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Most international curricula require students to develop conceptual and procedural understandings along with developing an understanding about the nature of science. Moreover, science education endeavours to produce scientifically literate citizens capable of making informed decisions about the social-scientific issues in their everyday lives; this is indeed the central purpose and aspiration of science education. However, the numbers of students taking science continue to be declining in Australia and New Zealand as well as in many European countries. We propose an as yet unexplored perspective, that of students not seeing the connectedness of the discipline as they grapple to understand the world around them. This paper takes the view that students need to understand the connectedness within the discipline of science. Moreover, one makes these connections when there is a broad understanding of the discipline. Is it possible that how and what is taught no longer interests those students we would like to see continue in science (Claxton, 2013)? We think conceptual, procedural, and epistemological knowledge is needed, but that it is insufficient for both scientific literacy and for engaging students so that they continue to study science. Evidence suggests that students need to learn science ideas, not just as facts, but to also understand how various science ideas are connected so that they can make sense of their world. We suggest that students need help to make these connections and to understand the connectedness of the discipline. We need to change not what we teach, but how we teach. [ABSTRACT FROM AUTHOR]

As professionals in geriatric medicine and social work, we are caregivers for our widowed mother of 90 years, a woman with neurocognitive disorder and multiple medical conditions. She has had repeated, problematic encounters with the health care system over the past 4 years. Caring successfully for an aging parent requires a comprehensive understanding of her unique medical, psychological, and functional status; need for social support; and overall goals of care. Poor communication between and among clinical teams--and with patients and families--is ubiquitous. The patient and family are not consistently listened to, or integrated, into the clinical team. We recount our experiences of one hospitalization and how we addressed the recurring obstacles we faced. Our training and experience gave us a firm understanding of the hazards of hospitalizing an elderly person and the need to be present, engaged, attentive, active, and vigilant. We caught and corrected major mistakes: failure to follow-up abnormal test results, multiple medication errors, undertreatment of pain, poor fall prevention, and inappropriate assessment and placement for rehabilitation. In a dysfunctional health care system, the family is, and must be, the ultimate fail-safe mechanism. We identify potentially effective solutions for the problems we encountered: adoption of dementia-sensitive and patient- and family-centered care, improved communication, better management of information (including better systems for monitoring lab results and for dispensing and reconciling medications), expediting care, changing reimbursement and regulation, and improving discharge planning and placement. [ABSTRACT FROM AUTHOR]

Objective:People with serious mental illnesses and substance abuse problems (i.e., dual diagnosis) constitute a particularly challenging and costly clinical group. This study evaluated the feasibility and acceptability of a novel model of care in which a mobile interventionist used mobile phone text messaging to remotely monitor and provide daily support to individuals with psychotic disorders and substance use.Methods:Seventeen participants with dual diagnosis were enrolled in a 12-week single-arm trial. A clinical social worker served as the mobile interventionist and sent daily text messages to participants’ privately owned mobile phones to assess their medication adherence and clinical status. The mobile interventionist provided text-message feedback and support and suggested various coping strategies flexibly, in response to participants’ replies to prompts. At the end of the trial, participants completed a usability and satisfaction measure and two self-rated measures of therapeutic alliance with their clinicians. In one version, participants rated their relationship with their mobile interventionist; in the second version, they rated their relationship with their community-based treatment team.Results:Participants received an average of 139 text messages (SD= 37.5) each from the mobile interventionist over the 12-week trial. On average, participants responded to 87% of the mobile interventionist's messages that required a reply. More than 90% of participants thought the intervention was useful and rewarding and that it helped them be more effective and productive in their lives. Participants’ assessments of their relationship with the mobile interventionist were positive. Paired-samplet-test found that the therapeutic alliance ratings participants provided for their mobile interventionist were significantly higher than those provided for their community-based treatment team clinicians, who they met with regularly.Conclusions:Our findings suggest that text-message “hovering” can be conducted successfully with individuals with psychotic disorders and substance abuse. Developing a cadre of mobile interventionists who are specifically trained on how to engage patients via mobile devices while adhering to ethical guidelines and regulatory standards may be an effective way to strengthen service delivery models, improve patient outcomes, and reduce costs. [ABSTRACT FROM AUTHOR]

