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Background Women living with HIV are at increased risk of poor mental health and intimate partner violence (IPV). Mental health disorders have been consistently associated with suboptimal HIV-related outcomes. Little is known about the prevalence or correlates of mental health disorders among pregnant women living with HIV in sub-Saharan Africa. Methods This study assessed the prevalence of probable common mental disorders (CMD), i.e., depressive or anxiety disorders, and the relationship between probable CMD and recent IPV among pregnant women living with HIV in Cameroon. The sample included 230 pregnant women living with HIV aged > 18 enrolled in care at 10 HIV clinics in Cameroon. Probable CMD was assessed with the WHO Self Reporting Questionnaire (SRQ-20). Multivariable logistic regression was conducted to assess the relationship between IPV and probable CMD. Results Almost half (42%) of participants had probable CMD using a 7/8 cut-off of the SRQ-20. Emotional, physical, and sexual IPV were reported by 44, 37, and 31% of respondents, respectively. In multivariable regression analyses, all forms of IPV assessed were significantly associated with greater odds of probable CMD. Conclusions Pregnant women living with HIV in Cameroon had a high prevalence of probable CMD and IPV. Screening and services to address IPV and mental health are urgently needed for this population. Integrated interventions to both prevent and screen and address IPV and probable CMD should be developed, implemented, and evaluated.

A major clinical challenge of ovarian cancer is the development of malignant ascites accompanied by widespread peritoneal metastasis. In ovarian clear cell carcinoma (OCCC), a challenging subtype of ovarian cancer, this problem is compounded by near-universal primary chemoresistance; patients with advanced stage OCCC thus lack effective therapies and face extremely poor survival rates. Here we show that tumor-cell-expressed serine protease inhibitor Kazal type 1 (SPINK1) is a key driver of OCCC progression and metastasis. Using cell culture models of human OCCC, we find that shRNA silencing of SPINK1 sensitizes tumor cells to anoikis and inhibits proliferation. Knockdown of SPINK1 in OCCC cells also profoundly suppresses peritoneal metastasis in mouse implantation models of human OCCC. We next identify a novel autocrine signaling axis in OCCC cells whereby tumor-cell-produced interleukin-6 (IL-6) regulates SPINK1 expression to stimulate a common protumorigenic gene expression pattern leading to anoikis resistance and proliferation of OCCC cells. We further demonstrate that this signaling pathway can be successfully interrupted with the IL-6Rα inhibitor tocilizumab, sensitizing cells to anoikis in vitro and reducing metastasis in vivo. These results suggest that clinical trials of IL-6 pathway inhibitors in OCCC may be warranted, and that SPINK1 might offer a candidate predictive biomarker in this population.

Kimberlé Crenshaw’s scholarship on Black women has been the springboard for numerous education studies in which researchers use intersectionality as a theoretical framework; however, few have considered the possibilities of intersectionality as a methodological tool. In this literature synthesis, the authors (a) examined studies about Black women in higher education that had been published in the past 30 years to understand how those scholars applied intersectionality across Crenshaw’s three dimensions (i.e., structural, political, and representational) and (b) advanced a set of four strategies, arguably providing a guide for engaging “intersectionality methodology,” what the authors coin as “IM.” Implications for higher education research and social science research broadly are also presented.

This article documents the results of a meta-analysis of available correlational validity evidence for the Social Skills Improvement System Performance Screening Guide (SSIS-PSG), which is a brief teacher-completed rating scale designed to be used as part of universal screening procedures. Article inclusion criteria included (a) published in English in a peer-reviewed journal, (b) administration of the PSG, and (c) provided validity evidence representative of the relationship between PSG scores and scores on related variables. Ten studies yielding 147 correlation coefficients met criteria for inclusion. Data were extracted following established procedures in validity generalization and meta-analytic research. Extracted coefficients were of the expected direction and magnitude with theoretically aligned constructs, thereby providing evidence of convergent validity (e.g., PSG Math and Reading items were most strongly correlated with academic performance and academic behavior variables, with effect sizes ranging from .708 to .740; PSG Prosocial Behavior and Motivation to Learn items were most strongly correlated with broadband externalizing/internalizing problems, with effect sizes ranging from −.706 to −.717), although Prosocial Behavior and Motivation to Learn were not as effective at discriminating among divergent constructs. These results generally support the utility of the PSG in correlating with academic and social/behavioral outcomes in the schools.

The purpose of the study was to examine how four different high schools within one school district implemented the AVID program. The researcher used a comparative case study model to examine the different sites' programs and how the program and program implementation varied by site. The research questions answered how the AVID program was implemented by site, whether the program was implemented with fidelity, and if there were factors that impacted program implementation. The AVID district coordinator, site administrators and site coordinators were surveyed to gauge the understanding of the AVID program, program implementation, and how AVID implementation impacts the program fidelity by site. AVID research suggests that the program works to address the needs of students from underserved populations and aims to help them access advanced academic classes and achieve more success within those college prep courses and school overall. This study may help school districts, school administation and AVID personnel better understand how site implementation impacts overall program success and to see how barriers impact the implemenation process at school sites. Findings included, some school-based administrators and site coordinators did not feel they implemented the AVID program with fidelity, site administrators' involvement with the AVID implementation was inconsistent, most site administrators knew nothing about the specific rating of the AVID Coaching and Certification Instrument (CCI) or the measurement overall. Other findings were AVID site coordinators completed the AVID CCI and coordinated all aspects of the process and AVID implementation at the sites, site coordinators perceived that they implemented the AVID program with the most fidelity possible within their respective "means" but not with fidelity. Further, schools implemented the AVID Domains with varied degrees of fidelity according to the AVID CCI and each site had a unique implementation of the AVID program. Doctor of Education Advancement Via Individual Determination (AVID) is an educational program that aims to help underserved students learn how to successfully access classes that helps prepare them for college. The AVID program is offered in some schools to aid students in the academic middle through instruction, tutoring, and structures to learn how to be successful in honors courses within the middle and high school levels. School leaders need to understand how well AVID programs are being implemented within their school to ensure that the program can be the most successful to reach the students well. This research study looked at four AVID schools to see how well they implemented the AVID program in comparison to how it should be done, the role school administration had in the implementation, and how implementation differed at schools. The study used information from the AVID Coaching and Certification Instrument (the AVID report card), to see how the school scored and each AVID site administrator (building principal) and AVID site coordinator (the person who runs the AVID program at the school) were interviewed and asked several questions to better understand the program at each school, the role the site administrator and site coordinator played in running the program and how well the AVID staff understood how well the school did with the program at their school. The study found that schools implemented their programs differently, that the AVID principals did not feel they ran the program as it should be, and that most of the AVID principals did not know what the AVID CCI was or how their school scored. The AVID site coordinator was responsible for running AVID at the school, they ran the AVID program as well as they could but not as it should be.

