Comprehensive Cardiovascular Risk Factor Control With a Mobile Health Cardiovascular Risk Self-Management Program.

BACKGROUND: Mobile health technology's impact on cardiovascular risk factor control is not fully understood. This study evaluates the association between interaction with a mobile health application and change in cardiovascular risk factors. METHODS AND RESULTS: Participants with hypertension with or without dyslipidemia enrolled in a workplace-deployed mobile health application-based cardiovascular risk self-management program between January 2018 and December 2022. Retrospective evaluation explored the influence of application engagement on change in blood pressure (BP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and weight. Multiple regression analyses examined the influence of guideline-based, nonpharmacological lifestyle-based digital coaching on outcomes adjusting for confounders. Of 102 475 participants, 49.1% were women. Median age was 53 (interquartile range, 43-61) years, BP was 134 (interquartile range, 124-144)/84 (interquartile range, 78-91) mm Hg, TC was 183 (interquartile range, 155-212) mg/dL, LDL-C was 106 (82-131) mg/dL, and body mass index was 30 (26-35) kg/m2. At 2 years, participants with baseline systolic BP ≥140 mm Hg reduced systolic BP by 18.6 (SEM, 0.3) mm Hg. At follow up, participants with baseline TC ≥240 mg/dL reduced TC by 65.7 (SEM, 4.6) mg/dL, participants with baseline LDL-C≥160 mg/dL reduced LDL-C by 66.6 (SEM, 6.2) mg/dL, and participants with baseline body mass index ≥30 kg/m2 lost 12.0 (SEM, 0.3) pounds, or 5.1% of body weight. Interaction with digital coaching was associated with greater reduction in all outcomes. CONCLUSIONS: A mobile health application-based cardiovascular risk self-management program was associated with favorable reductions in BP, TC, LDL-C, and weight, highlighting the potential use of this technology in comprehensive cardiovascular risk factor control.

Birth weight, growth indices, and seminal parameters in male offspring are resilient features to maternal pre-conceptional dietary manipulation in sheep.

Gestational diet manipulation can lead to inadequate fetal nutrient supply resulting in low birth weight, limited postnatal growth, and consequently, reduced reproductive performance in the progeny. However, effects of short-term maternal pre-conceptional dietary manipulation on postnatal growth and reproductive parameters of male offspring in large animals remains unexplored. To determine these consequences, female crossbred (Polypay x Dorset) sheep were allocated to three groups (n = 33/group) of dietary manipulation for 21 days prior to mating under the following conditions: (1) control at 100 % of maintenance energy requirements (40 Kcal of metabolizable energy/kg body weight [BW]), (2) undernutrition (UN) at 50 % of Control intake, and (3) overnutrition (ON) at 200 % of maintenance energy. Singleton ram lambs (UN:9; C:12; ON:6) were monitored from birth until 8 months of age, including birth weight, weekly weights, weight gain, body mass index (BMI), and circulating testosterone. After weaning, monthly scrotal circumference and subcutaneous fat depth were measured. Semen morphology and motility were evaluated at 7 and 8 months of age. Birth weight, weight gain, and BMI at birth and weaning were not significantly different among nutritional treatments. None of the pre-conceptional diets affected body weight change from weaning until 36 weeks of age, BMI, fat depth, or scrotal circumference across the experiment. A sustained rise in plasma testosterone concentrations was detected when ram lambs were, on average, 82 days old and 37 kg. Both testosterone concentrations and scrotal circumference were positively correlated to body weight regardless of treatment group. In addition, seminal parameters did not differ among treatments, but a transient increase in plasma testosterone at 18 weeks of age was observed in ON ram lambs compared to control rams. In conclusion, birth weight, growth indices, and seminal parameters in singleton rams are resilient features in the progeny upon maternal pre-conceptional dietary manipulation in sheep.

Evaluating Mortality Outcomes, Transfusion Characteristics, and Risk Factors Associated With Cirrhotic Trauma Patients Undergoing Emergency Laparotomy Versus Non-Operative Management: A National Analysis.

