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Between 1982 and 1986, 126 patients who had undergoneACL reconstruction were followed in a prospectivemanner. One year follow-up statistics were reviewedfor the presence of 13 different complications.The most prevalent complications were quadricepsweakness, flexion contracture, and patellofemoral pain.Quadriceps weakness (strength less than 80% of thenormal side) was present in 65% of patients and correlatedpositively with flexion contracture, patellar irritability,and ACL reconstructions using patellar tendongrafts. Flexion contracture of 5° or more was presentin 24% of patients and correlated positively with increasedage and patellar irritability. Patellofemoral painwas present in 19% of patients and correlated positivelywith flexion contracture.Clinical relevance: The three most common complicationsof knee ligament surgery are shown to bestrongly interrelated. It is likely that a causal relationshipis present in which flexion contracture causes patellofemoralirritability, and that both of these factors, aloneor in combination, result in quadriceps weakness. If thistheory is correct, then it is crucial that postoperativerehabilitation programs place a major emphasis on theavoidance of flexion contracture.

Abstract Purpose The aims of the Advocate-BREAST project are to study and improve the breast cancer (BC) patient experience through education and patient-centered research. Methods In December 2021, an electronic REDCap survey was circulated to 6,918 BC survivors (stage 0–4) enrolled in the Mayo Clinic Breast Disease Registry. The questionnaire asked about satisfaction with BC care delivery, and education and support receive(d) regarding BC linked concerns. Patients also ranked Quality Improvement (QI) proposals. Results The survey received 2,437 responses. 18% had Ductal Carcinoma in Situ, 81% had early breast cancer (EBC), i.e. stage 1–3, and 2% had metastatic breast cancer (MBC). Mean age was 64 (SD 11.8), and mean time since diagnosis was 93 months (SD 70.2). 69.3% of patients received all care at Mayo Clinic. The overall experience of care was good (> 90%). The main severe symptoms recalled in year 1 were alopecia, eyebrow/eyelash thinning, hot flashes, sexual dysfunction, and cognitive issues. The main concerns recalled were fear of BC recurrence/spread; loved ones coping; fear of dying, and emotional health. Patients were most dissatisfied with information regarding sexual dysfunction, eyebrow/eyelash thinning, peripheral neuropathy, and on side effects of immunotherapy/targeted therapies. Top ranking QI projects were: i) Lifetime access to concise educational resources; ii) Holistic support programs for MBC and iii) Wellness Programs for EBC and MBC. Conclusions Patients with early and advanced BC desire psychological support, concise educational resources, and holistic care. Implications Focused research and QI initiatives in these areas will improve the BC patient experience.

Abstract Background The Diabetes Telemedicine Mediterranean Diet (DiaTeleMed) Study is a fully remote randomized clinical trial evaluating personalized dietary management in individuals with type 2 diabetes (T2D). The study aims to test the efficacy of a personalized behavioral approach for dietary management of moderately controlled T2D, versus a standardized behavioral intervention that uses one-size-fits-all dietary recommendations, versus a usual care control (UCC). The primary outcome will compare the impact of each intervention on the mean amplitude of glycemic excursions (MAGE). Methods Eligible participants are between 21 and 80 years of age diagnosed with moderately controlled T2D (HbA1c: 6.0 to 8.0%) and managed on lifestyle alone or lifestyle plus metformin. Participants must be willing and able to attend virtual counseling sessions and log meals into a dietary tracking smartphone application (DayTwo), and wear a continuous glucose monitor (CGM) for up to 12 days. Participants are randomized with equal allocation (n = 255, n = 85 per arm) to one of three arms: (1) Personalized, (2) Standardized, or (3) UCC. Measurements occur at 0 (baseline), 3, and 6 months. All participants receive isocaloric energy and macronutrient targets to meet Mediterranean diet guidelines, in addition to 14 intervention contacts over 6 months (4 weekly then 10 biweekly) to cover diabetes self-management education. The first 4 UCC intervention contacts are delivered via synchronous videoconferences followed by educational video links. Participants in Standardized receive the same educational content as those in the UCC arm, following the same schedule. However, all intervention contacts are conducted via synchronous videoconferences, paired with Social Cognitive Theory (SCT)-based behavioral counseling, plus dietary self-monitoring of planned meals using a mobile app that provides real-time feedback on calories and macronutrients. Participants in the Personalized arm receive all elements of the Standardized intervention, in addition to real-time feedback on predicted post-prandial glycemic response (PPGR) to meals and snacks logged into the mobile app. Discussion The DiaTeleMed Study aims to address an important gap in the current landscape of precision nutrition by determining the contributions of behavioral counseling and personalized nutrition recommendations on glycemic control in individuals with T2D. The fully remote methodology of the study allows for scalability and innovative delivery of personalized dietary recommendations at a population level. Trial registration ClinicalTrials.gov NCT05046886. Registered on September 16, 2021.