This qualitative study examines how professional associations in student affairs socialize graduate students and new professionals. Utilizing data from semi-structured interviews with 15 individual...

Background Team-based models of care are efficacious in improving outcomes for patients with mental and physical illnesses. However, primary care clinics have been slow to adopt these models. We used iterative stakeholder engagement to develop an intervention to improve the implementation of team-based care for this complex population. Methods We developed the initial framework for Relational Team Development (RELATED) from a qualitative study of Primary Care Providers’ (PCPs’) experiences treating mental illness and a literature review of practice facilitation and psychology clinical supervision. Subsequently, we surveyed 900 Colorado PCPs to identify factors associated with PCP self-efficacy in management of mental illness and team-based care. We then conducted two focus groups for feedback on RELATED. Lastly, we convened an expert panel to refine the intervention. Results We developed RELATED, a two-part intervention delivered by a practice facilitator with a background in clinical psychology. The facilitator observes PCPs during patient visits and provides individualized coaching. Next, the facilitator guides the primary care team through a practice change activity with a focus on relational team dynamics. Conclusion The iterative development of RELATED using stakeholder engagement offers a model for the development of interventions tailored to the needs of these stakeholders. Trial registration Not applicable. Electronic supplementary material The online version of this article (10.1186/s12875-019-1010-z) contains supplementary material, which is available to authorized users.

COVID-19 is a devastating respiratory and inflammatory illness caused by a new coronavirus that is rapidly spreading throughout the human population. Over the past 12 months, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, has already infected over 160 million (&gt, 20% located in United States) and killed more than 3.3 million people around the world (&gt, 20% deaths in USA). As we face one of the most challenging times in our recent history, there is an urgent need to identify drug candidates that can attack SARS-CoV-2 on multiple fronts. We have therefore initiated a computational dynamics drug pipeline using molecular modeling, structure simulation, docking and machine learning models to predict the inhibitory activity of several million compounds against two essential SARS-CoV-2 viral proteins and their host protein interactors—S/Ace2, Tmprss2, Cathepsins L and K, and Mpro—to prevent binding, membrane fusion and replication of the virus, respectively. All together, we generated an ensemble of structural conformations that increase high-quality docking outcomes to screen over &gt, 6 million compounds including all FDA-approved drugs, drugs under clinical trial (&gt, 3000) and an additional &gt, 30 million selected chemotypes from fragment libraries. Our results yielded an initial set of 350 high-value compounds from both new and FDA-approved compounds that can now be tested experimentally in appropriate biological model systems. We anticipate that our results will initiate screening campaigns and accelerate the discovery of COVID-19 treatments.

Bile acid diarrhoea (BAD) is a widespread gastrointestinal disease that is often misdiagnosed as irritable bowel syndrome and is estimated to affect 1% of the United Kingdom (UK) population alone. BAD is associated with excessive bile acid synthesis secondary to a gastrointestinal or idiopathic disorder (also known as primary BAD). Current licensed treatment in the UK has undesirable effects and has been the same since BAD was first discovered in the 1960s. Bacteria are essential in transforming primary bile acids into secondary bile acids. The profile of an individual’s bile acid pool is central in bile acid homeostasis as bile acids regulate their own synthesis. Therefore, microbiome dysbiosis incurred through changes in diet, stress levels and the introduction of antibiotics may contribute to or be the cause of primary BAD. This literature review focuses on primary BAD, providing an overview of bile acid metabolism, the role of the human gut microbiome in BAD and the potential options for therapeutic intervention in primary BAD through manipulation of the microbiome.

International audience; In the current context of biodiversity erosion, ecological restoration is sometimes the only way to reinforce plant population and preserve them from the deterioration of their natural habitat. Dwarf bulrush (Typha minima Hoppe) is an endangered pioneer clonal plant, which grows in frequently disturbed habitats along Eurasian temperate piedmont rivers. In the Alps, its population has decreased by 85% over the last century and numerous pressures (e.g. river works) continue to threaten its remnants. The main objective of this study is to identify an adapted ecological engineering protocol for field transplantation of T. minima in order to maximize restoration success. Several transplantation experiments were implemented between 2013 and 2016 along a French alpine river, the Isère. Five distinct transplantation protocols were tested by individually varying the following parameters: bank type (redesigned bank and embankment protection), transplantation height above water level (5 levels between +0.45 m and + 1.55 m above the average water level), initial biomass transplanted (high, medium and low), initial plot shape (linear strip or square plots) and species association (without or with Salicaceae or Poaceae). During the first two or three years, several clonal traits relative to the spatial monopolization and colonization abilities of T. minima were monitored and analyzed. Our analysis showed that T. minima's ability to colonize was optimal on natural banks, at medium transplantation heights and in linear strip plots. In addition, spatial monopolization and colonization speed, through both sexual and vegetative reproduction, were maximized with a higher initial biomass. Lastly, species association did not affect the colonization ability of T. minima. Our study provides valuable information for future conservation plans and restoration projects for T. minima.