BACKGROUND: Patients with liver cirrhosis (LC) demonstrate significantly elevated mortality rates following a traumatic event. This study aims to examine and compare the clinical outcomes in adult trauma patients with pre-existing LC undergoing laparotomy or non-operative management (NOM). Additionally, the study aims to investigate various patient outcomes, including mortality rate based on transfusion needs and timing. METHODS: This retrospective cohort study utilized the American College of Surgeons Trauma Quality Program Participant Use File (ACS-TQIP-PUF) 2017-21 to compare laparotomy vs NOM in adults (≥18 years) with pre-existing LC who presented to trauma facilities with isolated blunt solid organ abdominal injuries (Injury Severity Score ≥16, Abbreviated Injury Scale solid organ abdomen ≥3). RESULTS: Among 929 patients, 38.2% underwent laparotomy, while 61.7% received NOM. The in-hospital mortality rate was lower for patients who received NOM (52.3% vs 20.0%, P < .01). The risk of in-hospital mortality was significantly associated with laparotomy (OR 5.22, 95% CI: 2.06-13.18, P < .01) and sepsis (OR 99.50, 95% CI: 6.99-1415.28, P < .01). On average an increase in blood units in 4 hours was observed among those who experienced an in-hospital mortality (OR 5.65, 95% CI: 3.05-8.24, P < .01) and those who underwent laparotomy (OR 3.85, 95% CI: 1.36-6.34, P < .01). CONCLUSION: Trauma patients with moderate to severe isolated organ injury and Liver cirrhosis had significantly higher mortality rates, acute renal failure, whole blood units received, as well as longer ICU-LOS when undergoing laparotomy compared to non-operative management.

International Anal Neoplasia Society's consensus guidelines for anal cancer screening.

The International Anal Neoplasia Society (IANS) developed consensus guidelines to inform anal cancer screening use among various high-risk groups. Anal cancer incidence estimates by age among risk groups provided the basis to identify risk thresholds to recommend screening. Guided by risk thresholds, screening initiation at age 35 years was recommended for men who have sex with men (MSM) and transgender women (TW) with HIV. For other people with HIV and MSM and TW not with HIV, screening initiation at age 45 years was recommended. For solid organ transplant recipients, screening initiation beginning from 10 years post-transplant was recommended. For persons with a history of vulvar precancer or cancer, screening initiation was recommended starting within 1 year of diagnosis of vulvar precancer or cancer. Persons aged ≥45 years with a history of cervical/vaginal HSIL or cancer, perianal warts, persistent (>1 year) cervical HPV16, or autoimmune conditions could be considered for screening with shared decision-making, provided there is adequate capacity to perform diagnostic procedures (high-resolution anoscopy [HRA]). Anal cytology, high-risk (hr) human papillomavirus (HPV) testing (including genotyping for HPV16), and hrHPV-cytology co-testing are different strategies currently used for anal cancer screening that show acceptable performance. Thresholds for referral for HRA or follow-up screening tests are delineated. These recommendations from IANS provide the basis to inform management of abnormal screening results, considering currently available screening tools. These guidelines provide a pivotal foundation to help generate consensus among providers and inform the introduction and implementation of risk-targeted screening for anal cancer prevention.

Centre-based early education interventions for improving school readiness: A systematic review.

