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Abstract Background Mucopolysaccharidosis II (MPS II) is a rare lysosomal storage disease characterized by iduronate-2-sulfatase gene (IDS) deficiency and downstream glycosaminoglycan accumulation. Two-thirds of patients present with neuronopathic disease and evaluating cognitive function in these patients is challenging owing to limitations of currently available tests. During the clinical development of intrathecal idursulfase (idursulfase-IT), regulatory authorities requested qualitative data to further understand the neurocognitive changes observed by the investigators through the clinical trials. Results This qualitative study consisted of semi-structured interviews with all nine of the principal investigators who participated in the idursulfase-IT phase 2/3 (NCT02055118) and extension (NCT02412787) trials. These investigators enrolled the 56 patients with neuronopathic MPS II who qualified for the extension phase of the trial. The investigators were asked to rate the disease status of their patients. Of the 56 patients, 49 (88%) were rated as having disease that was improved/improving, stabilized or slowing progression compared with the expected outcomes with no treatment. Three patients were rated as worsening, while the remaining four patients were considered to have slowing progression or worsening disease. Similar results were demonstrated for patients aged from 3 to under 6 years at baseline, with 33 of 39 patients (85%) rated as having disease that was improved/improving, stabilized or slowing progression. Of the seven patients rated with slowing progression/worsening or worsening disease, five of them had an IDS variant other than missense, while two had a missense class variant. All the assigned improved/improving ratings were in patients receiving idursulfase-IT from the start of the phase 2/3 trial. Moreover, patients under 3 years of age at baseline were all rated as either improved/improving or stabilized disease. In a blinded review of patient profiles, investigators were requested to assign a disease status rating to 18 patients with large IDS deletions; 67% of these patients were rated as improved/improving or stabilized disease. Conclusions This qualitative analysis provides a snapshot of clinicians’ considerations when evaluating treatment in patients with neuronopathic MPS II, compared with the expected decline in cognitive function in the absence of treatment. The results highlight the importance of robust assessment tools in treatment evaluation.

Abstract Background The associations of adiposity with aggressive prostate cancer risk are unclear. Using two‐sample Mendelian randomization, we assessed the association of metabolically unfavourable adiposity (UFA), favourable adiposity (FA) and for comparison body mass index (BMI), with prostate cancer, including aggressive prostate cancer. Methods We examined the association of these genetically predicted adiposity‐related traits with risk of prostate cancer overall, aggressive and early onset disease using outcome summary statistics from the PRACTICAL consortium (including 15,167 aggressive cases). Results In inverse‐variance weighted models, there was little evidence that genetically predicted one standard deviation higher UFA, FA and BMI were associated with aggressive prostate cancer [OR: 0.85 (95% CI:0.61–1.19), 0.80 (0.53–1.23) and 0.97 (0.88–1.08), respectively]; these associations were largely consistent in sensitivity analyses accounting for horizontal pleiotropy. There was no strong evidence that genetically determined UFA, FA or BMI were associated with overall prostate cancer or early age of onset prostate cancer. Conclusions We did not find differences in the associations of UFA and FA with prostate cancer risk, which suggest that adiposity is unlikely to influence prostate cancer via the metabolic factors assessed; however, these did not cover some aspects related to metabolic health that may link obesity with aggressive prostate cancer, which should be explored in future studies.