Background Active patient engagement in research is critically important, but can be difficult in controversial areas where patients have conflicting perspectives. Objectives In this Lesson's Learned report, we describe engagement of patients with divergent views in guiding a controlled interrupted time series evaluation of chronic opioid therapy risk reduction initiatives implemented by a large health plan. Methods A nine-person Patient Advisory Committee (PAC) advised the scientific team on the evaluation and reporting of results on diverse outcomes important to patients, including pain and function, opioid use disorder, overdose, motor vehicle accidents, and medically attended injuries. Patients were selected with varied perspectives on opioid prescribing for chronic pain. Multiple strategies facilitated PAC engagement: making room for personal experience; investing upfront in setting the stage for working together including an initial face to face meeting; clarifying shared values; and including individuals skilled in group process and collaboration. PAC meetings were organized separately from regular meetings of the scientific team. Results Shared values identified to guide the research were: Safety, respect, autonomy, compassion, knowledge and teamwork. PAC guidance altered key scientific decisions regarding assessment of patient outcomes, doctor-patient collaboration, and analytic approaches. Conclusions Separate meetings of the PAC and scientific team enhanced opportunities for patients to influence the study design, analyses and interpretation of evaluation results. Convening a large group of patients with diverse perspectives and experiences was productive and influential in guiding the evaluation. Patient selection and building rapport allowed PAC members with divergent perspectives to work together effectively.

BACKGROUND The literature on community-engaged research provides important principles to guide research partnerships, but concrete descriptions of the complexities involved in developing, navigating, and maintaining such partnerships are lacking. OBJECTIVES To describe and assess a longstanding, complex research partnership between Indigenous and academic pharmacogenetic research partners, with attention to co-learning and capacity building lessons learned. METHODS Descriptive thematic analysis of 11 semistructured interviews with interdisciplinary research partners situated at Indigenous and academic settings. RESULTS Lessons learned included the need for explicit negotiation around mentoring expectations, and discussion on advisory and staff roles. Partners need to be aware not only of the structures, policies, and hierarchies within each partner institution, but also the tacit value commitments and understandings entailed in their different missions. CONCLUSIONS This study highlights that the concept of "bidirectional" learning as it is usually presented in the literature fails to capture the complexity of how partnerships work.

The purpose of this study was to investigate the experiences of women in the Sistah Network, an affinity group at a predominantly White institution, with mentoring goals to enhance the educational ...

Objective The aim of this study was to determine whether homophobic victimization was associated with alcohol consumption and riding with an intoxicated driver or driving a car while under the influence of alcohol or drugs among adolescent men who have sex with men (MSM). Methods Cross-sectional analysis used baseline data from a national HIV prevention trial (NCT03167606) for adolescent MSM aged 13–18 years (N = 747). Multivariable logistic regression models assessed associations between homophobic victimization (independent variable) and alcohol-related outcomes (dependent variables), controlling for age, parents’ education level, sexual orientation, health literacy, race, and ethnicity. Results Most participants (87%) reported at least one form of homophobic victimization in their lifetime, with verbal insults being the most frequently reported (82%). In the bivariate analysis, alcohol consumption and riding with an intoxicated driver or driving a car while under the influence were associated with many forms of victimization. Exposure to at least one form of victimization was associated with increased odds of alcohol consumption (OR: 2.31; 95% CI: 1.38–3.87) and riding with an intoxicated driver or driving a car while under the influence (OR: 2.25; 95% CI: 1.26–4.00), after controlling for covariates. Conclusion Increased risk of alcohol consumption and risky alcohol-related behaviors were found among adolescent MSM who experienced homophobic victimization. Interventions should address homophobic victimization and its impact on adolescent MSM, as well as disentangling motivations for underage drinking, riding with an intoxicated driver or driving a car while under the influence.

Objective: We aimed to determine if opioid risk reduction initiatives including dose reduction and risk mitigation strategies for chronic noncancer pain patients receiving chronic opioid therapy (COT) had a differential impact on average daily opioid doses of COT patients at higher risk for opioid-related adverse outcomes compared with lower-risk patients. Design: Interrupted time series. Setting: Group Health Cooperative (GH), a health care delivery system and insurance within Washington State, between 2006 and 2014. Population: GH enrollees on COT defined as receiving a supply of 70 or more days of opioids within 90 days using electronic pharmacy data for filled prescriptions. Methods: We compared the average daily morphine equivalent doses (MED) of COT patients with and without each of the following higher-risk characteristics: mental disorders, substance use disorders, sedative use, and male gender. Results: In all four pairwise comparisons, the higher-risk subgroup had a higher average daily MED than the lower-risk subgroup across the study period. Adjusted for covariates, modest differences in the annual rate of reduction in average daily MED were noted between higher- and lower-risk subgroups in three pairwise comparisons: those with mental disorders vs without (-8.2 mg/y vs -5.2 mg/y, P = 0.005), with sedative use vs without (-9.2 mg/y vs -5.8 mg/y, P = 0.004); mg), in men vs women (-8.8 mg/y vs -5.9 mg/y, P = 0.01). Conclusion: Using clinical policy initiatives in a health care system, dose reductions were achieved among COT patients at higher risk for opioid-related adverse outcomes that were at least as large as those among lower-risk patients.

