The Resilient Youth Program: a promising skills-based online program for resiliency and stress management.

BACKGROUND: Prevention programs that target resilience may help youth address mental health difficulties and promote well-being during public health crises. AIMS: To examine the preliminary efficacy of the Resilient Youth Program (RYP). METHOD: The RYP was delivered remotely from a US academic medical centre to youth in the community via a naturalistic pilot study. Data from 66 youth (ages 6-18, Mage = 11.65, SD = 3.02) and their parents were collected via quality assurance procedures (May 2020 to March 2021). Pre/post-intervention child/parent-reported psychological and stress symptoms as well as well-being measures were compared via Wilcoxon signed rank tests. Child/parent-reported skills use data were collected. RESULTS: Among child-reported outcomes, there were significant decreases in physical stress (p = .03), anxiety (p = .004), depressive symptoms (p < .001) and anger (p = .002), as well as increased life satisfaction (p = .02). There were no significant differences in child-reported psychological stress (p = .06) or positive affect (p = .09). Among parent-reported child outcomes, there were significant decreases in psychological (p < .001) and physical stress (p = .03), anxiety (p < .001), depressive symptoms (p < .001), and anger (p < .002) as well as increased positive affect (p < .001) and life satisfaction (p < .001). Effect sizes ranged from small to medium; 77% of youth (73% of parents) reported using RYP skills. Age and gender were not associated with outcome change. CONCLUSIONS: The RYP may help reduce psychological/stress symptoms and increase well-being among youth; further research is needed.

Dynamics of a deep-water seagrass population on the Great Barrier Reef: annual occurrence and response to a major dredging program.

Global seagrass research efforts have focused on shallow coastal and estuarine seagrass populations where alarming declines have been recorded. Comparatively little is known about the dynamics of deep-water seagrasses despite evidence that they form extensive meadows in some parts of the world. Deep-water seagrasses are subject to similar anthropogenic threats as shallow meadows, particularly along the Great Barrier Reef lagoon where they occur close to major population centres. We examine the dynamics of a deep-water seagrass population in the GBR over an 8 year period during which time a major capital dredging project occurred. Seasonal and inter-annual changes in seagrasses were assessed as well as the impact of dredging. The seagrass population was found to occur annually, generally present between July and December each year. Extensive and persistent turbid plumes from a large dredging program over an 8 month period resulted in a failure of the seagrasses to establish in 2006, however recruitment occurred the following year and the regular annual cycle was re-established. Results show that despite considerable inter annual variability, deep-water seagrasses had a regular annual pattern of occurrence, low resistance to reduced water quality but a capacity for rapid recolonisation on the cessation of impacts.

Nutrition educator adoption and implementation of an experiential foods curriculum.

OBJECTIVE: Describe changes in Nutrition Educator (NE) and Extension Agent (EA) motivation, self-efficacy, and behavioral capability over time after experiential food tasting curriculum training. Identify promoters of curriculum adoption, implementation, and future use. DESIGN: Mixed methods design including surveys, lesson implementation reports, and interviews. SETTING: New Mexico limited-resource schools. PARTICIPANTS: Convenience sample of New Mexico Extension NE (n = 42) and their EA supervisors (n = 21). INTERVENTION: Three-hour curriculum training employing Social Cognitive Theory and Diffusion of Innovations. MAIN OUTCOME MEASURES: Perceived change in motivation, self-efficacy, and behavioral capability from post-training through 8-month post-training; promoters and challenges to curriculum adoption, implementation, and future use. ANALYSIS: Repeated-measures ANOVA analyzed perceived behavior change over time. Significance was set at P ≤ .05. Qualitative responses were categorized by theme. RESULTS: Gains in NE motivation, self-efficacy, and behavioral capability were sustained at 8 months post-training. High adoption/implementation rates (79%) were attributed to strong implementation expectations, observational learning, experiential training elements, and perceived curriculum compatibility. Environmental factors including time constraints, personnel turnover, and scheduling conflicts proved challenging. CONCLUSIONS AND IMPLICATIONS: Maximizing curriculum simplicity and compatibility and incorporating behavioral capability, observational learning, and expectations into training support adoption and use. Adaptations and techniques to problem-solve challenges should be provided to new curricula implementers.

