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OBJECTIVETo evaluate hearing outcomes and effects of stimulation rate on performance with the Nucleus Freedom cochlear implant (Cochlear Americas, Denver, CO).STUDY DESIGN AND SETTINGRandomized, controlled, prospective, single‐blind clinical study using single‐subject repeated measures (A‐B‐A‐B) design at 14 academic centers in the United States and Canada and comparison with outcomes of a prior device by the same manufacturer.PATIENTSSeventy‐one severely/profoundly hearing impaired adults.RESULTSSeventy‐one adult recipients were randomly programmed in two different sets of rate: ACE or higher rate ACE RE. Mean scores for Consonant Nucleus Consonant words is 57%, Hearing in Noise Test (HINT) sentences in quiet 78%, and HINT sentences in noise 64%. Sixty‐seven percent of subjects preferred slower rates of stimulation, and performance did not improve with higher rates of stimulation using this device.CONCLUSIONSSubjects performed well, and there was no advantage to higher stimulation rates with this device.SIGNIFICANCEHigher stimulation rates do not necessarily result in improved performance.

Purpose Southwest Oncology Group (SWOG)/Intergroup study 9623 was undertaken to compare treatment with an anthracycline-based adjuvant chemotherapy regimen followed by high-dose chemotherapy (HDC) with autologous hematopoietic progenitor cell support (AHPCS) with a modern dose-dense dose-escalated (nonstandard) regimen including both an anthracycline and a taxane. Patients and Methods Participants in this phase III randomized study had operable breast cancer involving four or more axillary lymph nodes and had completed mastectomy or breast-conserving surgery. Patients were randomly assigned to receive four cycles of doxorubicin and cyclophosphamide followed by HDC with AHPCS or to receive sequential dose-dense and dose-escalated chemotherapy with doxorubicin, paclitaxel, and cyclophosphamide. The primary end point of this study was disease-free survival (DFS). Results Among 536 eligible patients, there was no significant difference between the two arms for DFS or overall survival (OS). Estimated five-year DFS was 80% (95% CI, 76% to 85%) for dose-dense therapy and 75% (95% CI, 69% to 80%) for transplantation. Estimated 5-year OS was 88% (95% CI, 84% to 92%) for dose-dense therapy and 84% (95% CI, 79% to 88%) for transplantation. Conclusion There is no evidence that transplantation was superior to dose-dense dose-escalated therapy. Transplantation was associated with an increase in toxicity and a possibly inferior outcome, although the hazard ratios were not significantly different from 1.

We report a brief treatment format for young sexually abused boys that has both diagnostic and therapeutic implications. A general format is outlined, and then a group is described in more detail. Examples from each session are given that illustrate both therapeutic issues and issues related to the effects of sexual abuse on this sample. Implications for longer, more intensive treatment are given.

A sample of 31 boys sexually assaulted in the previous 18 months was compared on the Child Behavior Checklist with 33 boys who had a diagnosis of oppositional or conduct disorder. The boys ranged in age from 3 to 8 years old. The conduct-disordered boys were being seen in outpatient therapy with their parents. The two groups did differ significantly, with the sexually abused group being less externalizing and more sexualized than the conduct disorder group.

The following questions are considered in this article from a clinician's perspective, in light of the data provided by three articles in this special section: Should therapy be abuse specific? Who should be the focus of treatment, children or families? Is more severe abuse harder to treat than moderate abuse? Are certain symptoms harder to treat than others? What is the preferable treatment modality? How long should therapy last to make a difference? Should developmental stages be considered in child therapy? How can a practicing clinician most efficiently measure outcome? In addition, the implications of the studies represented in these articles are discussed, and the author stresses the usefulness and value of research and empirical data in the effort to improve treatment outcomes in clinical practice.

The authors measured ambient illumination exposure in healthy volun teers in San Diego, California (latitude 32° 43' N, n = 30), and Rochester, Minne sota (latitude 44° 1'N, n = 24), during each of the four quarters of the year, which were centered on the solstices and equinoxes. Subjects wore photosensors on their wrists and lapels (or foreheads while in bed) 24 h per day for an average of 5-6 days per quarter. The maximum of the two illumination readings was stored each minute. Annual average time spent per day in outdoor illumination (≥ 1000 lux) was significantly higher in San Diego than it was in Rochester (p <.04). Daily durations of illumination at or exceeding thresholds of 1,10,100,1000, and 10,000 lux were highly seasonal in the sample as a whole (p < .01 at 1 lux, p < .0001 at other thresholds). Seasonal variation in outdoor illumination was far more pronounced in Rochester than it was in San Diego (interaction p < .001) but remained significant in San Diego ( p ≤ .03). Seasonal variation in indoor illumi nation was generally similar in the two cities. The median Rochester subject experienced illumination ≥ 1000 lux for 2 h 23 min per day during summer and 23 min per day during winter. The corresponding times in San Diego were 2 h 10 min and 1 h 20 min. Neither age nor gender predicted illumination duration at any level. Both season and geographic location strongly influenced human illumination exposure, and behavior (choice of indoor vs. outdoor environment) was the most important mediating factor.

Dissociative and sexual behaviors were assessed in a sample of 350 children ages 7-18. Four groups were evaluated: a nonpsychiatric comparison sample, a psychiatric sample with no history of sexual abuse, a psychiatric sample with clear evidence of sexual abuse, and another group for whom sexual abuse was likely but not substantiated. All children completed the Trauma Symptom Checklist-Children (TSC-C), and varying numbers completed the Rorschach and MMPI. Parents completed the Child Behavior Checklist (CBC), Child Sexual Behavior Inventory (CSBI), and Child Dissociation Checklist (CDC). Mean differences on the Dissociation and Sexual Concerns subscales of the TSC-C existed between the nonpsychiatric and psychiatric groups. The Dissociation subscale was significantly correlated with MMPI Scale 8 and CDC. Sexual Concerns were significantly related to sexual content on the Rorschach, CBC sex problems, and the CSBI. Duration and nature of abuse significantly contributed over and above age and gender in predicting total score on the Dissociation subscale.