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When do children become unequal in reading and math skills? Some research claims that inequality grows mainly before school begins. Some research claims that schools cause inequality to grow. And some research--including the 2004 study ''Are Schools the Great Equalizer?''--claims that inequality grows mainly during summer vacations. Unfortunately, the test scores used in the Great Equalizer study suffered from a measurement artifact that exaggerated estimates of inequality growth. In addition, the Great Equalizer study is dated and its participants are no longer school-aged. In this article, we replicate the Great Equalizer study using better test scores in both the original data and a newer cohort of children. When we use the new test scores, we find that variance is substantial at the start of kindergarten and does not grow but actually shrinks over the next two to three years. This finding, which was not evident in the original Great Equalizer study, implicates the years before kindergarten as the primary source of inequality in elementary reading and math. Total score variance grows during most summers and shrinks during most school years, suggesting that schools reduce inequality overall. Changes in inequality are small after kindergarten and do not replicate consistently across grades, subjects, or cohorts. That said, socioeconomic gaps tend to shrink during the school year and grow during the summer, while the black-white gap tends to follow the opposite pattern.

The present study describes student learning and personal outcomes associated with learning research methods in introductory psychology, via one of two semester-long projects: one involving performing naturalistic observation of the behavior of community members, and the other involving performing a 60-minute interview of local veterans regarding a psychological concept (incorporating features of service-learning). Both projects taught the same basic research concepts. Among students completing the observational project (n = 38), strong Time 1 scores on a research methods quiz declined slightly by Time 2 assessment; interest in aggregating and interpreting data declined; and personal attitudes about community service did not change over the course of the semester. Among students completing the service-learning project (n = 41), quiz scores and interest in research did not change, and attitudes about community service changed in some ways over time (depending on student age). It is concluded that encouraging original scholarly inquiry among introductory-level students can have various academic and personal benefits to students, but that service-learning elements in such projects may increase their attractiveness to students. Limitations and recommendations for future research are discussed.

Since the mid-1990s, however, the popularity, diversity, and application of virtual worlds have spread rapidly. As a result, existing taxonomies and topologies increasingly are becoming less effective at being able to classify and organize the growing diversification of content available in today's virtual worlds. This article presents the methodical process used to establish a taxonomy framework that (i) is grounded in a controlled vocabulary and employs objectively assessable classification rules and (ii) utilizes a methodological historical review to identify prominent traits of virtual worlds in order to create a multidimensional structure capable of visualizing a classification scheme appropriate to today's virtual worlds and adaptable to tomorrow's technologies. By using this taxonomy visualization framework, researchers and practitioners can (i) better clarify the scope of the field, (ii) utilize a common mechanism for categorizing and comparing known elements within the field, and (iii) better identify gaps in knowledge (and gaps in technology) needing development. (Contains 9 figures.)

Qualitative methods and data are likely to be most useful in the assessment of environmental attributes and less appropriate where participants' interpretations of environments are to be measured. The determination of the appropriateness of quantitative and qualitative methods should be made on the basis of what is being measured. (Author/IRT)

Examined the effects of performance cues on descriptions of leader behavior. Results demonstrated that performance cues directly affected subject descriptions of leader initiating structure and consideration. Subject involvement directly affected only subject ratings of consideration. Performance data was a more salient cue for uninvolved observers than for involved participants. (WAS)

Context: Deficits in the hip range of motion are associated with hip and groin injuries. Accurate and reliable goniometric measurements are important in identifying those at risk of injury and determining the efficacy of treatment interventions. Smartphone goniometric applications are regularly used to assess joint ranges of motion; however, there is limited knowledge on the reliability of this method in relation to the hip, particularly between clinicians with different levels of experience. Objective: To determine the intratester and intertester reliability of a smartphone clinometer application for the assessment of hip goniometric measurements in healthy volunteers by an experienced and novice clinician. Design: Reliability study. Setting: University Athletic Therapy facility. Participants: Physically active, university students. Main Outcome Measures: The study determined the intra- and intertester (experienced vs novice clinician) reliability of goniometric measurements of the hip joint (modified Thomas test and seated hip internal and external rotation) using a smartphone goniometric application. Intraclass correlation coefficients (ICCs), standard error of measurement, and minimal detectable change at a 95% confidence interval were used to assess reliability. Results: Goniometric measurements demonstrated good to excellent relative intratester reliability for the modified Thomas test (ICC =.94), external rotation (ICC =.93–.95), and internal rotation (ICC =.80–.81). Intertester reliability for expert and novice clinicians was also excellent for the modified Thomas test (ICC =.98), external rotation (ICC =.95), and internal rotation (ICC =.92). Intratester and intertester standard error of measurement and minimal detectable change at 95% confidence interval values were similar for both testers and ranged from 1.9° to 3.6° and 5° to 10.1° and from 1.1° to 2.3° and 2.9° to 6.5°, respectively. Conclusion: Smartphone-based goniometric measurements of hip range of motion have high intratester and intertester reliability for novice and expert clinicians. It may be a useful, simple, and inexpensive resource for clinicians. [ABSTRACT FROM AUTHOR]

In Australia the impacts of climate change are resulting in considerable water scarcity, a scenario affecting the green and blue spaces that provide well-recognized individual health benefits. However, far less is known about the social health benefits of these spaces, particularly for those residing in rural Australian river communities. In this geographic context, water issues are compounded by a dominant culture that privileges the commodification of water for agricultural purposes over other interests. Using an environmental justice perspective consistent with a green social work approach, this proof-of-concept study contributes a critical element to water debates by examining the cultural, recreational, and environmental meanings of water for the rural river community of Mildura. Results from an online mixed-methods questionnaire (N = 33) show that people privileged cultural meanings of water as fundamental to life, were concerned for river health, and felt marginalized in water debates. Findings suggest that understanding communities' hydrosocial relationships is key to environmentally and socially just water management and to individual, community, and environmental health. Social work can contribute to such environmental issues by working collaboratively to enable communities to exercise their voices and to advocate to decision makers to include consideration of environmental, social, and cultural impact. [ABSTRACT FROM AUTHOR]

Purpose: We sought to understand concerns fundamental to planning medical education specific to rural southern African Americans who are virtually nonexistent in American medical schools. Methods: A diverse multidisciplinary research team conducted this qualitative study with 3 focus groups, including 17 rural medical educators recruited nationwide, 10 African American alumni of a rural medical education pipeline in Alabama, and 5 community and institutional associates of this pipeline. Analysis of recorded transcripts generated themes fitting an ecological model suggesting concerns and intervention foci at individual, community, and institutional levels. Findings: Three major themes operating at all ecological levels were: (1) How "rural minority student" is defined, with "rural" often supplanting race to indicate minority status; (2) Multiple factors relate to rural racial minority student recruitment and success, including personal relationships with peers, mentors, and role models and supportive institutional policies and culturally competent faculty; and (3) Challenges to recruitment and retention of rural minority students, especially financial concerns and preparation for medical education. Conclusions: Our findings suggest that individuals, communities, and institutions provide intervention points for planning medical education specific to southern rural African Americans. These spheres of influence project a need for partnership among communities and rural medical educators to affect broad programmatic and policy changes that address the dire shortage of rural African American health professionals to help ameliorate health inequities experienced in their home communities. It is likely that linear thinking and programming will be replaced by integrated, intertwined conceptualizations to reach this goal. [ABSTRACT FROM AUTHOR]