Barriers in acquiring, maintaining, and generalizing daily living skills are factors that contribute to discrepancies in independent living outcomes among transition age youth and young adults with intellectual and developmental disabilities (IDD). Acquisition and generalization of daily living skills empowers transition age youth and young adults with disabilities to meet their own needs with minimal reliance on others. Infusing the use of technology as a self-prompting device facilitates the acquisition of tasks that may not be otherwise attainable. In this study, self-directed video prompting on an iPad with the My Pictures Talk application was used to help young adults with IDD in a postsecondary program acquire daily living skills in a single subject, multiple probe across subjects design. The effects of the intervention on generalization to tasks that were one, two, and three components different were also assessed. Results demonstrated a functional relationship between the introduction of the intervention and improvement in skill performance.

Supplemental material, Table_S1 for SSIS Performance Screening Guide as an Indicator of Behavior and Academics: A Meta-Analysis by Jeremy R. Sullivan, Victor Villarreal, Evette Flores, Alyssa Gomez and Blaire Warren in Assessment for Effective Intervention

International audience; Riparian ecosystems are of utmost importance for many key ecosystem services, such as nutrient filtering or flood and erosion control. Restoring degraded riverbanks using soil bioengineering techniques initiates secondary succession improving both protection from erosion and riparian ecological functions. These techniques often rely on the settlement of Salicaceae and sometimes Tamaricaceae species that can be strongly impacted by beaver browsing. During the last decade European beaver (Castor fiber) populations have largely grown in France and can thus impact restored riverbanks, leading practitioners to adapt their management strategy. We conducted a study to assess the feeding preference of C. fiber and their browsing spatial pattern in semi natural riverbanks in the French Alps (Isère, France) by measuring browsing impacts along a transect. Our results indicate selective browsing occurrences at two nested spatial scales: firstly, beavers create large preferentially browsed patches (* 8 m diameter) secondly, at a finer scale within these patches, they demonstrate a selective browsing between plant species. Among the species used in soil bioengineering, Myricaria germanica showed the lower browsing selectivity with only 2.5% of browsing probability while Salix eleagnos and Salix pur-purea (10%) and Populus nigra, Salix daphnoides and Salix alba (20%) showed significant higher selectivity by beaver. Our results suggest that within the beaver presence area soil bioengineering techniques should consider adjusting both the composition and the spatial pattern of plant species settlement to mitigate the impacts of beaver on restored riverbanks.

Background Patients with mental illness are frequently treated in primary care, where Primary Care Providers (PCPs) report feeling ill-equipped to manage their care. Team-based models of care improve outcomes for patients with mental illness, but multiple barriers limit adoption. Barriers include practical issues and psychosocial factors associated with the reorganization of care. Practice facilitation can improve implementation, but does not directly address the psychosocial factors or gaps in PCP skills in managing mental illness. To address these gaps, we developed Relational Team Development (RELATED). Methods RELATED is an implementation strategy combining practice facilitation and psychology clinical supervision methodologies to improve implementation of team-based care. It includes PCP-level clinical coaching and a team-level practice change activity. We performed a preliminary assessment of RELATED with a convergent parallel mixed method study in 2 primary care clinics in an urban Federally Qualified Health Center in Southwest, USA, 2017-2018. Study participants included PCPs, clinic staff, and patient representatives. Clinic staff and patients were recruited for the practice change activity only. Primary outcomes were feasibility and acceptability. Feasibility was assessed as ease of recruitment and implementation. Acceptability was measured in surveys of PCPs and staff and focus groups. We conducted semi-structured focus groups with 3 participant groups in each clinic: PCPs; staff and patients; and leadership. Secondary outcomes were change in pre- post- intervention PCP self-efficacy in mental illness management and team-based care. We conducted qualitative observations to better understand clinic climate. Results We recruited 18 PCPs, 17 staff members, and 3 patient representatives. We ended recruitment early due to over recruitment. Both clinics developed and implemented practice change activities. The mean acceptability score was 3.7 (SD=0.3) on a 4-point Likert scale. PCPs had a statistically significant increase in their mental illness management self-efficacy [change = 0.9, p-value= Conclusions RELATED was feasible and highly acceptable. It led to positive changes in PCP self-efficacy in Mental Illness Management. If confirmed as an effective implementation strategy, RELATED has the potential to significantly impact implementation of evidence-based interventions for patients with mental illness in primary care.

Background As biobanks play an increasing role in the genomic research that will lead to precision medicine, input from diverse and large populations of patients in a variety of health care settings will be important in order to successfully carry out such studies. One important topic is participants’ views towards consent and data sharing, especially since the 2011 Advanced Notice of Proposed Rulemaking (ANPRM), and subsequently the 2015 Notice of Proposed Rulemaking (NPRM) were issued by the Department of Health and Human Services (HHS) and Office of Science and Technology Policy (OSTP). These notices required that participants consent to research uses of their de-identified tissue samples and most clinical data, and allowing such consent be obtained in a one-time, open-ended or “broad” fashion. Conducting a survey across multiple sites provides clear advantages to either a single site survey or using a large online database, and is a potentially powerful way of understanding the views of diverse populations on this topic. Methods A workgroup of the Electronic Medical Records and Genomics (eMERGE) Network, a national consortium of 9 sites (13 separate institutions, 11 clinical centers) supported by the National Human Genome Research Institute (NHGRI) that combines DNA biorepositories with electronic medical record (EMR) systems for large-scale genetic research, conducted a survey to understand patients’ views on consent, sample and data sharing for future research, biobank governance, data protection, and return of research results. Results Working across 9 sites to design and conduct a national survey presented challenges in organization, meeting human subjects guidelines at each institution, and survey development and implementation. The challenges were met through a committee structure to address each aspect of the project with representatives from all sites. Each committee’s output was integrated into the overall survey plan. A number of site-specific issues were successfully managed allowing the survey to be developed and implemented uniformly across 11 clinical centers. Conclusions Conducting a survey across a number of institutions with different cultures and practices is a methodological and logistical challenge. With a clear infrastructure, collaborative attitudes, excellent lines of communication, and the right expertise, this can be accomplished successfully.

