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Search Results: 1 - 10 of 4732 matches for " Kelly Lambert "
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Skin-Sparing Mastectomy: An Update for Clinical Practice  [PDF]
Kelly Lambert, Kefah Mokbel
Surgical Science (SS) , 2013, DOI: 10.4236/ss.2013.41010

Aim: To review the oncological safety and aesthetic advantage of skin-sparing mastectomy (SSM) for invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS). Controversies including the impact of radiotherapy (RT) on immediate breast reconstruction (IBR), preservation of the nipple-areola complex (NAC) and the role of endoscopic mastectomy are also considered. Methods: Literature review using Medline and PubMed. Results: SSM is safe in selected cases; including IBC < 5 cm, multi-centric tumours, DCIS and for risk-reduction surgery. Inflammatory breast cancers and tumours with extensive involvement of the skin represent contra-indications to SSM due to an unacceptable risk of local recurrence. SSM can facilitate IBR and is associated with an excellent aesthetic result. Prior breast irradiation or the need for post-mastectomy radiotherapy (PMRT) do not preclude SSM, however the cosmetic outcome may be adversely affected. Nipple/areola preservation is safe for peripherally located node negative tumours. A frozen section protocol for the retro-areolar tissue should be considered in these cases. The advent of acellular tissue matrix systems has widened the applicability of implant-based immediate reconstruction following SSM. Data on endoscopic mastectomy is limited and superiority over conventional SSM has not been demonstrated. Conclusion: SSM is safe in selected cases and is associated with advantages over simple mastectomy, including a superior aesthetic outcome and a potential reduction in the number of reconstructive procedures per patient.

Ductal Carcinoma In Situ: Recent Advances and Future Prospects
Kelly Lambert,Neill Patani,Kefah Mokbel
International Journal of Surgical Oncology , 2012, DOI: 10.1155/2012/347385
Abstract: Introduction. This article reviews current management strategies for DCIS in the context of recent randomised trials, including the role of sentinel lymph node biopsy (SLNB), adjuvant radiotherapy (RT) and endocrine treatment. Methods. Literature review facilitated by Medline, PubMed, Embase and Cochrane databases. Results. DCIS should be managed in the context of a multidisciplinary team. Local control depends upon clear surgical margins (at least 2?mm is generally acceptable). SLNB is not routine, but can be considered in patients undergoing mastectomy (Mx) with risk factors for occult invasion. RT following BCS significantly reduces local recurrence (LR), particularly in those at high-risk. There remains a lack of level-1 evidence supporting omission of adjuvant RT in selected low-risk cases. Large, multi-centric or recurrent lesions should be treated by Mx and immediate reconstruction should be discussed. Adjuvant hormonal treatment may reduce the risk of LR in selected cases with hormone sensitive disease. Conclusion. Further research is required to determine the role of new RT regimes and endocrine therapies. Biological profiling and molecular analysis represent an opportunity to improve our understanding of tumour biology in DCIS to rationalise treatment. Reliable identification of low-risk lesions could allow treatment to be less radical. 1. Introduction 1.1. Diagnosis The introduction of national mammographic screening programmes and the increasing use of digital mammography and MRI have dramatically changed the clinical presentation of DCIS. Prior to this, DCIS made up a small proportion of all breast malignancy and was only diagnosed in patients presenting with a palpable mass, pathological nipple discharge, or occasionally found as an incidental biopsy finding [1, 2]. In contrast, it is now most frequently identified in asymptomatic women with screen-detected micro calcifications [3] and makes up a larger proportion of breast malignancy. Approximately one fifth of all screen-detected breast cancers are now DCIS [4]. Although the rates of all breast malignancy have increased with time, between 1980 and 1995, Western countries have experienced a four-fold “increase” in the incidence of DCIS specifically, particularly in women of screening age [5]. Data from a systematic review of 374 studies reported the pooled incidence of DCIS in the early 1970s as 5.8/100000 and this had risen to 32.5/100000 in 2004 [6]. A higher proportion of the cases post screening were non comedo DCIS, which is considered less aggressive. Screening and cancer registry
Contingency-based emotional resilience: effort-based reward training and flexible coping lead to adaptive responses to uncertainty in male rats
Kelly G. Lambert,Molly M. Hyer,Timothy Landis,Massimo Bardi
Frontiers in Behavioral Neuroscience , 2014, DOI: 10.3389/fnbeh.2014.00124
Abstract: Emotional resilience enhances an animal's ability to maintain physiological allostasis and adaptive responses in the midst of challenges ranging from cognitive uncertainty to chronic stress. In the current study, neurobiological factors related to strategic responses to uncertainty produced by prediction errors were investigated by initially profiling male rats as passive, active or flexible copers (n = 12 each group) and assigning to either a contingency-trained or non-contingency trained group. Animals were subsequently trained in a spatial learning task so that problem solving strategies in the final probe task, as well-various biomarkers of brain activation and plasticity in brain areas associated with cognition and emotional regulation, could be assessed. Additionally, fecal samples were collected to further determine markers of stress responsivity and emotional resilience. Results indicated that contingency-trained rats exhibited more adaptive responses in the probe trial (e.g., fewer interrupted grooming sequences and more targeted search strategies) than the noncontingent-trained rats; additionally, increased DHEA/CORT ratios were observed in the contingent-trained animals. Diminished activation of the habenula (i.e., fos-immunoreactivity) was correlated with resilience factors such as increased levels of DHEA metabolites during cognitive training. Of the three coping profiles, flexible copers exhibited enhanced neuroplasticity (i.e., increased dentate gyrus doublecortin-immunoreactivity) compared to the more consistently responding active and passive copers. Thus, in the current study, contingency training via effort-based reward (EBR) training, enhanced by a flexible coping style, provided neurobiological resilience and adaptive responses to prediction errors in the final probe trial. These findings have implications for psychiatric illnesses that are influenced by altered stress responses and decision-making abilities (e.g., depression).