Background: Palliative care requires innovative methods to understand what works, for whom, in what circumstances and why. Realist evaluation has become one prominent approach due to its preoccupation with building, and testing, causal theories to explain the influence of contextual factors on outcomes. Undertaking realist evaluation is not without challenges and may amplify issues of underrepresentation, disempower those working in palliative care, and produce results with poor ecological validity. Complementary approaches are needed which mitigate these challenges, whilst producing credible findings that advances knowledge. Purpose: In this article it is outlined how realist evaluation provides a toolkit to advance research to explain, and empirically test, the complex contours of palliative care. Moreover, it is proposed that transformative evaluation can provide a catalyst to engage and empower those within palliative care, create the opportunity for care transformation, and produce more informed and authentic theories. Discussion: Contemporary issues in palliative care pertain to the complexity of palliative care, the insufficiency of experimental designs alone, and the challenges of achieving inclusive research participation. In this article it is argued that theory led, participatory, opportunistic and naturalistic approaches can provide an antidote to the issues in the literature. The combination also mitigates many methodological critiques of the individual approaches, by increasing the transformative potential of realist evaluation, and explanatory potential of transformative evaluation. [ABSTRACT FROM AUTHOR]

Background: To support student mental health, school staff must have knowledge of evidence-based practices and the capacity to implement them. One approach used to address this challenge is a group-based telementoring model called Extension for Community Healthcare Outcomes (ECHO). In other applications (e.g., healthcare settings), ECHO has been shown to increase healthcare professionals' self-efficacy and knowledge of evidence-based practices leading to improved patient outcomes. Objectives: This study examined the potential for ECHO to be used as a method for increasing school staff engagement and knowledge of evidence-based school mental health practices. Methods: Using a quasi-experimental design, this study compared outcomes across two professional development experiences aimed at promoting school staff ability to provide evidence-based mental health services. School staff from four school districts participated in a school mental health training initiative. All participants (N = 57) had access to asynchronous, online mental health modules. A sub-sample (n = 33) was also offered monthly ECHO sessions. Results: Tests of group difference in outcomes revealed significant increases in engagement with online learning (d = 0.58) and satisfaction (d = 0.82) for those who participated in ECHO as compared to those who did not. Knowledge about evidence-based practices was not significantly different between groups. Conclusions: Results suggest that group-based telementoring may be a promising approach for improving engagement and satisfaction with training initiatives aimed at promoting evidence-based school mental health practices. However, further study of ProjectECHO using experimental designs is needed to make causal inferences about its effect on provider outcomes. [ABSTRACT FROM AUTHOR]

Background Recently, researchers have commented that shoulder special tests cannot identify the structure causing rotator cuff symptoms and should only be considered pain provocation tests. Others have disagreed, reporting that special tests were able to accurately detect the presence of rotator cuff involvement. Purpose The purpose of this study was to determine the knowledge, use, and perceived effectiveness of 15 selected special tests utilized to examine patients with possible rotator cuff dysfunction. Study Design Descriptive study using survey. Methods An electronic survey was returned by 346 members of the Academies of Orthopedic and Sports Physical Therapy through list serves. Descriptions and pictures for 15 special tests of the shoulder were included in the survey. Information regarding years of clinical experience and American Board of Physical Therapy Specialties (ABPTS) specialist certification in Sports or Orthopedics was collected. Respondents were asked if they could identify and use the special tests to evaluate dysfunction of the rotator cuff - and how confident they were in ability of the tests to diagnose dysfunction of the rotator cuff. Results The four tests most readily known by respondents included the empty can, drop arm, full can, and Gerber's tests, and the four tests used regularly by the respondents included the infraspinatus, full can, supraspinatus, and champagne toast tests. The infraspinatus, champagne toast, external rotation lag (ERLS), and the belly-off tests were found to be the be most useful for establishing a diagnosis of the muscle-tendon complex involved. Years of experience and clinical specialization was not relevant to knowledge or use or these tests. Conclusions This study will allow clinicians and educators to understand which special tests are easily identified, regularly used, and perceived as helpful for the diagnosis of muscles involved in a rotator cuff dysfunction. Level of Evidence 3b [ABSTRACT FROM AUTHOR]

The opioid epidemic has greatly increased the number of pregnant women with opioid use and newborns exposed to opioids in utero. Mothers with opioid use disorder can face stigma by nurses in perinatal care settings, contributing to negative care experiences. A survey was distributed to nurses caring for mothers and newborns exposed to opioids in a large urban hospital in the Pacific Northwest United States (n = 89) from March to July 2019. Survey measures included participant characteristics, attitude toward substance use in pregnancy and postpartum (stigma, compassion satisfaction, comfort, and knowledge), and open-ended questions. Relationships among variables and questionnaire items were examined using Pearson's correlations, 2-sample t tests, and simultaneous multiple linear regression. Qualitative description was used to analyze open-ended questions. Nurses' stigma was negatively correlated with compassion satisfaction (r = −0.63), feeling knowledgeable (r = −0.36), and comfortable in providing care to this population (r = −0.44). Nurses identified defensiveness, lack of trust, and inadequate social support as key challenges in this patient population. Nurses suggested more support for mothers and nurses, increased nursing education, and clinical guidelines to improve clinical practice and foster therapeutic relationships. Findings highlight potential strategies to improve nursing care for chemically dependent mothers and their infants. These strategies may offer practical approaches to reduce stigma, develop therapeutic relationships, and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Though attention has been given to investigating the role of generalist case management in addressing complex needs, largely absent to date is an enquiry to develop the theory for rural community-based social work and human service case management. The purpose of this article is to describe how a two-stage exploratory mixed methods research methodology led to the formulation of a series of theoretical constructs to inform rural case management theory. This article describes Stage 2 of the study, a Delphi method with social work academics where vignettes and a rating scale were strategically combined to transform rural case management practice experience into constructs to inform rural practice theory. We conclude the article by contending that mixed method research designs hold promise for other areas of human services work, where practice theory grounded in-field experience is sought. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether prophylactic administration of oxytocin plus ergonovine or oxytocin plus carboprost is more effective than oxytocin alone in reducing the need for additional uterotonics among women undergoing cesarean delivery for labor arrest.Methods: In this double-blind, three-arm randomized controlled trial, participants were assigned to receive either oxytocin 5 units intravenous alone, or with ergonovine 0.25 mg intravenous or carboprost 0.25 mg intramuscular immediately after delivery, followed with maintenance infusion of oxytocin 40 milliunits/minute in all groups. Uterine tone was assessed at 3, 5, and 10 minutes after delivery, and additional uterotonics were administered if deemed necessary. The primary outcome was intraoperative need for additional uterotonics. Secondary outcomes included uterine tone, calculated blood loss, and side effects. A sample size of 34 per group (n=102), based on the null hypothesis that there is no association between treatment assignment and the need for additional uterotonics, permitted independent post hoc pairwise comparisons between oxytocin plus ergonovine, oxytocin plus carboprost, and oxytocin alone using an adjusted P-value of .025. The association between the need for additional uterotonics and treatment group was assessed using the χ2 test.Results: From June 2013 through July 2019, 105 participants were randomized (35 per group) and data from 100 participants were analyzed: oxytocin (n=35), oxytocin plus ergonovine (n=33), and oxytocin plus carboprost (n=32). There was no difference in the requirement of additional intraoperative uterotonics across groups (oxytocin [37%] vs oxytocin plus ergonovine [33%] vs oxytocin plus carboprost [34%], P=.932). Uterine tone and calculated blood loss were similar across groups. Incidence of nausea or vomiting was higher in oxytocin plus ergonovine (85%; odds ratio [OR] 5.3, 95% CI 1.7-16.9, P=.003) and oxytocin plus carboprost (72%; OR 2.4, 95% CI 0.9-6.7, P=.086) compared with the oxytocin (51%) group.Conclusion: Compared with oxytocin alone, prophylactic use of a combination of uterotonic drugs did not reduce the need for additional uterotonics at cesarean delivery for labor arrest.Clinical Trial Registration: ClinicalTrials.gov, NCT01869556. [ABSTRACT FROM AUTHOR]