Researchers and policymakers recommend communicating summary research results to biobank participants when feasible. To date, however, there have been few explorations of participant preferences for dedicating resources to this activity. Fifteen semi-structured interviews were conducted with participants of a genetic medicine biobank. Participants were interviewed by phone about their motivation for participation, and opinions about the allocation of resources to communicating summary results. De-identified transcripts were used for a directed content analysis. Most biobank participation was altruistic. All participants were not only interested in receiving summary results but also expressed a clear preference for allocating limited funds to conducting additional genetic research. The results suggest that participants have a nuanced view about the allocation of biobank resources to returning summary results, and asking their opinion is a valuable exercise. Researchers may benefit from transparency about research goals and involving biobank participants in decisions about return of summary results.

Adolescent smoking cessation efforts to date have tended to focus on regular smokers. Consequently, infrequent and occasional smokers' receptivity and response to smoking cessation interventions is unknown. To address this gap, this study examines data from the Hutchinson Study of High School Smoking-a randomized trial that examined the effectiveness of a telephone-delivered smoking cessation intervention for a large, population-based cohort of adolescent smokers proactively recruited in an educational setting.The study population included 1837 proactively identified high school smokers. Intervention receptivity, engagement, and outcomes were examined among adolescent infrequent (1-4days/month) and occasional (5-19days/month) smokers and compared with regular smokers (20 or more days/month).With regard to treatment receptivity, intervention recruitment did not differ by smoking frequency. For engagement, intervention completion rates were higher for infrequent smokers (80.5%) compared with occasional (63.8%) and regular smokers (61.5%, p0.01). Intervention effect sizes were not statistically different across groups.Adolescent infrequent and occasional smokers are at least as receptive to a proactively delivered smoking cessation intervention as regular smokers and can benefit just as much from it. Including these adolescent smokers in cessation programs and research-with the goal of interrupting progression of smoking before young adulthood-should help reduce the high smoking prevalence among young adults.

In this paper, we employ Critical Race Theory theoretically and methodologically to examine the racialized experiences of students of color in higher education and student affairs (HESA) graduate preparation programs. We employ counter-storytelling as a method for constructing narratives that disrupt the master narrative found within HESA graduate preparation programs, which often boast an espoused commitment to diversity and social justice. Based on a study of 29 graduate students of color in 21 master’s programs across the United States, the counter-stories reflect the endemic nature of racism in graduate education including the classroom, academic program, and campus. Students expressed experiences of tokenization, disappointment, feelings of frustration, anger, and racial battle fatigue. Implications for improving racial climates in graduate education are also shared.

International audience; The highly invasive knotweeds (Reynoutria spp.) are still infrequent in mountain regions. Despite their current low abundance, they may represent a significant threat for high elevation ecosystems if their population dynamics remain as aggressive as in lowlands during their range expansion to higher elevation. The aim of this study is to assess the knotweed's invasion potential in mountainous regions by studying patch dynamics along an elevational gradient (between 787 and 1666 m a.s.l.) and by reviewing existing literature on their presence and performance in mountains. The outlines of 48 knotweed patches located in the French Alps were measured in 2008 and in 2015 along with biotic, abiotic and management variables. Based on these variables, knotweed's cover changes and patch density were predicted using mixed models. Results showed that elevation has no effect on knotweeds dynamics along the studied elevational gradient. It appeared that the local expansion of knotweed patches is essentially controlled by the patches' initial size and the distance to roads and rivers, i.e. to obstacles and sources of disturbance. Shade and patches' size also impact knotweed patch density, probably through an effect on the species' clonal reproduction and foraging strategies. Interestingly, patches seemed insensitive to the gradient of mowing frequency sampled in this study (between zero and five times per year). All evidences indicate that the knotweed complex is able to colonize and thrive in mountains areas. However, due to the particularities of its spatial dynamics, adequate and timely actions could easily be undertaken to prevent further invasion and associated impacts and reduce management costs.

Small bowel obstructions (SBOs) caused by adhesions are a common, often life-threatening postsurgical complication with few treatment options available for patients. This study examines the efficacy of a manual physical therapy treatment regimen on the pain and quality of life of subjects with a history of bowel obstructions due to adhesions in a prospective, controlled survey based study. Changes in six domains of quality of life were measured via ratings reported before and after treatment using the validated Small Bowel Obstruction Questionnaire (SBO-Q). Improvements in the domains for pain (p=0.0087), overall quality of life (p=0.0016), and pain severity (p=0.0006) were significant when average scores before treatment were compared with scores after treatment. The gastrointestinal symptoms (p=0.0258) domain was marginally significant. There was no statistically significant improvement identified in the diet or medication domains in the SBO-Q for this population. Significant improvements in range of motion in the trunk (p≤0.001), often limited by adhesions, were also observed for all measures. This study demonstrates in a small number of subjects that this manual physical therapy protocol is an effective treatment option for patients with adhesive small bowel obstructions as measured by subject reported symptoms and quality of life.