Abstract Background Metachromatic leukodystrophy (MLD) is a rare lysosomal storage disease caused by deficient activity of arylsulfatase A (ASA). Treatment options for patients are limited; gene therapy based on haematopoietic stem cell transplantation is the only approved treatment for some subtypes of MLD. Any therapeutic benefit of treatments must be meaningful for patients and their families. We evaluated the clinical meaningfulness of slowing the decline in gross motor function as measured by the Gross Motor Function Classification in MLD (GMFC-MLD) from the caregiver perspective via semi-structured telephone interviews with caregivers of children with late-infantile MLD. We also evaluated the perceived significance of declines in communication abilities measured by the Expressive Language Function Classification in MLD (ELFC-MLD). This work could help to inform the endpoints of a phase 2 clinical trial (NCT03771898) assessing the efficacy of intrathecal recombinant human ASA in MLD. Results Twelve caregivers were recruited, reporting on 12 children with MLD. Children had a mean age of 6.1 years; mean age at symptom onset was 17.6 months. Most children (10/12) progressed from walking without support (categories 0–1) to a loss of locomotion (categories 5–6) in ≤ 2 years. Caregivers felt that GMFC-MLD and ELFC-MLD accurately described motor and language declines in their children, respectively. Most caregivers (10/12) reported that the idea of delaying disease progression would be meaningful. Further, a slowing of motor function decline in GMFC-MLD, from category 1 to category 3 or from category 2 to category 4 over 2 years, was seen as meaningful by all caregivers asked; however, only 3/12 caregivers reported that delayed decline would be meaningful if baseline category was ≥ 3. Caregivers also reported that delaying expressive language decline at any level that did not indicate a complete loss of expressive language (indicated by categories 1–3) would be meaningful. Conclusions Caregivers of children with MLD felt that a delayed decline in gross motor function, as assessed by the GMFC-MLD, would be meaningful, supporting the selection of primary and secondary endpoints for the phase 2 clinical trial. Communication abilities were another area of significance for consideration in future clinical trial design.

Abstract Background Patient-reported outcome (PRO) measures are important to consider when evaluating treatments, yet there are no PRO measures for patients with acromegaly that have been developed in accordance with US Food and Drug Administration guidance. Acromegaly is a rare, chronic condition caused by hypersecretion of growth hormone. Disease activity is monitored by measurement in serum of growth hormone and insulin-like growth factor-I. The objectives of this research were to develop the Acromegaly Symptom Diary (ASD), establish a scoring algorithm, and evaluate the psychometric measurement properties of the ASD. Methods Semistructured interviews consisting of concept elicitation and cognitive debriefing components were conducted with 16 adult participants with acromegaly. The concept elicitation component identified symptoms important to individuals with acromegaly. The cognitive debriefing component gathered information about the participants’ experience with each proposed item of the ASD, their thought process for answering each question, and their interpretation of the items. The psychometric properties of the draft ASD were then evaluated using data from the ACROBAT Evolve (NCT03792555; n = 13) and ACROBAT Edge (NCT03789656; n = 47) clinical trials. Results The 16 participants from the interviews described ongoing symptoms, with the most frequently reported being joint pain (n = 13) and fatigue (n = 12), followed by swelling (n = 8), headache (n = 7), and mood swings (n = 6), and were able to interpret and understand the ASD items and had no issues with the 24-hour recall period. From data collected in the clinical studies, the psychometric properties of internal consistency (0.91 − 0.80), test-retest reliability with item-level and total ASD scores (> 0.70), baseline construct validity (r ≥ |0.38|) across scales, and responsiveness to change (r = 0.52–0.56) were supported for the ASD. The proposed preliminary threshold range to characterize a meaningful change from the patients’ perspective for the ASD total is a 4- to 6-point change for improvement or worsening out of a total score of 70. Conclusion These findings provide qualitative and quantitative evidence to support the ASD as fit for the purpose of evaluating the symptom experience of patients with acromegaly in clinical trials.

Abstract Background This study evaluates the effectiveness of a targeted telephone-based case management service that aimed to reduce ED attendance amongst frequent attenders, known to disproportionately contribute to demand. Evidence on the effectiveness of these services varies. Methods A 24-month controlled before-and-after study, following 808 patients (128 cases and 680 controls (41 were non-compliant)) who were offered the service in the first four months of operation within a UK ED department. Patients stratified as high-risk of reattending ED within 6 months by a predictive model were manually screened. Those positively reviewed were offered a non-clinical, nurse-led, telephone-based health coaching, consisting of care planning, coordination and goal setting for up to 9 months. Service effectiveness was estimated using a difference-in-differences (DiD) analysis. Incident rate of ED and Minor Injury Unit (MIU) attendances and average length of stay in intervention recipients and controls over 12 months after receiving their service offer following ED attendance were compared, adjusting for the prior 12-month period, sex and age, to give an incidence rate ratio (IRR). Results Intervention recipients were more likely to be female (63.3% versus 55.4%), younger (mean of 69 years versus 76 years), and have higher levels of ED activity (except for MIU) than controls. Mean rates fell between periods for all outcomes (except for MIU attendance). The Intention-to-Treat analysis indicated non-statistically significant effect of the intervention in reducing all outcomes, except for MIU attendances, with IRRs: ED attendances, 0.856 (95% CI: 0.631, 1.160); ED admissions, 0.871 (95% CI: 0.628, 1.208); length of stay for emergency and elective admissions: 0.844 (95% CI: 0.619, 1.151) and 0.781 (95% CI: 0.420, 1.454). MIU attendance increased with an IRR: 2.638 (95% CI: 1.041, 6.680). Conclusions Telephone-based health coaching appears to be effective in reducing ED attendances and admissions, with shorter lengths of stay, in intervention recipients over controls. Future studies need to capture outcomes beyond acute activity, and better understand how services like this provide added value.