A small subset of education studies analyzes school data collected seasonally (separating the summer from the school year). At first, this work was primarily known for documenting learning loss in the summers, but scholars have since recognized that observing how inequality changes between summer and school periods provides leverage for understanding how schools influence inequality. Results based on this analytic technique confirm current views in some ways, but in other ways the patterns challenge existing wisdom. For example, Black/White gaps in math and reading skills often grow faster when school is in versus out, consistent with the view that schools exacerbate racial inequality. But socioeconomic gaps produce the opposite pattern, suggesting that schools are compensatory across this dimension. In this review, I consider the logic behind seasonal research, the empirical patterns it has produced, and the kinds of new questions it motivates. [ABSTRACT FROM AUTHOR]

Despite decades of improvement in the quality and outcomes of cardiovascular care, significant gaps remain. Existing quality improvement strategies are often limited in scope to specific clinical conditions and episodic care. Health services and outcomes research is essential to inform gaps in care but rarely results in the development and implementation of care delivery solutions. Although individual health systems are engaged in projects to improve the quality of care delivery, these efforts often lack a robust study design or implementation evaluation that can inform generalizability and further dissemination. Aligning the work of health care systems and health services and outcomes researchers could serve as a strategy to overcome persisting gaps in cardiovascular quality and outcomes. We describe the inception of the Cardiovascular Quality Improvement and Care Innovation Consortium that seeks to rapidly improve cardiovascular care by (1) developing, implementing, and evaluating multicenter quality improvement projects using innovative care designs; (2) serving as a resource for quality improvement and care innovation partners; and (3) establishing a presence within existing quality improvement and care innovation structures. Success of the collaborative will be defined by projects that result in changes to care delivery with demonstrable impacts on the quality and outcomes of care across multiple health systems. Furthermore, insights gained from implementation of these projects across sites in Cardiovascular Quality Improvement and Care Innovation Consortium will inform and promote broad dissemination for greater impact. [ABSTRACT FROM AUTHOR]

Research involving vulnerable consumer populations is on the increase, and understanding the social consequences of consumption within different marketing contexts has become a common theme across Consumer Culture Theory, transformative consumer research, and critical marketing. Yet the diverse difficulties faced by researchers who investigate consumer vulnerability have not been sufficiently addressed. In line with the need for greater reflexivity in research, this paper reflects on our own research experiences, and highlights the complexities associated with conducting research on sensitive topics in challenging contexts. With reference to such experiences, we illustrate the phenomenon of researcher vulnerability and discuss its implications for knowledge generation within the marketing domain. [ABSTRACT FROM PUBLISHER]

Background: Acute flaccid myelitis is characterized by acute-onset flaccid limb weakness with predominantly gray matter lesions in the spinal cord spanning one or more segments. Rates of full recovery are poor, and there is no standard treatment or definitive cause.Methods: This is a retrospective review of children diagnosed with acute flaccid myelitis in Texas during 2016. Patients were identified through a Texas collaborative of six hospitals in four major metropolitan areas. Data abstraction included health history, illness presentation, medical treatments, laboratory studies, imaging data, recovery, and ability to perform activities of daily living up to approximately two years from illness onset.Results: Among all sites, 21 patients met inclusion criteria. Treatments varied with the most common being intravenous immunoglobulin, high-dose methylprednisolone, and plasmapheresis. No differences were seen in response to medical treatments. A potential etiology was found in 12 (57%) cases, including four with enterovirus D68. Five cases recovered fully. Of the 16 patients without full recovery, abilities ranged from (1) able to perform all activities of daily living for age independently (n = 5), (2) mild deficits (n = 5), and (3) substantial reliance on caregivers for activities of daily living (n = 6).Conclusion: Many reports describe symptoms and outcomes of acute flaccid myelitis, but limited data are available on long-term functional outcomes. We were unable to make a strong case for any single cause or treatment modality. Fortunately, the majority of patients (15, 71%) were able to perform activities of daily living with complete independence or only mild deficits. [ABSTRACT FROM AUTHOR]

Objective: Although Indigenous women are exposed to high rates of risk factors for perinatal mental health problems, the magnitude of their risk is not known. This lack of data impedes the development of appropriate screening and treatment protocols, as well as the proper allocation of resources for Indigenous women. The objective of this systematic review and meta-analysis was to compare rates of perinatal mental health problems among Indigenous and non-Indigenous women.Methods: We searched Medline, EMBASE, PsycINFO, CINAHL, and Web of Science from their inceptions until February 2019. Studies were included if they assessed mental health in Indigenous women during pregnancy and/or up to 12 months postpartum.Results: Twenty-six articles met study inclusion criteria and 21 were eligible for meta-analysis. Indigenous identity was associated with higher odds of mental health problems (odds ratio [OR] 1.62; 95% confidence interval [CI], 1.25 to 2.11). Odds were higher still when analyses were restricted to problems of greater severity (OR 1.95; 95% CI, 1.21 to 3.16) and young Indigenous women (OR 1.86; 95% CI, 1.51 to 2.28).Conclusion: Indigenous women are at increased risk of mental health problems during the perinatal period, particularly depression, anxiety, and substance misuse. However, resiliency among Indigenous women, cultural teachings, and methodological issues may be affecting estimates. Future research should utilize more representative samples, adapt and validate diagnostic and symptom measures for Indigenous groups, and engage Indigenous actors, leaders, and related allies to help improve the accuracy of estimates, as well as the well-being of Indigenous mothers, their families, and future generations.Trial Registration: PROSPERO-CRD42018108638. [ABSTRACT FROM AUTHOR]

Background. Urinary tract infection (UTI) is the most common bacterial infection in the world. Some cases can have serious complication as death by septic shock. With the increasing spread of multidrug-resistant bacteria, the therapeutic possibilities against the complicated UTI are exhausted, forcing the use of broad-spectrum antibiotics such as meropenem. Objectives. To evaluate the penetrating ability of meropenem to renal tissue using an enzymatic biosensor in samples of renal cortex and its correlation with plasma levels. Method. We conducted a descriptive study in humans with indication of kidney biopsy. Meropenem was administered 1 hour before performing the biopsy, and the concentrations of meropenem in a series of samples of plasma and renal biopsy were determined. Results. Renal biopsy and plasma samples of 14 patients, 64% women with body mass index of 26.3 kg/m2 (SD ± 2.9) and estimated glomerular filtration rate of 57.5 mL/min/1.73 m2 (SD ± 44.1), were examined. Renal biopsy was done at 68.9 minutes (SD ± 20.3), and the second plasma sample was obtained at 82.1 minutes (SD ± 21.2) and the third at 149.6 minutes (SD ± 31.5). The mean kidney meropenem concentration was 3.1 μg/mL (SD ± 1.9). For each patient, a decay curve of plasma meropenem concentration was constructed. The proportion of meropenem concentrations in renal tissue and plasma at biopsy moment was 14% (SD ± 10) with an interquartile range of 5.5–20.3%. With normal renal function, meropenem can achieve a bactericidal effect towards bacteria with MIC-90 < 0.76 μg/mL in the renal parenchyma. Conclusions. Meropenem is effective to treat the most frequent uropathogens with the bactericidal effect. Nevertheless, for resistant bacteria, it is necessary to adjust the dose to achieve adequate parenchymal concentration. [ABSTRACT FROM AUTHOR]