In 2013, the U.S. Preventive Services Task Force (USPSTF) recommended screening followed by brief behavioral counseling to reduce alcohol misuse. Our study, Options Regarding Consumption of Alcohol (ORCA), was one of the studies included in an evidence review that comprised 23 RCTs. ORCA was designed to test whether a primary care–based intervention would reduce alcohol misuse among patients who screened positive for risky or hazardous drinking. Data collection occurred between 1995 and 1999; data analysis was conducted in 2000–2002. Study design and implementation built from a behavioral counseling research paradigm with four components: (1) population-based screening; (2) centralized delivery of intervention components; (3) involvement of primary care practitioners to motivate and reinforce behavior change; and (4) personalization of intervention components. In this paper, we assess the study features using the Pragmatic–Explanatory Continuum Indicator Summary Model domains. As a randomized trial, the study included some explanatory features (e.g., standardized follow-up surveys administered by study personnel); however, several aspects of the study were highly pragmatic. Practicable recruitment and training of providers, embedding population-based screening in pre-visit surveys, and keeping the delivery of the primary care intervention components consistent with the tempo and competing priorities of practice are three key features that contributed to the study’s success and relevance to the USPSTF.

This single participant multiple baseline research design measured the effects of repeatedly reading narrative books to children who used voice output augmentative communication devices to communicate. The study sought to determine if there was a difference observed in the number of turns taken when reading stories repeatedly. Three girls ranging in age from seven to nine listened to a different illustrated narrative book during each baseline session. During the intervention phase, a single illustrated book was read repeatedly to each child for six sessions followed by an additional intervention of a second illustrated book for six more sessions. Two of the three participants took more turns during the repeated reading when comparing mean scores. Upon visual inspection it appears the increases were generally in the first couple of repeated readings and then a slope return was displayed toward the baseline level over the six repeated readings. Implications for practice are shared.

In this study, we share the racialized experiences of 29 students of color in higher education and student affairs graduate programs, focusing specifically on their relationships with faculty, their experiences in classrooms, and the strategies they recommend for inclusion. Participants indicated that they are expected to serve as the racial expert in classrooms and that many faculty fail to effectively facilitate discussions related to race and racism and to intervene in instances of racial microaggressions. Participants convey effective strategies to build racially-inclusive classrooms which include authenticity, vulnerability, and validation.

Objective: This analysis examined patients9 perceptions about trust within the doctor-patient relationship related to managing opioid pain medications. We compared perceptions among chronic opioid therapy (COT) patients who were and were not exposed to opioid risk reduction initiatives. Methods: Between 2014 and 2016, we surveyed 1588 adults with chronic pain receiving COT about their trust in their prescribing doctor, their perceptions of their doctor9s trust in them, their concerns about opioid prescribing, and their knowledge of opioid safety concerns. The population included adults receiving care in intervention settings that implemented opioid risk reduction initiatives and control settings with similar COT patients that did not. Results: Overall, 82.2% of COT patients said they trusted their doctor9s judgment, with more agreement among patients in the control clinics (86.3%; n = 653) than in the intervention clinics (77.9%; n = 935; P = .002). Similarly, slightly more patients in the control clinics believed their physician trusted how they managed their opioid pain medicines (91.1%) compared with the intervention clinics (86.2%; P = .002). The percent who worried that their doctor would stop prescribing opioid pain medicine was 29.3% in intervention clinics and 21.8% in control clinics (P = .007). Conclusions: Although COT patients typically reported favorable perceptions of doctor-patient trust in managing opioid pain medicines, implementation of opioid risk reduction initiatives may have reduced levels of trust for a minority of COT patients. This suggests that it may be possible to implement opioid risk-reduction initiatives while sustaining high levels of doctor-patient trust for most COT patients.

Background “Pneumonia and influenza” are the third leading cause of death in New York City. Since 2012, pneumonia and influenza have been the only infectious diseases listed among the 10 leading causes of death in NYC. Most pneumonia and influenza deaths in NYC list pneumonia as the underlying cause of death, not influenza. We therefore analyzed death certificate data for pneumonia in NYC during 1999–2015. Methods We calculated annualized pneumonia death rates (overall and by sociodemographic subgroup) and examined the etiologic agent listed. Results There were 41 400 pneumonia deaths during the study period, corresponding to an annualized age-adjusted death rate of 29.7 per 100 000 population. Approximately 17.5% of pneumonia deaths specified an etiologic agent. Age-adjusted pneumonia death rate declined over the study period and across each borough. Males had an annualized age-adjusted pneumonia death rate 1.5 (95% confidence interval [CI], 1.5–1.5) times that of females. Non-Hispanic blacks had an annualized age-adjusted pneumonia death rate 1.2 (95% CI, 1.2–1.2) times that of non-Hispanic whites. The annualized pneumonia death rate increased with age group above 5–24 years and neighborhood-level poverty. Staten Island had an annualized age-adjusted pneumonia death rate 1.3 (95% CI, 1.2–1.3) times that of Manhattan. In the multivariable analysis, pneumonia deaths were more likely to occur among males, non-Hispanic blacks, persons aged ≥65 years, residents of neighborhoods with higher poverty levels, and in Staten Island. Conclusions While the accuracy of death certificates is unknown, investigation is needed to understand why certain populations are disproportionately recorded as dying from pneumonia in NYC.

Children bring their own background knowledge and experiences to their engagement with a story, yet teachers often fail to tap into their deeper understandings. This article shares the authors' experiences in introducing “grand conversations” to a group of 2nd-grade students and shows how one can facilitate authentic, student-led literary discussions to uncover deeper meaning. Interactive strategies during literary reading can help engage students as they discuss the theme's relevance to their own lives. Findings from the study indicate how such conversations can help learners make deep connections among story, their personal lives, and the outside world. This can be an important strategy in building children's identities as they try to interact with and understand themselves in respect to the world around them.

