Amy M. Peterson

Discussing Bad News in the Outpatient Oncology Clinic: Rethinking Current Communication Guidelines

Aware that his pancreatic cancer had metastasized to his liver, Mr B and his adult son and daughter traveled several hundred miles to see an oncologist at a regional comprehensive cancer center. As the oncologist explained the treatment options, Mr B and his family occasionally interrupted with questions, statements, or expressions of emotion. During the interaction, Mr B and his family learned that surgery was not a treatment option, as they had hoped. They also learned that Mr B was not eligible for any clinical trials. The only available option was chemotherapy, but it carried the potential for severe adverse effects, had less than a 10% chance of shrinking the tumor, and had no chance of “melting the tumor away.” In response to one of the son’s questions, the oncologist said that complementary or alternative medicines were not available at this center. As part of his response to the daughter’s question about the urgency of a treatment decision, the oncologist mentioned that the cancer had been in Mr B’s body for a number of years. Mr B and both of his children asked several questions about this piece of information, indicating their surprise and dismay. Mr B shook his head and exclaimed, “And I go to the doctor all the time!” As the discussion concluded, the oncologist provided details about how chemotherapy might be delivered and repeated that there was no urgency to the decision.

Impact of Biodiesel Emission Products from a Multi-Cylinder Direct Injection Diesel Engine on Particulate Filter Performance

As diesel emission regulations continue to increase, the use of exhaust aftertreatment systems containing, for example the diesel oxidation catalyst (DOC) and diesel particulate filter (DPF) will become necessary in order to meet these stringent emission requirements. The addition of a DOC and DPF in conjunction with utilizing biodiesel fuels requires extensive research to study the implications that biodiesel blends have on emissions as well as to examine the effect on aftertreatment devices. The proceeding work discusses results from a 2006 VM Motori four-cylinder 2.8L direct injection diesel engine coupled with a diesel oxidation catalyst and catalyzed diesel particulate filter. Tests were done using ultra low sulfur diesel fuel blended with 20% choice white grease biodiesel fuel to evaluate the effects of biodiesel emission products on the performance and effectiveness of the aftertreatment devices and the effect of low temperature combustion modes.

Children's Positive Dispositional Attributes, Parents’ Empathic Responses, and Children's Responses to Painful Pediatric Oncology Treatment Procedures

Pain/distress during pediatric cancer treatments has substantial psychosocial consequences for children and families. The authors examined relationships between childrens positive dispositional attributes, parents’ empathic responses, and childrens pain/distress responses to treatment procedures. Participants were 41 pediatric cancer patients and parents. Several weeks before treatment, parents rated childrens resilience and positive dimensions of temperament. Parents’ pretreatment empathic affective responses to their children were assessed. Childrens pain/distress during treatments was rated by multiple independent raters. Childrens resilience was significantly and positively associated with parents’ empathic affective responses and negatively associated with childrens pain/distress. Childrens adaptability and attention focusing also showed positive relationships (p < 0.10) with parents’ empathic responses. Parents’ empathic responses mediated effects of childrens resilience on childrens pain/distress. Childrens positive dispositional attributes influence their pain/distress during cancer treatments; however, these effects may be mediated by parents’ empathic responses. These relationships provide critical understanding of the influence of parent–child relationships on coping with treatment.

Satisfaction with support versus size of network: Differential effects of social support on psychological distress in parents of pediatric cancer patients

This study examined the direct and buffering effects of social support on longer‐term global psychological distress among parents coping with pediatric cancer. In both sets of analyses, we examined whether these effects depended on the dimension of social support provided (i.e., satisfaction with support versus size of support network).

Parent Caregiver Self-Efficacy and Child Reactions to Pediatric Cancer Treatment Procedures

This study examined how parents’ sense of self-efficacy specific to caregiving for their child during cancer treatment procedures affected children’s distress and cooperation during procedures. Potential correlates of caregiver self-efficacy (ie, demographics, child clinical characteristics, parent dispositional attributes, and social support) were also examined. Participants were 119 children undergoing cancer treatment procedures and their parents. Parents’ self-efficacy about 6 procedure-specific caregiver tasks was measured. Parents, children, nurses, and observers rated child distress and parents, nurses and observers rated child cooperation during procedures. Higher parent self-efficacy about keeping children calm during procedures predicted lower child distress and higher child cooperation during procedures. Parent dispositional attributes (eg, enduring positive mood, empathy) and social support predicted self-efficacy. Parent caregiver self-efficacy influences child distress and cooperation during procedures and is associated with certain parent attributes. Findings suggest the utility of identifying parents who would benefit from targeted interventions to increase self-efficacy about caregiving during treatment procedures.

