Promoting Coordination and Collaboration in Tribal Home Visiting Programs in the United States.

BACKGROUND: A joint statement from two federal agencies in the United States calls for coordination and collaboration between programs serving families of infants and toddlers who are at risk or developmentally delayed or disabled U.S. Department of Education and U.S. Department of Health and Human Services. Policy guidance: Joint statement on collaboration and coordination of the MIECHV and IDEA Part C programs. (2017). Individuals with Disabilities Education Act. ED/HHS Joint Guidance Document: Collaboration and Coordination of the Maternal, Infant, and Early Childhood Home Visiting Program and the Individuals with Disabilities Education Act Part C Programs. Young Native American children living on tribal lands in this country are currently eligible for two federal programs associated with these agencies which overlap in mission and implementation. PURPOSE: This paper outlines potential strategies for creating a more seamless system of services for tribal families involving more centralized intake processes and procedures, cross training of staff to work across programs, and adopting more unifying approaches to program implementation. CONCLUSION: A streamlined system of services will result in interventions that better support family and child outcomes while reducing duplication of services, consolidating the limited number of qualified professionals available to provide services, and increasing convenience and cultural attunement of services to Native American families currently participating in both programs.

Melanoma and CLL co-occurrence and survival: role of KC history.

BACKGROUND: Survival following melanoma and chronic lymphocytic leukemia (CLL) have both been individually associated with previous history of non-melanoma skin cancers (specifically keratinocyte carcinomas [KC]). Furthermore, melanoma and CLL have been reported to occur within the same patients. The survival experience of patients with both cancers is understudied, and the role of history of KC is unknown. Additional research is needed to tease apart the independent associations between KC and CLL survival, KC and melanoma survival, and the co-occurrence of all three cancers. METHODS: A retrospective cohort study was conducted among patients who were diagnosed with melanoma and/or CLL at a comprehensive cancer center between 2008 and 2020. Multivariable Cox regression models were used to examine the association between history of KC and survival following melanoma and/or CLL with careful consideration of calendar year of diagnosis, treatment regimens and other risk factors. A nested case-control study comparing patients with both CLL and melanoma to those with only CLL or only melanoma was conducted to compare blood parameters across the three groups. RESULTS: A time-dependent association was observed between history of KC and favorable melanoma survival within 4 years following diagnosis and poorer survival post 7 years after melanoma diagnosis. History of KC was not significantly associated with survival following the diagnosis of CLL, after adjustment for clinical factors including historical/concurrent melanoma. Patients with co-occurring melanoma and CLL tended to be diagnosed with melanoma first and had elevated blood parameters including white blood cell and lymphocyte counts as compared with patients who were diagnosed with only melanoma. CONCLUSIONS: History of KC was an independent predictor of survival following melanoma but not of CLL. Additional studies are needed to determine if blood parameters obtained at the time of melanoma diagnosis could be used as a cost-effective way to identify those at high risk of asymptomatic CLL for the promotion of earlier CLL diagnosis.

Assessing the Contribution of Scanned Outside Documents to the Completeness of Real-World Data Abstraction.

PURPOSE: Electronic health record (EHR) data are widely used in precision medicine, quality improvement, disease surveillance, and population health management. However, a significant amount of EHR data are stored in unstructured formats including scanned documents external to the treatment facility presenting an informatics challenge for secondary use. Studies are needed to characterize the clinical information uniquely available in scanned outside documents (SODs) to understand to what extent the availability of such information affects the use of these real-world data for cancer research. MATERIALS AND METHODS: Two independent EHR data abstractions capturing 30 variables commonly used in oncology research were conducted for 125 patients treated for advanced non-small-cell lung cancer at a comprehensive cancer center, with and without consideration of SODs. Completeness and concordance were compared between the two abstractions, overall, and by patient groups and variable types. RESULTS: The overall completeness of the data with SODs was 77.6% as compared with 54.3% for the abstraction without SODs. The differences in completeness were driven by data related to biomarker tests, which were more likely to be uniquely available in SODs. Such data were prone to missingness among patients who were diagnosed externally. CONCLUSION: There were no major differences in completeness between the two abstractions by demographics, diagnosis, disease progression, performance status, or oral therapy use. However, biomarker data were more likely to be uniquely contained in the SODs. Our findings may help cancer centers prioritize the types of SOD data being abstracted for research or other secondary purposes.

History of keratinocyte carcinoma and survival after a second primary malignancy: the Moffitt Cancer Center patient experience.