Background: Globally, children are legally obliged to attend school at a certain age (ranging from 4 to 7 years old). Developmental differences are rarely considered at school entry nor are they always reflected in the teaching and learning environment. Children who start school without being ready to cope may be significantly disadvantaged. Failure at school can impact directly on long-term outcomes such as unemployment, crime, adolescent pregnancy, and psychological and physical morbidity in adulthood. In contrast, experiencing success at school can impact positively on a child's self esteem, behaviour, attitude, and future outcomes. School readiness interventions aim to prepare a child for the academic content of education and the psychosocial competencies considered important for learning such as self-regulation, listening, following instructions and learning to share in play and other social settings. There is a need for evidence of the effectiveness of centre-based school readiness interventions. Objectives: To evaluate the effectiveness of centre-based interventions for improving school readiness in preschool children. Search Methods: In October 2021 we searched CENTRAL, MEDLINE, Embase, ERIC, PsycINFO, ERIC, eight additional databases and three trials registers. Other eligible studies were identified through handsearches of reference lists, reports, reviews and relevant websites. Selection Criteria: We included randomised controlled trials (RCTs) and quasi-RCTs comparing centre-based school readiness interventions to no intervention, wait-list control or treatment as usual (TAU) for children (aged three to 7 years before starting compulsory education). The primary outcomes were school readiness and adverse effects. Data Collection and Analysis: We used standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of evidence. Main Results: We included data from 32 trials involving 16,899 children (6590 included in at least one meta-analysis). Four studies compared centre-based early education interventions with no treatment controls. Twenty-two trials compared an enriched school curriculum to treatment as usual (TAU). Children were aged between 3 and 7 years old (mean age 4.4 years), 51.7% were boys and at least 70% were from a racial/ethnic minority group. Most studies were conducted in the USA and mainly located in areas of high socioeconomic deprivation. Interventions were delivered in centre-based settings (pre-kindergarten or elementary schools), for at least one half day, 4 days per week over the academic year. Follow-up ranged from up to 1 year (short-term), 1-2 years (medium-term) and over 2 years (long-term). We judged the certainty of evidence to be very low to moderate across all outcome measures. We downgraded the certainty of the evidence because the included studies were at an unclear or high risk of bias due to poor reporting, imprecision arising from small sample sizes and wide confidence intervals, and inconsistency due to statistical heterogeneity. Most studies were considered to be low or unclear risk for selection, detection, performance, attrition, selective reporting, and other bias. Allocation bias was at high risk in 10 studies. The US federal government funded most of the studies. Comparison 1. Centre-based early education interventions for improving school readiness versus no intervention Cognitive development. There may be little to no difference in cognitive development between centre-based early education interventions and no intervention at long-term follow-up (MD: 3.28, 95% CI: 0.23 to 6.34; p = 0.04; 2 studies, 361 participants; low certainty evidence). Emotional well-being and social competence. There may be no clear difference in social skills in centre-based early education interventions compared to the no intervention control group at short-term follow-up (SMD: -0.11, 95% CI: -0.54 to 0.33; p = 0.63; 3 studies, 632 participants; low certainty evidence). Heterogeneity for this outcome was substantial (I² = 71%). Health development. Narrative analysis from a single study showed that centre-based early education interventions may improve health development outcomes such as health checks, immunisation compliance and dental care (1 study, 142 participants; low certainty evidence).None of the studies reported on school readiness, adverse effects, or physical development. Comparison 2. Centre-based early education interventions for improving school readiness versus TAU School readiness. The evidence is very uncertain about the effect of centre-based early education interventions compared to TAU on school readiness up to 1 year post-intervention (SMD: 1.17, 95% CI: -0.61 to 2.95; p = 0.20; 2 studies, 374 participants; very low certainty evidence). Heterogeneity for this outcome was considerable (I² = 95%). Cognitive development. The evidence is very uncertain about the effect on cognitive development between centre-based early education interventions and TAU at long-term follow-up (MD: 9.34, 95% CI: -6.64 to 25.32; p = 0.25; 2 studies, 136 participants; very low certainty evidence). Heterogeneity for this outcome was considerable (I² = 92%). Emotional well-being and social competence. A meta-analysis of 12 studies demonstrated there may be little to no difference in social skills between centre-based early education interventions and TAU at short-term follow-up (SMD: 0.11, 95% CI: -0.05 to 0.28; p = 0.19; 12 studies, 4806 participants; low certainty evidence). Physical development. Evidence from one study showed that centre-based early education interventions likely have little to no difference in increasing fine motor skills compared to TAU at short-term follow-up (MD: 0.80, 95% CI: -1.11 to 2.71; 1 study, 334 participants; moderate certainty evidence).None of the studies measured adverse effects or health development. Authors' Conclusions: We found very low, low and moderate-certainty evidence that centre-based interventions convey little to no difference to children starting school compared to no intervention or TAU, up to 1 year. More research, measuring relevant outcomes, conducted outside the USA, is required to improve programmes designed to meet the needs of children starting school.

Knowledge Is Power: Utilizing Human-Centered Design Principles with People Living with Dementia to Co-Design a Resource and Share Knowledge with Peers.

This paper describes the process used by a group of people living with young-onset dementia to inform the development and delivery of a post-diagnosis peer guide. It draws on the four stages of human-centered design and applies them in a new context of supporting resilience for people following a diagnosis of dementia. (1) Discover: The group discussed in-depth their perspectives on what it takes to be resilient while living with dementia and how this can be maintained. (2) Define: The group decided to collate practical information and knowledge based on their personal experiences into a booklet to support the resilience of others following a diagnosis of dementia. (3) Develop: The booklet was designed and developed together with input from other people living with dementia, facilitated by the authors. (4) Deliver: The group guided the professional production of the booklet 'Knowledge is Power'. Over 8000 copies have been distributed to memory clinics, post-diagnostic support organizations and people living with dementia across Wales. A bilingual English-Scottish Gaelic adaptation and an adaptation for people in England have since been developed. The success of 'Knowledge is Power' highlights the importance of working alongside people with dementia to share knowledge and support their resilience.

