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To compare the findings of standard clinical assessments and of complementary clinical and laboratory methods for determining whether community-wide treatment for trachoma is warranted in a remote Queensland community.Three cross-sectional screening surveys, 2019-2021, complemented by laboratory pathology testing.Small community in northwest Queensland with geographic and cultural ties to Northern Territory communities where trachoma persists.Children aged 1-14 years; opportunistic screening of people aged 15 years or more.Prevalence of clinical signs of trachoma, Chlamydia trachomatis infection, ocular non-chlamydial infections, and seropositivity for antibodies to the C. trachomatis Pgp3 protein.During the three surveys, 73 examinations of 58 children aged 1-4 years, 309 of 171 aged 5-9 years, and 142 of 105 aged 10-14 years for trachoma were undertaken, as were 171 examinations of 164 people aged 15 years or more; 691 of 695 examinations were of Aboriginal or Torres Strait Islander people (99%), 337 were of girls or young women (48%). Clinical signs consistent with trachomatous inflammation-follicular were identified in 5-9-year-old children 23 times (7%), including in eleven with non-chlamydial infections and one with a C. trachomatis infection. One child (10-14 years) met the criteria for trachomatous scarring. Two of 272 conjunctival swab samples (all ages) were polymerase chain reaction-positive for C. trachomatis (0.7%). Two of 147 people aged 15 years or more examined in 2019 had trichiasis, both aged 40 years or more. Seven of 53 children aged 1-9 years in 2019 and seven of 103 in 2021 were seropositive for anti-Pgp3 antibodies.Despite the prevalence of clinical signs consistent with trachomatous inflammation-follicular among 5-9-year-old children exceeding the 5% threshold for community-wide treatment, laboratory testing indicated that childhood exposure to ocular C. trachomatis is rare in this community. Laboratory testing should be integrated into Australian trachoma guidelines.

Recent surveys identified trachomatous inflammation - follicular (TF) at endemic levels in the Torres Strait Islands; however, local health staff do not report trachomatous trichiasis (TT) in adults. We undertook a cross-sectional survey involving eye examination and microbiological testing to better understand this disconnect.We examined 169 of 207 (82%) residents and collected ocular swabs for polymerase chain reaction (PCR) testing for Chlamydia trachomatis. Other viral PCR tests and bacterial culture were also performed.TF prevalence in children aged 5-9 years was 23% (7/30). No ocular C. trachomatis was identified by PCR. For the 72 participants (43%) with follicles, bacterial culture was positive for 11 (15%) individuals. No individual had trachomatous trichiasis.Follicular conjunctivitis consistent with TF was prevalent but ocular C. trachomatis and cicatricial trachoma were absent. Non-chlamydial infections or environmental causes of follicular conjunctivitis may be causing TF in this community.In similar settings, reliance on simplified clinical assessment alone may lead to an overestimation of the public health problem posed by trachoma. Consideration should be given to incorporating C. trachomatis PCR, and in certain settings, a detailed clinical exam could be performed by an experienced ophthalmologist during prevalence surveys.

Background Engagement in physical activity (PA) post-treatment can improve health outcomes and quality of life among cancer survivors. The purpose of this study is to explore United States (US) older adult cancer survivors’ (OACS) reasons for engaging in group-based PA classes, to identify themes supporting exercise motivations in the context of cancer recovery. Methods OACS participating in a fitness program at a large US comprehensive cancer center completed semi-structured interviews. Transcripts were analyzed using modified grounded theory, and demographic data were analyzed descriptively. Results Modified grounded theory analysis (n = 25; age M = 70.92, SD = 10.82; 9 cancer types) identified individual rationales for exercise grounded in collective experience. Participants’ internal motivations for PA are shaped by the desire for control over an uncertain future and post-treatment body, obtained by literally “moving forward” post-cancer; this is supported by external motivations for social connections that present a positive model of survivorship, within a setting that instills confidence and safety. Conclusions Exercise can be a way for older adults to tap into internal and external motivations that support cancer survivorship. Interventions that make explicit connections between exercise and cancer recovery, facilitate interpersonal interaction, and promote a sense of safety may be the most effective. The concepts identified in this study can inform the development of future interventions to improve long-term behavior change among OACS and evaluate existing PA programs.