Background: Some individuals living with obesity may be relatively metabolically healthy, whilst others suffer from multiple conditions that may be linked to adverse metabolic effects or other factors. The extent to which the adverse metabolic component of obesity contributes to disease compared to the non-metabolic components is often uncertain. We aimed to use Mendelian randomisation (MR) and specific genetic variants to separately test the causal roles of higher adiposity with and without its adverse metabolic effects on diseases. Methods: We selected 37 chronic diseases associated with obesity and genetic variants associated with different aspects of excess weight. These genetic variants included those associated with metabolically ‘favourable adiposity’ (FA) and ‘unfavourable adiposity’ (UFA) that are both associated with higher adiposity but with opposite effects on metabolic risk. We used these variants and two sample MR to test the effects on the chronic diseases. Results: MR identified two sets of diseases. First, 11 conditions where the metabolic effect of higher adiposity is the likely primary cause of the disease. Here, MR with the FA and UFA genetics showed opposing effects on risk of disease: coronary artery disease, peripheral artery disease, hypertension, stroke, type 2 diabetes, polycystic ovary syndrome, heart failure, atrial fibrillation, chronic kidney disease, renal cancer, and gout. Second, 9 conditions where the non-metabolic effects of excess weight (e.g. mechanical effect) are likely a cause. Here, MR with the FA genetics, despite leading to lower metabolic risk, and MR with the UFA genetics, both indicated higher disease risk: osteoarthritis, rheumatoid arthritis, osteoporosis, gastro-oesophageal reflux disease, gallstones, adult-onset asthma, psoriasis, deep vein thrombosis, and venous thromboembolism. Conclusions: Our results assist in understanding the consequences of higher adiposity uncoupled from its adverse metabolic effects, including the risks to individuals with high body mass index who may be relatively metabolically healthy. Funding: Diabetes UK, UK Medical Research Council, World Cancer Research Fund, National Cancer Institute.

Abstract Background and methods Metachromatic leukodystrophy (MLD) is a rare, autosomal recessive lysosomal storage disease caused by deficient activity of arylsulfatase A. Neurological involvement results in severe disability and premature death, but understanding of the natural history of the disease remains limited. In this study, 32 caregivers of patients with MLD in the USA (16 with late-infantile MLD; 16 with juvenile MLD) were interviewed about their experiences of the disease. Qualitative analysis of the interview transcripts was performed to gain insights into symptom onset, the diagnostic process and disease progression, with a focus on the differences between late-infantile and juvenile MLD. Results The mean ages of patients at interview were 7.6 years and 20.7 years for individuals with late-infantile and juvenile MLD, respectively. Patients with late-infantile MLD had a mean age of 1.5 years at symptom onset and 2.6 years at diagnosis. The most common initial symptoms in this group related to problems with gross motor function (12/16 patients); 11 patients never learned to walk independently. For patients with juvenile MLD, the mean ages at symptom onset and diagnosis were 8.7 years and 11.6 years, respectively. Cognitive or social/behavioural problems were the most common first reported symptoms in this group (9/16 and 7/16 patients, respectively); these were generally followed by deterioration in motor function. The rate of functional decline was more rapid in patients with late-infantile MLD than those with juvenile MLD; the mean time from first symptom to first functional loss was 1 year versus 6.1 years, respectively. Nine patients with juvenile MLD and three with late-infantile MLD had undergone a haematopoietic stem cell transplant; outcomes following transplant were variable. Conclusions Our data highlight clear overall differences in symptom profiles and disease progression between late-infantile and juvenile MLD, but also indicate some degree of interindividual variability within each subtype. These findings are broadly consistent with previously published descriptions of MLD and enhance our knowledge of the natural history of the disease, which ultimately should help to improve patient care and aid assessments of the effectiveness of disease-related interventions in the future.

