Reinforcing value of food, enriched home environment, and changes in percent overweight in children.

OBJECTIVE: The decision to eat is often a choice made in the context of food and non-food alternatives. However, no research, to the authors' knowledge, has assessed the combination of the motivation to eat, as indexed by the relative reinforcing value of food (RRVFOOD ), and the enriched home environment, i.e., access to activities that can serve as alternatives to eating on weight gain. METHODS: This study used a cross-sectional design to study how RRVFOOD and the enriched home environment predict percent overweight change over 2 years in 291 children aged 6 to 9 years and of varying socioeconomic status. RESULTS: Results showed that RRVFOOD and access to food were positively associated with baseline percent overweight, and an enriched home environment was negatively related to baseline percent overweight. RRVFOOD and an enriched home environment interacted to predict change in percent overweight. Children with a high relative RRVFOOD and a relatively non-enriched environment showed the greatest relative weight gain. CONCLUSIONS: These results suggest that providing an enriched home environment may reduce the effects of food reinforcement and being motivated to eat on weight gain in childhood, and this represents a novel approach to intervention that can be used to strengthen current behavioral approaches to prevent obesity in children.

A Peer-to-Peer Suicide Prevention Workshop for Medical Students.

Introduction: An estimated 11% of medical students experience suicidal ideation during medical school. Many medical schools teach students how to intervene on behalf of patients experiencing suicidal ideation, but no curriculum in MedEdPORTAL teaches students how to intervene on behalf of peers. Methods: The authors designed, implemented, and evaluated a 2-hour workshop to equip medical students with skills and resources to intervene on behalf of a peer in crisis. This workshop comprised a peer-led didactic session and small-group sessions with role-plays and a guided debrief. The resource included a slide deck for the didactic session, a facilitator guide for the small-group session, a student handout with role-plays and self-evaluation questions, and the pre-/postsurvey. Results: This workshop was conducted with cohorts of first- and second-year medical students (n = 273) in October and November 2019. Pre-/postsurveys showed the greatest improvements in suicide prevention knowledge (self-rated) and the confidence in and likelihood of asking peers about suicide. Discussion: Student feedback indicated that the most valuable parts of the workshop were the peer-led nature of the didactic session, the perspective of a peer's lived experience, and the role-plays. Opportunities for improvement included the scheduling of the session, the potentially triggering nature of the role-play exercises, and the importance of enabling students to opt out discreetly. A version of this workshop is now a permanent part of the first-year curriculum at our institution.

3D iPSC modeling of the retinal pigment epithelium-choriocapillaris complex identifies factors involved in the pathology of macular degeneration.

The retinal pigment epithelium (RPE)-choriocapillaris (CC) complex in the eye is compromised in age-related macular degeneration (AMD) and related macular dystrophies (MDs), yet in vitro models of RPE-CC complex that enable investigation of AMD/MD pathophysiology are lacking. By incorporating iPSC-derived cells into a hydrogel-based extracellular matrix, we developed a 3D RPE-CC model that recapitulates key features of both healthy and AMD/MD eyes and provides modular control over RPE and CC layers. Using this 3D RPE-CC model, we demonstrated that both RPE- and mesenchyme-secreted factors are necessary for the formation of fenestrated CC-like vasculature. Our data show that choroidal neovascularization (CNV) and CC atrophy occur in the absence of endothelial cell dysfunction and are not necessarily secondary to drusen deposits underneath RPE cells, and CC atrophy and/or CNV can be initiated systemically by patient serum or locally by mutant RPE-secreted factors. Finally, we identify FGF2 and matrix metalloproteinases as potential therapeutic targets for AMD/MDs.

Use of a Model Maturity Matrix to Build a Quality Improvement Infrastructure for Psychiatric Care.

Despite a call to action by accreditation bodies and payers alike, the infrastructure needed to continuously improve the quality and safety of behavioral health care has been slow to develop. The causes of this are complex and multifactorial yet likely include underdeveloped leadership and capacity to sustainably improve the quality of psychiatric care. This article proposes the use of a quality improvement maturity matrix to serve as both an implementation strategy and a self-assessment measure to strategically guide this infrastructure development. The matrix describes six phases of development across three domains that are generalizable to various behavioral health care settings.

