U.S. Media Enjoyment without Strong Media Literacy Undermines Adolescents' and Mothers' Reported Efforts to Reduce Unhealthy Eating in Jamaica.

We investigate whether media literacy and media use can moderate the association between U.S. media enjoyment and unhealthy eating among remotely acculturating "Americanized" adolescents and their mothers in Jamaica (n = 164 individuals/82 dyads; Madolescent.age  = 12.83, SD = 0.48, 48% female; Mmother_age  = 39.25, SD = 5.71). Socioeconomically diverse participants completed questionnaires reporting their degree of enjoyment of U.S. media (i.e., remote acculturation), media literacy (i.e., critical thinking about food media/advertising), and adherence to national dietary guidelines to reduce sugar/fat. Multilevel modeling showed that enjoying U.S. media and consuming high levels of U.S. TV plus Jamaican TV are associated with lower efforts to reduce sugar and fat. However, high media literacy, whether one's own or a close family member's, weakens or nullifies that association.

Feel American, Watch American, Eat American? Remote Acculturation, TV, and Nutrition Among Adolescent-Mother Dyads in Jamaica.

Globalization prompts remote acculturation toward U.S. culture in Jamaica; this study used a bioecological systems approach to examine its proximal impact on nutrition through U.S. cable TV consumption, and maternal influences in the home. Overall, 330 randomly selected adolescent-mother dyads from schools in Kingston, Jamaica (Madolescent_age  = 13.8 years, SDadolescent_age  = 1.8) completed questionnaires reporting American identity and behavioral preferences, daily time spent watching U.S.-produced TV programs, and frequency of eating unhealthy foods. Actor-partner interdependence models revealed that girls' American identity/behavior directly predicted their unhealthy eating, whereas girls' mothers and boys' American identity/behavior indirectly predicted unhealthy eating as mediated by their U.S. TV hours. Additionally, mothers' American identity/behavior predicted daughters' unhealthy eating as mediated by mothers' U.S. TV hours. Remote acculturation theory may facilitate more targeted research and prevention/intervention.

Genome-wide association study identifies novel loci predisposing to cutaneous melanoma.

We performed a multistage genome-wide association study of melanoma. In a discovery cohort of 1804 melanoma cases and 1026 controls, we identified loci at chromosomes 15q13.1 (HERC2/OCA2 region) and 16q24.3 (MC1R) regions that reached genome-wide significance within this study and also found strong evidence for genetic effects on susceptibility to melanoma from markers on chromosome 9p21.3 in the p16/ARF region and on chromosome 1q21.3 (ARNT/LASS2/ANXA9 region). The most significant single-nucleotide polymorphisms (SNPs) in the 15q13.1 locus (rs1129038 and rs12913832) lie within a genomic region that has profound effects on eye and skin color; notably, 50% of variability in eye color is associated with variation in the SNP rs12913832. Because eye and skin colors vary across European populations, we further evaluated the associations of the significant SNPs after carefully adjusting for European substructure. We also evaluated the top 10 most significant SNPs by using data from three other genome-wide scans. Additional in silico data provided replication of the findings from the most significant region on chromosome 1q21.3 rs7412746 (P = 6 × 10(-10)). Together, these data identified several candidate genes for additional studies to identify causal variants predisposing to increased risk for developing melanoma.

Assessing Foods and Nutrition Competencies in Youth.

OBJECTIVE: To develop a comprehensive assessment of foods and nutrition competencies with robust psychometric properties for the 4-H Foods and Nutrition Project. DESIGN: The Assessment of Foods and Nutrition Competencies in Adolescents was developed through a systematic measurement development process by a group of researchers, practitioners, and program alumni familiar with the theory of change and implementation procedures of the 4-H Foods and Nutrition Project. SETTING: Recruitment was conducted through the 4-H Online membership management program for 4-H members throughout Texas to complete online survey questions. PARTICIPANTS: Four hundred twenty-four Texas 4-H members in grades 6-12. VARIABLES MEASURED: Survey items addressing 6 specific foods and nutrition competencies dimensions. ANALYSIS: A series of reliability and confirmatory factor analyses were conducted to assess the psychometric qualities of Assessment of Foods and Nutrition Competencies in Adolescents. RESULTS: Assessment of Foods and Nutrition Competencies in Adolescents was found to possess good factor structure, reliability, validity, and measurement invariance. Program participants showed an advantage over nonparticipants in most core foods and nutrition competencies concerning positive behavioral changes. CONCLUSIONS AND IMPLICATIONS: Assessment of Foods and Nutrition Competencies in Adolescents comprehensively captures the core competencies promoted by the 4-H Foods and Nutrition Project and possesses the psychometric qualities critical for program evaluation. A more diversity-focused outreach effort is needed for inclusive youth programs like the 4-H Foods and Nutrition Project to benefit the general youth population.