Objective:People with serious mental illnesses and substance abuse problems (i.e., dual diagnosis) constitute a particularly challenging and costly clinical group. This study evaluated the feasibility and acceptability of a novel model of care in which a mobile interventionist used mobile phone text messaging to remotely monitor and provide daily support to individuals with psychotic disorders and substance use.Methods:Seventeen participants with dual diagnosis were enrolled in a 12-week single-arm trial. A clinical social worker served as the mobile interventionist and sent daily text messages to participants’ privately owned mobile phones to assess their medication adherence and clinical status. The mobile interventionist provided text-message feedback and support and suggested various coping strategies flexibly, in response to participants’ replies to prompts. At the end of the trial, participants completed a usability and satisfaction measure and two self-rated measures of therapeutic alliance with their clinicians. In one version, participants rated their relationship with their mobile interventionist; in the second version, they rated their relationship with their community-based treatment team.Results:Participants received an average of 139 text messages (SD= 37.5) each from the mobile interventionist over the 12-week trial. On average, participants responded to 87% of the mobile interventionist's messages that required a reply. More than 90% of participants thought the intervention was useful and rewarding and that it helped them be more effective and productive in their lives. Participants’ assessments of their relationship with the mobile interventionist were positive. Paired-samplet-test found that the therapeutic alliance ratings participants provided for their mobile interventionist were significantly higher than those provided for their community-based treatment team clinicians, who they met with regularly.Conclusions:Our findings suggest that text-message “hovering” can be conducted successfully with individuals with psychotic disorders and substance abuse. Developing a cadre of mobile interventionists who are specifically trained on how to engage patients via mobile devices while adhering to ethical guidelines and regulatory standards may be an effective way to strengthen service delivery models, improve patient outcomes, and reduce costs. [ABSTRACT FROM AUTHOR]

Objective: Mobile Health (mHealth) approaches can support the rehabilitation of individuals with psychiatric conditions. In the current article, we describe the development of a smartphone illness self-management system for people with schizophrenia. Methods: The research was conducted with consumers and practitioners at a community-based rehabilitation agency. Stage 1: 904 individuals with schizophrenia or schizoaffective disorder completed a survey reporting on their current use of mobile devices and interest in mHealth services. Eight practitioners completed a survey examining their attitudes and expectations from an mHealth intervention, and identified needs and potential obstacles. Stage 2: A multidisciplinary team incorporated consumer and practitioner input and employed design principles for the development of e-resources for people with schizophrenia to produce an mHealth intervention. Stage 3: 12 consumers participated in laboratory usability sessions. They performed tasks involved in operating the new system, and provided "think aloud" commentary and post-session usability ratings. Results: 570 (63%) of survey respondents reported owning a mobile device and many expressed interest in receiving mHealth services. Most practitioners believed that consumers could learn to use and would benefit from an mHealth intervention. In response, we developed a smartphone system that targets medication adherence, mood regulation, sleep, social functioning, and coping with symptoms. Usability testing revealed several design vulnerabilities, and the system was adapted to address consumer needs and preferences accordingly. Conclusions and Implications for Practice: Through a comprehensive development process, we produced an mHealth illness self-management intervention that is likely to be used successfully, and is ready for deployment and systemic evaluation in real-world conditions. [ABSTRACT FROM AUTHOR]

This paper explores how first-hand experience of an ephemeral, alternative community--which we are theorizing as a transformative space--may affect how men (re)conceptualize masculine appearance style in more plural or open-ended terms. In particular, we are interested in how men have experienced the community created by the Burning Man Project, an annual eight-day gathering of nearly 50,000 men and women in the Black Rock Desert of Nevada. Based on two years of participant observation research in 2007 and 2008, qualitative interviews, and photographic and video documentation, we will illustrate how men renegotiate masculinity and self-expression through outfits worn at Burning Man and secondly, explore how the Burning Man space influences participants' appearances in their everyday lives. [ABSTRACT FROM AUTHOR]

Objective: This report provides a program description of a supported housing residence for individuals with co-occurring diabetes and serious mental illnesses and preliminary health outcome data. Methods: Weight, blood glucose levels and satisfaction survey data were collected retrospectively on 13 individuals referred to the program. Results: Results indicate that individuals lost weight and fasting glucose readings fell into the ADA recommended range in the first six months of participation. Overall, consumers participating in the program were satisfied with the diabetes education and monitoring services provided. Conclusions and Implications for Practice: While preliminary results suggest that consumers benefit, this study only begins to address how integrated behavioral health and diabetes-specific programming in residential settings meets the needs of persons with severe mental illnesses and diabetes. A more thorough understanding of the impact of these programs on consumers' health outcomes is needed to inform how to deliver diabetes management curricula and support consumers to improve their overall health. [ABSTRACT FROM AUTHOR]