IntroductionAlthough shortcomings in clinician–family communication and decision making for incapacitated, critically ill patients are common, there are few rigorously tested interventions to improve outcomes. In this manuscript, we present our methodology for the Pairing Re-engineered Intensive Care Unit Teams with Nurse-Driven Emotional support and Relationship Building (PARTNER 2) trial, and discuss design challenges and their resolution.Methods and analysisThis is a pragmatic, stepped-wedge, cluster randomised controlled trial comparing the PARTNER 2 intervention to usual care among 690 incapacitated, critically ill patients and their surrogates in five ICUs in Pennsylvania. Eligible subjects will include critically ill patients at high risk of death and/or severe long-term functional impairment, their main surrogate decision-maker and their clinicians. The PARTNER intervention is delivered by the interprofessional ICU team and overseen by 4–6 nurses from each ICU. It involves: (1) advanced communication skills training for nurses to deliver support to surrogates throughout the ICU stay; (2) deploying a structured family support pathway; (3) enacting strategies to foster collaboration between ICU and palliative care services and (4) providing intensive implementation support to each ICU to incorporate the family support pathway into clinicians’ workflow. The primary outcome is surrogates’ ratings of the quality of communication during the ICU stay as assessed by telephone at 6-month follow-up. Prespecified secondary outcomes include surrogates’ scores on the Hospital Anxiety and Depression Scale, the Impact of Event Scale, the modified Patient Perception of Patient Centredness scale, the Decision Regret Scale, nurses’ scores on the Maslach Burnout Inventory, and length of stay during and costs of the index hospitalisation.We also discuss key methodological challenges, including determining the optimal level of randomisation, using existing staff to deploy the intervention and maximising long-term follow-up of participants.Ethics and disseminationWe obtained ethics approval through the University of Pittsburgh, Human Research Protection Office. The findings will be published in peer-reviewed journals.Trial registration numberNCT02445937

Introduction: If integrated care approaches are to be properly adapted to local contexts, a better understanding is required of key determinants of implementation and how these might be appropriately supported. Purpose: This study applied the Canadian Context and Capabilities for Integrating Care (CCIC) Framework to investigate factors influencing the implementation and outcomes of a complex integrated care change programme in Torbay and South Devon (TSD) and, more specifically, in one of five sub-localities, Coastal. Methods: A case study method using embedded ‘Researchers in Residence’ to conduct action-based participatory research and deploying mixed qualitative methods. Results: The relative importance of some domains differ between the English and Canadian studies. In this case study, physical features (structural and geographic) were found to be very pertinent to the relative success of the Coastal Locality, as were empowered clinical leadership, with readiness for change being expressed through processes and cultures that were risk-enabling, strengths-based, person-/outcome-focused. Conclusions: The CCIC Framework provided a useful tool capturing key elements of complex system change with key domains being transferable across settings, while also finding local variation in the UK. This would encourage its wider application so that further comparisons can be made of the ways in which different contextual and implementation properties impact upon delivery and outcomes.

Abstract Background Metachromatic leukodystrophy (MLD) is a rare disease with three forms based on the age at onset of signs and symptoms. The objective of this study was to develop a caregiver-reported clinical outcome assessment that measures impairments in physical functioning related to activities of daily living in patients with juvenile MLD. Methods A targeted literature review and exploration of proprietary research, including a conceptual model, were conducted. Concept elicitation interviews were conducted to elicit additional concepts related to impairments in patients’ physical functioning with caregivers of five individuals with juvenile MLD. Based on the research review and concept elicitation interviews, the conceptual model was updated and the Impact of Juvenile Metachromatic Leukodystrophy on Physical Activities (IMPA) scale draft items were created. Cognitive debriefing interviews were conducted with six additional caregivers to finalize the conceptual model and to refine the IMPA scale. Results Initially, 17 potentially important concepts were identified and addressed in the draft IMPA scale. Following the cognitive debriefing interviews, 15 activities/items remained: brush teeth, comb/brush hair, bathe/shower, dress self, eat, drink, use pencil/crayon, sit upright, use toilet, get on/off toilet, walk, use stairs, get in/out of bed, get in/out of chair/wheelchair, and get in/out of vehicle. Items that did not uniquely contribute to the purpose of the instrument were removed. Conclusion The IMPA scale, developed according to regulatory standards, provides a means of detecting changes in activities of daily living in individuals with juvenile MLD and can hence be used in future studies to measure benefits of therapeutic interventions.