Kinetical Inflation and Quintessence by F-Harmonic Map  [PDF]
Antonin Kanfon, Dominique Lambert Lambert
Journal of Modern Physics (JMP) , 2012, DOI: 10.4236/jmp.2012.311213
Abstract: We were interested, along this work, in the phenomena of the quintessence and the inflation due to the F-harmonic maps, in other words, in the functions of the scalar field such as the exponential and trigo-harmonic maps. We showed that some F-harmonic map such as the trigonometric functions instead of the scalar field in the lagrangian, allow, in the absence of term of potential, reproduce the inflation. However, there are other F-harmonic maps such as exponential maps which can’t produce the inflation; the pressure and the density of this exponential harmonic field being both of the same sign. On the other hand, these exponential harmonic fields redraw well the phenomenon of the quintessence when the variation of these fields remains weak. The problem of coincidence, however remains.
Do Couple-Based Interventions Make a Difference for Couples Affected by Cancer?: A Systematic Review
Tim W Regan, Sylvie Lambert, Afaf Girgis, Brian Kelly, Karen Kayser, Jane Turner
BMC Cancer , 2012, DOI: 10.1186/1471-2407-12-279
Abstract: A systematic review of the cancer literature was performed to identify experimental and quasi-experimental couple-based interventions published between 1990 and 2011. To be considered for this review, studies had to test the efficacy of a psychosocial intervention for couples affected by cancer. Studies were excluded if they were published in a language other than English or French, focused on pharmacological, exercise, or dietary components combined with psychosocial components, or did not assess the impact of the intervention on psychological distress (e.g., depression, anxiety) or quality of life. Data were extracted using a standardised data collection form, and were analysed independently by three reviewers.Of the 709 articles screened, 23 were included in this review. Couple-based interventions were most efficacious in improving couple communication, psychological distress, and relationship functioning. Interventions had a limited impact on physical distress and social adjustment. Most interventions focused on improving communication and increasing understanding of the cancer diagnosis within couples. Interventions were most often delivered by masters-level nurses or clinical psychologists. Although most were delivered in person, few were telephone-based. No difference in efficacy was noted based on mode of delivery. Factors associated with uptake and completion included symptom severity, available time and willingness to travel.Given effect sizes of couple-based interventions are similar to those reported in recent meta-analyses of patient-only and caregiver-only interventions (~d=.35-.45), it appears couple-based interventions for patients with cancer and their partners may be at least as efficacious as patient-only and caregiver-only interventions. Despite evidence that couple-based interventions enhance psycho-social adjustment for both patients and partners, these interventions have not yet been widely adopted. Although more work is needed to facilitate t
The cost of community-managed viral respiratory illnesses in a cohort of healthy preschool-aged children
Stephen B Lambert, Kelly M Allen, Robert C Carter, Terence M Nolan
Respiratory Research , 2008, DOI: 10.1186/1465-9921-9-11
Abstract: We conducted a 12-month cohort study in 234 preschool children with impact diary recording and PCR testing of nose-throat swabs for viruses during an ARI. We used applied values to estimate a virus-specific mean cost of ARIs.Impact diaries were available for 72% (523/725) of community-managed illnesses between January 2003 and January 2004. The mean cost of ARIs was AU$309 (95% confidence interval $263 to $354). Influenza illnesses had a mean cost of $904, compared with RSV, $304, the next most expensive single-virus illness, although confidence intervals overlapped. Mean carer time away from usual activity per day was two hours for influenza ARIs and between 30 and 45 minutes for all other ARI categories.From a societal perspective, community-managed ARIs are a significant cost burden on families and society. The point estimate of the mean cost of community-managed influenza illnesses in healthy preschool aged children is three times greater than those illnesses caused by RSV and other respiratory viruses. Indirect costs, particularly carer time away from usual activity, are the key cost drivers for ARIs in children. The use of parent-collected specimens may enhance ARI surveillance and reduce any potential Hawthorne effect caused by compliance with study procedures. These findings reinforce the need for further integrated epidemiologic and economic research of ARIs in children to allow for comprehensive cost-effectiveness assessments of preventive and therapeutic options.Respiratory virus infections are a major cause of morbidity and healthcare usage in children, resulting in substantial costs for families and society [1-5]. Given their ubiquity, there has been surprisingly little research examining the costs associated with childhood respiratory infections that has involved collecting primary data from families. Even for influenza, the most studied of all respiratory viruses, cost-of-illness and vaccine cost-effectiveness evaluations in children have tended to re