PURPOSE: History of keratinocyte carcinoma (KC) has been associated with survival following the diagnosis of a second primary malignancy (SPM), with the direction of the association varying by cancer type. Research is needed to elucidate the role of other key factors in this association. METHODS: A retrospective cohort study was conducted among patients newly diagnosed and/or treated at Moffitt Cancer Center in December 2008-April 2020 with breast cancer, lung cancer, melanoma, colon cancer, prostate cancer, and non-Hodgkin lymphoma/chronic lymphocytic leukemia (NHL/CLL) (n = 29,156). History of KC was obtained from new patient intake questionnaires. Age- and stage-adjusted hazard ratios (HR) and 95% confidence intervals (CI) were calculated to estimate the association between history of KC and survival following each cancer, stratified by demographic/clinical characteristics. RESULTS: KC history was most prevalent in patients with melanoma (28.7%), CLL (19.8%) and lung cancer (16.1%). KC history was associated with better overall survival following prostate cancer (HR = 0.74, 95% CI = 0.55-0.99) and poorer overall survival following CLL (HR = 1.73, 95% CI = 1.10-2.71). Patients with a history of KC experienced better survival within the first four years of a melanoma diagnosis (HR = 0.79, 95% CI = 0.67-0.92); whereas poorer survival was observed for patients who survived 7 + years after a melanoma diagnosis (HR = 2.18, 95% CI = 1.17-4.05). Stratification by treatment and stage revealed directional differences in the associations between KC history and survival among patients with breast cancer and melanoma. CONCLUSIONS: KC history may be a predictor of survival following an SPM, possibly serving as a marker of immune function and/or DNA damage repair capacity.

A Systematic Review of Music Interventions to Support Parent-Child Attachment.

Secure attachment in early childhood is important for wellbeing throughout life. Music interventions show promise for supporting early parent-child relationships; however, their effects on attachment security are unclear as few music intervention evaluations have measured attachment outcomes. This systematic literature review aimed to synthesize published empirical literature examining the effects of music interventions on relationship quality between typically developing children aged birth to 5 years old and their parents. The study aimed to: (1) establish whether music interventions were associated with changes in attachment-related outcomes; (2) identify music intervention characteristics likely to support secure attachment; and (3) elucidate processes through which music techniques may have contributed to attachment-related changes. Included interventions focused on the parent-child dyad, involved a substantial music component delivered by a music therapist or an allied health professional, and assessed and/or described relationship outcome/s. A total of 23 studies describing 15 unique interventions met criteria for inclusion and represented approximately 808-815 parent-child dyads. Mothers were the most common caregivers. All interventions demonstrated some effectiveness, including in attachment-related outcomes such as bonding, emotional co-regulation, and parental sensitivity. All interventions involved singing, suggesting it may be especially suitable for supporting parent-child attachment; other music techniques used included instrument playing and movement to music. Findings suggested that music interventions may facilitate attachment-related changes through intervening in psychological processes, including parental sensitivity, reflective functioning, and emotional co-regulation. Future research should develop music interventions aiming specifically to support attachment quality, and music intervention evaluations should use validated attachment assessments and longitudinal study designs.

Chronic cannabis use and attentional bias: Extended attentional capture to cannabis cues.

INTRODUCTION: A significant proportion of chronic cannabis users experience occupational, social, and psychological problems thought to reflect, in part, cannabis-related cognitive and emotional attentional biases. The emotional attentional blink (EAB) is a unique test of attentional bias that assesses automatic responses, cue-detection failures, and rapid and temporally extended biases. Using the EAB, we tested users' and non-users' attentional biases and how cannabis exposure correlates with these attentional biases. METHODS: Forty-eight regular cannabis users and 51 non-users completed demographic, psychological, and cannabis-use reports and two EAB target-detection experiments. Each experiment comprised 160 trials. Each trial included a rapid serial visual presentation of images with one of four types of distractor images (cannabis, generically positive, neutral, or scrambled) preceding the target image. Distractor images were presented 200ms (Lag 2) or 800ms (Lag 8) before the target in Experiment 1 and 200ms (Lag 2) or 500ms (Lag 5) before the target in Experiment 2. RESULTS: Chronic cannabis users exhibited exaggerated, immediate attentional bias (Lag 2) and exaggerated, extended attentional bias (Lag 5) compared to non-users. The intensity of cannabis-use (grams per week) correlated with more errors at the extended attentional bias durations (Lags 5 and 8). CONCLUSIONS: Our results represent novel evidence of automatic attentional capture consistent with an exaggerated "wanting" motive in models of addiction. Our unique evidence of temporally extended attentional biases is consistent with attentional disengagement deficits associated with chronic cannabis use.