Child and Maternal Factors Associated with Feeding Practices in Children with Poor Growth.

The development of adequate growth and healthy eating behaviors depends on nutritious food and responsive feeding practices. Our study examined (1) the relationship between maternal concern about child weight or perceived feeding difficulties and their feeding practices, and (2) the moderating role of child temperament and maternal mental health on their feeding practices. A cross-sessional study included mother-child dyads (n = 98) from a tertiary growth and feeding clinic. Children had a mean age of 12.7 ± 5.0 months and a mean weight-for-age z-score of -2.0 ± 1.3. Responsive and controlling feeding practices were measured with the Infant Feeding Styles Questionnaire. Spearman correlation and moderation analysis were performed. Maternal concern about child weight and perceived feeding difficulties were negatively correlated with responsive feeding (r = -0.40, -0.48, p < 0.001). A greater concern about child weight or perceived feeding difficulties was associated with greater use of pressure feeding practices when effortful control was low (B = 0.49, t = 2.47, p = 0.01; B = -0.27, p = 0.008). Maternal anxiety had a significant moderation effect on the relationship between feeding difficulty and pressure feeding (B = -0.04, p = 0.009). Higher maternal concern about child weight and perceived feeding difficulties were associated with less responsive satiety feeding beliefs and behaviors. Both child effortful control and maternal anxiety influenced the relationship between weight and feeding concerns and the use of pressure feeding practices.

Inequality in early childhood: risk and protective factors for early child development.

Inequality between and within populations has origins in adverse early experiences. Developmental neuroscience shows how early biological and psychosocial experiences affect brain development. We previously identified inadequate cognitive stimulation, stunting, iodine deficiency, and iron-deficiency anaemia as key risks that prevent millions of young children from attaining their developmental potential. Recent research emphasises the importance of these risks, strengthens the evidence for other risk factors including intrauterine growth restriction, malaria, lead exposure, HIV infection, maternal depression, institutionalisation, and exposure to societal violence, and identifies protective factors such as breastfeeding and maternal education. Evidence on risks resulting from prenatal maternal nutrition, maternal stress, and families affected with HIV is emerging. Interventions are urgently needed to reduce children's risk exposure and to promote development in affected children. Our goal is to provide information to help the setting of priorities for early child development programmes and policies to benefit the world's poorest children and reduce persistent inequalities.

Food-Focused Media Literacy for Remotely Acculturating Adolescents and Mothers: A Randomized Controlled Trial of the "JUS Media? Programme".

PURPOSE: Unhealthy eating is a major modifiable risk factor for noncommunicable diseases and obesity, and remote acculturation to U.S. culture is a recently identified cultural determinant of unhealthy eating among adolescents and families in low/middle-income countries. This small-scale randomized controlled trial evaluated the efficacy of the "JUS Media? Programme," a food-focused media literacy intervention promoting healthier eating among remotely acculturating adolescents and mothers in Jamaica. METHODS: Gender-stratified randomization of 184 eligible early adolescents and mothers in Kingston, Jamaica (i.e., 92 dyads: Madolescent.age = 12.79 years, 51% girls) determined 31 "Workshops-Only" dyads, 30 "Workshops + SMS/texting" dyads, and 31 "No-Intervention-Control" dyads. Nutrition knowledge (food group knowledge), nutrition attitudes (stage of nutritional change), and nutrition behavior (24-hour recall) were primary outcomes assessed at four time points (T1/baseline, T2, T3, T4) across 5 months using repeated measures analysis of covariances. RESULTS: Compared to control, families in one or both intervention groups demonstrated significantly higher nutrition knowledge (T3 adolescents, T4 mothers: mean differences .79-1.08 on a 0-6 scale, 95% confidence interval [CI] .12-1.95, Cohen's ds = .438-.630); were more prepared to eat fruit daily (T3 adolescents and mothers: .36-.41 on a 1-5 scale, 95% CI .02-.77, ds = .431-.493); and were eating more cooked vegetables (T4 adolescents and T2 and T4 mothers: .20-.26 on a 0-1 scale, 95% CI -.03-.50, ds = .406-.607). Postintervention focus groups (6-month-delay) revealed major positive impacts on participants' health and lives more broadly. CONCLUSIONS: A food-focused media literacy intervention for remotely acculturating adolescents and mothers can improve nutrition. Replication in Jamaica and extension to the Jamaican diaspora would be useful.