Purpose: The importance of debriefing after high-fidelity simulation (HFS) is well accepted; however, no recommendations exist in physical therapy literature for how best to do this. The primary purpose of this study was to describe a format for debriefing and a secondary purpose was to report student responses to the educational benefit of that process. Methods: Based on a review of the literature and the HFS case objectives, a semi-structured debriefing format using open-ended questions was developed. Students were surveyed regarding the educational benefit of the debriefing process and the effectiveness of the debriefer using openended and Likert-scale questions. These responses were analyzed. Results: After each of the 3 HFS experiences, an experienced faculty member facilitated the debriefing process by moving students through a reaction, analysis, and summary phase. Based on student feedback, the debriefing format used seemed to be effective in providing an opportunity for student reflection. A statistically significant positive correlation was found between the perceived educational benefit of debriefing and the effectiveness of the debriefer. Conclusions:A semi-structured debriefing session after HFS, modeled on best practices in the literature, resulted in high student satisfaction. Future research should focus on standardization of the debriefing session and validating a debriefing tool. [ABSTRACT FROM AUTHOR]

Introduction: Talimogene laherparepvec is a first-in-class oncolytic immunotherapy for intratumoral injection with proven efficacy and tolerability in patients with unresectable early metastatic melanoma (stage IIIB-IVM1a) in the pivotal phase III OPTiM study. The objective was to characterize melanoma patients treated with talimogene laherparepvec in routine clinical practice in Germany.Methods: A retrospective chart review was conducted in unresectable stage IIIB-IVM1a melanoma patients. Data on demographics, disease and medical history, and use of talimogene laherparepvec were collected. A survey was also conducted to understand physician treatment decisions.Results: Data for 27 patients who initiated talimogene laherparepvec between June 2016 and July 2017 were analyzed (median age 68; stage IIIB/C disease 56%). All patients had prior surgery, and over half had repeated resections for recurrent disease (median 3). Overall, 48% of patients received at least one prior local treatment, mainly radiation therapy or electrochemotherapy. Talimogene laherparepvec was first-line systemic therapy in 63% of patients. The most frequent prior systemic treatment was immunotherapy (7/27 patients). At end of follow-up, 13 patients were still on talimogene laherparepvec and 14 patients had discontinued treatment. Among those who discontinued, 8 (57%) did not receive subsequent systemic therapy. Only one patient receiving first-line talimogene laherparepvec received a subsequent systemic therapy. Three patients stopped treatment because of no remaining injectable lesions. Median treatment duration was 22.1 weeks overall and 27.9 weeks in stage IIIB/C disease patients. Nearly all cutaneous lesions (93%) were injected with talimogene laherparepvec compared to subcutaneous (83%) and nodal lesions (77%). No new safety signals were reported. The main reasons given in the physician survey for treating with talimogene laherparepvec were good tolerability, overall efficacy, and lack of contraindications.Conclusion: Talimogene laherparepvec is now included as a routine treatment option for unresectable early metastatic melanoma in Germany. This study characterizes the first patients treated with talimogene laherparepvec in Europe and confirms the good tolerability observed in clinical trials.Trial Registration: EUPAS registry, EUPAS17410.Funding: Amgen Inc. [ABSTRACT FROM AUTHOR]

Objective: To examine the clinical utility of the Sport Concussion Assessment Tool-3 (SCAT3) in university athletes with concussion in the absence and presence of baseline data over time. Methods: Athletes with concussion (n = 23) and uninjured controls (n = 22) were prospectively evaluated at three time-points (baseline, 3-5 days, 3 weeks post-injury) with the SCAT3 components: (1) Post-Concussion Symptom Scale (PCSS); (2) Standardized Assessment of Concussion (SAC); and (3) modified Balance Error Scoring System (m-BESS). Sensitivity and specificity were calculated using reliable change indices and normative data from 458 athletes who completed baseline testing. Results: The PCSS total symptom score yielded highest sensitivity (47.4-72.2%) and specificity (78.6-91.7%) 3-5 days post-injury, with the SAC and m-BESS demonstrating little discriminative ability when used more than 3 days post-concussion. The utility of the SCAT3 was comparable when baseline or normative data was used for predicting concussion. Conclusion: The SCAT is a clinically useful tool for assessing concussion in the absence or presence of baseline data within the first 3-5 days post-injury. Clinical utility of the SCAT3 was driven by symptoms, which remains consistent in the SCAT5. Future research should explore whether additional cognitive elements in the SCAT5 improve utility beyond this timeframe. [ABSTRACT FROM AUTHOR]

The article presents an examination into the philosophy of research within organizational studies, particularly outlining the necessary value and proper utility of qualitative research within the field. The profound impact of environmental factors within organizational behavior is cited and the need for evaluative measures for such non-numeric influences is stressed. The intradisciplinary conflicts within social science research on the application or criticism of quantitative methodologies are outlined, highlighting the centrality over objectivity and subjectivity. Conclusions are offered outlining several forms of legitimate qualitative data systems that can be utilized accurately.

Background: Cystic Fibrosis (CF) management requires complex treatment regimens but adherence to treatment is poor and has negative health implications. There are various methods of measuring adherence, but little is known regarding the extent of adherence measurement in CF centres throughout the UK and Ireland.Objective: To determine the adherence monitoring practices in CF centres throughout the UK and Ireland, and to establish CF pharmacists' views on these practices.Setting: UK and Ireland Cystic Fibrosis Pharmacists' Group's annual meeting (2014).Methods: A questionnaire was designed, piloted and distributed to pharmacists attending the UK and Ireland Cystic Fibrosis Pharmacists' Group's annual meeting (2014). The main outcome measures were the methods of inhaled/nebulised antibiotic supply and the methods used to measure treatment adherence in CF centres. The questionnaire also ascertained the demographic information of participating pharmacists. Closed question responses were analysed using descriptive statistics. Open questions were analysed using content analysis.Results: Twenty-one respondents (84 % response) were included in the analysis and were mostly from English centres (66.7 %). Detailed records of patients receiving their inhaled/nebulised antibiotics were lacking. Adherence was most commonly described to be measured at 'every clinic visit' (28.6 %) and 'occasionally' (28.6 %). Patient self-reported adherence was the most commonly used method of measuring adherence in practice (90.5 %). The availability of electronic adherence monitoring in CF centres did not guarantee its use. Pharmacists attributed an equal professional responsibility for adherence monitoring in CF to Consultants, Nurses and Pharmacists. Seventy-six percent of pharmacists felt that the current adherence monitoring practices within their own unit were inadequate and associated with the absence of sufficient specialist CF pharmacist involvement. Many suggested that greater specialist pharmacist involvement could facilitate improved adherence monitoring.Conclusion: Current adherence knowledge is largely based on self-report. Further work is required to establish the most appropriate method of adherence monitoring in CF centres, to improve the recording of adherence and to understand the impact of increased specialist pharmacist involvement on that adherence. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies suggest that pulmonary function is associated with fruit and vegetable consumption and plasma concentrations of antioxidant vitamins. Also, expiratory flow limitation (EFL) has been reported to limit ventilation during exercise in healthy individuals. We hypothesized antioxidant vitamin supplementation (AVS) would increase resting expiratory flow rates in healthy subjects and reduce EFL during exercise.Methods: Ten healthy, nonsmoking subjects (5 M/5 W), consuming <5 servings of fruit and vegetables per day, participated in a randomized, single-blinded crossover design study with subjects receiving a placebo (PLA) or AVS [vitamins C (500 mg), E (400 IU), beta-carotene (15,000 IU), zinc (7.5 mg), selenium (50 mg), copper (1 mg), and manganese (2.5 mg)] for 4 weeks. After a minimum 4-week washout period, subjects received the alternate supplementation. Pulmonary function tests and total antioxidant status (TAS) from plasma were measured pre- and post-supplement period. Subjects completed a pre- and post-supplement treadmill test for 20 min at 70% [Formula: see text] followed by increasing workload until exhaustion.Results: AVS increased (p < 0.05) TAS by ~21% and resting expiratory flow rates (FEF25-75, FEF50) by ~9%. Following AVS, %EFL was significantly reduced by ~15% at minute 15, 20, and end-exercise with no change (p > 0.05) in end-expiratory lung volumes. Breathing frequency and ratings of perceived exertion and dyspnea were also lower (p < 0.05) at min 20 of exercise. No changes (p > 0.05) were evident at rest or during exercise with PLA.Conclusions: These results suggest that AVS can increase TAS, improve resting expiratory flow rates and reduce EFL during exercise in healthy subjects who are not meeting fruit and vegetable recommendations. [ABSTRACT FROM AUTHOR]

