Supporting the Writing Productivity of Biomedical Graduate Students: An Integrated, Structured Writing Intervention.

Writing is a critical skill for graduate students, but few studies in the literature describe how it is supported in the training of biomedical graduate students. The Initiative for Maximizing Student Development program at Loma Linda University aims to develop this important skill in its students through an integrated, structured writing intervention. Specifically, the program hired a writing specialist who taught writing seminars, facilitated writing and publishing workshops, and mentored students in one-on-one writing conferences. Doctoral students in the program, primarily underrepresented minority students with some not having English as a first language, all exhibited writing apprehension and blocking behaviors. The percentage of students graduating, publishing, and entering science careers, all of which require writing, is high. To yield insight into how this intervention worked, we conducted in-depth interviews of six of the earliest graduates, derived themes, analyzed data from pre- and post-assessments, and described their publication records. Participating students increased their writing confidence, adopted productive writing strategies, decreased writing anxiety and blocking behaviors, and published successfully.

Friendship chemistry: An examination of underlying factors☆.

Interpersonal chemistry refers to a connection between two individuals that exists upon first meeting. The goal of the current study is to identify beliefs about the underlying components of friendship chemistry. Individuals respond to an online Friendship Chemistry Questionnaire containing items that are derived from interdependence theory and the friendship formation literature. Participants are randomly divided into two subsamples. A principal axis factor analysis with promax rotation is performed on subsample 1 and produces 5 factors: Reciprocal candor, mutual interest, personableness, similarity, and physical attraction. A confirmatory factor analysis is conducted using subsample 2 and provides support for the 5-factor model. Participants with agreeable, open, and conscientious personalities more commonly report experiencing friendship chemistry, as do those who are female, young, and European/white. Responses from participants who have never experienced chemistry are qualitatively analyzed. Limitations and directions for future research are discussed.

Does Insurance Matter? Implementing Dialectical Behavior Therapy with Two Groups of Youth Engaged in Deliberate Self-harm.

This paper presents the outcomes of a Dialectical Behavior Treatment (DBT) program, implemented in intensive outpatient care with two groups of adolescents (n = 55 and n = 45), ages 12-18, who engaged in deliberate self-harm (DSH) but had different insurance/funding sources and risk backgrounds. This pre-post study examined variability in clinical functioning and treatment utilization between the two groups and investigated moderating risk factors. Findings support DBT's effectiveness in improving clinical functioning for youth with DSH regardless of insurance type. However, lower rates of treatment completion among youth without private insurance call for extra engagement efforts to retain high-risk youth in DBT.

Underrepresented minority high school and college students report STEM-pipeline sustaining gains after participating in the Loma Linda University Summer Health Disparities Research Program.

An urgent need exists for graduate and professional schools to establish evidence-based STEM (science, technology, engineering, and math) pipeline programs to increase the diversity of the biomedical workforce. An untapped yet promising pool of willing participants are capable high school students that have a strong STEM interest but may lack the skills and the guided mentoring needed to succeed in competitive STEM fields. This study evaluates and compares the impact of the Loma Linda University (LLU) Summer Health Disparities Research Program on high school (HS) and undergraduate (UG) student participants. The primary focus of our summer research experience (SRE) is to enhance the research self-efficacy of the participants by actively involving them in a research project and by providing the students with personalized mentoring and targeted career development activities, including education on health disparities. The results of our study show that our SRE influenced terminal degree intent and increased participant willingness to incorporate research into future careers for both the HS and the UG groups. The quantitative data shows that both the HS and the UG participants reported large, statistically significant gains in self-assessed research skills and research self-efficacy. Both participant groups identified the hands-on research and the mentor experience as the most valuable aspects of our SRE and reported increased science skills, increased confidence in science ability and increased motivation and affirmation to pursue a science career. The follow-up data indicates that 67% of the HS participants and 90% of the UG participants graduated from college with a STEM degree; for those who enrolled in graduate education, 61% and 43% enrolled in LLU, respectively. We conclude that structured SREs can be highly effective STEM strengthening interventions for both UG and HS students and may be a way to measurably increase institutional and biomedical workforce diversity.