Administering ziconotide and monitoring patients treated with ziconotide: expert opinions.

Some patients with chronic pain who are intolerant of or refractory to treatment with systemic analgesics may benefit from intrathecal therapy. Ziconotide is the first nonopioid analgesic approved by the United States Food and Drug Administration for intrathecal administration. Several randomized, double-blind, placebo-controlled clinical trials have demonstrated the efficacy and safety of ziconotide. However, the maximum recommended dosing and titration schedule provided in the prescribing information may be too aggressive for some patients, and experience has demonstrated that ziconotide is better tolerated with slower titration to a lower maximum dose. Efficacy can be assessed by an evaluation of changes in pain, functionality, and quality of life. Cognitive adverse events may be subtle; therefore, it is important that health care professionals not only monitor patients for signs and symptoms of cognitive adverse events, but also teach family members how to do the same. Careful patient assessment and monitoring can help optimize the potential benefit from treatment with ziconotide.

Cooking schools improve nutrient intake patterns of people with type 2 diabetes.

OBJECTIVE: To determine whether cooking classes offered by the Cooperative Extension Service improved nutrient intake patterns in people with type 2 diabetes. DESIGN: Quasi-experimental using pretest, posttest comparisons. SETTING: Community locations including schools, churches, and senior centers. PARTICIPANTS: One hundred seventeen people with type 2 diabetes, from diverse ethnic and socioeconomic backgrounds. INTERVENTION: Series of classes for people with type 2 diabetes and their family members that incorporated Social Cognitive Theory tenets. The classes featured current nutrition recommendations for people with type 2 diabetes and hands-on cooking, where participants prepared and ate a meal together. MAIN OUTCOME MEASURES: Three-day food records, completed prior to attending cooking schools and 1 month after, were used to measure changes in energy intake and selected nutrients. ANALYSIS: Program efficacy was assessed using the Wilcoxon signed-rank test to compare differences between pre-training and post-training variables. ANCOVA was used to determine whether program efficacy was affected by sociodemographics. RESULTS: Participants decreased (P < .05) intakes of energy, fat grams, percentage of calories from fat, saturated fat grams, cholesterol (mg), sodium (mg), and carbohydrate grams. CONCLUSIONS AND IMPLICATIONS: Nutrition education incorporating hands-on cooking can improve nutrient intake in people with type 2 diabetes from diverse ethnic and socioeconomic backgrounds.

Participant evaluation of teleconference support for African American women with breast cancer.

BACKGROUND: African American women with breast cancer face obstacles such as transportation and family obligations when attending standard support groups. Teleconference support circumvents barriers such as transportation to participation, but few evaluations have been reported about teleconference support. OBJECTIVE: The purpose of this article was to describe the format of a teleconference group and to provide a descriptive account of the participants' feedback about a teleconference group intervention. METHODS: A descriptive design was used. Participants completed the Overall Support Group Evaluation tool at the end of the 10th group session. RESULTS: Teleconference group participants' feedback indicated that they perceived they had gained knowledge about breast cancer and coping. The participants expressed that the group helped them to reach out and ask for support and improved family and work relationships. Also, participants rated the group highly for the presence of therapeutic factors. On a scale of 1 to 4, with 4 being the highest, mean scores ranged from 3.97 to 3.56. CONCLUSIONS: The participants gave high ratings of satisfaction in terms of knowledge gained, leadership style, and benefits. The participants perceived that the group increased their knowledge about cancer, improved family connections, and increased their ability to deal with their cancer. IMPLICATIONS FOR PRACTICE: Using teleconferencing technology to deliver a support group to African American breast cancer patients is a beneficial method to reach a disadvantaged population that may be unable to attend face-to-face groups.

Effective training design: use of theory and formative assessment.