The 'Natural' Accord of DuBois and Washington: An Environmentally Racialized Consciousness.

The conflict and discord between Booker T. Washington and W.E.B DuBois regarding their premise and approach to racial uplift for Black Americans have been very well documented. While Washington sought equality with accommodation, DuBois functioned through agitation. However, their biophilic accord and unity within the natural environment have been both underrecognized and underappreciated. As an honor to these esteemed racial and social justice giants, this special issue article reveals the universality of their environmental justice ideologies while also celebrating the beauty, power and foresight of their ecological language in script and speech.

Development of an item pool for a patient reported outcome measure of resilience for people living with dementia.

BACKGROUND AND OBJECTIVES: Policies to support people living with dementia increasingly focus on strengths-based approaches, highlighting the importance of building resilience. This research responds to the lack of a suitable resilience measure for people with dementia. It develops a pool of items to inform a new measure of resilience for this population. METHODS: A conceptual model and associated data informed the item generation of the draft resilience measure. Regular meetings with professionals (n = 7) discussed response-scale formatting, content and face validity, leading to refinement and item reduction. Cognitive interviews with people living with dementia (n = 11) then examined the face and content validity of items and the suitability of response-scale formatting. These two phases informed subsequent revision and further item reduction of the resilience measure. RESULTS: The first item generation exercise led to 140 items. These were independently assessed by the professionals and this refinement reduced the measure to 63 items across 7 domains of the conceptual model (psychological strengths; practical approaches for adapting to life with dementia; continuing with hobbies, interests and activities; strong relationships with family and friends; peer support and education; participating in community activities; the role of professional support services). Cognitive interviews explored the 63 items with people living with dementia. Detailed feedback led to items removed due to difficulty with (a) understanding (N = 7); (b) answering (n = 11); (c) low preference for that item (n = 6); and (d) presence of a preferred item within a cluster of similar questions (n = 4). Items were amended to enhance clarity/conciseness (n = 19) leading to a final 37-item pool. CONCLUSION: Established methods for measurement development included the expertise of people with dementia and led to the generation of a set of items for a new resilience measure that were understandable and acceptable to this target population. This 37-item pool reflects the conceptual understanding of resilience in dementia as being derived across individual, community and societal level resources.

Performance of the adaptive optics system for Laser Communications Relay Demonstration's Ground Station 1.

The Laser Communications Relay Demonstration is NASA's multi-year demonstration of laser communication from the Earth to a geosynchronous satellite. The mission currently has two optical ground stations (OGSs), with one in California (OGS1) and one in Hawaii (OGS2). Each ground terminal optical system consists of a high-order adaptive optics (AO) system, a laser transmit system, and a camera for target acquisition. The OGS1 AO system is responsible for compensating for the downlink beam for atmospheric turbulence and coupling it into the modem's single mode fiber. The mission requires a coupling efficiency of 50%, which necessitates a high-order AO system. To achieve this performance, the AO system uses two deformable mirrors with one mirror correcting for low-spatial-frequency aberrations with large amplitude and a second deformable mirror correcting for high-spatial-frequency aberrations with small amplitude. Turbulence is sensed with a Shack-Hartmann wavefront sensor. To meet its performance requirements in the most stressing conditions, the system can operate at frame rates of 20 kHz. This high frame rate is enabled by the design of the real-time control system. We present an overview of both the hardware and software design of the system, and describe the control system and methods of reducing non-common path aberrations. Finally, we show measured system performance.

UPDATED PROTOCOL: Universal school-based programmes for improving social and emotional outcomes in children aged 3-11 years: An evidence and gap map.

This is the protocol for an evidence and gap map. The objective of this EGM is to identify and map all primary studies (including randomised and cluster randomised trials) and systematic reviews on universal, school-based social and emotional learning programmes for young children (3-11 years) to create a live, searchable, and publicly available evidence and gap map.