The effects of simultaneous exercise and psychotherapy on depressive symptoms in inpatient, psychiatric older adults.

CONTEXT: Depression is the leading cause of early death, affecting 15% of Americans older than 65 y and costing $43 billion each year. The current mental health service system for seniors, particularly for the population hospitalized in acute inpatient psychiatric units, is fragmented because of poor funding and a shift to a transitory health care paradigm, leading to inadequate treatment modalities, questionable quality of care, and lack of research demonstrating the superiority of a particular treatment. These issues are likely to lead to a public health crisis in the coming years. OBJECTIVE: To investigate the effectiveness of combining exercise and psychotherapy in improving acute depressive symptoms among older adults who were receiving treatment in an inpatient psychiatric unit. DESIGN: Based on rolling admissions, inpatients were randomly assigned to 1 of 3 treatment groups. The study was blinded and controlled. SETTING: This study took place in inpatient psychiatric units at the Loma Linda University's Behavioral Medicine Center (LLUBMC) in Redlands, California. PARTICIPANTS: Participants were 78 inpatients, aged 50-89 y. INTERVENTION: Participants in the simultaneous exercise and psychotherapy (STEP) group (n = 26) took part in exercise and received psychotherapy for 30 min per session, whereas those in the TALK group (n = 26) received individual psychotherapy for 30 min per session. Participants in the control group (n = 26) served as a comparison group, receiving standard therapy. OUTCOME MEASURES: The effects of the interventions were determined by assessing differences from baseline to postintervention in the symptomatology of all 3 groups. The research team also administered the Behavioral and Symptom Identification Scale (BASIS-32) and the Geriatric Depression Scale (GDS) pre- and postintervention. RESULTS: At posttest, the STEP group (M = 4.24, SE = 0.62) had a better response than the TALK group (M = 11.34, SE = 0.62, P < .001), which in turn showed greater improvement than the control group (M = 14.84, SE = 0.62, P < .001). Overall, these results indicate that patients' posttreatment depression scores were significantly lower in those receiving the STEP treatment compared with those receiving individual psychotherapy only or standard care. CONCLUSION: A short-term exercise program consisting of 30 min of walking in conjunction with individual psychotherapy was an effective intervention for depression among older adults in inpatient psychiatric units.

Relationship between children's sleep and mental health in mothers of children with and without autism.

The study employed 90 children with autism spectrum disorders (ASDs) who were matched to 90 typically developing children on age, gender, and ethnicity. Using structural equation modeling, maternal sleep and maternal stress mediated the relationship between children's sleep and mothers' mental health for mothers of children with and without ASDs. Mothers of children with ASDs reported more problems related to children's sleep, their own sleep, greater stress, and poorer mental health; however, children's sleep and maternal sleep were more closely related to maternal stress for mothers of typically developing children. Implications of these findings and future directions for research are discussed.

Pain experience in children with advanced cancer.

BACKGROUND: It is important for health care professionals to understand the pain experience in children with advanced cancer. There has been increased attention to this topic, but systematic studies are limited. OBJECTIVE: To examine pain symptoms and management in children with advanced cancer using child self-report and nurse documentation. METHODS: A prospective, longitudinal method was used to collect data from 62 children over a 5-month period. Children were English and Spanish speaking, ages 6 to 17 years, with advanced cancer. Nurses also provided data. RESULTS: Across all interviews, pain was reported 56% of the time by all children. Nurses documented pain only 23% of the time. Children most frequently reported head pain (31%), followed by abdomen, lower back, leg, and feet pain (20% to 30%). Children consistently reported more intense pain compared with nurses. Nonopioids were used more frequently (45%) than opioids (32%), and nurses' perception of pain intensity was more highly correlated with administration of opioids (r = .72, P < .001). Children who died during their participation in this study received more opioids over time. Pain intensity was relatively stable over time. Nurses noted ethnicity related differences with higher pain levels for Caucasian children, who received analgesics more frequently. DISCUSSION: The children consistently reported pain. Child self-report and nurse documentation of pain differed, as did pain management among children who died compared with those who did not. Ethnicity differences in the identification and management of pain by nurses begs further study. Overall, nurses were aware of and responsive to pain and pain management.