False Memory ≠ False Memory: DRM Errors Are Unrelated to the Misinformation Effect
James Ost, Hartmut Blank, Joanna Davies, Georgina Jones, Katie Lambert, Kelly Salmon
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0057939
Abstract: The DRM method has proved to be a popular and powerful, if controversial, way to study ‘false memories’. One reason for the controversy is that the extent to which the DRM effect generalises to other kinds of memory error has been neither satisfactorily established nor subject to much empirical attention. In the present paper we contribute data to this ongoing debate. One hundred and twenty participants took part in a standard misinformation effect experiment, in which they watched some CCTV footage, were exposed to misleading post-event information about events depicted in the footage, and then completed free recall and recognition tests. Participants also completed a DRM test as an ostensibly unrelated filler task. Despite obtaining robust misinformation and DRM effects, there were no correlations between a broad range of misinformation and DRM effect measures (mean r = ?.01). This was not due to reliability issues with our measures or a lack of power. Thus DRM ‘false memories’ and misinformation effect ‘false memories’ do not appear to be equivalent.
What’s in a Bot? L2 Lexical Development Mediated through ICALL  [PDF]
Kelly Arispe
Open Journal of Modern Linguistics (OJML) , 2014, DOI: 10.4236/ojml.2014.41013

In recent years, the field of Second Language Acquisition (SLA) has made great strides to refocus its attention on the essential role that vocabulary plays in becoming a proficient L2 learner (Nation, 2001). Moreover, Computer Assisted Language Learning (CALL) has made advances in providing interactive online tools that help L2 learners strategically engage and work through their vocabulary development. This present study reports on how an Intelligent CALL tool (ICALL), Langbot, helps learners at the beginner and intermediate levels with their lexical acquisition. Modeled after instant messaging systems, which create a synchronous communicative environment, Langbot acts like a pedagogical scaffold or online buddy that caters to the vocabulary needs of each individual learner. It provides 1) translation requests with examples in context, 2) a frequency-based “word of the day” and 3) quizzes based on recent inquiries and a specific frequency range according to the learner’s level. The results from breadth and depth tests (N = 142), suggest that learners at all levels that have access to Langbot significantly improve their vocabulary breadth, while only intermediate-high learners with access to Langbot improve their vocabulary depth. Furthermore, survey data demonstrate Langbot’s effectiveness and accessibility based on learner perceptions.

Civic-Political Development in the Context of Economic Apartheid in Distressed Communities: A Theoretical Model  [PDF]
Diann Kelly
Advances in Applied Sociology (AASoci) , 2017, DOI: 10.4236/aasoci.2017.712025
Abstract: As class status improves, engagement in civic and political activities increases. These activities are voting, volunteerism and vocal activism. However, depressed socio-economic status leaves many individuals disengaged from civic-political structures. Applying Attachment Theory, this article proposes there are five statuses of civic-political development to being an engaged citizen. These statuses correspond to fixed class categories and are 1) disengaged and detached; 2) insecure, responsive; 3) insecure, subscribing; 4) secure, subscribing; 5) secure and defining. The lower the quintile, the less engaged an individual is in the civic-political structures of society and attached to their community. Organizing communities is one way to engage individuals into the civic-political structures of their community in spite of their economic status.
Nurses′ workplace stressors and coping strategies
Lambert Vickie,Lambert Clinton
Indian Journal of Palliative Care , 2008,
Abstract: Prior research has suggested that nurses, regardless of workplace or culture, are confronted with a variety of stressors. As the worldwide nursing shortage increases, the aged population becomes larger, there is an increase in the incidence of chronic illnesses and technology continues to advance, nurses continually will be faced with numerous workplace stressors. Thus, nurses, especially palliative care nurses, need to learn how to identify their workplace stressors and to cope effectively with these stressors to attain and maintain both their physical and mental health. This article describes workplace stressors and coping strategies, compares and contrasts cross-cultural literature on nurses′ workplace stressors and coping strategies, and delineates a variety of stress management activities that could prove helpful for contending with stressors in the workplace.
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