Background: Magnetic seizure therapy (MST) is a novel brain stimulation technique that uses a high-powered transcranial magnetic stimulation device to produce therapeutic seizures. Preliminary MST studies have found antidepressant effects in the absence of cognitive side effects but its efficacy compared to electroconvulsive therapy (ECT) remains unclear. The aim of this study was to investigate the therapeutic efficacy and cognitive profile of MST compared to standard right unilateral ECT treatment.Methods: Thirty-seven patients completed a course of at least nine ECT or MST treatments in a randomized double-blind protocol. Assessments of depression severity and cognition were performed before and after treatment.Results: No difference in the antidepressant effectiveness between the treatments was seen across any of the clinical outcome measures, although the overall response rates in both groups were quite low. In regards to cognition, following MST there were significant improvements in tests of psychomotor speed, verbal memory, and cognitive inhibition, with no reductions in cognitive performance. Following ECT there was significant improvement in only one of the cognitive inhibition tasks. With respect to the between-group comparisons, the MST group showed a significantly greater improvement on psychomotor speed than ECT.Conclusions: MST showed similar efficacy to right unilateral ECT in patients with treatment-resistant depression without cognitive side effects but in a sample that was only of sufficient size to demonstrate relatively large differences in response between the two groups. Future research should aim to optimize the methods of MST administration and compare its efficacy to ECT in large randomized controlled trials. [ABSTRACT FROM AUTHOR]

Background and Purpose: The Sieloff–King Assessment of Group Empowerment Within Organizations (SKAGEO) has demonstrated consistent reliability and validity, although past participants reported the need for revisions to further improve its clarity and ease of use in research. The purpose of this research was to use focus groups to revise the SKAGEO. Methods: Two focus groups were held (seven RNs and one student nurse). Thematic analysis was used to analyze the focus group discussions. Results: Five major themes, and eleven subthemes, were identified as areas for future revisions to further improve the instrument’s clarity and use in research. Conclusions: Revisions in the SKAGEO, based on the areas identified by the focus groups, would result in an instrument that would more easily be understood and incorporated into research. [ABSTRACT FROM AUTHOR]

The optimum time interval for 10 ml boluses of bupivacaine 0.0625% + fentanyl 2 μg.ml-1 as part of a programmed intermittent epidural bolus regimen has been found to be 40 min. This regimen was shown to be effective without the use of supplementary patient-controlled epidural analgesia boluses in 90% of women during the first stage of labour, although with a rate of sensory block to ice above T6 in 34% of women. We aimed to determine the optimum programmed intermittent epidural bolus volume at a 40 min interval to provide effective analgesia in 90% of women (EV90 ) during the first stage of labour, without the use of patient-controlled epidural analgesia. We performed a prospective double-blind dose-finding study using the biased coin up-and-down sequential allocation method in 40 women. The estimated EV90 was 11.0 (95%CI 10.0-11.7) ml with the isotonic regression method and 10.7 (95%CI 10.3-11.0) ml with the truncated Dixon and Mood method. Overall, 18 women had a sensory block above T6, and 37 women exhibited no motor block. No women required treatment for hypotension. In conclusion, it is not possible to reduce the programmed intermittent epidural bolus volume from 10 ml, used in our current regimen, without compromising the quality of analgesia. Using this regimen, a high proportion of women will develop a sensory block above T6. [ABSTRACT FROM AUTHOR]

Hemp-derivative (Cannabis sativa L.) food products containing trace levels of Δ-9-tetrahydrocannabinol (THC) are proposed for consumption in Australia and New Zealand; however, it is unclear whether use of these products will negatively affect existing drug screening protocols. This double-blind, within-subjects, cross-over trial assessed 35 adults (17 male; 18 female), aged 22-52 years [Mean=30.7, Standard Deviation (S.D)±7.6]. Low dose THC oil [5mL bearer sesame oil containing 10mg/kg THC (0.046mg THC per 5mL dose)]; high dose THC oil [5mL bearer sesame oil containing 20mg/kg THC (0.092mg THC per 5mL dose)]; and a placebo oil (THC negative) was consumed during a three-week protocol. The Securetec Drugwipe® II Twin device assessed THC presence (cut-off 20ng/mL) in oral fluid at baseline, at 5, 30, 60, 120 and 240min post-treatment. Blood was drawn at baseline, 30, 120 and 240min post-treatment, and urine at baseline and 240min post-treatment. No THC was detected in oral fluid, blood or urine samples at any time-point following consumption of the low or high THC dose. Trace concentrations of 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid (THCa) were detected in blood 4-h after consumption of the high THC treatment (M=0.0001mg/L) and in urine at 4-h post consumption of both low and high THC treatments (M=0.0001mg/L and 0.0004mg/L, respectively). Consumption of low-content THC oil does not result in positive biological assessments. It is therefore highly unlikely that ingestion of products containing these levels of THC will negatively impact existing region-specific drug driving enforcement protocols. [ABSTRACT FROM AUTHOR]

Bedside gastric ultrasonography can be performed reliably by anaesthetists to assess gastric content in the peri-operative period. We aimed to study the relationship between gastric cross-sectional area, assessed by ultrasound, and volumes of clear fluids ingested by pregnant women. We recruited 60 non-labouring third-trimester pregnant women in a randomised controlled and assessor-blinded study. A standardised scanning protocol of the gastric antrum was performed in the 45° semirecumbent and 45° semirecumbent-right lateral positions. Subjects were randomly allocated to drink one out of six predetermined volumes of apple juice (0 ml, 50 ml, 100 ml, 200 ml, 300 ml, 400 ml). Qualitative and quantitative assessments at a baseline period after an 8-h fast, and immediately after the drink, were used to establish the correlation between antral cross-sectional area and volume ingested. A predictive model to estimate gastric volume was developed. Antral cross-sectional area in the semirecumbent right lateral position significantly correlated with the ingested volume (Spearman rank correlation = 0.7; p < 0.0001). A cut-off value of 9.6 cm2 discriminated ingested volumes ≥ 1.5 ml.kg-1 with a sensitivity of 80%, a specificity of 66.7%, and an area under the curve of 0.82. A linear predictive model was developed for gastric volume based only on antral cross-sectional area (Volume (ml) = -327.1 + 215.2 × log (cross-sectional area) (cm2 )). We conclude that in pregnant women in the third trimester of gestation, the antral cross-sectional area correlates well with volumes ingested, and this cut-off value in the semirecumbent right lateral position discriminates high gastric volumes. [ABSTRACT FROM AUTHOR]