Written clarity and conciseness are desired by employers and emphasized in business communication courses. We developed and tested the efficacy of a cueing tool--Scribe Bene--to help students reduce their use of imprecise and ambiguous words and wordy phrases. Effectiveness was measured by comparing cue word usage between a treatment group given the tool and a control group without the tool. In written assignments, the treatment group used 16 of 23 cue words significantly less than the control group and this effect persisted over time. Implications for using automated cueing tools in teaching written communication skills are discussed.

Nutritional rickets is the failure of normal bone formation in children, caused by vitamin D deficiency, low calcium intake, or a combination of both. In the United States, prolonged breastfeeding without vitamin D supplementation is a major risk factor. Increasing awareness of the rationale for and importance of vitamin D supplements for all breastfed infants and children should reduce the incidence of vitamin D deficiency rickets and prevent bone deformity. [ABSTRACT FROM AUTHOR]

Movements precipitated by humanitarian crises have implications that touch upon immigration control and national interests, human rights, humanitarian and development principles, and the frameworks for international protection, cooperation and burden sharing. Existing legal and institutional frameworks manifest limited capacity to accommodate all those with protection needs. Even when frameworks exist, in practice there are considerable gaps in implementation.

2011 marks the anniversary of two important events in refugee protection. In 1951, the United Nations adopted the UN Convention Relating to the Status of Refugees. Forty years later, in 1991, the Executive Committee of the Office of the UN High Commissioner for Refugees (UNHCR) adopted Guidelines on the Protection of Refugee Women. Since 1991, there has been both progress and setbacks in providing equal and effective protection to both male and female refugees. The article concludes that the gap between rhetoric and reality for women and girls is still very large. Following a brief discussion of the demographic profile of refugees, the article discusses issues related to legal protection, physical security, and social and economic rights for refugee and displaced women. The article call for renewed efforts to implement fully the various legal instruments and guidelines that set out norms and standards of protection for refugees generally and women and girls specifically and to ensure that refugee and displaced women are able to participate actively in decisions that affect them and their families.

Researchers have much to do, not only to understand climate- and disaster-induced migration but also to transmit their understanding for the use of policymakers and practitioners.

In order to avoid displacement when possible, displacement and human mobility issues need to be better integrated within national and regional adaptation planning processes.

Objective To perform comparative validity testing for a bilingual interactive multimedia (IMM) dietary assessment tool that mimics a dietary recall against an interview-administered dietary recall. Design This was a two-period crossover design study. First, participants were randomly assigned to complete an IMM recall or interview-administered 24-hour recall. The IMM recall generated a nutrient profile that included 20 dietary constituents. The interview-administered recall was analyzed using the Food Intake Analysis System (FIAS) and the Expanded Food and Nutrition Education Program (EFNEP) Evaluating/Reporting System. The effect of substituting standardized portion sizes for reported portion sizes was examined. Subjects/setting Of 80 adult participants, 71 (91%) were female, 45 (56%) had 12th grade or less education, 65 (81%) had an annual income of $15,000 or less, and 21 (26%) completed the IMM recall in Spanish. Statistical analyses performed Analysis of variance and unadjusted and energy-adjusted correlations were used. Results No significant group differences were found for order of administration or demographic characteristics. There was only one significant (P=.025) method effect, whereby vitamin C intake was higher in the IMM recall than the FIAS. The unadjusted correlations between the IMM recalls and interview-administered recalls analyzed using both FIAS and EFNEP Evaluating/Reporting System were generally approximately 0.6. Energy-adjusted correlations were consistently lower. Substituting standardized portion sizes resulted in significant differences for six nutrients and caused all correlations to decrease. Conclusions The IMM dietary recall is a valid method for assessing dietary intake within the tested group. The results of comparative validity testing and positive reactions received from participants and nutrition educators indicate that diet assessment using IMM has tremendous potential. J Am Diet Assoc. 2005; 105:1206-1214.