Does therapeutic equivalence follow bioequivalence? A randomized trial to assess clinical effects after switching from Clozaril to generic clozapine (gen-clozapine).

This study prospectively assessed outcomes in a group of patients who were randomly switched from Clozaril to generic clozapine (Gen-Clozapine). The authors examined data from rating scales administered before the switch and at points after the switch. There were no statistically significant differences between the groups on any baseline measures, including psychiatric status and dose of medication. In the group of patients who were switched to the generic formulation, there was a significant increase in Global Assessment Scale scores by the end of the 6-month monitoring period. In the group of patients who remained on Clozaril, a significant decrease in the 32-item Behavior and Symptom Identification Scale scores was found at the end of the monitoring period. The results of this study suggest that clinical equivalence indeed followed bioequivalence when switching from Clozaril to Gen-Clozapine.

How useful is dual energy lateral vertebral assessment in a clinic setting?

Screening for osteoporotic vertebral fractures traditionally involves X-ray of the thoracic and lumbar spine. We evaluated use of dual energy X-ray technology in patients with osteoporosis. We found this technology useful in the clinic setting and it has advantages in that less radiation is delivered to the patient.

Commentary: the coalition for improving maternity services:.

A consumer advocate, two childbirth educators, and a certified nurse-midwife each provide commentary on the effectiveness of and potential uses for the Evidence Basis for the Ten Steps of Mother-Friendly Care.

Reproductive health and preconception counseling awareness in adolescents with diabetes: what they don't know can hurt them.

PURPOSE: This study explored the awareness of issues related to diabetes and pregnancy, preconception counseling (PC), and contraception in adolescent women with type 1 diabetes (T1D). METHODS: A descriptive-qualitative method was used to collect open-ended data during a telephone interview on reproductive health by same-gender research assistants. Eighty subjects were recruited from multiple sites (mean age = 17.6 +/- 1.0 year; range, 16-20). Questions focused on 2 themes, awareness of diabetes and reproductive health (pregnancy, PC, birth control) and where to seek information about these issues. Responses were written verbatim. Pattern recognition detected common themes. Results were cross-checked for interrater reliability. RESULTS: Overall, the response "don't know" or "never heard about it" was most frequently given. Most teens in this sample were unaware of the term preconception counseling; 65% (n = 52) indicated they knew nothing about PC. Many were not aware of the risks of pregnancy-related complications in women with diabetes. One fourth of the teens were aware of preplanning a pregnancy and the importance of good metabolic control. Many knew where to seek information about diabetes and pregnancy, and birth control. CONCLUSIONS: This sample of teens lacked awareness of pregnancy-related complications with diabetes, the term and role of PC in preventing these complications, and the importance for women with diabetes to use a highly effective birth control method for preventing an unplanned pregnancy. Because of its implications for future reproductive health behavior and preventing unplanned pregnancies and complications, during their routine clinic visits, it is imperative for health professionals to raise these issues with their adolescent female patients.

Occupational therapy compared with social work assessment for older people. An economic evaluation alongside the CAMELOT randomised controlled trial.

OBJECTIVES: To compare costs and outcome of occupational therapy-led assessment with social worker-led assessment of older people, in terms of their independence and quality of life. DESIGN: Cost-effectiveness analysis alongside a randomised controlled trial. The analysis took viewpoints of health services and patients. The primary outcome measure for cost-effectiveness was dependency using the Community Dependency Index (CDI). Secondary outcomes included utility scores based on the EuroQoL (EQ-5D). Resource use was measured for each patient, from clinical records and from patient carer interviews at 8 months. Unit costs of health and social care resources were derived from local sources and national datasets. Cost-effectiveness was analysed using cost-effectiveness acceptability curves. RESULTS: There were no differences between the two arms of the trial in terms of cost-effectiveness. There is an apparent increase in mean cost per case for the occupational therapy arm but this is not statistically significant (mean difference in cost per case 542 pounds, 95% CI 434-1,519 pounds). Mean total costs of care per participant were 4,379 pounds and 3,837 pounds for the occupational therapy and social work arms, respectively. At best the intervention would improve outcomes at a cost of 14,000 pounds per quality-adjusted life year (QALY). The probability of such an outcome was <50%. CONCLUSIONS: From a policy perspective, the lack of difference in clinical and cost-effectiveness means that either a social work or an occupational therapy service is successful in making care assessments that enable an older person to remain in their own home.