Effective nutrition education training should be guided by sound theory that specifically addresses behavior change. A 3-hour training was developed using diffusion of innovations (DOI) and social cognitive theories and formative assessment. Essential training components included interactive learning techniques and curriculum lesson practice. Descriptive statistics were used to analyze training satisfaction, paired samples t tests determined pre- to posttraining differences, and Pearson correlations and stepwise multiple regression were conducted to explore predictors of future curriculum use. Paraprofessional nutrition educators (NEs) and their supervisors rated the training high in acceptability, benefit, and clarity. NEs and supervisors improved knowledge about teaching the curriculum (t = 5.12, p < .01 and t = 8.31, p < .01, respectively), confidence (t = 3.93, p < .01 and t = 3.62, p < .01, respectively), motivation (t = 3.71, p < .01 and t = 2.63, p < .05, respectively), and information (t = 7.17, p < .01 and t = 4.15, p < .01, respectively) to teach the curriculum. The DOI attributes of relative advantage and trialability were correlated with intended future curriculum use by NEs (r = .577, p = .002 and r = .418, p = .027, respectively). Relative advantage was correlated with intended use by supervisors (r = .502, p = .040). These results underscore the importance of using both theory and formative assessment for successful training development.

Randomized trial of therapeutic group by teleconference: African American women with breast cancer.

BACKGROUND: The effects of a therapeutic group by teleconference for African American women with breast cancer have not been documented, although the benefits of therapeutic groups for European women are well established. African American women with breast cancer may experience social disconnection, a sense of being cut off from partners, family, and friends because of side effects of treatment and fatalistic beliefs about cancer. A therapeutic group by teleconference may counteract these problems and improve social connection. METHODS: A randomized trial design stratified by treatment type was used. Data were collected at baseline, at the end of the intervention, and 16 weeks from baseline. Repeated-measures, fixed-factor analyses of covariance were used for each outcome. The between-subject factors were group and replicate set, and the within-subject factor was time. Physical well being and educational level differed significantly between the 2 groups at baseline and were used as covariates. RESULTS: The mixed-model analysis of the outcome variables revealed significant changes over time for knowledge (P ≤ .001), with higher scores on knowledge observed for the control group. Group-by-time interactions were observed for fatalism (P = .0276), fear (P = .0163), and social connection (P = .0174) as measured by the Social Well Being subscale from the Functional Assessment of Cancer Treatment-Breast Cancer Version. No group-by-time interaction was observed for social connection as measured by the Social Support Questionnaire. Social connection measured with the Social Well Being subscale improved significantly in the intervention group, whereas fatalism and fear significantly decreased. CONCLUSIONS: In this study, the authors documented the benefits of a therapeutic group by teleconference, a novel way to provide support for African American women with breast cancer. Further research should include a behavioral outcome, such as treatment adherence.

Antecedents and mediators of community connection in African American women with breast cancer.

OBJECTIVE: To describe the theory of community connection defined as close relationships with women and men who are members of a neighborhood, a church, a work group, or an organization. Antecedent and mediator variables related to community connection are identified. DESIGN/METHODS: A cross-sectional design was used to assess for relationships among theorized antecedents and mediators of community connection in a sample of 144 African American women aged 21 years and older (mean = 54.9) who had been diagnosed with invasive/infiltrating ductal carcinoma. MEASUREMENT AND ANALYSES: Community connection was measured with the relational health indices-community subscale. Mediator analysis was conducted to assess significance of the indirect effects of the mediator variables, which were fear, breast cancer knowledge, and isolation. RESULTS: Community connection was found to be associated with three of the four antecedents, cancer stigma, stress, and spirituality, but not associated with fatalism. Effects were mediated primarily through fear and isolation with isolation as was more dominant of the two mediators. Surprisingly, breast cancer knowledge showed no significant mediator role. CONCLUSIONS: The importance of isolation and fear as mediators of community connection is highlighted by this research. The study could serve as a model for other researchers seeking to understand connection in ethnic groups and communities.

Evaluation of conceptual framework for recruitment of African American patients with breast cancer.