Introduction Referral rates to specialty care from primary care physicians vary widely. To address this variability, we developed and pilot tested a peer-to-peer coaching program for primary care physicians. Objectives To assess the feasibility and acceptability of the coaching program, which gave physicians access to their individual-level referral data, strategies, and a forum to discuss referral decisions. Methods The team designed the program using physician input and a synthesis of the literature on the determinants of referral. We conducted a single-arm observational pilot with eight physicians which made up four dyads, and conducted a qualitative evaluation. Results Primary reasons for making referrals were clinical uncertainty and patient request. Physicians perceived doctor-to-doctor dialogue enabled mutual learning and a pathway to return joy to the practice of primary care medicine. The program helped physicians become aware of their own referral data, reasons for making referrals, and new strategies to use in their practice. Time constraints caused by large workloads were cited as a barrier both to participating in the pilot and to practicing in ways that optimize referrals. Physicians reported that the program could be sustained and spread if time for mentoring conversations was provided and/or nonfinancial incentives or compensation was offered. Conclusion This physician mentoring program aimed at reducing specialty referral rates is feasible and acceptable in primary care settings. Increasing the appropriateness of referrals has the potential to provide patient-centered care, reduce costs for the system, and improve physician satisfaction.

Safety planning is a widespread intervention used with clients who have experienced domestic violence victimization. Although children are impacted by domestic violence, attention to the unique needs of children as they relate to domestic violence safety planning has received little attention to date. The authors conducted nine focus groups with domestic violence service providers about their perceptions of child safety planning. This article reports on the findings and implications of this focus group study that can inform the safety planning needs of children impacted by domestic violence. The themes discussed include Child Protective Services, the needs of older boys, school-related issues, custody-related issues, the extent to which children should be involved in safety planning, parenting issues, tools and tips for safety planning with children, and resources and services to promote children's safety.

Family planning service quality and clients' satisfaction with services are important determinants of clients' contraceptive use and continuation. We examine women's experiences at family planning clinics on a range of dimensions, including patient-centered communication (PCC), and identify experiences associated with higher ratings of service quality and satisfaction. New female clients (n = 748), ages 18-35 years, from clinics in three major metropolitan areas completed computer-administered interviews between 2008 and 2009. Factors associated with primary outcomes of service quality and satisfaction were assessed using multinomial and ordinary logistic regression, respectively. Higher scores on a Clinician-Client Centeredness Scale, measuring whether clinicians were respectful, listened, and provided thoughtful explanations, were associated with perceptions of good quality care and being very satisfied. Higher scores on a Clinic Discomfort Scale, measuring staff and waiting-room experiences, were associated with reduced satisfaction. Clients' interactions with clinicians, especially PCC, influence their perceptions of service quality, whereas their satisfaction with services is also influenced by the facility environment. These measures are adaptable for agencies to identify the factors contributing to their own clients' satisfaction-dissatisfaction with care and perceptions of service quality.

We examine the mediating role of body image dissatisfaction (BID) on the association between obesity and depression and the variation of this association as a function of years of education among a population-based sample of women aged 40-65 years.A series of sample-weighted logistic regression models were used to estimate the associations between obesity, BID, and depression, stratified by educational attainment. Data were obtained from a structured telephone interview of 4543 female health plan enrollees, including self-reported height and weight, the Patient Health Questionnaire assessment of depression, and a single-item measure of BID.Among those with16 years of education, in both the unadjusted and adjusted models, obesity and BID were significantly associated with depression. Similarly, among those with ≥ 16 years of education, obesity and BID were significantly associated with depression in the unadjusted models. However, in the adjusted model, only BID was associated with depression. A formal test for mediation suggests that the association between obesity and depression was mediated by BID regardless of level of education.Our data suggest that BID-mediated the obesity-depression association. In addition, obesity and BID may be salient risk factors for depression among middle-aged women as a function of the level of education.

No consensus exists about when researchers need additional participant consent (re-consent) to submit existing data to the federal database of Genotypes and Phenotypes (dbGaP). Re-consent for submission of their data to dbGaP was sought from 1,340 study participants, 1,159 (86%) of whom agreed. We invited the first 400 of those who agreed to complete a telephone survey about their reasoning for their consent decision and their satisfaction with the re-consent process; 365 participants completed the survey. Respondents reported that it was very (69%) or somewhat (21%) important that they were asked for their permission. Many respondents considered alternatives to consent, such as notification-only or opt-out, to be unacceptable (67% and 40%, respectively). These results suggest that re-consent for dbGaP deposition may be advisable in certain cases to anticipate and honor participant preferences.

Vancomycin is used in patients with severe burns and methicillin-resistant Staphylococcus aureus (MRSA) infection. This study investigated vancomycin pharmacokinetics in people with burns in comparison to people without burns and examined the factors contributing to pharmacokinetic variability. This was a retrospective, case-control study of hospitalised burns patients compared with a control patient cohort administered vancomycin without burn injury. Vancomycin pharmacokinetic parameters were determined using therapeutic drug monitoring data and a population pharmacokinetic modelling approach employing a two-compartment pharmacokinetic model. The impact of patient characteristics on vancomycin clearance was explored. Vancomycin clearance was significantly higher (p

Depression is the most common psychiatric disorder in patients with chronic kidney disease (CKD). We sought to determine the association of major depression with mortality among diabetic patients with late stage CKD.The Pathways Study is a longitudinal, prospective cohort study initiated to determine the impact of depression on outcomes among primary care diabetic patients. Subjects were followed from 2001 until 2007 for a mean duration of 4.4 years. Major depression, identified by the Patient Health Questionnaire-9, was the primary exposure of interest. Stage 5 CKD was determined by dialysis codes and estimated glomerular filtration rate (15 ml/min). An adjusted Cox proportional hazards multivariable model was used to determine the association of baseline major depression with mortality.Of the 4128 enrolled subjects, 110 were identified with stage 5 CKD at baseline. Of those, 34 (22.1%) had major depression. Over a period of 5 years, major depression was associated with 2.95-fold greater risk of death (95% CI=1.24-7.02) compared to those with no or few depressive symptoms.Major depression at baseline was associated with a 2.95-fold greater risk of mortality among stage 5 CKD diabetic patients. Given the high mortality risk, further testing of targeted depression interventions should be considered in this population.