Effect of aging, time, and temperature on fecal coliform counts during centrifugal dewatering and role of centrate in growth inhibition.

Recent studies have reported significant increases in fecal coliform counts in anaerobically digested sludge soon after centrifuge dewatering. The reasons behind these increases are not yet understood. This study investigated the role of inhibitor substances on the reactivation and regrowth of sludge bacteria and the effect of storage time and temperature on their growth behavior. The study consisted of full- and laboratory-scale testing, and quantified the microbiological and chemical characteristics of sludge, cake, and centrate samples under different temperatures and aging times. Significant reactivation was not observed at the treatment plants tested. Results showed that the regrowth phenomenon is not observed for all sludges, and differences in sludge characteristics and treatment processes may play a role in determining the regrowth behavior of sludge. Centrate collected from one of the treatment plants had an inhibitory effect on the growth of fecal coliform and was four times more toxic than cake to the bacteria. Chemical analyses of the centrate identified sulfide as one of the possible inhibitory compounds. The results also showed that fecal coliform have different growth and survival behavior compared to other sludge bacteria.

A double-blind, randomized, multicenter, controlled study to evaluate the immunogenicity, safety, and tolerability of varicella vaccine (VARIVAX™) passage extension 34 (PE34) process administered concomitantly with measles, mumps, and rubella vaccine (M-M-R™ II).

The varicella vaccine passage extension (VAR-PE) process was undertaken to extend the availability of varicella zoster virus (VZV)-containing vaccines. This study (V210-A03; NCT03239873) assessed the immunogenicity, safety, and tolerability of VAR-PE process in comparison with varicella vaccine commercial product 2016 (VAR) randomized 1:1 in 600 healthy children 12 to 23 months of age administered concomitantly with measles-mumps-rubella (MMR) vaccine. The VZV seroconversion rate at 6 weeks Postdose 1 in the PP population was 100% for both groups. VZV antibody response rates and GMTs of VZV antibodies to VAR-PE induced and were non-inferior to those induced by VAR 6 weeks Postdose 1. From Day 1 through Day 42, adverse events (AEs) were reported by 81.3% of participants Postdose 1 and 67.9% Postdose 2. From Day 1 through Day 42 Postdose 1, injection-site AEs related to varicella vaccine were reported by 31.1% and 29.7% of participants in VAR-PE and VAR, respectively, and Postdose 2, by 25.7% and 25.5% of participants in the VAR-PE and VAR groups, respectively. Systemic AEs were generally comparable for the 2 vaccination groups, with the exception of pyrexia and otitis media higher in VAR-PE, and diarrhea and teething higher in VAR. The incidence of systemic AEs was generally lower Postdose 2 compared with Postdose 1.

Transdisciplinary team science for global health: Case study of the JUS Media? Programme.

The world's most pressing health problems, such as the childhood obesity pandemic, demand creative new solutions. In this article it is argued that psychological theories, concepts, and methods are ripe for integration with those of other disciplines to synthesize innovative transdisciplinary global health solutions. As a model, the process of blending developmental and cross-cultural psychology with health and media sciences to develop a transdisciplinary intervention for youth and families in Jamaica-the J(amaican and) U(nited) S(tates) Media? Programme-is described. Jamaicans on the island are being inundated by the inflow of U.S. media, and those who have internalized U.S. culture and become "Americanized" via a process called remote acculturation are especially vulnerable to negative health habits promoted by U.S. media and advertising. In response, the JUS Media? Programme teaches critical thinking skills about food advertising (especially U.S.-produced) to decrease unhealthy eating among Americanized youth and families in Jamaica. In this article, first, transdisciplinarity is defined and distinguished from other scientific orientations (uni-, multi-, and interdisciplinarity) using the evolution of scholarship within JUS Media? Programme's transdisciplinary team as an example. Next, the application of transdisciplinary team science to global health problems is explained. As an example, the guiding transdisciplinary model for the JUS Media? Programme is described, and the cultural adaptation process used to design the JUS Media? Programme for Jamaican families is detailed. Finally, there is a reflection on best practices for transdisciplinary team leadership and collaboration. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Biopsychosocial Factors in Children Referred With Failure to Thrive: Modern Characterization for Multidisciplinary Care.