Streptococcus mutans is recognized as one of the key contributors to the dysbiotic state that results in dental caries. Existing treatment strategies reduce the incidence of tooth decay, but they also eliminate both the cariogenic and beneficial microbes. Here we introduce a novel treatment alternative using Sephadex, cross-linked dextranomer microspheres (DMs), typically used for gel filtration chromatography. In addition DM beads can be used for affinity purification of glucosyltransferases (GTFs) from S. mutans. In this study we take advantage of the native pathogenic mechanisms used by S. mutans to adhere, form a biofilm and induce dental caries through the expression of surface-associated GTFs. We demonstrate that planktonic and biofilm-grown (adhered to hydroxyapatite-coated pegs to mimic the tooth surface) S. mutans, specifically and competitively attach to DMs. Further investigation demonstrated that DMs are a specific affinity resin for S. mutans and other cariogenic/pathogenic oral streptococci, whereas other commensal and probiotic strains failed to readily adhere to DMs. Using antimicrobial cargo loaded into the DM lumen, we demonstrate that when in co-culture with non-binding to even modestly binding commensal species, S. mutans was selectively killed. This proof of concept study introduces a novel means to safely and effectively reduce the pool of S. mutans and other pathogenic streptococci in the oral cavity with limited disturbance of the necessary commensal (healthy) microbiota when compared with current oral healthcare products. [ABSTRACT FROM AUTHOR]

Background Early warning scores are widely used to identify deteriorating patients. Whilst their ability to predict clinical outcomes has been extensively reviewed, there has been no attempt to summarise the overall strengths and limitations of these scores for patients, staff and systems. This review aims to address this gap in the literature to guide improvements for the optimization of patient safety. Methods A systematic review was conducted of MEDLINE ® , PubMed, CINAHL and The Cochrane Library in September 2016. The citations and reference lists of selected studies were reviewed for completeness. Studies were included if they evaluated vital signs monitoring in adult human subjects. Studies regarding the paediatric population were excluded, as were studies describing the development or validation of monitoring models. A narrative synthesis of qualitative, quantitative and mixed- methods studies was undertaken. Findings 232 studies met the inclusion criteria. Twelve themes were identified from synthesis of the data: Strengths of early warning scores included their prediction value, influence on clinical outcomes, cross-specialty application, international relevance, interaction with other variables, impact on communication and opportunity for automation. Limitations included their sensitivity, the need for practitioner engagement, the need for reaction to escalation and the need for clinical judgment, and the intermittent nature of recording. Early warning scores are known to have good predictive value for patient deterioration and have been shown to improve patient outcomes across a variety of specialties and international settings. This is partly due to their facilitation of communication between healthcare workers. There is evidence that the prediction value of generic early warning scores suffers in comparison to specialty-specific scores, and that their sensitivity can be improved by the addition of other variables. They are also prone to inaccurate recording and user error, which can be partly overcome by automation. Conclusions Early warning scores provide the right language and environment for the timely escalation of patient care. They are limited by their intermittent and user-dependent nature, which can be partially overcome by automation and new continuous monitoring technologies, although clinical judgment remains paramount. [ABSTRACT FROM AUTHOR]

Background Contraceptive use is widely recognized as a means of reducing adverse health-related outcomes. However, dominant paradigms of contraceptive counseling may rely on a narrow definition of “evidence” (i.e., scientifically accurate but exclusive of individual women's experiences). Given increased enthusiasm for long-acting, reversible contraceptive methods, such paradigms may reinforce counseling that overprivileges effectiveness, particularly for groups considered at high risk of unintended pregnancy. This study investigates where and how women's experiences fit into the definition of evidence these counseling protocols use. Methods Using a qualitative approach, this analysis draws on semistructured interviews with 38 young (ages 18–24) Black and Latina women. We use a qualitative content analysis approach, with coding categories derived directly from the textual data. Findings Our analysis suggests that contraceptive decision making is an iterative, relational, reflective journey. Throughout contraceptive histories, participants described experiences evolving to create a foundation from which decision-making power was drawn. The same contraceptive-related decisions were revisited repeatedly, with knowledge accrued along the way. The cumulative experience of using, assigning meanings to, and developing values around contraception meant that young women experienced contraceptive decision making as a dynamic process. Implications for Practice This journey creates a rich body of evidence that informs contraceptive decision making. To provide appropriate, acceptable, patient-centered family planning care, providers must engage with evidence grounded in women's expertise on their contraceptive use in addition to medically accurate data on method effectiveness, side effects, and contraindications. [ABSTRACT FROM AUTHOR]

This article explores doctoral student satisfaction as related to interest in the professoriate and as influenced by issues of social justice, according to a national student survey. Results indicate that 85% of respondents were satisfied or very satisfied with their doctoral education. Most satisfying aspects were individualization or independence, collegiality or collaboration, praxis or translation, and reaching or achieving milestones. Least satisfying aspects were educational environments or climates, course quality, mentorship quality, and finances. Eighty percent reported that satisfaction was “explained by social justice training opportunities and a sense of a socially just institution.” At research-intensive universities, satisfaction predicted interest in the professoriate. Understanding student satisfaction may improve doctoral education and the faculty pipeline. [ABSTRACT FROM PUBLISHER]

In this longitudinal study, attributional and social processes involved in symptoms of mental health problems (depressive symptoms and aggressive behavior) were identified by investigating anxious and angry rejection sensitivity (RS), causal attributions of self-blame and peer-blame, and responses to rejection threat of withdrawal and retribution. Young adolescents (N = 713, grades 5-7) completed questionnaires three times in their regular classrooms over 14 months. Participants who reported more self-blame for rejection were more likely to withdraw in response to rejection threat, and withdrawal and anxious RS were associated with increased depressive symptoms at T3 relative to T1. In contrast, adolescents higher in the angry form of RS and who reported more peer-blame for rejection were more likely to seek retribution, which in turn was associated with more overt/relational aggressive behavior at T3 relative to T1. Depressive symptom level measured at T1 also was associated with later RS and coping with withdrawal, and aggressive behavior at T1 was associated with later retribution. Sex of the participants did not moderate any longitudinal associations, and only one prospective path, from T1 depressive symptoms to T2 RS anxious, was moderated by age. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the diagnostic sensitivity of computed diffusion-weighted (DW)-MR imaging for the detection of breast cancer.Materials and Methods: Local research ethics approval was obtained. A total of 61 women (median 48 years) underwent dynamic contrast enhanced (DCE)- and DW-MR between January 2011 and March 2012, including 27 with breast cancer on core biopsy and 34 normal cases. Standard ADC maps using all four b values (0, 350, 700, 1150) were used to generate computed DW-MR images at b = 1500 s/mm(2) and b = 2000 s/mm(2) . Four image sets were read sequentially by two readers: acquired b = 1150 s/mm(2) , computed b = 1500 s/mm(2) and b = 2000 s/mm(2) , and DCE-MR at an early time point. Cancer detection was rated using a five-point scale; image quality and background suppression were rated using a four-point scale. The diagnostic sensitivity for breast cancer detection was compared using the McNemar test and inter-reader agreement with a Kappa value.Results: Computed DW-MR resulted in higher overall diagnostic sensitivity with b = 2000 s/mm(2) having a mean diagnostic sensitivity of 76% (range 49.8-93.7%) and b = 1500 s/mm(2) having a mean diagnostic sensitivity of 70.3% (range 32-97.7%) compared with 44.4% (range 25.5-64.7%) for acquired b = 1150 s/mm(2) (both p = 0.0001). Computed DW-MR images produced better image quality and background suppression (mean scores for both readers: 2.55 and 2.9 for b 1500 s/mm(2) ; 2.55 and 3.15 for b 2000 s/mm(2) , respectively) than the acquired b value 1150 s/mm(2) images (mean scores for both readers: 2.4 and 2.45, respectively).Conclusion: Computed DW-MR imaging has the potential to improve the diagnostic sensitivity of breast cancer detection compared to acquired DW-MR. J. Magn. Reson. Imaging 2016;44:130-137. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the clinical utility of the reverse gradient algorithm in correcting distortions in diffusion-weighted images of the cervix and for increasing diagnostic performance.Materials and Methods: Forty-one patients ages 25-72 years (mean 40 ± 11 years) with suspected or early stage cervical cancer were imaged at 3T using an endovaginal coil. T2 -weighted (W) and diffusion-weighted images with right and left phase-encode gradient directions were obtained coronal to the cervix (b = 0, 100, 300, 500, 800 s mm(-2) ). Differences in angle of the endocervical canal to the x-axis between T2 W and right-gradient, left-gradient, and corrected images were measured. Uncorrected and corrected images were assessed for diagnostic performance when viewed together with T2 W images by two independent observers against subsequent histology.Results: The angles of the endocervical canal relative to the x-axis were significantly different between the T2 W images and the right-gradient images (P = 0.007), approached significance for left-gradient images (P = 0.055), and were not significantly different after correction (P = 0.95). Corrected images enabled a definitive diagnosis in 34% (n = 14) of patients classified as equivocal on uncorrected images. Tumor volume in this subset was 0.18 ± 0.44 cm(3) (mean ± SD; sensitivity of detection 100% [8/8], specificity 50% [3/6] for an experienced observer). Correction did not improve diagnostic performance for the less-experienced observer.Conclusion: Distortion-corrected diffusion-weighted images improved correspondence with T2 W images and diagnostic performance in a third of cases. [ABSTRACT FROM AUTHOR]