Influence of mental health on information seeking, risk perception and mask wearing self-efficacy during the early months of the COVID-19 pandemic: a longitudinal panel study across 6 U.S. States.

BACKGROUND: Understanding factors that influence information seeking, assessment of risk and mitigation behaviors is critical during a public health crises. This longitudinal study examined the influence of self-reported mental health during the early months of the COVID-19 pandemic on information seeking, risk perception and perceived mask wearing ability. Mental health screener items included fear, anger, and hopelessness in addition to avoidance, diminished functional ability and global distress. Theoretical models inform hypotheses linking mental health items and outcomes. METHODS: The research employed a longitudinal 6-state 3-wave online panel survey, with an initial sample of 3,059 participants (2,232 included in longitudinal analyses). Participants roughly represented the states' age, race, ethnicity, and income demographics. RESULTS: Women, those who identified as Hispanic/Latinx, Black Americans and lower income participants reported higher overall rates of distress than others. Information seeking was more common among older persons, Democrats, retirees, those with higher education, and those who knew people who had died of COVID-19. Controlling for such demographic variables, in multivariable longitudinal models that included baseline mental health measures, distress and fear were associated with increased information seeking. Distress and fear were also associated with increased risk perception, and feelings of hopelessness were associated with lower reported mask-wearing ability. CONCLUSIONS: Results advance understanding of the role mental health can play in information seeking, risk perception and mask wearing with implications for clinicians, public health practitioners and policy makers.

Expression of genes with biomarker potential identified in skin from DSLD-affected horses increases with age.

Degenerative Suspensory Ligament Desmitis (DSLD) negatively impacts connective tissues in horses, which often leads to progressive chronic pain and lameness. DSLD has been shown to be a systemic disorder that affects multiple body systems, including tendons, sclerae, and the aorta. Currently, the diagnosis is confirmed by post mortem histological examination of a tendon or suspensory ligament. Histology reveals inappropriate accumulations of proteoglycans in the tendons and other tissues in DSLD-affected horses. Unfortunately, there is no reliable method to diagnose DSLD in living horses. Recently, bone morphogenetic protein 2 (BMP2) was identified in active DSLD lesions. In addition, recent data from RNA sequencing (RNA-seq) showed overexpression of numerous genes, among them BMP2, FOS and genes for keratins in DSLD skin biopsies-derived RNA. We hypothesized that some of these genes can be used as biomarkers for diagnosis of DSLD in a panel. Overexpression of some of them was verified in quantitative real time PCR. Immunohistochemistry and RNAscope in-situ hybridization (ISH) assays were used to determine the level of overexpression of specific genes in skin biopsies from control and DSLD-affected horses. The RNAscope ISH assay has shown to be more reliable and more specific that immunohistochemistry. ISH confirmed a significant increase in KRT83 and BMP-2 in hair follicles in DSLD cases, as well as abnormally high expression of FOS in the epidermis, especially in aging horses. Because statistically relevant specificity and sensitivity was documented only for FOS and BMP2, but not KRT83 we recommend the use of FOS and BMP2 panel to diagnose DSLD. We conclude that a panel of two markers from the studied group (BMP2 and FOS) can serve as an additional diagnostic tool for DSLD in living horses, especially in older animals. Further studies are necessary to confirm if this biomarker panel could be used as a prospective tool to identify DSLD in horses as they age.

Anal cancer: a 20-year retrospective study from Australia.

BACKGROUNDS: Anal cancer is an uncommon condition, occurring at higher rates in specific subpopulations. Clinical experience is limited and substantial changes have recently occurred in our understanding of this condition. We, therefore, set out to characterize patients presenting with anal cancer and investigate whether there have been any changes over the past 20 years. METHODS: Retrospective audit of cases identified from pathology and clinical databases during the period 1 January 2000 to 31 December 2019. RESULTS: Two hundred and sixteen patients had anal squamous cell carcinomas, comprising 160 (74%) males and 56 (26%) females. Mean age at initial diagnosis was 55.1 ± 11.20 for males and 60.6 ± 15.18 for females (P = 0.02). At initial diagnosis, HIV-positive cases were significantly younger than HIV negative cases (mean 52.2 ± 9.35 vs. 62.8 ± 11.61, P < 0.001); 46% of cases were classified as intra-anal, 29% perianal and 25% both; 52% were > 2 cm at diagnosis. At presentation, intra-anal cases were larger and more advanced than perianal cases (P = 0.049). Compared with the period 2000-2009, anal cancers presented more commonly in 2010-2019 (148 vs. 76), were more likely to occur in HIV-negative people and to be diagnosed at a similar stage. CONCLUSION: The number of anal cancer cases almost doubled over the study period and people living with HIV presented 10 years younger than others. Perianal cases presented earlier than those originating in intra-anal locations. Together with the large size at diagnosis, this suggests the potential value of screening, particularly for intra-anal cancers in those at high risk.