African diasporic theory offers a way to break out of oppositional thinking and evolutionary notions of progress. African American epistemologies--in conversation with other African diasporic thought--can be characterized as moving beyond either/or frameworks to "both/and" ways of knowing. Identity nots become identity (k)nots when entanglement replaces opposition and evolution as an organizing logic to account for diverse subject positions. Drawing on African diasporic theory, we propose a new (k)notty model to describe the entanglements within fashion subjectivity. The productive nodes of our examination include the wardrobe of Michelle Obama, the "sagging" (low-slung pants) phenomenon, National Basketball Association dress codes, and the business strategy of Sean John. The knot metaphor highlights how stories and explanations can only be viewed as tentative and partial, as power relations both reveal and conceal multiple truths and meanings. [ABSTRACT FROM AUTHOR]

Background: Although women make up nearly half of medical school classes in the United States, just over 20% of residents in surgery are women (excluding obstetrics/gynecology). The objective of this study was to identify whether the proportion of women surgeons on the faculty who have frequent encounters with medical students during their surgery rotation influences the student’s perceptions about women surgeons or their career choice.Methods: Seven US medical schools with proportions of women surgeons on the fulltime faculty varying from 10% to 40% were selected to participate in this survey. Women medical students graduating in the spring of 2000 were asked to complete an anonymous 29 question survey designed to assess their perceptions of women surgeons’ career satisfaction. Demographic information about the students such as career choice, age, and marital status was also collected. The differences in responses between those schools with 40% women faculty and those with less than 15% were analyzed.Results: The overall response rate was 74% (305 of 413). Forty-five percent of students had daily or weekly contact with a woman surgery attending. There were no differences in perceptions of women surgeons’ career satisfaction for those students at schools with 40% women surgeons versus those with less than 15%. However, 21 of 24 (88%) students choosing surgery as a career were from the three schools with a greater number of women surgical role models (P <0.0001). Students who chose a career in surgery perceived the women faculty’s career satisfaction to be higher than did those students not choosing a surgical career (P <0.01).Conclusions: Women medical students perception of women surgeons’ career satisfaction did not appear to be affected by the proportion of women surgeons on the faculty at their medical school. However, their choice of surgery as a career was strongly associated with a higher proportion of women on the surgical faculty. [Copyright &y& Elsevier]

Beauty is often formulated as a singular image, system, or narrative. Missing in these formulations are conceptualizations of personal desire, agency, and affiliation with community aesthetics. The following essay seeks to "complicate" current understandings of beauty-understandings that implicitly assume heterosexuality-by focusing on how lesbians do beauty to negotiate within and across four discourses. These discourses, we argue, function like cultural conversations that include verbal and visual messages, individual acts and media images, and dominant and community looks. Lesbians negotiate mixed responses to these discourses, in pan, through lesbian styling. In the process, lesbians' assertions of agency allow for a reclaiming of beauty. To illustrate the ways lesbians re-frame and reclaim beauty in everyday life, we rely upon the voices and experiences of lesbians from Northern California. [ABSTRACT FROM AUTHOR]

The following proposal for an MA and Ph.D. programme at the University of California, Davis, is the culmination of four years of meetings and other organizing activities focused on the formal institutionalization of cultural studies at UC Davis. Groundwork for the proposed cultural studies programme began in a series of discussions held by an interdisciplinary group of faculty about how to create the opportunity for structured graduate teaching, advising and research in cultural studies at UC Davis. The Dean of Graduate Studies at that time encouraged this group to submit a preproposal for an MA and Ph.D. in cultural studies. Faculty involved in the original discussions subsequently drew up a pre-proposal and held further informal meetings. E-mail lists were created and information was disseminated. Eventually, an executive committee, whose charge it was to draw up a formal proposal, was formed. The following proposal grew out of the executive committee's early efforts. Cultural studies at UC Davis cuts across myriad units, programmes, clusters and centres in two colleges in the humanities, social sciences, and agricultural environmental studies and involves a unique collectivity of faculty and students interested in class, gender, race, ethnicity, sexuality, transnationalism, postcolonialism and related areas of enquiry. The UC Davis proposal, therefore, forges many connections across a wide variety of cultural studies interests. [ABSTRACT FROM AUTHOR]

Explores the interconnections between gay communities and cultural spaces in the context of style in the United States. Uses of clothing and appearance style by gays; Position of gays in the commodity capital; Ambivalence among gay and lesbian communities in embracing subculture and target market as categories to establish fashion identities.