New York City was a "global COVID-19 hotspot" in spring 2020. Many health teams rapidly transitioned to telehealth platforms. Little is known about the experiences of inpatient palliative care services who delivered telehealth services during the pandemic. This study was aimed to explore the experiences of an interdisciplinary palliative care team in meeting the holistic needs of oncology inpatients via telehealth over a 10-week period during the first COVID-19 surge. A targeted sample of interdisciplinary palliative specialists at an urban comprehensive cancer center participated in in-depth interviews that explored participants' experiences delivering physical, psychosocial, and spiritual care via telehealth. An interdisciplinary coding team followed a rigorous thematic text analysis approach and met regularly to reach consensus on emerging themes. Eleven palliative specialists from six disciplines (chaplaincy, medicine, nursing, pharmacy, physician assistant, and social work) participated. Seventy-three percent reported not receiving telehealth training prior to COVID-19 and 64% were "not at all" or "somewhat comfortable" delivering telepalliative care. Several themes were identified, including the barriers related to telehealth, the impact of telehealth on the quality of relationships with patients, their families, and coworkers, and the changes in perceived self-efficacy of fulfilling job responsibilities. Telehealth use has increased significantly during COVID-19, requiring further evaluation of its utility. Participants reported both positive and negative inpatient telepalliative care experiences associated with various domains of professional functioning, such as communication, relationships with key stakeholders, and self-efficacy. Enhanced telehealth training and support must be improved to sustain the palliative workforce and promote high-quality patient and family care in the future.In spring 2020, New York City was a COVID-19 global hotspot. The palliative care team at a major cancer center rapidly transitioned to a “virtual service” (i.e., telehealth) without any physical contact with oncology inpatients for a 10-week period. No infrastructure for inpatient telehealth had been established prior to the transition. We wanted to explore how effective the interdisciplinary palliative care team felt in meeting the psychosocial, spiritual, and physical needs of patients and their families via telehealth. The palliative care team consisted of advanced practice providers, physicians, a chaplain, pharmacist, and social worker. Through participant interviews, our research team identified common themes related to the barriers and facilitators of telehealth; various effects on the quality of relationships with patients, their families, and coworkers; and diverse experiences related to the team’s perceived effectiveness in delivering telepalliative care. There are several implications to consider. Inpatient practice settings must design telehealth infrastructures to ensure both patient and provider protections when in-person care is not possible. Multilevel policies must direct investments in telehealth training for health professionals to support high-quality care during future public health crises. Research should be directed toward developing and measuring enhanced telehealth interventions to support effective and holistic virtual palliative care delivery for inpatient settings.

Background The epidemiology of trachoma in several Pacific Islands differs from other endemic settings, in that there is a high prevalence of clinical signs of trachoma, particularly trachomatous inflammation—follicular (TF), but few cases of trichiasis and limited evidence of ocular chlamydial infection. This so-called “Pacific enigma” has led to uncertainty regarding the appropriate public health response. In 2019 alongside Nauru’s national trachoma population survey, we performed bacteriological and serological assessments of children to better understand the typology of trachoma and to determine whether there is a need for trachoma interventions. Methods We used two-stage cluster sampling, examining residents aged ≥1 year and collecting household-level water, sanitation, and hygiene (WASH) variables. Children aged 1–9 years provided conjunctival swabs and finger-prick dried blood spots to investigate the presence of Chlamydia trachomatis nucleic acid and anti-Pgp3 antibodies, respectively. Principal Findings In 818 participants aged 1–9 years, the age-adjusted TF prevalence was 21.8% (95% CI 15.2–26.2%); ocular C. trachomatis prevalence was 34.5% (95% CI 30.6–38.9), and anti-Pgp3 antibody prevalence was 32.1% (95% CI 28.4%–36.3%). The age- and gender-adjusted prevalence of trichiasis in ≥15-year-olds was 0.3% (95% CI 0.00–0.85), but no individual with trichiasis had trachomatous scarring (TS). Multivariable analysis showed an association between age and both TF (OR per year of age 1.3 [95% CI 1.2–1.4]) and anti-Pgp3 positivity (OR 1.2 [95% CI 1.2–1.3]). There were high rates of access to water and sanitation and no WASH variable was associated with the presence of TF. Conclusions TF, nucleic acid, and age-specific antibody prevalence collectively indicate that high levels of C. trachomatis transmission among children present a high risk of ocular damage due to trachoma. The absence of trichiasis with trachomatous scarring suggest a relatively recent increase in transmission intensity.