Functional Family Therapy for families of youth (age 11-18) with behaviour problems: A systematic review and meta-analysis.

Background: Functional Family Therapy (FFT) is a short-term family-based intervention for youth with behaviour problems. FFT has been widely implemented in the USA and other high-income countries. It is often described as an evidence-based program with consistent, positive effects. Objectives: We aimed to synthesise the best available data to assess the effectiveness of FFT for families of youth with behaviour problems. Search Methods: Searches were performed in 2013-2014 and August 2020. We searched 22 bibliographic databases (including PsycINFO, ERIC, MEDLINE, Science Direct, Sociological Abstracts, Social Services Abstracts, World CAT dissertations and theses, and the Web of Science Core Collection), as well as government policy databanks and professional websites. Reference lists of articles were examined, and experts were contacted to search for missing information. Selection Criteria: We included randomised controlled trials (RCTs) and quasi-experimental designs (QEDs) with parallel cohorts and statistical controls for between-group differences at baseline. Participants were families of young people aged 11-18 with behaviour problems. FFT programmes were compared with usual services, alternative treatment, and no treatment. There were no publication, geographic, or language restrictions. Data Collection and Analysis: Two reviewers independently screened 1039 titles and abstracts, read all available study reports, assessed study eligibility, and extracted data onto structured electronic forms. We assessed risks of bias (ROB) using modified versions of the Cochrane ROB tool and the What Works Clearinghouse standards. Where possible, we used random effects models with inverse variance weights to pool results across studies. We used odds ratios for dichotomous outcomes and standardised mean differences for continuous outcomes. We used Hedges g to adjust for small sample sizes. We assessed the heterogeneity of effects with χ 2 and I 2. We produced separate forest plots for conceptually distinct outcomes and for different endpoints (<9, 9-14, 15-23, and 24-42 months after referral). We grouped studies by study design (RCT or QED), and then assessed differences between these two subgroups of studies with χ 2 tests. We generated robust variance estimates, using correlated effects (CE) models with small sample corrections to synthesise all available outcome data. Exploratory CE analyses assessed potential moderators of effects within these domains. We used GRADE guidelines to assess the certainty of evidence on six primary outcomes at 1 year after referral. Main Results: Twenty studies (14 RCTs and 6 QEDs) met our inclusion criteria. Fifteen of these studies provided some valid data for meta-analysis; these studies included 10,980 families in relevant FFT and comparison groups. All included studies had high risks of bias on at least one indicator. Half of the studies had high risks of bias on baseline equivalence, support for intent-to-treat analysis, selective reporting, and conflicts of interest. Fifteen studies had incomplete reporting of outcomes and endpoints. Using the GRADE rubric, we found that the certainty of evidence for FFT was very low for all of our primary outcomes. Using pairwise meta-analysis, we found no evidence of effects of FFT compared with other active treatments on any primary or secondary outcomes. Primary outcomes were: recidivism, out-of-home placement, internalising behaviour problems, external behaviour problems, self-reported delinquency, and drug or alcohol use. Secondary outcomes were: peer relations and prosocial behaviour, youth self esteem, parent symptoms and behaviour, family functioning, school attendance, and school performance. There were few studies in the pairwise meta-analysis (k < 7) and little heterogeneity of effects across studies in most of these analyses. There were few differences between effect estimates obtained in RCTs versus QEDs. More comprehensive CE models showed positive results of FFT in some domains and negative results in others, but these effects were small (standardised mean difference [SMD] <|0.20|) and not significantly different from no effect with one exception: Two studies found positive effects of FFT on youth substance abuse and two studies found null results in this domain, and the overall effect estimate for this outcome was statistically different from zero. Over all outcomes (15 studies and 293 effect sizes), small positive effects were detected (SMD = 0.19, SE = 0.09), but these were not significantly different from zero effect. Prediction intervals showed that future FFT evaluations are likely to produce a wide range of results, including moderate negative effects and strong positive results (-0.37 to 0.75). Authors' Conclusions: Results of 10 RCTs and five QEDs show that FFT does not produce consistent benefits or harms for youth with behavioural problems and their families. The positive or negative direction of results is inconsistent within and across studies. Most outcomes are not fully reported, the quality of available evidence is suboptimal, and the certainty of this evidence is very low. Overall estimates of effects of FFT may be inflated, due to selective reporting and publication biases.