Abstract Background Implementation of new practices in team-based settings requires teams to work together to respond to new demands and changing expectations. However, team constructs and team-based implementation approaches have received little attention in the implementation science literature. This systematic review summarizes empirical research examining associations between teamwork and implementation outcomes when evidence-based practices and other innovations are implemented in healthcare and human service settings. Methods We searched MEDLINE, CINAHL, APA PsycINFO and ERIC for peer-reviewed empirical articles published from January 2000 to March 2022. Additional articles were identified by searches of reference lists and a cited reference search for included articles (completed in February 2023). We selected studies using quantitative, qualitative, or mixed methods to examine associations between team constructs and implementation outcomes in healthcare and human service settings. We used the Mixed Methods Appraisal Tool to assess methodological quality/risk of bias and conducted a narrative synthesis of included studies. GRADE and GRADE-CERQual were used to assess the strength of the body of evidence. Results Searches identified 10,489 results. After review, 58 articles representing 55 studies were included. Relevant studies increased over time; 71% of articles were published after 2016. We were unable to generate estimates of effects for any quantitative associations because of very limited overlap in the reported associations between team variables and implementation outcomes. Qualitative findings with high confidence were: 1) Staffing shortages and turnover hinder implementation; 2) Adaptive team functioning (i.e., positive affective states, effective behavior processes, shared cognitive states) facilitates implementation and is associated with better implementation outcomes; Problems in team functioning (i.e., negative affective states, problematic behavioral processes, lack of shared cognitive states) act as barriers to implementation and are associated with poor implementation outcomes; and 3) Open, ongoing, and effective communication within teams facilitates implementation of new practices; poor communication is a barrier. Conclusions Teamwork matters for implementation. However, both team constructs and implementation outcomes were often poorly specified, and there was little overlap of team constructs and implementation outcomes studied in quantitative studies. Greater specificity and rigor are needed to understand how teamwork influences implementation processes and outcomes. We provide recommendations for improving the conceptualization, description, assessment, analysis, and interpretation of research on teams implementing innovations. Trial registration This systematic review was registered in PROSPERO, the international prospective register of systematic reviews. Registration number: CRD42020220168.

Background: The unexpected COVID-19 pandemic impacted not only students at institutions of higher learning, but also faculty who often made rapid transitions from face-to-face to online or distance learning. Distance learning has been shown to negatively impact college students' physical activity, screen time, and mental health concerns. Little is known, however, about the transition and impact of the pandemic and distance learning on university faculty. Purpose: The purpose of this study was to examine the impact of the rapid transition from traditional face-to-face teaching methodologies to distance learning on professional quality of life, physical activity, screen time, and anxiety and depression among faculty. Methods: A descriptive survey design with snowball sampling, was used to collect data anonymously, online. An electronic survey was developed to explore professional quality of life, physical activity, screen time, anxiety, and depression. Results: The COVID-19 pandemic and subsequent rapid transition of teaching and learning methodologies impacted not only students, but faculty at institutions of higher learning. Most faculty indicated concerns with their professional quality of life, putting them at moderate risk of burnout. A negative correlation between leisure time and anxiety or depression was found as well as a positive correlation between increased screen time and depression. Conclusion: Increased screen time and decreased physical activity or leisure time may contribute to increased faculty burnout, depression, and anxiety. University administration may need to consider strategies to help faculty cope with transitions to unfamiliar teaching methodologies and self-care behavioral changes to avoid faculty dissatisfaction and disengagement.

Mathematics teachers may at times take on the role of counselors to address the "math anxious" in their classrooms. Today math anxiety is real and is a factor in attracting young people to many STEM fields. By the time many young people reach middle school, they have developed certain dispositions toward mathematics. What strategies will lessen the negative disposition and anxiety many students have toward math? The strategies included in this article are applicable for both general and special education teachers, especially when used together to prevent and reduce math anxiety. It is important that all students feel confident in their ability to do mathematics in an age that relies so heavily on problem solving, technology, science, and mathematics. In a STEM world it really is a school's obligation to see that their students value and feel confident in their ability to do math, because ultimately, all decisions individuals make and choices of careers may be determined in part by their attitudes toward mathematics.