Symptoms in children with advanced cancer: child and nurse reports.

BACKGROUND: Systematic studies on the specific symptom experience in children with advanced cancer are limited. OBJECTIVE: The objective of the study was to examine the common symptoms and to explore commonly occurring symptoms over time. METHODS: A prospective and longitudinal study design was used. Data were collected at 10 data points from 60 children over a 5-month period. Children ranged from 6 to 17 years old, spoke English or Spanish, were diagnosed with advanced cancer, and were receiving healthcare in 1 of 4 Southern California hospitals. Nurses' documentations of symptoms were examined. RESULTS: The study sample was composed of children 6 to 12 years old (52%) and 13 to 17 years old (48%); 42% were female, and 58% were male. Fifty-five percent were Latino, and 30% were Caucasian. Pain, nausea, drowsiness, and energy loss were reported by children in more than 50% of the interviews. Children's and nurses' reports of symptoms were similar except children reported significantly more frequency and intensity of pain. CONCLUSION: Children with advanced cancer were able to report and describe their symptoms. There were few differences by gender, age, and ethnicity. IMPLICATIONS FOR PRACTICE: It is important that children's symptoms are clearly communicated to nurses, and these study findings may be used to anticipate and manage the symptoms experienced by children with advanced cancer.

The reliability and validity of the English and Spanish Strengths and Weaknesses of ADHD and Normal behavior rating scales in a preschool sample: continuum measures of hyperactivity and inattention.

OBJECTIVE: To evaluate the reliability and validity of the English and Spanish versions of the Strengths and Weaknesses of ADHD-symptom and Normal-behavior (SWAN) rating scale. METHOD: Parents of preschoolers completed both a SWAN and the well-established Strengths and Difficulties Questionnaire (SDQ) on two separate occasions over a span of 3 months; instruments were in the primary language of the family (English or Spanish). RESULTS: Psychometric properties for the English and Spanish versions of the SWAN were adequate, with high internal consistency and moderate test-retest reliability. Skewness and kurtosis statistics for the SWAN were within the range expected for a normally distributed population. The SWAN also demonstrated adequate convergent and discriminant validity in correlations with the various subscales of the SDQ. CONCLUSION: Psychometric properties of both the English and Spanish versions of the SWAN indicate that it is a reliable and valid instrument for measuring child attention and hyperactivity. The stability of ratings over time in this preschool sample was moderate, which may reflect the relative instability of these characteristics in preschool children.

Parenting Intervention to Reduce Attention and Behavior Difficulties in Preschoolers: A CUIDAR Evaluation Study.

In this study, we evaluated CUIDAR, a program that provides community-based 10-week parent training to reduce attention and behavior problems in preschool children. We recruited 154 predominantly low-income and Latino preschoolers and their parents to participate in this evaluation study. We collected data prior to and immediately following intervention and one year later. At the time of follow-up, we also recruited 15 parents who had initially enrolled, but never participated in the program to serve as a comparison group for a limited set of analyses. From pre to post intervention, we observed significant, positive changes in eight out of ten measured parenting behaviors. From pre intervention to follow-up, improvements in the use of transitional statements and planning ahead were significant. Children's SDQ Total Difficulties scores significantly decreased from pre to post intervention (d = .36), and we observed significant, positive changes in all SDQ subscales. From pre intervention to follow-up, children's SDQ Total Difficulties scores significantly decreased (d = .71) and all SDQ subscales reflected significant, positive changes. We observed no significant differences in reported barriers to participation between parents who participated in the program and those who enrolled, but never participated. Intervention gains were moderated by several factors, including history of out-of-home care and family structure. Our results should be interpreted cautiously because not all analyses included a comparison group, and a randomized trial of CUIDAR effectiveness is still needed.

Childhood sexual abuse severity reconsidered: a factor structure of CSA characteristics.