Findings from confederate paradigms predict that mimicry is an adaptive route to social connection for rejection-sensitive individuals (Lakin, Chartrand, & Arkin, 2008). However, dyadic perspectives predict that whether mimicry leads to perceived connection depends on the rejection sensitivity (RS) of both partners in an interaction. We investigated these predictions in 50 college women who completed a dyadic cooperative task in which members were matched or mismatched in being dispositionally high or low in RS. We used a psycholinguistics paradigm to assess, through independent listeners' judgments (N = 162), how much interacting individuals accommodate phonetic aspects of their speech toward each other. Results confirmed predictions from confederate paradigms in matched RS dyads. However, mismatched dyads showed an asymmetry in levels of accommodation and perceived connection: Those high in RS accommodated more than their low-RS partner but emerged feeling less connected. Mediational analyses indicated that low-RS individuals' nonaccommodation in mismatched dyads helped explain their high-RS partners' relatively low perceived connection to them. Establishing whether mimicry is an adaptive route to social connection requires analyzing mimicry as a dyadic process influenced by the needs of each dyad member. [ABSTRACT FROM AUTHOR]

Objective: To compare sensitivity and specificity of endovaginal versus external-array coil T2-W and T2-W + DWI for detecting and staging small cervical tumours.Methods: Optimised endovaginal and external array coil MRI at 3.0-T was done prospectively in 48 consecutive patients with stage Ia/Ib1 cervical cancer. Sensitivity/specificity for detecting tumour and parametrial extension against histopathology for a reading radiologist were determined on coronal T2-W and T2W + DW images. An independent radiologist also scored T2-W images without and with addition of DWI for the external-array and endovaginal coils on separate occasions >2 weeks apart. Cohen's kappa assessed inter- and intra-observer agreement.Results: Median tumour volume in 19/38 cases positive on subsequent histology was 1.75 cm(3). Sensitivity, specificity, PPV, NPV were: reading radiologist 91.3 %, 89.5 %, 91.3 %, 89.5 %, respectively; independent radiologist T2-W 82.6 %, 73.7 %, 79.1 %, 77.8 % for endovaginal, 73.9 %, 89.5 %, 89.5 %, 73.9 % for external-array coil. Adding DWI improved sensitivity and specificity of endovaginal imaging (78.2 %, 89.5 %); adding DWI to external-array imaging improved specificity (94.7 %) but reduced sensitivity (66.7 %). Inter- and intra-observer agreement on T2-W + DWI was good (kappa = 0.67 and 0.62, respectively).Conclusion: Endovaginal coil T2-W MRI is more sensitive than external-array coil for detecting tumours <2 cm(3); adding DWI improves specificity of endovaginal imaging but reduces sensitivity of external-array imaging.Key Points: • Endovaginal more accurate than external-array T2-W MRI for detecting small cervical cancers. • Addition of DWI improves sensitivity and specificity of endovaginal T2-W imaging. • Addition of DWI substantially reduces sensitivity of external-array T2-W imaging. [ABSTRACT FROM AUTHOR]

Background: The language profile of behavioral variant frontotemporal dementia (bvFTD) remains to be fully defined.Objective: We aimed to quantify the extent of language deficits in this patient group.Methods: We assessed a cohort of patients with bvFTD (n = 24) in relation to patients with semantic variant primary progressive aphasia (svPPA; n = 14), nonfluent variant primary progressive aphasia (nfvPPA; n = 18), and healthy age-matched individuals (n = 24) cross-sectionally and longitudinally using a comprehensive battery of language and general neuropsychological tests. Neuroanatomical associations of language performance were assessed using voxel-based morphometry of patients' brain magnetic resonance images.Results: Relative to healthy controls, and after accounting for nonverbal executive performance, patients with bvFTD showed deficits of noun and verb naming and single word comprehension, diminished spontaneous propositional speech, and deterioration in naming performance over time. Within the bvFTD group, patients with MAPT mutations had more severe impairments of noun naming and single word comprehension than patients with C9orf72 mutations. Overall the bvFTD group had less severe language deficits than patients with PPA, but showed a language profile that was qualitatively similar to svPPA. Neuroanatomical correlates of naming and word comprehension performance in bvFTD were identified predominantly in inferior frontal and antero-inferior temporal cortices within the dominant hemispheric language network.Conclusions: bvFTD is associated with a language profile including verbal semantic impairment that warrants further evaluation as a novel biomarker. [ABSTRACT FROM AUTHOR]

Symptoms suggesting altered processing of pain and temperature have been described in dementia diseases and may contribute importantly to clinical phenotypes, particularly in the frontotemporal lobar degeneration spectrum, but the basis for these symptoms has not been characterized in detail. Here we analysed pain and temperature symptoms using a semi-structured caregiver questionnaire recording altered behavioural responsiveness to pain or temperature for a cohort of patients with frontotemporal lobar degeneration (n = 58, 25 female, aged 52-84 years, representing the major clinical syndromes and representative pathogenic mutations in the C9orf72 and MAPT genes) and a comparison cohort of patients with amnestic Alzheimer's disease (n = 20, eight female, aged 53-74 years). Neuroanatomical associations were assessed using blinded visual rating and voxel-based morphometry of patients' brain magnetic resonance images. Certain syndromic signatures were identified: pain and temperature symptoms were particularly prevalent in behavioural variant frontotemporal dementia (71% of cases) and semantic dementia (65% of cases) and in association with C9orf72 mutations (6/6 cases), but also developed in Alzheimer's disease (45% of cases) and progressive non-fluent aphasia (25% of cases). While altered temperature responsiveness was more common than altered pain responsiveness across syndromes, blunted responsiveness to pain and temperature was particularly associated with behavioural variant frontotemporal dementia (40% of symptomatic cases) and heightened responsiveness with semantic dementia (73% of symptomatic cases) and Alzheimer's disease (78% of symptomatic cases). In the voxel-based morphometry analysis of the frontotemporal lobar degeneration cohort, pain and temperature symptoms were associated with grey matter loss in a right-lateralized network including insula (P < 0.05 corrected for multiple voxel-wise comparisons within the prespecified anatomical region of interest) and anterior temporal cortex (P < 0.001 uncorrected over whole brain) previously implicated in processing homeostatic signals. Pain and temperature symptoms accompanying C9orf72 mutations were specifically associated with posterior thalamic atrophy (P < 0.05 corrected for multiple voxel-wise comparisons within the prespecified anatomical region of interest). Together the findings suggest candidate cognitive and neuroanatomical bases for these salient but under-appreciated phenotypic features of the dementias, with wider implications for the homeostatic pathophysiology and clinical management of neurodegenerative diseases. [ABSTRACT FROM AUTHOR]

