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Purpose This study investigated factors associated with declines in emotional well-being (EWB) over time in breast cancer survivors. Methods Women with breast cancer (Stages I-III) residing in Los Angeles, CA or Detroit, MI and reported to the Surveillance, Epidemiology, and End Results registries between June 2005-February 2007 completed surveys at 9 months and 4 years after diagnosis. EWB was measured by the Functional Assessment of Cancer Treatment-Breast. Using a stress coping framework, logistic regression models assessed associations between personal, social, and clinical correlates, appraisal (e.g., worry about recurrence) and coping factors (e.g., emotional support) to EWB declines. Results Among eligible women who completed primary breast cancer treatment, 772 completed both surveys and 192 (24.9%) experienced EWB declines over time. Women with past or current depression were more likely to report EWB decline (p<.01). Survivors who perceived they did not receive enough information about risk of breast cancer recurrence during primary treatment were more likely to have EWB decline (OR 0.53, 95% CI 0.32-0.87). Greater perceived likelihood of recurrence (OR 1.95, 95% CI 1.01-5.29) and increased worry about recurrence (OR 1.38, 95% CI 1.10-1.72) were associated with EWB decline. Higher spirituality beliefs and practices were associated with EWB decline. Conclusions A considerable number of breast cancer patients report emotional well-being declines over time. Early identification of women who are vulnerable, such as women with past depression, is crucial to improve quality of care. Women would benefit from education about cancer recurrence and tailored strategies to manage worry about recurrence over time. Implication for Cancer Survivors Understanding actual risk of recurrence and managing worry about recurrence is important for cancer survivors. Emotional concerns are common for individuals with cancer so survivors should feel free to reach out and discuss such concerns with providers well into the survivorship period.

Environmental factors have been implicated in the etiology of autism spectrum disorder (ASD); however, the role of heavy metals has not been fully defined. This study investigated whether blood levels of mercury, arsenic, cadmium, and lead of children with ASD significantly differ from those of age- and sex-matched controls. One hundred eighty unrelated children with ASD and 184 healthy controls were recruited. Data showed that the children with ASD had significantly (p < 0.001) higher levels of mercury and arsenic and a lower level of cadmium. The levels of lead did not differ significantly between the groups. The results of this study are consistent with numerous previous studies, supporting an important role for heavy metal exposure, particularly mercury, in the etiology of ASD. It is desirable to continue future research into the relationship between ASD and heavy metal exposure.

In consideration of the range of clay content of Chinese earth dams, the world's highest prototype tests have been made to research on the effects of cohesive strength of filling of cohesive homogeneous earth dam on breach formation. Three breach mechanisms were presented, they were the source-tracing erosion of dam body with the form of "multilevel headcut", "two-helix flow" erosion of dam crest and collapse of breach sidewalls due to instability. It can be concluded that the cohesive strength of filling of earth dam has great effect on breach formation. When the cohesive strength is bigger, the breach process becomes slower, and the peak outflow and the final width and depth of breach become smaller. The main character of the breach formation is head cutting and dumping collapse. When the cohesive strength is smaller, the breach process becomes faster, and the peak outflow, the final width and depth of breach become bigger. The main character of the breach formation is single level head cutting and shearing collapse. earth dam, breach, mechanism, headcut, two-helix flow