To address the lack of empirically grounded measures of childhood sexual abuse severity, a survey of self-report items was developed following a thorough review of the childhood sexual abuse literature. An exploratory factor analysis was conducted using data collected from a convenience sample of college students that included 275 females and males with a history of childhood sexual abuse. The solution produced seven factors interpreted as the following: (a) less intrusive forms of childhood sexual abuse (e.g., sexual invitations, kissing), (b) more intrusive forms of childhood sexual abuse (e.g., oral sex, intercourse), (c) humiliation/fear, (d) childhood sexual abuse involving photography, (e) familiarity with the perpetrator, (f) physical force/rape, and (g) active digital penetration. Correlations among these factors further suggested the existence of two relatively independent second-order factors, one based on the levels of physical intrusiveness and the other composed of the psychological/emotional factors. While arguably the most common measurement of severity, physical intrusiveness had little association with critical factors such as humiliation, fear, and association with the perpetrator. Consequently, physical intrusiveness appears to be an inadequate stand-alone measure of childhood sexual abuse severity. These results are proposed to lay the groundwork for an improved, more comprehensive measure of childhood sexual abuse severity.

A cultural research approach to instrument development: the case of breast and cervical cancer screening among Latino and Anglo women.

To illustrate the implementation of a bottom-up approach to the study of culture in health disparities, this article describes the development of a cultural cancer screening scale (CCSS) using mixed methodologies. The aim was to identify cultural factors relevant to breast and cervical cancer screening, develop an instrument to assess them and examine its preliminary psychometric properties among Latin American (Latino) and non-Latino White (Anglo) women in Southern California. Seventy-eight Latino and Anglo women participated in semi-structured interviews, which were content coded based on Triandis' methods for the analysis of subjective culture. Based on the emerging cultural elements, items relevant to cancer screening were developed and pilot tested with 161 participants. After the instrument was refined, 314 Latino and Anglo women from various socioeconomic backgrounds completed the CCSS and data were factor analyzed resulting in five cultural factors: cancer screening fatalism, negative beliefs about health professionals, catastrophic disease expectations, symptomatic deterrents and sociocultural deterrents. The instrument demonstrated measurement equivalence, adequate reliability and predictive validity. The research and the CCSS are discussed in terms of implications for the study of culture in relation to health disparities and the development of evidence-based interventions with culturally diverse populations and their health professionals.

Recovery of putative pathogens from paper point sampling at different depths of periodontal lesions.

BACKGROUND: The aim of this study was to compare the recovery of three putative periodontal pathogens from periodontal lesions in samples using paper points inserted to different depths of the lesions. METHODS: Twenty 6-8 mm deep periodontal lesions with bleeding on probing were studied. Microbial samples were obtained using paper points inserted to three different depths of the lesions: orifice of lesion; 2 mm into the lesion; and to the base of lesion. Culturing was used for recovery and identification of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia. RESULTS: The recovery of each of the three putative periodontal pathogens was similar following sampling at the various depths of the lesions. CONCLUSIONS: The findings may be explained by the fact that the paper points become saturated as they pass through the orifice of the lesion. Absorption of microorganisms will therefore primarily occur at the orifice. It is also conceivable that the pathogens may be present in similar proportions throughout the various depths of the periodontal lesions.

Bone density assessments of dental implant sites: 3. Bone quality evaluation during osteotomy and implant placement.

PURPOSE: In previous publications of this series of studies on human cadaver jaws, bone densities were assessed and compared using subjective evaluation, conventional computed tomography (CT), and cone-beam computed tomography (CBCT). The aim of this study was to compare subjective bone quality during osteotomy and implant insertion resistance torque to noninvasive subjective and objective radiographic bone density assessments. MATERIALS AND METHODS: Forty-two designated implant sites were selected. Self-tapping implants were inserted into these sites. The operator subjectively rated the bone density during the osteotomy procedure. Resistance torque was recorded during insertion of the implants. RESULTS: Subjective drilling resistance was modestly correlated to subjective radiographic density evaluation (Lekholm and Zarb; Spearman's rho of 0.53, P < .001). Subjective drilling resistance compared to the bone density in Hounsfield units (HU) obtained using CT and CBCT showed correlation coefficients of 0.61 and 0.59, respectively (P < .001). Significant overlap of density values was found for adjacent drilling ratings. On average, a difference in bone density of 180 HU was required to identify differences between drilling resistance groups. Comparisons of 2 implant insertion resistance torque variables (highest reading and regression slope of available readings) with CT and CBCT HU showed correlation coefficients of 0.61 to 0.63 (P < .01). CONCLUSION: Insertion torque resistance was modestly correlated with objective CT and CBCT measurements of bone density. The merit of these assessments of cadavers awaits clinical study.