The article presents information on appearance management as border construction. Establishing identity in everyday life entails, in part, the construction and repair of borderlines that define who we are versus who we are not. The work these borderlines require reveals their fragility. Perhaps nowhere is this more evident than in the management of personal appearance. In this context, measures and gauges are likely to lack precision and to beget ambiguity. A symbolic interactionist approach to appearance management offers a nexus of concepts that are vital to identity construction: agency, emergent meanings, and negotiation. It also fosters an awareness of actions and transactions that enables individuals to vie for preferred identities in the face of stigmatizing or discrediting social labels. Data in this exploration were drawn from a larger study of identity and appearance which consists of nearly 300 in-depth interviews with people, predominantly students, of different communities.

A theoretical explanation of fashion change is offered, drawing upon symbolic-interactionist insights on fashion and appearance, and developing macro-micro connections between cultural ambivalence and the negotiation of meaning as inspired by symbolic ambiguity in appearances. The postmodern condition, connected with advanced capitalism, spawns cultural ambivalence and a plethora of clothing styles that emerge, in part, to clarify and lend expression to ambivalence, A broad variety of do thing styles, however, coupled with tendencies toward production of self, contribute to a high degree of ambiguity in individually constructed appearances, the meaning of which must then be collectively negotiated in social interaction. Failure of clothing styles to resolve cultural ambivalence results in fashion change in an on-going dialectic. [ABSTRACT FROM AUTHOR]

Introduction: Multidrug-resistant (MDR) Gram-negative infections complicate care of combat casualties. We describe the clinical characteristics, resistance patterns, and outcomes of Pseudomonas aeruginosa infections in combat casualties.Methods: Combat casualties included in the Trauma Infectious Disease Outcomes Study with infections with and without P. aeruginosa isolation during initial hospitalization were compared. Pseudomonas aeruginosa from initial wound, blood, and serial isolates (≥7 days from previous isolate) collected from June 2009 through February 2014 was subjected to antimicrobial susceptibility testing, pulsed-field gel electrophoresis, and whole genome sequencing for assessing clonality. Multidrug resistance was determined using the CDC National Healthcare Safety Network definition.Results: Of 829 combat casualties with infections diagnosed during initial hospitalization, 143 (17%) had P. aeruginosa isolated. Those with P. aeruginosa were more severely injured (median Injury Severity Score 33 [interquartile range (IQR) 27-45] vs 30 [IQR 18.5-42]; P < .001), had longer hospitalizations (median 58.5 [IQR 43-95] vs 38 [IQR 26-56] days; P < .001), and higher mortality (6.9% vs 1.5%; P < .001) than those with other organisms. Thirty-nine patients had serial P. aeruginosa isolation (median 2 subsequent isolates; IQR: 1-5), with decreasing antimicrobial susceptibility. Ten percent of P. aeruginosa isolates were MDR, associated with prior exposure to antipseudomonal antibiotics (P = .002), with amikacin and colistin remaining the most effective antimicrobials. Novel antimicrobials targeting MDR Gram-negative organisms were also examined, and 100% of the MDR P. aeruginosa isolates were resistant to imipenem/relabactam, while ceftazidime/avibactam and ceftolozane/tazobactam were active against 35% and 56% of the isolates, respectively. We identified two previously unrecognized P. aeruginosa outbreaks involving 13 patients.Conclusions: Pseudomonas aeruginosa continues to be a major cause of morbidity, affecting severely injured combat casualties, with emergent antimicrobial resistance upon serial isolation. Among MDR P. aeruginosa, active antimicrobials remain the oldest and most toxic. Despite ongoing efforts, outbreaks are still noted, reinforcing the crucial role of antimicrobial stewardship and infection control. [ABSTRACT FROM AUTHOR]