Summary Background The monoclonal antibody m102.4 is a potent, fully human antibody that neutralises Hendra and Nipah viruses in vitro and in vivo. We aimed to investigate the safety, tolerability, pharmacokinetics, and immunogenicity of m102.4 in healthy adults. Methods In this double-blind, placebo-controlled, single-centre, dose-escalation, phase 1 trial of m102.4, we randomly assigned healthy adults aged 18–50 years with a body-mass index of 18·0–35·0 kg/m2 to one of five cohorts. A sentinel pair for each cohort was randomly assigned to either m102.4 or placebo. The remaining participants in each cohort were randomly assigned (5:1) to receive m102.4 or placebo. Cohorts 1–4 received a single intravenous infusion of m102.4 at doses of 1 mg/kg (cohort 1), 3 mg/kg (cohort 2), 10 mg/kg (cohort 3), and 20 mg/kg (cohort 4), and were monitored for 113 days. Cohort 5 received two infusions of 20 mg/kg 72 h apart and were monitored for 123 days. The primary outcomes were safety and tolerability. Secondary outcomes were pharmacokinetics and immunogenicity. Analyses were completed according to protocol. The study was registered on the Australian New Zealand Clinical Trials Registry, ACTRN12615000395538. Findings Between March 27, 2015, and June 16, 2016, 40 (52%) of 77 healthy screened adults were enrolled in the study. Eight participants were assigned to each cohort (six received m102.4 and two received placebo). 86 treatment-emergent adverse events were reported, with similar rates between placebo and treatment groups. The most common treatment-related event was headache (12 [40%] of 30 participants in the combined m102.4 group, and three [30%] of ten participants in the pooled placebo group). No deaths or severe adverse events leading to study discontinuation occurred. Pharmacokinetics based on those receiving m102.4 (n=30) were linear, with a median half-life of 663·3 h (range 474·3–735·1) for cohort 1, 466·3 h (382·8–522·3) for cohort 2, 397·0 h (333·9–491·8) for cohort 3, and 466·7 h (351·0–889·6) for cohort 4. The elimination kinetics of those receiving repeated dosing (cohort 5) were similar to those of single-dose recipients (median elimination half-time 472·0 [385·6–592·0]). Anti-m102.4 antibodies were not detected at any time-point during the study. Interpretation Single and repeated dosing of m102.4 were well tolerated and safe, displayed linear pharmacokinetics, and showed no evidence of an immunogenic response. This study will inform future dosing regimens for m102.4 to achieve prolonged exposure for systemic efficacy to prevent and treat henipavirus infections. Funding Queensland Department of Health, the National Health and Medical Research Council, and the National Hendra Virus Research Program.

BackgroundHigh levels of moral distress in nursing professionals, of which oncology nurses are particularly prone, can negatively impact patient care, job satisfaction, and retention.Aim“Positive Attitudes Striving to Rejuvenate You: PASTRY” was developed at a tertiary cancer center to reduce the burden of moral distress among oncology nurses.Research DesignA Quality Improvement (QI) initiative was conducted using a pre- and post-intervention design, to launch PASTRY and measure its impact on moral distress of the nursing unit, using Hamric’s Moral Distress Scale–Revised (MDS-R.) This program consisted of monthly 60-minute sessions allowing nurses to address morally distressing events and themes, such as clinicians giving “false hope” to patients or families. The PASTRY program sessions were led by certified clinicians utilizing strategies of discussion and mind-body practices.ParticipantsClinical nurses working on an adult leukemia/lymphoma unit.Ethical considerationsThis was a QI initiative, participation was voluntary, MDS-R responses were collected anonymously, and the institution’s Ethics Committee oversaw PASTRY’s implementation.FindingsWhile improvement in moral distress findings were not statistically significant, the qualitative and quantitative findings demonstrated consistent themes. The PASTRY program received strong support from nurses and institutional leaders, lowered the nursing unit’s moral distress, led to enhanced camaraderie, and improved nurses’ coping skills.DiscussionMeasurement of moral distress is innately challenging due to its complexity. This study reinforces oncology nurses have measurable moral distress. Interventions should be implemented for a safe and healing environment to explore morally distressing clinical experiences. Poor communication among multidisciplinary team members is associated with moral distress among nurses. Programs like PASTRY may empower nurses to build support networks for change within themselves and institutions.ConclusionThis QI initiative shows further research on moral distress reduction should be conducted to verify findings for statistical significance and so that institutional programs, like PASTRY, can be created.