The objective of this study was to characterize biopsychosocial characteristics in children with failure to thrive with a focus on 4 domains: medical, nutrition, feeding skills, and psychosocial characteristics. A retrospective cross-sectional chart review was conducted of children assessed at the Infant and Toddler Growth and Feeding Clinic from 2015 to 2016. Descriptive statistics were used to analyze the data. One hundred thirty-eight children, 53.6% male, mean age 16.9 months (SD = 10.8), were included. Approximately one quarter of the children had complex medical conditions, medical comorbidities, and developmental delays. The mean weight-for-age percentile was 15.5 (SD = 23.9), and mean weight-for-length z score was -1.51 (SD = 1.4). A total of 22.5% of children had delayed oral-motor skills and 28.3% had oral aversion symptoms. Caregiver feeding strategies included force feeding (14.5%) and the use of distractions (47.1%). The multifactorial assessment of failure to thrive according to the 4 domains allowed for a better understanding of contributing factors and could facilitate multidisciplinary collaboration.

A double-blind, randomized, controlled, multi-center safety and immunogenicity study of a refrigerator-stable formulation of VARIVAX®.

OBJECTIVE: VARIVAX® (varicella virus vaccine, live Oka/Merck, Merck & Co., Inc., Kenilworth, NJ, USA) was originally licensed as a frozen formulation. A refrigerator-stable formulation of VARIVAX was subsequently developed to allow for increased availability of the product around the world. The objective of this study (V210-051) was to demonstrate that the safety, tolerability and immunogenicity profile of the refrigerator-stable formulation of VARIVAX was similar to the frozen formulation. METHODS: In this double-blind, randomized, multicenter study, healthy 12- to 23-month-old children with negative vaccination and clinical histories for measles, mumps, rubella, varicella, and zoster were vaccinated with either a refrigerator-stable formulation of VARIVAX (at two dosage levels; 8000 PFU [N = 320] or 25,000 PFU [N = 315]) or the frozen formulation of VARIVAX (10,000 PFU, N = 323) given concomitantly with M-M-RII® (measles, mumps, and rubella virus vaccine live, Merck & Co., Inc., Kenilworth, NJ, USA). Children were followed for 42 days after vaccination for adverse experiences. Immunogenicity was evaluated 6 weeks after vaccination. RESULTS: The refrigerator-stable formulation of VARIVAX was generally well tolerated. The incidence of adverse experiences was similar between all three groups. No vaccine-related serious adverse experiences were reported with any of the vaccine formulations. The immune response (percentage of subjects with varicella antibody titers ≥5 gpELISA units) for both refrigerator-stable formulations of VARIVAX at 6 weeks postvaccination was similar to that of the frozen formulation. Administration of either refrigerator-stable formulation of VARIVAX with M-M-RII yielded seroconversion rates and GMTs for measles, mumps and rubella that were comparable to those achieved after administration of the frozen formulation of VARIVAX with M-M-RII. CONCLUSION: The safety, tolerability, and immunogenicity profile of the refrigerator-stable varicella vaccine was similar to that of the frozen formulation.

Child development: risk factors for adverse outcomes in developing countries.

Poverty and associated health, nutrition, and social factors prevent at least 200 million children in developing countries from attaining their developmental potential. We review the evidence linking compromised development with modifiable biological and psychosocial risks encountered by children from birth to 5 years of age. We identify four key risk factors where the need for intervention is urgent: stunting, inadequate cognitive stimulation, iodine deficiency, and iron deficiency anaemia. The evidence is also sufficient to warrant interventions for malaria, intrauterine growth restriction, maternal depression, exposure to violence, and exposure to heavy metals. We discuss the research needed to clarify the effect of other potential risk factors on child development. The prevalence of the risk factors and their effect on development and human potential are substantial. Furthermore, risks often occur together or cumulatively, with concomitant increased adverse effects on the development of the world's poorest children.