Background: Personal sensing has shown promise for detecting behavioral correlates of depression, but there is little work examining personal sensing of cognitive and affective states. Digital language, particularly through personal text messages, is one source that can measure these markers.Methods: We correlated privacy-preserving sentiment analysis of text messages with self-reported depression symptom severity. We enrolled 219 U.S. adults in a 16 week longitudinal observational study. Participants installed a personal sensing app on their phones, which administered self-report PHQ-8 assessments of their depression severity, collected phone sensor data, and computed anonymized language sentiment scores from their text messages. We also trained machine learning models for predicting end-of-study self-reported depression status using on blocks of phone sensor and text features.Results: In correlation analyses, we find that degrees of depression, emotional, and personal pronoun language categories correlate most strongly with self-reported depression, validating prior literature. Our classification models which predict binary depression status achieve a leave-one-out AUC of 0.72 when only considering text features and 0.76 when combining text with other networked smartphone sensors.Limitations: Participants were recruited from a panel that over-represented women, caucasians, and individuals with self-reported depression at baseline. As language use differs across demographic factors, generalizability beyond this population may be limited. The study period also coincided with the initial COVID-19 outbreak in the United States, which may have affected smartphone sensor data quality.Conclusions: Effective depression prediction through text message sentiment, especially when combined with other personal sensors, could enable comprehensive mental health monitoring and intervention. [ABSTRACT FROM AUTHOR]

Several national bodies have proposed using mobile technology to improve mental health services. But rates of current use and interest in using technology to enhance services among individuals with serious mental illness are uncertain. The authors surveyed 1,592 individuals with serious mental illness regarding their use of mobile devices and interest in using mobile technologies to enhance mental health services. Seventy-two percent of survey respondents reported currently owning a mobile device, a rate approximately 12 % lower than the general adult population. The most common uses were for talking, followed by texting, and internet activities. Both mobile device users and nonusers expressed interest in future mobile services. [ABSTRACT FROM AUTHOR]

Background: There is a 20-year delay between the development of effective interventions for individuals with severe mental illness and widespread adoption in public mental health care settings. Academic-provider collaborations can shorten this gap, but establishing and maintaining partnerships entail significant challenges. Aims: This paper identifies potential barriers to academic-provider research collaborations and provides guidelines to overcome these obstacles. Method: Authors from an academic institution and community mental health organization outline the components of their long-standing partnership, and discuss the lessons learned that were instrumental in establishing the collaborative model. Results: Realistic resource allocation and training, a thorough understanding of the service model and consumer characteristics, systemic and bidirectional communication and concrete plans for post-project continuation are necessary at all project phases. Conclusions: A shared decision-making framework is essential for effective academic institution and community mental health agency collaborations and can facilitate long-term sustainability of novel interventions. [ABSTRACT FROM AUTHOR]

Recent reclassification of the Klebsiella genus to include Klebsiella variicola, and its association with bacteremia and mortality, has raised concerns. We examined Klebsiella spp. infections among battlefield trauma patients, including occurrence of invasive K. variicola disease. Klebsiella isolates collected from 51 wounded military personnel (2009–2014) through the Trauma Infectious Disease Outcomes Study were examined using polymerase chain reaction (PCR) and pulsed-field gel electrophoresis. K. variicola isolates were evaluated for hypermucoviscosity phenotype by the string test. Patients were severely injured, largely from blast injuries, and all received antibiotics prior to Klebsiella isolation. Multidrug-resistant Klebsiella isolates were identified in 23 (45%) patients; however, there were no significant differences when patients with and without multidrug-resistant Klebsiella were compared. A total of 237 isolates initially identified as K. pneumoniae were analyzed, with 141 clinical isolates associated with infections (remaining were colonizing isolates collected through surveillance groin swabs). Using PCR sequencing, 221 (93%) isolates were confirmed as K. pneumoniae, 10 (4%) were K. variicola, and 6 (3%) were K. quasipneumoniae. Five K. variicola isolates were associated with infections. Compared to K. pneumoniae, infecting K. variicola isolates were more likely to be from blood (4/5 versus 24/134, p = 0.04), and less likely to be multidrug-resistant (0/5 versus 99/134, p<0.01). No K. variicola isolates demonstrated the hypermucoviscosity phenotype. Although K. variicola isolates were frequently isolated from bloodstream infections, they were less likely to be multidrug-resistant. Further work is needed to facilitate diagnosis of K. variicola and clarify its clinical significance in larger prospective studies. [ABSTRACT FROM AUTHOR]