Spanish director Julio Medem’s visually stunning yet controversial 2007 film Chaotic Ana was panned for its ostensibly Manichaean treatment of gender relations and its crudely scatological ending, both of which have distracted attention from the work’s fascinating incursions into global politics. While the film’s complex layering of hawk and dove imagery figures centuries of male violence against women, it is also imbricated with an extended meditation on the divergent roles of the United States and Spain on the contemporary world stage. Through the male protagonist Said, a Saharawi painter, the film artfully shifts postcolonial guilt for the fate of the Western Sahara from the former colonizer Spain to the United States. Even as the film obfuscates Spain’s multifaceted imperial past, it engages in a withering indictment of U.S. foreign policy in the post-9/11 era, indicating through a web of symbolic references to the Statue of Liberty that Americans have turned away from their once-vaunted mission. That mission, the film (problematically) suggests, must now be taken up by Spain, which, together with other enlightened European nations, serves as a beacon for global justice, drawing upon the Spanish National Court’s declaration of universal jurisdiction to prosecute the U.S. government’s neocolonial crimes against humanity.

In 1989 Roberta Cohen challenged scholars, policymakersand practitioners who focused exclusively on refugees– people who had crossed an international border – torethink their approach. She has continued to identify researchquestions intersecting the interests of the two communities.

Trafficking of people within countries has been relatively neglected. Should those who are internally trafficked be regarded as IDPs?

Since the early 1970s, conflict in Burundi has caused more than 200,000 Burundians to lose their lives, many to flee abroad and manymore to be displaced, some temporarily and some more long term.

Traditionally, dietetics professionals have used computers to perform nutrient analysis (1,2), word processing, and spreadsheet applications (1). Emerging computer technology, however, provides individual users with the ability to easily produce […]

Diet-related diseases are the primary contributor to morbidity and mortality. The risk for these diseases can be reduced with a whole-food plant-based (WFPB) diet, butmost people are never counseled on this dietary pattern. An experiential education program was designed and conducted in which sample of 30 nurse practitioners, registered nurses, and physicians learned about and followed a WFPB diet for 3 weeks. The objective was for the health care providers to increase their knowledge and acceptance of WFPB diets and increase their likelihood of counseling patients on this dietary pattern. Participants completed preintervention and postintervention questionnaires assessing dietary intake, knowledge, weight, mood, energy, benefits, barriers, self-efficacy, and likelihood of continuing to follow, or counsel patients about a WFPB diet. Participants decreased intake of animal-derived foods, increased intake of WFPB foods, had improvements in mood and energy, and lost weight. Perceived barriers to following and counseling about a WFPB diet declined and self-efficacy improved. Participants were likely to continue a WFPB diet and discuss the diet with their patients. The three-week intervention changed providers' knowledge, skills, and attitudes about WFPB diets. If nurse practitioners and other providers accept WFPB diets, more patients may be educated on this dietary pattern, helping to reduce the burden of diet-related chronic diseases. [ABSTRACT FROM AUTHOR]

This study identifies a set of journals that report on interior design research and proposes a ranking of those journals determined by a survey of peer reviews. Based on an online survey, journals in which interior designers commonly publish were assessed in terms of prestige, contribution to theory, contribution to practice, and contribution to teaching. It was found that while a diversity of journals were proposed, there was agreement among interior design educators in the ranking of a top tier of journals. Furthermore, it was found that academic status, type of institutional affiliation, and geographic location are all significant to journal rankings. The results of the study offer a guide to both evaluators and those evaluated when judging or selecting research outlets and in the process of tenure and promotion decisions. [ABSTRACT FROM AUTHOR]

Digitized photographs of nutritional food can be found in the booklets distributed by daycare providers in Colorado. The booklets are used to promote the USDA's Child and Adult Care Food Program. The digitized photographs can be improved if more time is spent in experimenting with contrast and brightness. The digitized photographs should also vary in size, and the grayscale halftones should be enhanced. Other improvements in digitizing can be achieved through increased precision in formatting and layout and through photocopying copies of laser-printed computer output.