PURPOSE/OBJECTIVES: To describe the Heiney-Adams Recruitment Framework (H-ARF); to delineate a recruitment plan for a randomized, behavioral trial (RBT) based on H-ARF; and to provide evaluation data on its implementation. DATA SOURCES: All data for this investigation originated from a recruitment database created for an RBT designed to test the effectiveness of a therapeutic group convened via teleconference for African American women with breast cancer. DATA SYNTHESIS: Major H-ARF concepts include social marketing and relationship building. The majority of social marketing strategies yielded 100% participant recruitment. Greater absolute numbers were recruited via Health Insurance Portability and Accountability Act waivers. Using H-ARF yielded a high recruitment rate (66%). CONCLUSIONS: Application of H-ARF led to successful recruitment in an RBT. The findings highlight three areas that researchers should consider when devising recruitment plans: absolute numbers versus recruitment rate, cost, and efficiency with institutional review board-approved access to protected health information. IMPLICATIONS FOR NURSING: H-ARF may be applied to any clinical or population-based research setting because it provides direction for researchers to develop a recruitment plan based on the target audience and cultural attributes that may hinder or help recruitment.

Practice-based commissioning and COPD in Easington.

In Easington the local practice-based commissioning (PBC) group and NHS County Durham and Darlington Community Health Services set up a working group, comprising of GPs, nurses, ambulance services and social workers, to examine local care services for patients suffering from Chronic obstructive pulmonary disease (COPD). The new COPD pathway was launched in August 2008. The new clinical pathway has delivered greater efficiencies, cost savings and improved patient satisfaction.

From ethnography to the EAST method: a tractable approach for representing distributed cognition in Air Traffic Control.

Command and control is a generic activity involving the exercise of authority over assigned resources, combined with planning, coordinating and controlling how those resources are used. The challenge for understanding this type of activity is that it is not often amenable to the conventional experimental/methodological approach. Command and control tends to be multi-faceted (so requires more than one method), is made up of interacting socio and technical elements (so requires a systemic approach) and exhibits aggregate behaviours that emerge from these interactions (so requires methods that go beyond reductionism). In these circumstances a distributed cognition approach is highly appropriate yet the existing ethnographic methods make it difficult to apply and, for non-specialist audiences, sometimes difficult to meaningfully interpret. The Event Analysis for Systemic Teamwork method is put forward as a means of working from a distributed cognition perspective but in a way that goes beyond ethnography. A worked example from Air Traffic Control is used to illustrate how the language of social science can be translated into the language of systems analysis. Statement of Relevance: Distributed cognition provides a highly appropriate conceptual response to complex work settings such as Air Traffic Control. This paper deals with how to realise those benefits in practice without recourse to problematic ethnographic techniques.

Cause of death in pediatric and infant heart transplant recipients: review of a 20-year, single-institution cohort.

BACKGROUND: As infant and pediatric heart transplantation becomes more common, there is a growing need to better understand the causes of failure or death, if we are to continue to improve the outcome in these children. METHODS: A multidisciplinary team reviewed all deaths occurring in the cohort of infants and children transplanted during the first 20 years of the Loma Linda Pediatric Heart Transplant program, with 2 additional years of follow-up beyond the 20-year accrual period, and classified them as to cause. RESULTS: There were 169 deaths among 421 recipients, with a median follow-up of 9.7 years. Autopsy was performed in 128 cases. The causes of death, in decreasing order of frequency, included acute rejection (26.0%), infection (16.0%), cardiac allograft vasculopathy (CAV) (14.2%), technical issues (8.3%), acute graft dysfunction (6.5%), neoplasm (7.1%), chronic graft dysfunction (4.7%) and miscellaneous factors (10.1%), and in twelve deaths (7.1%) the cause was unclassified. Acute graft dysfunction and technical issues accounted for nearly two-thirds of the deaths in the first 30 days after transplant, while acute rejection resulted in the largest number of deaths after the first year (30.4%), with CAV a close second (23.5%). CONCLUSIONS: Acute graft dysfunction and technical issues were the most frequent cause of early death. Late deaths were most often due to acute rejection and CAV, which differs somewhat from the experience reported in adults. Acute rejection was the single most important cause of late mortality, and resulted in a significant number of late sudden and unexpected deaths.