Evaluation of the Brief Adjustment Scale-6 (BASE-6): A measure of general psychological adjustment for measurement-based care.

The current study evaluated the Brief Adjustment Scale-6 (BASE-6), a measure of general psychological adjustment. The psychometric properties of the BASE-6 are documented using 3 adult samples, including online participants (Sample 1: n = 459), college students (Sample 2: n = 244), and a clinical sample (Sample 3: n = 296). Acceptability ratings comparing the BASE-6 to the Outcome Questionnaire-45.2 (OQ-45.2; Lambert et al., 1996) are provided. Factor analyses showed the items were well represented by a single factor, indicating a unidimensional factor structure. The BASE-6 demonstrated good internal consistency (α = .87-.93) and there was good test-retest reliability (intraclass correlation = .77) across 1 week. In Samples 1 and 2, there was moderate to high convergent validity with the OQ-45.2 total score (r = .66-.81, p < .001), and Symptom Distress (r = .66-.80, p < .001), Interpersonal (r = .54-.68, p < .001), and Social Role (r = .57-.69, p < .001) subscales. In Sample 3, there was high convergent validity with the Patient Health Questionnaire-9 (r = .80, p < .001) and the Generalized Anxiety Disorder-7 (r = .76, p < .001). BASE-6 item and total scores were generally higher in the clinical sample compared with the nonclinical samples. Participants perceived the BASE-6 as easier to use, and more acceptable on a weekly basis compared with the OQ-45.2. Results provide preliminary evidence that the BASE-6 has acceptable psychometric properties and may show promise in the context of measurement-based care. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Leveraging Health Information Technology to Meet The Joint Commission's Standard for Measurement-Based Care: A Case Study.

INTRODUCTION: Three decades of research have shown that routinely collecting patient-reported outcomes throughout treatment to inform clinical decision making or measurement-based care (MBC) can improve clinical outcomes, yet widespread adoption continues to be elusive. APPROACH: This article describes how a community behavioral health center addressed Element of Performance (EP) 1 of The Joint Commission's revised MBC standard using health information technology (HIT)-facilitated MBC and a comprehensive implementation plan grounded in the Consolidated Framework for Implementation Research. RESULTS: Across the initial 15-month implementation period, 96.8% of patients who had an intake evaluation also completed baseline measurements via an HIT known as a measurement feedback system (MFS), and 91.5% (78.6%-100%) completed at least one repeated measure. CONCLUSION: MFS reduces many of the logistical barriers of MBC, but implementation of MFS-facilitated MBC requires a comprehensive implementation plan that includes strategies to address barriers across all relevant domains for successful uptake.

Positive aspects of being a heterosexual ally to lesbian, gay, bisexual and transgender (LGBT) people.

Research on heterosexual allies has focused on heterosexual identity development models and pathways to ally activism. The positive aspects or positive experiences of identifying as an ally to lesbian, gay, bisexual, and transgender (LGBT) identified individuals and communities have received little attention. Using an online survey of participants recruited from LGBT ally related social media, we collected open-ended responses to a question about the positive aspects of self-identifying as a heterosexual ally. A final analytic sample of 292 self-identified male and female heterosexual adults (age 18-71, M = 33.47, SD = 13.32) provided responses that generated 8 themes. Positive aspects of being a heterosexual ally were: (a) increased knowledge and awareness, (b) upholding values of justice, (c) beneficial individual relationships, (d) community belonging, (e) educating others, (f) being a role model, (g) using social privilege, and (h) speaking out and taking a stand. The findings suggest that being a heterosexual ally is rewarding and may enhance individual well-being. These findings provide information that may contribute to effective ally development efforts.

Weakness after gastric bypass.

Two patients underwent gastric bypasses and had uneventful hospital courses. In the early postoperative periods, both developed severe, protracted vomiting, weakness, and hyporeflexia. After thorough laboratory and clinical evaluations by neurologists, the patients were diagnosed with Guillain-Barré syndrome, although there were many atypical features. The clinical presentations of these patients are very similar to case reports of nutritional polyneuropathy associated with gastric partitioning. This paper addresses the difficulties of differentiating these two diagnoses.