MR spectroscopy: predicting long-term neuropsychological outcome following pediatric TBI.

PURPOSE: To identify useful acute indicators of long-term neurocognitive outcome beyond clinical variables for children and adolescents treated for a traumatic brain injury (TBI). MATERIALS AND METHODS: The efficacy of magnetic resonance spectroscopy (MRS) acquired 6+/-4 days after TBI in 20 children/adolescents in predicting intellectual and neuropsychological functioning one to four years post injury was assessed. Short echo-time single voxel MRS (SVS) from normal-appearing brain was compared to intermediate echo-time multivoxel MR spectroscopic imaging (MRSI) from normal-appearing and visibly-injured brain acquired through the level of the corpus callosum (CC). RESULTS: N-acetyl aspartate (NAA) was moderate to strongly correlated with cognitive scores. Mean NAA/creatine (Cre) from MRSI alone explained over 40% of the variance in cognitive scores and 18% of the variance above and beyond demographic and clinical variables alone. Mild to moderate associations were noted between SVS metabolites (glutamate/glutamine [Glx] and myoinositol [mI]) and cognitive scores, with no such associations apparent for choline (Cho) or Cre. Exploratory analyses revealed trends for regional neuroimaging data and specific cognitive abilities. CONCLUSION: Acute MR spectroscopy of the pediatric brain injury patient improves prognostic ability and may provide valuable information for early treatment and intervention planning.

Assessing alexithymia in French-speaking samples: psychometric properties of the Observer Alexithymia Scale-French translation.

In the present study, we evaluated the psychometric properties of the Observer Alexithymia Scale-French translation (OAS-F), a 33-item, observer-rated alexithymia measure. The scale, accessible to lay and professional raters, taps everyday expressions of alexithymia. French university students (N = 159) were asked to rate a person they knew well or ask an acquaintance to rate them. Those being rated (N = 159) were parents, siblings, children, and friends. OAS-F total and subscale scores were comparable to those in the English normative samples. Moreover, OAS scores were reliable, and the scale's five-factor structure (distant, uninsightful, somatizing, humorless, and rigid) was confirmed. Importantly, too, OAS total scores correlated 0.31 with (self-report) 20-item Toronto Alexithymia Scale (TAS) scores. The OAS-F appears to be a psychometrically sound observer-rated alexithymia measure.

Susceptibility weighted imaging: neuropsychologic outcome and pediatric head injury.

Traumatic brain injury is among the most frequent pediatric neurologic disorders in the United States, affecting multiple aspects of neuropsychologic functioning. This study assessed the efficacy of susceptibility weighted imaging as a predictor of long-term neuropsychologic functioning after pediatric brain injury compared with magnetic resonance spectroscopic imaging. Susceptibility weighted imaging is a relatively new method that is considered superior to traditional magnetic resonance imaging sequences for detecting hemorrhagic diffuse axonal injury. In this study, imaging and spectroscopy were acquired 6 +/- 4 days after injury. Measures of neuropsychologic functioning were administered to 18 children and adolescents 1-4 years post injury. Negative correlations between lesion number and volume with neuropsychologic functioning were demonstrated. Lesion volume explained over 32% of the variance in cognitive performance, explaining at least an additional 20% beyond injury severity and age at injury alone and 19% beyond magnetic resonance spectroscopic metabolite variables. Exploratory analyses resulted in notable trends, with lesions in deeper brain regions more strongly associated with poorer neuropsychologic performance. Improved detection of the extent of diffuse axonal injury following a brain injury will allow for a better understanding of its association with long-term outcome, which in turn can improve prognostic efficacy for effective treatment planning.

Bone density assessments of dental implant sites: 2. Quantitative cone-beam computerized tomography.