Optimization of Swirler-Venturi Mixer Geometry for Fuel Reformer Application

Swirler Venturi Mixers (SVM) is an excellent candidate as the fuel-air mixer in fuel cell reformer applications. A numerical parametric study is carried out to provide design guideline for its geometry. Parameters considered are the length of the diffuser, throat lengths, swirler vane angles, and the air-steam inlet geometry. The effect on spray structure and fuel air mixing are characterized using CFD simulation for representative fuel cell reformer processes, namely Catalytic Partial Oxidation Reformer (CPOX), AutoThermal Reforming (ATR) and Steam Reforming (SR). The degree of vaporization, the uniformity of the fuel-air ratio, and the pressure drop before the catalytic bed are used as the criteria to determine the performance. Cold-flow spray visualization using water is also carried out to show the effect of swirl and wall impingement for certain geometry. The simulation results with hot air case with venturi with 60 o Swirler has more attached flow and gives more uniform vapor distribution when compared to 0 o and 30 o swirler. Higher swirler angle helps in better mixing of fuel and enables in good heat transfer and evaporation of fuel. Venturi with 8-inch divergence diffuser has more complete vaporization because of higher residence time and slow expansion of air. Higher inlet temperature of CPOX produces better vaporization when compared to ATR, which has higher flow rate. Single premixed inlet geometry produces the lowest pressure drop compared to other inlet geometry considered. Cold flow experimental results show significant wall wetting and asymmetric spray for cases with stronger than necessary swirling flow, which could be induced by tangential injection inlets.

Effects of B20 on combustion, emissions and performance of a light-duty diesel engine

This paper compares 20% bio-diesel (B20-choice white grease) fuel with baseline ultra low sulfur diesel (ULSD) fuel on the performance of combustion and emissions of a light-duty 4-cylinder 2.8-liter common-rail DI diesel engine. The results show that operating the engine in the Low Temperature Combustion (LTC) regime produces lower PM and NOx with a slight penalty in fuel consumption, THC, and CO emissions. B20, in general, produces less soot. A slight increase in NOx emissions is shown with B20 compared to ULSD, with an exception at the high speed point where B20 has lower NOx values. In addition, the performance and emission characteristics are investigated as a function of the ECU injection strategy. The addition of pilot injections is found to effectively reduce combustion noise and extends the injection retard window to reach LTC combustion regimes with acceptable noise level for LD diesel engines.© 2009 ASME

Numerical Simulation of Coolant Electrolysis in Composite Plate PEM Fuel Cell Stacks

Two- and three- dimensional numerical models of a PEM fuel cell have been developed to investigate the effects of shunt current within the coolant channel. The model accounts for the electrostatic equation solved for a ten cell fuel stack for idealized and realistic coolant channels including varying conductivities of the solution. The electrostatic equation was solved in the coolant channel for the fully insulated, non-insulated, and incremental lengths of insulation on the channels. The model results found that the length of the insulation on the coolant channel plays an important role in shunt current reduction and fuel cell performance. The case of insulating the coolant channels was found to show that current density propagated further into the channels as increased lengths of insulation were used. However, the strength of the current density from the ending point of the insulation was found to decrease with increasing insulation lengths. Furthermore, a simple experiment was conducted idealizing the fuel cell as batteries connected in series and then submerged in a low conductivity solution. A camera was used to capture the current potential in the different “stacks” and to validate the numerical model.Copyright

Effects of B20 on Emissions and the Performance of a Diesel Particulate Filter in a Light-Duty Diesel Engine

This paper compares 20% bio-diesel (B20-choice white grease) fuel with baseline ultra low sulfur diesel (ULSD) fuel on the emissions and performance of a diesel oxidation catalyst (DOC) and diesel particulate filter (DPF) coupled to a light-duty 4-cylinder 2.8-liter common-rail DI diesel engine. The present paper focuses on the comparison of the fuel effects on loading and active regeneration of the DPF between B20 and ULSD. B20, in general, produces less soot and has lower regeneration temperature compared to soot loaded with ULSD. NO2 concentrations before the DPF were found to be 6% higher with B20, indicating more availability of NO2 to oxidize the soot. Exhaust speciation of the NO2 availability indicates that the slight increase in NOx from B20 is not the dominant cause for the lower temperature regeneration and faster regeneration rate but the reactivity of the soot that is in the DPF. Formaldehyde concentrations are found to be higher with B20 during regeneration due to increased oxygen concentrations in the exhaust stream. Finally the oil dilution effect due to post injection to actively regenerate the DPF is also investigated using a prototype oil sensor and FTIR instrumentation. Utilizing an active regeneration strategy accentuates the possibility of fuel oil dilution of the engine oil. The onboard viscosity oil sensor used was in good agreement with the viscosity bench test and FTIR analysis and provided oil viscosity measurement over the course of the project. Operation with B20 shows significant fuel dilution and needs to be monitored to prevent engine deterioration.Copyright