Background: Yoga interventions need fidelity monitoring to standardize the trial process and ensure adherence. We examined fidelity measures of current yoga trials and developed a fidelity assurance process in a phase III randomized clinical trial addressing chemotherapy-induced peripheral neuropathy among cancer survivors. Methods: We qualitatively analyzed the fidelity monitoring components in published clinical trials on yoga therapy for chemotherapy-induced peripheral neuropathy through a literature search in PubMed from inception to February 2023. Leveraging fidelity measures for community-based, complex interventions and yoga therapy reporting guidelines, we developed an instructor/participant-oriented fidelity checking approach in an ongoing phase III trial evaluating yoga for improving chemotherapy-induced peripheral neuropathy in cancer survivors. Two researchers independently assessed 4 of 8 video recordings of yoga instructor-led training sessions (50%) and participant-kept home practice logs using a developed fidelity checklist. Results: None of the 4 eligible yoga trials specifically have intervention fidelity measures. We prospectively incorporated yoga instructor training, virtual delivery, and participant engagement strategies in the phase III trial protocol following guidelines. All trial yoga instructors were trained under study protocol to ensure compliance and participant engagement. There was high intervention fidelity in all instructor-led virtual sessions: an average of 100% adherence to class structure and three-thirds on specific skills. Assessment of participant adherence to the established home yoga protocol was 63%. Conclusion: Yoga trials for chemotherapy-induced peripheral neuropathy need adequate fidelity measures. Our study provides a feasible fidelity-monitoring approach to ensure trial intervention delivery and protocol adherence by instructors and participants in oncological settings.

University of California Health (UCH) provided a system-wide, rapid response to the humanitarian crisis of unaccompanied children crossing the southern U.S. border in the midst of the COVID-19 pandemic in 2021. In collaboration with multiple federal, state, and local agencies, UCH mobilized a multidisciplinary team to deliver acute general and specialty pediatric care to unaccompanied children at 2 Californian emergency intake sites (EISs). The response, which did not disrupt normal UCH operations, mobilized the capacities of the system and resulted in a safe and developmentally appropriate environment that supported the physical and mental health of migrant children during this traumatic period. The capacities of UCH's 6 academic health centers ensured access to trauma-informed medical care and culturally sensitive psychological and social support. Child life professionals provided access to exercise, play, and entertainment. Overall, 260 physicians, 42 residents and fellows, 4 nurse practitioners participated as treating clinicians and were supported by hundreds of staff across the 2 EISs. Over 5 months and across both EISs, a total of 4,911 children aged 3 to 17 years were cared for. A total of 782 children had COVID-19, most infected before arrival. Most children (3,931) were reunified with family or sponsors. Continuity of care after reunification or placement in a long-term shelter was enhanced by use of an electronic health record. The effort provided an educational experience for residents and fellows with instruction in immigrant health and trauma-informed care. The effort benefitted from UCH's recent experience of providing a system-wide response to the COVID-19 pandemic. Lessons learned are reported to encourage the alignment and integration of academic health centers' capacities with federal, state, and local plans to better prepare for and respond to the accelerating need to care for those in the wake of disasters and humanitarian crises.

Introduction: The lack of disability-accessible medical diagnostic equipment (MDE) in primary care impedes the receipt of quality medical care by people with mobility impairments. Cross-sectional surveys and observational studies have found

With the increased emphasis in communicative language learning and task-based language teaching, classroom assessment increasingly includes performance-based assessments (e.g., essays, speeches, projects, presentations), which require careful planning and can be challenging to implement and assess. The ability to design and use well-designed assessments for language performance tasks is a critical skill for classroom instructors. A rubric is a tool to more objectively measure the quality of the language performance when assessing language use in open-ended tasks. Analytic rubrics, with multiple categories and descriptions reflecting various levels of performance, help the instructor evaluate the effectiveness of instruction, document evidence of learner progress, and give feedback to learners. This article synthesizes theoretical and empirical scholarship in order to describe how to construct well-designed analytic rubrics for classroom language assessment. Four main steps are described: (1) establishing categories, (2) describing levels of performance, (3) reviewing the components of the rubric before implementation, and (4) evaluating the effectiveness of the rubric after implementation.

Destruction wrought by hurricanes can physically impact schools, houses, and businesses, all of which can delay or prevent recovery within communities. This study investigated the awareness among five private K-12 Christian administrators of the United States Department of Education (USDOE) guidelines for developing emergency operation plans (EOPs) for effective response and recovery. The five administrators were selected from a pool of 12 whose schools sustained on-site damage during the 2017 hurricane season. Their interview responses supported evidence of general knowledge of USDOE guidelines. Notably, veteran administrators reported that their previous hurricane response experience was more useful than their knowledge of government EOP guidelines.