The purpose of this research was to determine perceptions of low-income and Hispanic audiences residing in a rural mountain county toward a bilingual interactive multimedia nutrition education program, La Cocina Saludable (The Healthy Kitchen). In-depth key informant interviews were conducted by a Cooperative Extension agent and a local bilingual woman at 2 sites serving these audiences. All participants at the Early Head Start Center had engaged with La Cocina Saludable prior to the interviews and received lesson reminders for each completed module. In contrast, only 2 of the recruited participants at Eagle Care Clinic had used the program prior to the interviews. Of 27 total interviews, 25 (89%) were conducted in Spanish. All participants at the Early Head Start expressed positive comments about using the program and would be willing to spend more time on the computer. They also reported having tried several concepts at home, such as using less oil and eating fewer fats, using a shopping list, eating correct portion sizes, eating whole-wheat bread, and cleaning the cutting board after each food. The participants at the clinic were positive about possibly using a computer to learn about nutrition, especially during the long time waiting for their appointments. However, they felt that they needed more information about the program or permission to use it. Although the participants at the 2 locations had different experiences with the program, the results from the interviews provided information about outcomes and insight into implementation strategies to increase reach.

Date Presented 04/02/2022 Understanding the relationship between age and pedal use is crucial for accurate recommendations in driving. This study examined the relationship between age and foot pressure inaccuracy in healthy adults ages 30 to 60 years. The results showed no significant difference between foot pressure inaccuracy and age, but what does this mean to the clinician? This presentation will provide clinical implications as well as other important points to consider when assessing pedal use in clients. Primary Author and Speaker: Mary Culshaw Additional Authors and Speakers: Susan Martin Touchinsky, Maria Nagle, Ashley Swackhamer, Emily Szuter [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore how students' aesthetic understanding and ability to empathize were impacted by multiple learning experiences in the environment of an art museum. As part of a semester-long class in elementary art methods, education majors experienced a docent-led tour of the local art museum, featuring the work of fibre artist Deidre Scherer. The tour was followed by a series of learning events centred on the exhibit and the study of end-of-life care, the theme of Scherer's work. Students then answered structured questionnaires prompting them to process the learning events with intentional reflection. A qualitative method of enquiry sought to uncover the lived experiences of the students enrolled in the class. Through these encounters, students developed empathy and understanding as well as the ability to describe the meanings of the art in terms of their own life scenarios. [ABSTRACT FROM AUTHOR]

ABSTRACT Systems of journal ranking can be arbitrary and problematic, particularly in highly specialized academic fields where journals are of limited scope and circulation. One field in which journal ranking is problematic is interior design. This article addresses existing ranking systems for academic journals and explores the limitations of these ranking systems. An attempt is made to suggest effective methods that could be developed for ranking interior design journals. The multiple factors that need to be considered in ranking journals in such a specialized field are discussed, including ranking bias, categorical specialization, and geographic and institutional variables. Implications of this review indicate that journal ranking for interior design should be considered within the context of relevant specialized journals rather than the current practice that places interior design in a broad comparative ranking system outside of its field. Multiple cross-referencing measurements, including impact factors, subject-specific citation rates, and acceptance rates, as well as prestige factors based on peer perceptual ranking of interior design journals need to be implemented. Faculty and institutional evaluations need to be based on composite factors that take into account not only a meaningful journal ranking system, but also a broader, and at the same time more accurate, metric to include the actual value of the publication itself, the focus of research, and the goals of the individual and of the institution. [ABSTRACT FROM AUTHOR]

A Classroom Response System (CRS) is a communication device instructors can use to promote active learning. CRS have been shown to have other benefits including better attendance, increased peer instruction, higher test scores, better grades, and the ability to use contingent teaching methods. Contingent teaching methods allow instructors to gain real-time understanding of what students know and comprehend and make adjustments to lesson plans as needed. This study investigated hospitality students' attitudes regarding CRS technology. The study was conducted over a three-semester period and surveyed hospitality students (n=117) in an introductory foods course in which a CRS was used. Students indicated CRS helped them understand concepts, engage in discussion, and motivated them to attend. [ABSTRACT FROM AUTHOR]