Background: International travel is a risk factor for incident colonization with extended spectrum beta-lactamase (ESBL)-producing organisms. These and other multidrug-resistant (MDR) bacteria are major pathogens in combat casualties. We evaluated risk factors for colonization with MDR bacteria in US military personnel travelling internationally for official duty.Methods: TravMil is a prospective observational study enrolling subjects presenting to military travel clinics. We analysed surveys, antimicrobial use data, and pre- and post-travel perirectal swabs in military travellers to regions outside the continental USA, Canada, Western or Northern Europe, or New Zealand, presenting to one clinic from 12/2015 to 12/2017. Recovered Gram-negative isolates underwent identification and susceptibility testing (BD Phoenix). Characteristics of trip and traveller were analysed to determine risk factors for MDR organism colonization.Results: 110 trips were planned by 99 travellers (74% male, median age 38 years [IQR 31, 47.25]); 72 trips with returned pre- and post-travel swabs were completed by 64 travellers. Median duration was 21 days (IQR 12.75, 79.5). 17% travelled to Mexico/Caribbean/Central America, 15% to Asia, 57% to Africa and 10% to South America; 56% stayed in hotels and 50% in dormitories/barracks. Travellers used doxycycline (15%) for malaria prophylaxis, 11% took an antibiotic for travellers' diarrhoea (TD) treatment (fluoroquinolone 7%, azithromycin 4%). Incident MDR organism colonization occurred in 8 travellers (incidence density 3.5/1000 travel days; cumulative incidence 11% of trips [95% CI: 4-19%]), all ESBL-producing Escherichia coli. A higher incidence of ESBL-producing E. coli acquisition was associated with travel to Asia (36% vs 7%, P = 0.02) but not with travel to other regions, TD or use of antimicrobials. No relationship was seen between fluoroquinolone or doxycycline exposure and resistance to those antimicrobials.Conclusions: Incident colonization with MDR organisms occurs at a lower rate in this military population compared with civilian travellers, with no identified modifiable risk factors, with highest incidence of ESBL acquisition observed after South Asia travel. [ABSTRACT FROM AUTHOR]

Technology-enabled mental health services have the potential to expand the reach of care and reduce clinician demand. While the efficacy of technology-enabled mental health services is well established, there have been few successful implementations of such services into community care settings. Using mixed methods, 89 clinicians and supervisors at a mental health service organization shared attitudes toward and interest in using a variety of technologies in their work. Participants discussed several challenges and opportunities for technology-enabled mental health services. Whilst clinicians saw potential for technology to engage individuals both in and outside the clinical environment, the range of therapeutic techniques used by clinicians presented a challenge in implementing a tool to meet their needs. Client technology access was a concern, and although text messaging would facilitate communication, current HIPAA and payment structures restrict this ability. With these considerations, we offer recommendations for implementing technological services in community mental health organizations. [ABSTRACT FROM AUTHOR]

For early emerging adults with serious mental health conditions, vocational services with peer mentors are a promising adaptation of adult system evidence-based practices. Peer mentors were added to the Individual Placement and Support model of supported employment for 17- to 20-year-olds receiving residential and psychiatric care. To explore the feasibility of vocational peer mentors, open-ended satisfaction surveys and the Working Alliance Inventory were administered to mentees at 12 months. Thematic analysis of surveys reveals the importance of peer mentor authenticity, flexibility, and being a graduate of the mental health program where vocational services were based. Valued relational processes include the act of talking in the community, feeling understood, and forming a bond with peer mentors. Mentees with positive peer mentoring experiences reported stronger working alliances. This study sheds light onto near-age mentoring relational processes for this population, which can inform future research of mentoring processes and intervention design. [ABSTRACT FROM AUTHOR]

Effective services are needed to assist young people with serious mental health conditions to successfully transition to employment or education, especially among those with intensive adolescent mental health service utilization. To meet these needs, the Individual Placement and Support (IPS) model of supported employment was adapted and its feasibility was tested in a psychiatric treatment program for early-emerging adults. Participants were 17-20 years old (mean age = 18.5 years). Most were African American, under the custody of the state, with a primary mood disorder diagnosis. Adaptations to IPS included adding the following: near age peer mentors, a supported education component, and a career development focus. This open trial feasibility study tracked the model's development, recruitment, and retention and tracked vocational and educational outcomes for 12 months. Model refinement resulted in the development of a separate educational specialist position, greater integration of the peer mentor with the vocational team, and further specification of the role of peer mentor. There was an 80% retention rate in the feasibility evaluation. Of the 35 participants, 49% started a job and/or enrolled in an education program over the 12-month period. [ABSTRACT FROM AUTHOR]