Are occupational therapists more effective than social workers when assessing frail older people? Results of CAMELOT, a randomised controlled trial.

OBJECTIVES: To compare the effectiveness of occupational therapist-led assessments of older people on dependency and service costs with that of social worker-led assessments. DESIGN: Pragmatic community-based randomised controlled trial over 2 years 4 months. SETTING: Cambridgeshire, UK. PARTICIPANTS: 321 older people aged 65 and over living in their own homes and 113 carers. INTERVENTION: participants were randomised to two groups, to receive either occupational therapist-led or social worker-led assessment. OUTCOME MEASURES: Primary outcome was dependency (Community Dependency Index). Secondary outcomes included quality of life scores (EQ-5D) and psychological outlook (Perceived Stress Scale (PSS)). Outcome measures for carers included Carer Assessment of Difficulty Index (CADI), PSS and EQ-5D, collected at baseline, 4 and 8 months. Resource use data were collected from professional practice records, participants and carers at final follow-up. RESULTS: 264 (82%) of the randomised participants completed the study. No between-group statistically significant differences were found, except that carers in the occupational therapist arm had significantly better EQ-5D scores at the 8 month follow-up (thermometer P = 0.03) and in the social worker arm better CADI scores on stress (P = 0.047) and amount of caring (P = 0.049). CONCLUSIONS: There was no clear difference in patient-centred effectiveness measures between occupational therapists and social workers in assessing frail older people and their carers in the community. More extensive use of primary care health services by occupational therapists may have contributed to the differences in EQ-5D scores for carers. Delays in making occupational therapy assessments and in completing recommended housing adaptations may have contributed to these negative findings.

Tearing down the walls between O.R. and S.P.D.

The focus of this article is the relationship between the Operating Room (O.R.) and the Sterile Processing Department (S.P.D.). The goal is to help readers gain insights into the driving forces which impact on both departments and to help them establish realistic expectations for improving the performance and quality of this relationship. It is important to discuss ways to solve conflict and enhance teamwork between the O.R. and S.P.D. Both departments need to establish a common understanding and ensure that everyone "talks the same language" and "tears down the walls" between them. For the purpose of this article the short form of S.P.D. will be used for Sterile Processing Department (sometimes known as Central Processing), the department where instrument processing takes place and the distribution center for the entire hospital's supplies.

Survival and growth of Listeria monocytogenes and Escherichia coli O157:H7 in ready-to-eat iceberg lettuce washed in warm chlorinated water.

Cut iceberg lettuce inoculated with Escherichia coli O157:H7 and Listeria monocytogenes before and after washing for 3 min in cold (4 degrees C) and warm (47 degrees C) water containing 100 mg/liter total chlorine was stored at I and 10 degrees C in oxygen-permeable film packages (6,000 to 8,000 cc/m2/24 h). Cold chlorinated water was detrimental to the survival of E. coli O157: H7 and L. monocytogenes at both storage temperatures. In contrast, washing in warm chlorinated water favored the growth of both pathogens in lettuce stored at 10 degrees C. There was no evidence of a relationship between the magnitude of spoilage microflora and the fate of either bacterium.

RT-PCR Based Detection of Rupestris stem pitting associated virus Within Field-Grown Grapevines Throughout the Year.

The presence of Rupestris stem pitting associated virus (RSPaV) can go unnoticed since symptoms appear only if additional viruses are present. Detection by reverse transcription-polymerase chain reaction (RT-PCR) is possible; however, this assay could be unreliable if the tissue that is being tested has detection-interfering compounds, or if the virus has a low titer. This paper reports on (i) use of a recently developed extraction method and internal control to determine which tissues from field-grown grapevines yield extracts that are reliable for virus detection by RT-PCR, and (ii) a survey for RSPaV of different tissues from the Vitis vinifera varieties Riesling, Chardonnay, Cabernet Franc, Merlot, Sauvignon Blanc, Pinot Noir, and Gamay, as well as from the rootstocks 3309 and Riparia, which were harvested in Ontario, Canada, at different times of the year. Amplifiable extracts were obtained from virtually all bud, shoot tip, seed, and cane samples tested. Detectable amounts of RSPaV were generally found in all tissues of infected plants except young buds collected in the summer. A combination of three single buds from dormant canes, less time-consuming than the preparation of cane shavings, was a reliable source for RSPaV detection.