Using an integrated methods approach to analyse the emergent properties of military command and control.

This paper applies the event analysis for systemic teamwork (EAST) method to an example of military command and control. EAST offers a way to describe system level emergent properties that arise from the complex interactions of system components (human and technical). These are described using an integrated methods approach and modelled using Task, Social and Propositional networks. The current article is divided into three parts: a brief description of the military command and control context, a brief description of the EAST method, and a more in depth presentation of the analysis outcomes. The emergent properties of the military scenario relate to the degree of system reconfigurability, systems level situational awareness and the role of mediating technology. The findings are compared with similar analyses undertaken in civilian domains, in which the latest developments in command and control, under the aegis of Network Enabled Capability (NEC), are already in place.

Intrathecal triple therapy decreases central nervous system relapse but fails to improve event-free survival when compared with intrathecal methotrexate: results of the Children's Cancer Group (CCG) 1952 study for standard-risk acute lymphoblastic leukemia, reported by the Children's Oncology Group.

The Children's Cancer Group (CCG) 1952 clinical trial for children with standard-risk acute lymphoblastic leukemia (SR-ALL) compared intrathecal (IT) methotrexate (MTX) with IT triples (ITT) (MTX, cytarabine, and hydrocortisone sodium succinate [HSS]) as presymptomatic central nervous system (CNS) treatment. Following remission induction, 1018 patients were randomized to receive IT MTX and 1009 ITT. Multivariate analysis identified male sex, hepatomegaly, CNS-2 status, and age younger than 2 or older than 6 years as significant predictors of isolated CNS (iCNS) relapse. The 6-year cumulative incidence estimates of iCNS relapse are 3.4% +/- 1.0% for ITT and 5.9% +/- 1.2% for IT MTX; P = .004. Significantly more relapses occurred in bone marrow (BM) and testicles with ITT than IT MTX, particularly among patients with T-cell phenotype or day 14 BM aspirate containing 5% to 25% blasts. Thus, the estimated 6-year event-free survivals (EFS) with ITT or IT MTX are equivalent at 80.7% +/- 1.9% and 82.5% +/- 1.8%, respectively (P = .3). Because the salvage rate after BM relapse is inferior to that after CNS relapse, the 6-year overall survival (OS) for ITT is 90.3% +/- 1.5% versus 94.4% +/- 1.1% for IT MTX (P = .01). It appears that ITT improves presymptomatic CNS treatment but does not improve overall outcome.

Intensification of therapy for children with lower-risk acute lymphoblastic leukemia: long-term follow-up of patients treated on Children's Cancer Group Trial 1881.

PURPOSE: From December 1988 through December 1992, the Children's Cancer Group (CCG) conducted a randomized trial (CCG-1881) designed to evaluate the impact of adding a single delayed intensification phase of therapy to standard therapy for patients with newly diagnosed low-risk acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS: Patients (n = 778) with newly diagnosed ALL, 2 to 9 years of age at diagnosis with an initial WBC count less than 10,000/microL, were eligible for this protocol. All patients received induction, consolidation, and interim maintenance phases of therapy over the first 16 weeks. At week 16, patients remaining in remission were randomly assigned to receive or not receive a single 7-week delayed intensification (DI) phase of therapy. Maintenance therapy was given in lieu of or after DI, with total duration of therapy approximately 3 years for boys and 2 years for girls. RESULTS: Patients randomized to receive DI experienced fewer relapse events in all categories. Kaplan-Meier life-table estimates for continuous complete remission (CCR) at 7 years for the randomized regimens were 77% (SE, 2.4%) for the standard regimen and 83% (SE, 2.7%) for the DI regimen (P =.072). The only prognostic factor of significance post-randomization in this selected low-risk population was the day 14 marrow response (P =.0001). CONCLUSION: The addition of a single DI phase of therapy was well tolerated and augmented 7-year CCR by 6% (SE of the difference, 3.3%), resulting in 26% fewer adverse events. Overall survival for eligible patients at 7 years is 90% (SE, 1.2%).