Objective: Engaging persons with co-occurring disorders in substance use treatment presents a significant challenge for public mental health service providers. Standardized, user-friendly guidelines may have great benefit for community mental health outreach staff working with individuals with co-occurring disorders. The purpose of this study is to describe the impact of a brief, structured goal development curriculum ("Fresh Start") on clinicians' motivational interviewing skills and to assess clinician and consumer satisfaction with the curriculum. Method: Four clinicians, each working with 3-4 consumer participants, were assessed with the Yale Adherence and Competency Scale prior to and during use of Fresh Start to determine improvements in motivational interviewing and goal setting. Consumer participants were assessed in brief qualitative interviews to assess satisfaction. Chart-review of routinely collected substance use data was used to assess reductions in use. Results: Clinicians demonstrated high ratings in relational motivational interviewing skills at baseline which were maintained at study conclusion. Clinicians had lower technical motivational interviewing skills at baseline and made modest improvements in motivational interviewing techniques targeting increasing change talk. Fresh Start participants completed an average of 10 sessions (SD = 2.35). Among the 16 consumers who volunteered to participate in using the Fresh Start curriculum, 12 finished the program and 9 decided to reduce use and composed a sobriety plan. Conclusions and Implication for Practice: High rates of completion indicate acceptability of the curriculum and feasibility for implementing the program in a community setting. Short, goal-setting interventions are needed and under proper conditions may be teachable in vivo. [ABSTRACT FROM AUTHOR]

Vulnerable transition age youth, such as those in foster care and with serious mental health conditions, are at increased risk for lower rates of employment. Social capital is empirically linked to employment in the general population, yet little is known about the role of social capital in employment for at-risk transition age youth. Focus groups were conducted with young people with serious mental health conditions and their vocational specialists. Discussions reveal that both social and cultural capital influence employment processes. Those with employment experience value the motivation to work provided through others compared to those with no employment experience. Consistently employed describe strong working relationships with vocational specialists and possession of self-awareness, professionalism, and work-place knowledge as critical for employment success, while inconsistently employed describe worries about controlling emotions or behaviors on the job. Building social and cultural capital are explored as potential service provider goals. [ABSTRACT FROM AUTHOR]

Background Recent work has argued that genus Klebsiella is best divided into 3 clades: K. pneumoniae (Kp) , K. quasipneumoniae (Kq), and K. variicola (Kv). Kv has drawn attention from reports of higher mortality and virulence. We evaluated a previously defined group of military trauma patients with Klebsiella infections for the presence of Kv, described clinical and isolate characteristics, and compared Kv and Kp groups. Methods All initial and serial (≥7 days from prior isolate) infecting Kp isolates (identified by clinical laboratories without the ability to speciate Kq and Kv) were collected from the Trauma Infectious Disease Outcomes Study (6/09–12/14). Additionally, a previously defined group of colonizing isolates linked to the infecting isolates and a selection of random colonizers were included from groin swabs. DNA extraction and PCR targeting Kv per published methods was performed. Antimicrobial susceptibilities were determined using the BD Phoenix Automated Microbiology System and CLSI criteria. Multidrug resistance was defined as either resistance to ≥3 classes of aminoglycosides, β-lactams, carbapenems and/or fluoroquinolones or production of ESBL or KPC. Results Of 237 archived Kp isolates (from 122 patients), 10 (4%) were identified as Kv by PCR (from 8 [7%] patients). The Kv sources were 4 from blood (40%), 1 intra-abdominal (10%) and 5 from groin (50%). Six (3%) isolates were identified as Kq (4 from groin and 2 from respiratory specimens). The Kv and Kp patients were all males, with a median age of 25 (IQR 21–46) and 23 (IQR 21–28), length of hospital stay of 24 days (IQR: 5–106) and 53 days (IQR 36–74), and Injury Severity Score of 21 (IQR: 10–50) and 38 (IQR: 30–45), respectively. There were no deaths in the Kv group compared with 4 with Kp. Infecting Kv isolates were more likely to be from blood compared with Kp (80% vs. 17%, P = 0.04). No infecting Kv isolates were multidrug-resistant compared with 70% of infecting Kp isolates (P < 0.01). Conclusion Kv represented 4% of the previously identified Kp isolates in this population. Patient characteristics were similar in both groups. While Kv was less resistant than Kp, it was more likely to be associated with invasive disease in this group. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Reports on the seasonal distribution patterns for fish and decapod crustaceans by habitat type for a Cape Cod estuary in Nauset Marsh, Massachusetts. Fish larval supply; Habitat use; Faunal composition of Nauset Marsh.