Novel mutations in the TK2 gene associated with fatal mitochondrial DNA depletion myopathy.

Mitochondrial DNA depletion syndromes are a heterogeneous group of childhood neurological disorders characterised by a quantitative abnormality of mitochondrial DNA. We describe two siblings who presented at 8 months and 14 months with myopathy, which rapidly progressed and resulted in death by respiratory failure at age 14 and 18 months, respectively. Muscle biopsy revealed marked respiratory chain defects, with real-time PCR confirming a dramatic depletion of mitochondrial DNA. Sequencing of the thymidine kinase 2 (TK2) gene revealed two, novel heterozygous mutations (p.Q87X and p.N100S) with parental DNA analysis confirming the transmission of mutated alleles.

Setting priorities in global child health research investments: guidelines for implementation of CHNRI method.

This article provides detailed guidelines for the implementation of systematic method for setting priorities in health research investments that was recently developed by Child Health and Nutrition Research Initiative (CHNRI). The target audience for the proposed method are international agencies, large research funding donors, and national governments and policy-makers. The process has the following steps: (i) selecting the managers of the process; (ii) specifying the context and risk management preferences; (iii) discussing criteria for setting health research priorities; (iv) choosing a limited set of the most useful and important criteria; (v) developing means to assess the likelihood that proposed health research options will satisfy the selected criteria; (vi) systematic listing of a large number of proposed health research options; (vii) pre-scoring check of all competing health research options; (viii) scoring of health research options using the chosen set of criteria; (ix) calculating intermediate scores for each health research option; (x) obtaining further input from the stakeholders; (xi) adjusting intermediate scores taking into account the values of stakeholders; (xii) calculating overall priority scores and assigning ranks; (xiii) performing an analysis of agreement between the scorers; (xiv) linking computed research priority scores with investment decisions; (xv) feedback and revision. The CHNRI method is a flexible process that enables prioritizing health research investments at any level: institutional, regional, national, international, or global.

Immunogenicity and safety of zoster vaccine live administered with quadrivalent influenza virus vaccine.

OBJECTIVES: Randomized, blinded, placebo-controlled trial to evaluate the safety and immunogenicity of ZOSTAVAX™ (ZV) administered concomitantly with quadrivalent inactivated influenza vaccine (IIV4) in adults≥50years of age (NCT02519855). METHODS: Overall, 440 participants were randomized into the Concomitant Group (CG) and 442 into the Sequential Group (SG). The CG received ZV and IIV4 at separate injection sites on Day 1 and matching placebo at Week 4. The SG received placebo and IIV4 (2015-2016 influenza season) at separate injection sites on Day 1 and ZV at Week 4. IMMUNOGENICITY ENDPOINTS: Varicella-zoster virus (VZV) antibody geometric mean titer (GMT) and geometric mean fold-rise (GMFR) from baseline to 4weeks postvaccination, measured by glycoprotein enzyme-linked immunosorbent assay (gpELISA) and adjusted for age and prevaccination titer. Influenza strain-specific GMT at baseline and 4weeks postvaccination was measured by hemagglutination inhibition (HAI) assay. SAFETY ENDPOINTS: Injection-site and systemic adverse experiences (AEs) within 28days following any vaccination and serious AEs throughout the study. RESULTS: The adjusted VZV antibody GMT ratio (CG/SG) was 0.87 (95%CI: 0.80, 0.95), meeting the prespecified noninferiority criterion. The VZV antibody GMFR in the CG was 1.9 (95%CI: 1.76, 2.05), meeting the acceptability criterion. Influenza antibody GMT ratios for A/H1N1, A/H3N2, B/Yamagata and B/Victoria were 1.02 (95%CI: 0.88, 1.18), 1.10 (95%CI: 0.94, 1.29), 1.00 (95%CI: 0.88, 1.14), and 0.99 (95%CI: 0.87, 1.13), respectively. The frequency of vaccine-related injection-site and systemic AEs was comparable between groups. No vaccine-related serious AE was observed. CONCLUSION: The concomitant administration of ZV and IIV4 to adults≥50years of age induced VZV-specific and influenza-specific antibody responses that were comparable to those following administration of either vaccine alone, and was generally well tolerated.

Endurance training and detraining in mitochondrial myopathies due to single large-scale mtDNA deletions.