BackgroundOverweight and obesity are growing problems for primary care. Although effective weight management programs exist, these programs experience significant attrition, which limits effectiveness.ObjectivesThis study examined provider and staff perceptions of attrition from the Veterans Health Administration MOVE!® Weight Management Program as an initial step toward understanding attrition from primary care-based programs.ParticipantsMOVE!® clinicians, primary care providers, and other staff members who interacted with patients about participating in MOVE!® (n=754) from Department of Veterans Affairs medical centers throughout the United States. Respondents were predominantly female (80.8%), Caucasian (79.2%), and trained as nurses (L.P.N., R.N., or N.P.; 50%).MeasureParticipants completed a web-mediated survey; items assessed agreement with personal and programmatic reasons for dropout, and allowed respondents to indicate the number one reason for dropout in an open-ended format. This survey was adapted from an existing tool designed to capture patient perceptions.ResultsRespondents indicated that veterans experienced practical barriers to attendance (eg, transportation and scheduling difficulties) and desire for additions to the program (eg, a live exercise component). Low motivation was the primary factor identified by respondents as associated with dropout, particularly as noted by MOVE!® clinicians (versus other providers/staff; P<0.01).ConclusionsThese findings suggest that programmatic changes, such as adding additional meeting times or in-session exercise time, may be of benefit to MOVE!®. In addition, increasing the use of techniques such as Motivational Interviewing among providers who refer patients to MOVE!® may improve participant engagement in MOVE!® and other primary care-based weight management programs. Further research is needed to effectively identify those likely to withdraw from weight management programs before achieving their goals, and the reasons for withdrawal. [ABSTRACT FROM PUBLISHER]

The article presents a study on the development and validation of a concise and comprehensive activity rating scale for athletically active children and adolescents who are 10 to 18 years old. It cites the lack of outcome measures necessary for conducting outcomes research in orthopaedic surgery. The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) can be used to evaluate activity level as a prognostic variable for clinical research.

The present study describes student learning and personal outcomes associated with learning research methods in introductory psychology, via one of two semester-long projects: one involving performing naturalistic observation of the behavior of community members, and the other involving performing a 60-minute interview of local veterans regarding a psychological concept (incorporating features of service-learning). Both projects taught the same basic research concepts. Among students completing the observational project (n = 38), strong Time 1 scores on a research methods quiz declined slightly by Time 2 assessment; interest in aggregating and interpreting data declined; and personal attitudes about community service did not change over the course of the semester. Among students completing the service-learning project (n = 41), quiz scores and interest in research did not change, and attitudes about community service changed in some ways over time (depending on student age). It is concluded that encouraging original scholarly inquiry among introductory-level students can have various academic and personal benefits to students, but that service-learning elements in such projects may increase their attractiveness to students. Limitations and recommendations for future research are discussed. [ABSTRACT FROM AUTHOR]

This research investigated lay conceptualisations about health using a progressive mixed-method approach, culminating in a new self-report measure of lay concepts of health. In Study 1, 223 community and college-aged adults provided everyday descriptors of healthy people. These open-ended qualitative responses were narrowed to 259 distinct descriptors, and subsequently rated on their importance to health by a second lay sample (Study 2). The health descriptors rated as most important were then subjected to exploratory factor analysis in Study 3, resulting in five distinguishable factors. Proposed scale items were then administered again (to college students, in Study 4), and a confirmatory factor analysis (CFA) was performed. The CFA supported a four-factor model, comprised of Social-Emotional Health, Positive Health Practices, Absence of Stress and Anxiety, and Adequate Rest, presented as the college student version of the Lay Concepts of Health Inventory. The measure, as well as limitations and recommendations for future research, are presented. [ABSTRACT FROM AUTHOR]

Objective: To examine socio-environmental, behavioral, and predisposing, reinforcing, and enabling (PRE) factors contributing to post-migration dietary behavior change among a sample of traditional Hispanic males. Design: In this descriptive study, semistructured interviews, a group interview, and photovoice, followed by group interviews, were used to examine dietary change and contributing factors. The behavioral, environmental, organizational, and educational assessment phases of the PRECEDE-PROCEED model guided the organization of dietary contributing factors for development of a nutrition intervention. Setting: The southern region of Mississippi. Participants: Traditional Hispanic males (n = 19) were identified from 35 Hispanic males who participated in a larger study. The traditional Hispanic males were identified by the Acculturation Rating Scale for Mexican Americans-II and the Marginality Scale. Analysis: Using the Grounded Theory approach to data analysis, themes and core categories relating to dietary behavior were identified and defined during the analysis process. The constant comparison method was used to identify key themes among coders. Results: Cultural gender role and living structure, as socio-environmental factors, influenced the PRE dietary factors. Conclusions and Implications: Multiple factors influence dietary behavior in the target population. The identified socio-environmental factors underlie the PRE factors and, therefore, must first be addressed in nutrition interventions. [ABSTRACT FROM AUTHOR]

While rapid changes in the treatment of cancer have been driven by research-based evidence, innovations in cancer care delivery have lagged behind that seen in cancer treatment. A literature review and ten semi-structured interviews were conducted to identify models of care in the ambulatory oncology setting to be adopted by a comprehensive cancer center. Four models were identified from the literature review but none were widely recognized or adopted by administrators. Findings suggested some common themes that should be included in an optimal model of care. These themes are in support of the burgeoning efforts seen in the promotion of interprofessional education and practice for quality improvement. Unique challenges related to the contextual factors in the ambulatory oncology settings suggest quality improvement interventions should be tailored to meet the specific needs of the care facility and its workforce. [ABSTRACT FROM AUTHOR]

Background: Transcription factors often play important roles in tumourigenesis. Members of the PEA3 subfamily of ETS-domain transcription factors fulfil such a role and have been associated with tumour metastasis in several different cancers. Moreover, the activity of the PEA3 subfamily transcription factors is potentiated by Ras-ERK pathway signalling, which is itself often deregulated in tumour cells.Methods: Immunohistochemical patterns of PEA3 expression and active ERK signalling were analysed and mRNA expression levels of PEA3, ER81, MMP-1 and MMP-7 were determined in gastric adenocarcinoma samples.Results: Here, we have studied the expression of the PEA3 subfamily members PEA3/ETV4 and ER81/ETV1 in gastric adenocarcinomas. PEA3 is upregulated at the protein level in gastric adenocarcinomas and both PEA3/ETV4 and ER81/ETV1 are upregulated at the mRNA level in gastric adenocarcinoma tissues. This increased expression correlates with the expression of a target gene associated with metastasis, MMP-1. Enhanced ERK signalling is also more prevalent in late-stage gastric adenocarcinomas, and the co-association of ERK signalling and PEA3 expression also occurs in late-stage gastric adenocarcinomas. Furthermore, the co-association of ERK signalling and PEA3 expression correlates with decreased survival rates.Conclusions: This study shows that members of the PEA3 subfamily of transcription factors are upregulated in gastric adenocarcinomas and that the simultaneous upregulation of PEA3 expression and ERK pathway signalling is indicative of late-stage disease and a poor survival prognosis. [ABSTRACT FROM AUTHOR]