Development of complexity categories for an investigational drug services complexity scoring tool to assess pharmacy effort in clinical trial initiation and maintenance.

PURPOSE: Research pharmacy effort required to safely and compliantly manage investigational products (IP) varies between studies. No validated tool exists in the United States to evaluate these differences in effort. The Vizient Pharmacy Research Committee Investigational Drug Services (IDS) Subcommittee previously developed a systematic complexity scoring tool (CST) through expert consensus to assign a complexity score for pharmacy effort. This project seeks to develop and validate complexity categories based on CST scores. METHODS: Vizient member institutions in IDS assigned a CST complexity score and a perceived complexity category (low, medium, or high) for study initiation and maintenance. Receiver operating characteristic (ROC) curve analysis defined the best CST score cutoff points for each complexity category. Comparing the CST-assigned to the user-perceived complexity category determined whether the CST-assigned complexity category aligned with practitioner assignment. RESULTS: A total of 322 responses were used to determine complexity score categories. The AUC values for study initiation and maintenance were 0.79 (P < 0.001) for the low/medium boundary and 0.80 (P < 0.001) for the medium/high boundary, suggesting the performance of the CST is good. The agreement between CST-assigned and user-perceived complexity categories was 60% for study initiation and 58% for maintenance. The Kendall rank correlation coefficient between the raters and ROC categories was strong, with a value of 0.48 for study initiation and 0.47 for maintenance. CONCLUSION: Development of the CST allows IDS pharmacies to objectively measure the complexity of clinical trials, which is a significant step towards assessing workload and guiding resource allocation.

Perspective: Challenges and Strategies to Reduce the Sodium Content of Foods by the Food Service Industry.

Most Americans have dietary sodium intakes that exceed the recommended limits, which is a risk factor for hypertension and CVD. The share of total food expenditures for foods prepared and consumed away from home (FAFH) is ∼55%. These foods are consumed at various venues, including restaurants, workplaces, schools and universities, military installations, and assisted living/long-term care facilities. The food service industry has dealt with and continues to deal with various challenges in its attempt to reduce the sodium content in the foods that they prepare and sell. Despite these challenges, there have been various successful strategies used to reduce the sodium content in FAFH. This perspective article provides an overview of the challenges and strategies that have been used by the food service industry to reduce sodium in FAFH, as well as future sodium reduction strategies. Because of the widespread consumption of FAFH, implementing such future strategies could have a profound impact on the sodium content of the American diet.

'I have never bounced back': resilience and living with dementia.

OBJECTIVE: This work responds to the limited research about resilience when living with dementia and develops a conceptual model to inform service development and healthcare practices for this population. METHODS: An iterative process of theory building across four phases of activity (scoping review n = 9 studies), stakeholder engagement (n = 7), interviews (n = 11) generated a combined sample of 87 people living with dementia and their carers, including those affected by rare dementias to explore their lived experiences. An existing framework of resilience developed in other populations served as the starting point to analyse and synthesise the findings, inspiring a new conceptual model of resilience unique to the experience of living with dementia. RESULTS: The synthesis suggests resilience encompasses the daily struggles of living with a dementia; people are not flourishing, thriving or 'bouncing back', but are managing and adapting under pressure and stress. The conceptual model suggests resilience may be achieved through the collective and collaborative role of psychological strengths, practical approaches to adapting to life with dementia, continuing with hobbies, interests and activities, strong relationships with family and friends, peer support and education, participating in community activities and support from healthcare professionals. Most of these themes are not reflected in resilience outcome measures. CONCLUSIONS: Practitioners adopting a strengths-based approach utilising the conceptual model at the point of diagnosis and post-diagnosis support may help individuals achieve resilience through appropriately tailored services and support. This 'resilience practice' could also extend to other degenerative or debilitating chronic conditions a person faces in their life course.