This trial examined whether a stepped care program for depression, which initiated treatment with internet cognitive behavioral therapy, including telephone and messaging support, and stepped up non-responders to telephone-administered cognitive behavioral therapy (tCBT), was noninferior, less costly to deliver, and as acceptable to patients compared to tCBT alone. Adults with a diagnosis of major depressive episode (MDE) were randomized to receive up to 20 weeks of stepped care or tCBT. Stepped care (n = 134) was noninferior to tCBT (n = 136) with an end-of-treatment effect size of d = 0.03 and a 6-month post-treatment effect size of d = −0.07 [90% CI 0.29 to 0.14]. Therapist time in stepped care was 5.26 (SD = 3.08) hours versus 10.16 (SD 4.01) for tCBT (p < 0.0001), with a delivery cost difference of $-364.32 [95% CI $-423.68 to $-304.96]. There was no significant difference in pre-treatment preferences (p = 0.10) or treatment dropout (39 in stepped care; 27 in tCBT; p = 0.14). tCBT patients were significantly more satisfied than stepped care patients with the treatment they received (p < 0.0001). These findings indicate that stepped care was less costly to deliver, but no less effective than tCBT. There was no significant difference in treatment preference or completion, however satisfaction with treatment was higher in tCBT than stepped care. clinicaltrials.gov Identifier: NCT01906476. • Stepped care used internet cognitive behavioral therapy (iCBT) + telephone CBT [tCBT]). • Stepped care was noninferior to tCBT for depression at both post-treatment and 6-month follow-up. • Stepped care cost approximately half to administer, compared to tCBT. • Treatment dropout for stepped care was not significantly different from tCBT. [ABSTRACT FROM AUTHOR]

Background Biocides play an integral role in infection control. Paralleling concern about rising incidence of multidrug-resistant (MDR) organisms is a concern for resistance to biocides. In small studies, several genes involved in the production of efflux pump proteins have been identified as markers of biocide resistance in Klebsiella spp. namely cepA , qacA , qacE , qac∆E , and acrA. This study aimed to analyze the Klebsiella spp. isolates of a previously defined military trauma group with a high incidence of MDR organisms for the presence of these genes and their correlation with other resistance. Methods All infecting K. pneumoniae, K. variicola , and K. quasipneumoniae isolates archived by the Trauma Infectious Disease Outcomes Study (June 2009–December 2014) were selected. Additionally, all colonizing isolates linked with infecting isolates were included; the remainder to total 50 MDR and 46 non-MDR colonizing isolates were chosen randomly. Antimicrobial identification and susceptibilities were determined by CLSI criteria using the BD Phoenix Automated Microbiology System. PCR according to published methods for cepA , qacA , qacE , qac∆E , and acrA was accomplished in duplicate. MDR was defined as either resistance to ≥3 classes of aminoglycosides, β-lactams, carbapenems and/or fluoroquinolones or production of an ESBL or KPC. Results A total of 237 isolates (221 K. pneumoniae , 10 K. variicola , 6 K. quasipneumoniae) met inclusion criteria, of which 149 (63%) were MDR. All isolates had been exposed to antimicrobials prior to isolation. Of all isolates, 234 (98%) carried cepA : 218 (98%) K. pneumoniae carried cepA, 10 (100%) K. variicola carried cepA, and 6 (100%) of K. quasipneumoniae carried cepA. In addition, 148 (62%) isolates with cepA were MDR. One (10%) K. variicola isolate carried qacE along with cepA. This isolate was the only MDR K. variicola. None of the isolates carried qacA, qac∆E, or acrA. Conclusion We confirmed the near universal presence of the cepA biocide resistance gene in Klebsiella spp. isolated from trauma patients in Iraq and Afghanistan. In the largest evaluation of biocide resistance genes in Klebsiella spp. to our knowledge, the presence of qacA , qacE , qac∆E , and acrA was less common than has been reported elsewhere. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]