Background Effective smoking cessation for youth is urgently needed, but the literature guiding such efforts is nascent. We evaluated the implementation of a proactive intervention for adolescent smoking cessation that incorporated motivational interviewing (MI) and cognitive behavioral skills training (CBST).

Background The Hutchinson Study of High School Smoking randomized trial was designed to rigorously evaluate a proactive, personalized telephone counseling intervention for adolescent smoking cessation. Methods Fifty randomly selected Washington State high schools were randomized to the experimental or control condition. High school junior smokers were proactively identified (N = 2151). Trained counselors delivered the motivational interviewing plus cognitive behavioral skills training telephone intervention to smokers in experimental schools during their senior year of high school. Participants were followed up, with 88.8% participation, to outcome ascertainment more than 1 year after random assignment. The main outcome was 6-months prolonged abstinence from smoking. All statistical tests were two-sided. Results The intervention increased the percentage who achieved 6-month prolonged smoking abstinence among all smokers (21.8% in the experimental condition vs 17.7% in the control condition, difference = 4.0%, 95% confidence interval [CI] = -0.2 to 8.1, P = .06) and in particular among daily smokers (10.1% vs 5.9%, difference = 4.1%, 95% CI = 0.8 to 7.1, P = .02). There was also generally strong evidence of intervention impact for 3-month, 1-month, and 7-day abstinence and duration since last cigarette (P = .09, .015, .01, and .03, respectively). The intervention effect was strongest among male daily smokers and among female less-than-daily smokers. Conclusions Proactive identification and recruitment of adolescents via public high schools can produce a high level of intervention reach; a personalized motivational interviewing plus cognitive behavioral skills training counseling intervention delivered by counselor-initiated telephone calls is effective in increasing teen smoking cessation; and both daily and less-than-daily teen smokers participate in and benefit from telephone-based smoking cessation intervention.

While Others have focused on gender-based language and the workplace, this research study explores gender-based language, in this case women's language, and the classroom. The study specifically examines examples of women's language and how this language affects student response in the classroom. Five variables have been identified as characteristic of women's language—politeness, gestures, intonation, praise/saving face for others, and tag questions—and were used to evaluate the language of a female teacher in an Algebra II classroom. The data, consisting of field notes and transcriptions of audiotaped lessons, were analyzed for evidence of terms, expressions, and gestures associated with women's language. Observed student responses to the teacher's use of women's language were also analyzed. Findings indicate that the teacher used examples of traits associated with women's language throughout the lessons, as well as a range of intonation patterns and numerous hand gestures. Findings also showed...

Genetic information is used increasingly in health care. Some experts have argued that genetic information is qualitatively different from other medical information and, therefore, raises unique social issues. This view, called "genetic exceptionalism," has importantly influenced recent policy efforts. Others have argued that genetic information is like other medical information and that treating it differently may actually result in unintended disparities. Little is known about how the general public views genetic information. To identify opinions about implications of genetic and other medical information among the general population, we conducted a series of focus groups in Seattle, WA. Participants were women and men between ages 18 and 74, living within 30 miles of Seattle and members of the Group Health Cooperative. A structured discussion guide was used to ensure coverage of all predetermined topics. Sessions lasted approximately 2 hr; were audio taped and transcribed. The transcripts formed the basis of the current analysis. Key findings included the theme that genetic information was much like other medical information and that all sensitive medical information should be well protected. Personal choice (i.e., the right to choose whether to know health risk information and to control who else knows) was reported to be of crucial importance. Participants had an understanding of the tensions involved in protecting privacy versus sharing medical information to help another person. These data may guide future research and policy concerning the use and protection of medical information, including genetic information.

Background The Hutchinson Study of High School Smoking was the first randomized trial to show effectiveness of a smoking cessation intervention on 6-months prolonged smoking abstinence at one year post-intervention in a large population-based sample of adolescent smokers. An important question remains: Do the positive effects from teen smoking cessation interventions seen at up to 12 months post-intervention endure into young adulthood? This study examines for the first time whether such positive early effects from teen smoking cessation intervention can endure into young adulthood in the absence of additional intervention. Methods High school smokers (n = 2,151) were proactively recruited into the trial from fifty randomly selected Washington State high schools randomized to the experimental (Motivational Interviewing + Cognitive Behavioral Skills Training telephone counseling intervention) or control (no intervention) condition. These smokers were followed to 7 years post high school to ascertain rates of six-year prolonged smoking abstinence in young adulthood. All statistical tests are two-sided. Results No evidence of intervention impact at seven years post high school was observed for the main endpoint of six-year prolonged abstinence, neither among all smokers (14.2% in the experimental condition vs. 13.1% in the control condition, difference = +1.1%, 95% confidence interval (CI) = -3.4 to 5.8, p = .61), nor among the subgroups of daily smokers and less-than-daily smokers, nor among other a priori subgroups. But, observed among males was some evidence of an intervention impact on two endpoints related to progress towards quitting: reduction in number of days smoked in the past month, and increase in the length of the longest quit attempt in the past year. Conclusions There was no evidence from this trial among adolescent smokers that positive effectiveness of the proactive telephone intervention for smoking abstinence, observed previously at one year post-intervention, was sustained for the long-term into young adulthood. In light of the positive short-term effectiveness consistently observed from this and other trials for teen smokers, together with the lack of evidence from this study that such short-term impact can endure into young adulthood, sustained interventions that continue into young adulthood should be developed and tested for long-term impact. Trial Registration ClinicalTrials.gov NCT00115882