ObjectivesThe following scoping review aims to identify and map the existing evidence for HIT interventions among women with DV experiences in the United States. And provide guidance for future research, and facilitate clinical and technical applications for healthcare professionals.MethodsFive databases, PubMed, EBSCOhost CINAHL, Ovid APA PsycINFO, Scopus and Google Scholar, were searched from date of inception to May 2023. Reviewers extracted classification of the intervention, descriptive details, and intervention outcomes, including physical safety, psychological, and technical outcomes, based on representations in the included studies.ResultsA total of 24 studies were included, identifying seven web-based interventions and four types of abuse. A total of five studies reported safety outcomes related to physical health. Three studies reported depression, anxiety, and post-traumatic stress disorder as psychological health outcomes. The effectiveness of technology interventions was assessed in eight studies.ConclusionDomestic violence is a major public health issue, and research has demonstrated the tremendous potential of health information technology, the use of which can support individuals, families, and communities of domestic violence survivors.

BackgroundMost people with mental health problems do not seek help, with delays of even decades in seeking professional help. Lack of engagement with professional mental health services can lead to poor outcomes and functional impairment. However, few effective interventions have been identified to improve help-seeking in adults, and those that exist are not widely implemented to deliver public health impact. Co-designing interventions with people with lived experience of mental ill-health and other relevant stakeholders is critical to increase the likelihood of uptake and engagement with these programs. ObjectiveThis study aims to (1) test the effectiveness of a co-designed help-seeking program on increasing professional help-seeking intentions in employees in a workplace setting; (2) determine whether the program reduces mental illness stigma and improves help-seeking intentions and behavior, mental health literacy, mental health symptoms, and work and activity functioning relative to the control condition; (3) explore factors that facilitate broader implementation of the co-designed program; and (4) explore the cost-effectiveness of the co-designed program compared to the control condition over 6 months. MethodsA 2-arm cluster randomized controlled trial will be conducted (target sample: N=900 from 30 to 36 workplaces, with n=25 to 35 participants per workplace). The trial will compare the relative effectiveness of an enhanced interactive program (intervention condition) with a standard psychoeducation-alone program (active control condition) on the primary outcome of professional help-seeking intentions as measured by the General Help-Seeking Questionnaire. Secondary outcomes include the impact on mental illness stigma; mental health literacy; help-seeking attitudes and behavior; work and activity functioning; quality of life; and symptoms of mental ill-health including depression, anxiety, and general psychological distress. ResultsFacilitators of and risks to the trial are identified and addressed in this protocol. Recruitment of workplaces is scheduled to commence in the first quarter of 2024. ConclusionsIf effective, the program has the potential to be ready for rapid dissemination throughout Australia, with the potential to increase appropriate and efficient service use across the spectrum of evidence-based services. Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000270617p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385376 International Registered Report Identifier (IRRID)PRR1-10.2196/55529

The Canadian academy is dominated by Western epistemologies that devalue Indigenous ways of knowing and marginalize Indigenous communities, cultures, and histories (Louie et al., 2017). This paper draws on a cross-disciplinary, interprofessional collaboration between a School of Public Health Sciences and School of Social Work to develop an online graduate course that sought to advance knowledge and practice in Indigenous wellbeing and health through a social justice lens. We explore key considerations, strategies, and challenges undertaken by an interdisciplinary group of non-Indigenous professors to create a learning experience for students that challenges colonial ways of seeing, being, knowing, and doing in the professional practice fields of public health and social work and that serves to elevate and sustain Indigenous voices, knowledges, sciences, and practices within the academy. In doing so, we centre the process of course development, including working with an Indigenous Advisory Circle and Indigenous contributors of content, guest lecture videos, and artwork. The paper describes the creation of a relational teaching and learning community, while raising concerns about the institutionalization of this approach to Indigenous-focused course development in the absence of the structural changes needed to enhance the presence of Indigenous faculty and Elders in academic institutions.

Abstract Background Anorexia nervosa (AN) has amongst the highest mortality rates and the highest treatment costs of any psychiatric disorder. Recently, interest in non-invasive brain stimulation as a novel treatment for AN has grown. These include repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). Methods This double-blind, randomised sham-controlled trial will compare the relative acceptability and efficacy of tDCS and rTMS in people with AN. 70 participants will be randomised to active or sham tDCS, or active or sham rTMS treatment (2:1:2:1 ratio) over an 8-week treatment period. Participants will receive treatment as usual across the study duration. The primary outcomes are change on the Eating Disorder Examination Questionnaire and treatment acceptability. Secondary outcomes will include change in weight, cognition, mood, interpersonal functioning, and quality of life. Following the 8-week assessment, all participants will have the option of receiving an additional 12 weeks of at-home tDCS. A follow-up assessment will be conducted at 20 weeks post treatment. Discussion Research into non-invasive brain stimulation as treatments for AN has potential to improve clinical outcomes for patients by comparing the relative efficacy and acceptability of both treatment modalities in the inpatient and at-home setting (i.e., for at-home tDCS) results from this study will provide important information for informing future larger clinical trials of these treatments for AN. Trial registration ClinicalTrials.gov Identifier: NCT05788042.