grant (CA016672). Declaration of Interests The authors declare that except for income received from the primary employer, no financial support or compensation has been received from any individual or corporate entity over the past 3 years for research or professional service, and there are not personal financial holdings that could be perceived as constituting a potential conflict of interest, except in the case of Dr Cinciripini.

Dr Cinciripini has served on the scientific advisory board of Pfizer Pharmaceuticals and has conducted educational talks sponsored by Pfizer on smoking cessation for physicians. Acknowledgments We would like to acknowledge the research staff at The University of Texas MD Anderson Cancer Center who assisted with implementation of the original project. Contributors: Y. Castro is lead author and conceptualized the research question, conducted the data analysis, interpreted the results, and drafted the manuscript. D. Wetter conceptualized the research question, interpreted the results, reviewed and edited manuscript drafts, and is the principal investigator on the grant supporting AV-951 the original research. D. Kendzor, M. Businelle, C. Mazas, L. Cofta-Woerpel, and P. Cinciripini helped with the conceptualization and methodology of the paper and reviewed and edited manuscript drafts. C. Mazas, L. Cofta-Woerpel, and P. Cinciripini helped with the conceptualization and methodology of the original research project and assisted with data collection and study procedures. Human Participant Protection: This study was approved by The University of Texas MD Anderson Cancer Center Institutional Review Board.