At present there are limited therapeutic interventions for patients with mitochondrial myopathies. Exercise training has been suggested as an approach to improve physical capacity and quality of life but it is uncertain whether it offers a safe and effective treatment for patients with heteroplasmic mitochondrial DNA (mtDNA) mutations. The objectives of this study were to assess the effects of exercise training and detraining in eight patients with single, large-scale mtDNA deletions to determine: (i) the efficacy and safety of endurance training (14 weeks) in this patient population; (ii) to determine the effect of more prolonged (total of 28 weeks) exercise training upon muscle and cardiovascular function and (iii) to evaluate the effect of discontinued training (14 weeks) upon muscle and cardiovascular function. Our results show that: (i) 14 weeks of exercise training significantly improved tolerance of submaximal exercise and peak capacity for work, oxygen utilization and skeletal muscle oxygen extraction with no change in the level of deleted mtDNA; (ii) continued training for an additional 14 weeks maintained these beneficial adaptations; (iii) the cessation of training (detraining) resulted in loss of physiological adaptation to baseline capacity with no overall change in mutation load. Patients' self assessment of quality of life as measured by the SF-36 questionnaire improved with training and declined with detraining. Whilst our findings of beneficial effects of training on physiological outcome and quality of life without increases in the percentage of deleted mtDNA are encouraging, we did not observe changes in mtDNA copy number. Therefore there remains a need for longer term studies to confirm that endurance exercise is a safe and effective treatment for patients with mitochondrial myopathies. The effects of detraining clearly implicate physical inactivity as an important mechanism in reducing exercise capacity and quality of life in patients with mitochondrial myopathy.

Experimental strategies towards treating mitochondrial DNA disorders.

An extensive range of molecular defects have been identified in the human mitochondrial genome (mtDNA), causing a range of clinical phenotypes characterized by mitochondrial respiratory chain dysfunction. Sadly, given the complexities of mitochondrial genetics, there are no available cures for mtDNA disorders. In this review, we consider experimental, genetic-based strategies that have been or are being explored towards developing treatments, focussing on two specific areas which we are actively pursuing--assessing the benefit of exercise training for patients with mtDNA defects, and the prevention of mtDNA disease transmission.

Setting priorities in global child health research investments: assessment of principles and practice.

This article reviews theoretical and practical approaches for setting priorities in global child health research investments. It also provides an overview of previous attempts to develop appropriate tools and methodologies to define priorities in health research investments. A brief review of the most important theoretical concepts that should govern priority setting processes is undertaken, showing how different perspectives, such as medical, economical, legal, ethical, social, political, rational, philosophical, stakeholder driven, and others will necessarily conflict each other in determining priorities. We specially address present research agenda in global child health today and how it relates to United Nation's (UN) Millennium Development Goal 4, which is to reduce child mortality by two-thirds between 1990 and 2015. The outcomes of these former approaches are evaluated and their benefits and shortcomings presented. The case for a new methodology for setting priorities in health research investments is presented, as proposed by Child Health and Nutrition Research Initiative, and a need for its implementation in global child health is outlined. A transdisciplinary approach is needed to address all the perspectives from which investments into health research can be seen as priorities. This prioritization requires a process that is transparent, systematic, and that would take into account many perspectives and build on advantages of previous approaches.

Married State Preceptorship Model: Crossing the State Line in New Graduate Nurse Transition to Practice.

BACKGROUND: The transition to practice for new graduate nurses poses distinct challenges at the point of care. The complicated work environment necessitates a preceptorship model that maintains safety at all times. METHOD: This study used survey, focus groups, and interviews to assess the effects of the married state preceptorship model (MSPM) on the experiences and perceptions of the new nurses and preceptors in a hospital setting. RESULTS: The result validated the original findings from the new nurses' survey, indicating all (N = 28, 100%) of the new nurses found the MSPM to be beneficial, promote safety, and lessen anxiety, and 27 (96%) thought it helped them to assume a full patient load. The preceptors' survey revealed that 29 (97%) of the preceptors thought the MSPM promoted safety, 30 (100%) thought it boosted confidence, and 30 (100%) believed it meet the needs of the new nurses. CONCLUSION: The study showed same thematic saturation on partnership, critical thinking, learning, and transition. The change in culture has been strengthened in the replicate study referring to their acclimatization in the unit through the MSPM. J Contin Educ Nurs. 2016;47(11):511-517.