A long-standing collaboration between interior design faculty and health sciences faculty at a university has allowed for innovation of course development by combining design principles and health in the study of end-of-life care. An honors seminar was designed using an interdisciplinary model. Instructors, students, and content were integrated on multidimensional levels. The course was co-taught by a team from the interior design and health disciplines. Interprofessional service learning became the framing pedagogy to augment clinical preparation of future health professionals. The innovative pedagogy was developed to engage honors students in community service learning through the vehicles of art and health. The course offered interdisciplinary didactic and experiential opportunities to explore the interrelatedness of content, form, and subject as a unifying aesthetic framework that focuses on end-of-life care. The interdisciplinary educational model took a humanistic approach to the artistic study of end-of-life care, incorporating the historical context of disease and illness as a subject matter and form in art. The successful integration of art and health allowed students to come to terms with the intangible experiences of the cycle of life, death and dying. [ABSTRACT FROM AUTHOR]

Objective: To examine characteristics and patterns of healthcare utilization of patients with fibromyalgia (FM) under the care of general practitioners (GPs) in Germany.Research design and methods: Retrospective cohort study, using a large electronic database with information on GP encounters in Germany (IMS MediPlus). We identified all patients, aged ≥18 years, with any encounters for FM (ICD-10 diagnosis code M79.7) between February 1, 2004 and January 31, 2007. We also constituted a comparison group consisting of randomly selected patients with one or more GP encounters – but none for FM – during this period, who we matched to FM patients based on age and sex. Characteristics and healthcare utilization of patients in the FM and comparison groups were then examined over the 1-year period, February 1, 2006–January 31, 2007.Main outcome measures: Prevalence of co-morbidities; use of pain-related pharmacotherapy; number of GP office visits; number of specialist referrals; and number of sick notes (physician-excused absences from work).Results: The study sample consisted of 4983 FM patients and an identical number in the comparison group. Mean age was 58 years; 87% were women. The prevalence of various co-morbidities was greater among FM patients, including painful neuropathies (33% vs. 18% for comparison group) and depression (20% vs. 5%) (both p<0.01); more FM patients also received pain-related pharmacotherapy (67% vs. 28%; p<0.01). Compared with patients in the comparison group, FM patients averaged approximately twice as many GP visits (11.4 [SD=10.1] vs. 5.8 [7.5]), referrals (4.5 [5.2] vs. 2.2 [3.6]), and sick notes (0.6 [1.8] vs. 0.3 [1.1]) (all p<0.01).Limitations: Information in the study database is limited to GP encounters, and the sensitivity and specificity of our case-finding methods are unknown.Conclusions: Patients with FM under the care of GPs in Germany have comparatively more co-morbidities and higher levels of healthcare utilization. [ABSTRACT FROM AUTHOR]

Institute of Medicine reports provide evidence of the failings of the healthcare system in the United States and a vision of the required transformation. The Institute for Healthcare Improvement and the Robert Wood Johnson Foundation created the Transforming Care at the Bedside initiative in 2003 to develop and validate a process for transforming care in hospital medical-surgical units. The authors describe Transforming Care at the Bedside as implemented by one of Institute for Healthcare Improvement/Robert Wood Johnson's initial pilot hospitals, including promising outcomes and a model for spreading the initiative. [ABSTRACT FROM AUTHOR]

Examines teacher activism of the 1960s and 1970s as a foundation for understanding the reform movement to professionalize teaching. Effort of teachers to improve the quality of teaching through higher standards and a national teacher exam; Opposition of several organization on teachers' unions; Examples of anti-union legislation action.

A bilingual interactive multimedia dietary recall was developed for use in the Expanded Food and Nutrition Education Program. This recall was evaluated by nutrition professionals to determine effectiveness of the introduction, food groupings, graphics, audio, and program flow. Users first report food choices from 167 graphically represented foods. Then, food variety, cooking techniques, and portion sizes are displayed. Last, users can add and delete foods. A nutrient profile comprised of 20 dietary constituents is generated. This recall provides potential for stimulating food recall with audio and visual cues, promoting more honest reports of food intake and saving staff time. [ABSTRACT FROM AUTHOR]