PURPOSE: Bone density was evaluated in designated implant sites using a novel volumetric computerized tomographic device. Those measurements were then compared with traditional quantitative computerized axial tomography and subjective bone density evaluation. MATERIALS AND METHODS: Sixty-three potential sites for implant placement in jaws from 9 human cadavers were used. Indicator rods 2 mm in diameter were placed in all sites. Radiographic images representing 1-mm buccolingual slices immediately mesial and distal to the rods were selected. Bone density in Hounsfield units was assessed using quantitative cone-beam computerized tomography (QCBCT) and quantitative computerized tomography (QCT) in a standardized implant area superimposed on the images. Bone density was also subjectively evaluated by 2 independent examiners using the Lekholm and Zarb classification. RESULTS: The QCBCT bone density values were generally found to be higher than the corresponding QCT measurements. The correlations between the QCT and QCBCT values, however, were very high in spite of this systematic difference between the 2 methods. The Lekholm and Zarb ratings for the 2 examiners showed correlation coefficients ranging between 0.46 and 0.60 for the relationships with the QCBCT values. For each of the scores used for the subjective classification, however, a wide range of corresponding QCBCT values was observed. DISCUSSION: High dosage has been the major impediment to the utilization of CT in implant dentistry. The development of a reliable volumetric CT alternative with reduced radiation should provide an effective method for the assessment of both bone quantity and bone density. CONCLUSIONS: Access to objective radiographic bone density values should constitute a valuable supplement to subjective bone density evaluations prior to implant placement. QCBCT could be considered an alternative diagnostic tool for preoperative bone density evaluation, especially since the reported radiation dose is minimal.

Pain experienced by patients during periodontal recall examination using thinner versus thicker probes.

BACKGROUND: The aim of the present study, performed during periodontal recall visits, was to compare the levels of pain experienced by patients during periodontal probing using probes with tip diameters of either 0.40 mm or 0.63 mm. METHODS: Three groups of 20 adult patients were examined by three different therapists. Diagonal maxillary/mandibular quadrants were probed with a 0.40 mm and a 0.63 mm probe, respectively. At the completion of probing of each quadrant, the patients were asked to describe their pain using a visual analog scale (VAS). RESULTS: Most patients showed low VAS pain scores for both probes. However, using an arbitrary threshold of VAS > or =40 mm to indicate significant pain, some patients had a painful experience. Lower median pain responses following probing with the 0.63 mm probe compared to the 0.40 mm probe were observed for patients of therapist 1, and for the quartile of all 60 patients that showed the highest VAS scores. For therapist 2 and 3 groups, no differences were found. The pain levels expressed by the three groups of patients varied, confirming results of our previous studies, which also observed differences in patients' pain experiences following probing by different therapists. CONCLUSIONS: The ability to deliver dental care with a minimum of patient discomfort would seem to be an essential part of the skills of individual clinicians. We would like to suggest that dental therapists periodically evaluate this part of their skill by asking patients to express their pain experiences following various procedures using VAS scales.

Ability of examiners to estimate the pain experienced by patients from probing during initial periodontal examination.

BACKGROUND: The aims of the present study were to identify the level of pain experienced by patients from probing during periodontal examination, and to determine to what extent the examining periodontist and the dental assistant could estimate the degree of pain experienced by the patients. METHODS: For each of three periodontists, 20 patients referred for periodontal diagnosis and treatment were selected. The periodontist carried out his examination, which included probing at six sites per tooth. Following probing, the patients rated the pain using a visual analog scale (VAS). The periodontist and the dental assistant who helped out during the examination independently rated the pain level they perceived that each patient experienced, also using a VAS. RESULTS: Most patients showed low pain responses to probing. However, using an arbitrary threshold of VAS > or =40 mm to indicate significant pain, some patients had a painful experience. Differences were observed between the pain levels expressed by the three groups of patients. While two of the three periodontists were able to appraise the pain experienced by their patients, the third was not. CONCLUSIONS: It seems important that the periodontist at the first encounter with the patient should be sensitive to the discomfort the examination may entail. This may influence the patients' decision to accept the required treatment, and may also affect the patients' attitude to and co-operation with the subsequent treatment.