Background Advance care planning, the process through which patient values and goals are explored and documented, is a core quality indicator in cancer care. However, patient values are predominantly elicited at the end of life; patient values earlier in serious illness are not clearly delineated. The objective of this analysis is to assess the content of patient-verified summaries of health-related values among newly diagnosed cancer outpatients in order to develop a theoretical framework to guide future values discussions and optimize person-centered oncologic care. Methods Values summaries among patients with gastrointestinal (GI) cancers or myelodysplastic syndrome (MDS) were extracted from the medical record. Modified grounded theory analysis included interdisciplinary team coding of values summaries to identify key domains; code categorization; and identification of thematic constructs during successive consensus meetings. A final round of coding stratified themes by disease type. Results Analysis of 128 patient values summary documents from 67 patients (gastrointestinal [GI] cancers, n = 49; myelodysplastic syndrome [MDS], n = 18) generated 115 codes across 12 categories. Resultant themes demonstrated patients’ focus on retaining agency, personhood and interpersonal connection amidst practical and existential disruption caused by cancer. Themes coalesced into a theoretical framework with 5 sequenced constructs beginning with the cancer diagnosis, leading to 3 nesting constructs of individual identity (character), interpersonal (communication) preferences and needs, and social identity (connection), signifying sources of meaning and fulfillment. Values differences between GI cancer and MDS patients—including greater focus on normalcy, prognosis, and maintaining professional life among GI patients—reflected the distinct therapeutic options and prognoses across these disease groups. Conclusions Patient values reflect goals of meaning-making and fulfillment through individual agency and interpersonal supports in the setting of a newly diagnosed cancer. Early, nurse-led values discussions provide important and patient-specific data that are informative and likely actionable by clinicians in the delivery of person-centered care. Values can also facilitate discussions between patients and families and clarify patient preferences.

The number of interventions available for children with autism spectrum disorder (ASD) has expanded greatly in recent years, although relatively little is known about the factors that influence family caregivers as they make treatment decisions for their children. This study involved a statewide survey of parents of young children with ASD to examine the relative weights of the factors that influenced their treatment decisions. Results suggested that caregivers rely on their own intuition for much decision making, although selected professionals are also influential. Implications for professionals working with children with ASD and their families are discussed.

Background With the adoption of digital pathology, image analysis (IA) of immunohistochemistry (IHC) slides can be integrated seamlessly into the digital pathology workflow. A pathologist can now use IA efficiently while reading the digital IHC slides on a computer monitor. Thus, the clinical acceptance of a digital pathology system for IHC quantitation depends both on the performance of the IHC IA, and the ability to manually read digital IHC slides on the monitor. A multisite study was conducted to compare the manual reading of IHC Human Epidermal Growth Factor Receptor 2 (HER2) slides on a monitor, using Aperio Technologies, Inc. ScanScope XT instrument and the Spectrum digital pathology information management system to conventional manual microscopy (MM). Design A total of 180 breast cancers were immunohistochemically stained using Dako HercepTest and assayed: (site 1) 80 retrospective specimens with equal HER2 score distribution from an academic center, and (site 2) 100 prospective specimens from a reference laboratory. At each site, 3 pathologists carried out a blinded read of the glass slides using a conventional light microscope, and reporting the HER2 score for each. The glass slides were scanned using a 20× objective, and after a wash-out period and randomization of the slides, the same 3 pathologists carried out another blinded read of the same slides, but this time of the digital image of the slides on the monitor, again reporting the HER2 score. Each of the methods: MM and reading digital slides on a computer monitor, from now on called manual digital read (MDR) were evaluated separately and comparatively using Percent Agreement (PA) of negative HER2 scores (0, 1+) versus equivocal (2+) versus positive HER2 scores (3+). Results Comparable PA values were obtained for MM and MDR IHC HER2 images on the monitor (MM: 76.3% to 91.3%; MDR: 70.0% to 86.0%; MM vs. MDR: 61.3% to 92.5%). Conclusions Results of manually reading IHC HER2 slides on a monitor using Aperio Technologies, Inc. digital pathology system show substantial equivalence to those obtained by conventional manual microscopy. The digital slides are easily read on a monitor.

The purpose of this study was to examine the efficacy of personal digital assistants (PDAs) as cognitive aids in a sample of individuals with severe traumatic brain injury (TBI).The group included 23 community-dwelling individuals at least 1 year post-severe TBI, who had difficulties in performing everyday tasks due to behavioural memory problems. Participants were trained by an occupational therapist to use PDAs as cognitive aids and assessed for occupational performance (using Canadian Occupational Performance Measure (COPM)) and participation in everyday life tasks (using Craig Handicap Assessment and Rating Technique-Revised (CHART)) before training and 8 weeks after training concluded.Statistically significant improvement was noted for self-ratings of occupational performance and satisfaction with occupational performance (COPM); significant improvement in a self-rating of participation was noted (CHART-R).A brief training intervention utilizing PDAs as cognitive aids is associated with improved self-ratings of performance in everyday life tasks among community-dwelling individuals with severe TBI.

Although there is a substantial research literature on the effects of random responding on the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen,Kaemmer, 1989), there are very few studies available on this topic with the MMPI-A (Butcher et al., 1992). Archer and Elkins (1999) found that MMPI-A validity scales F and VRIN were particularly useful in detecting entirely random profiles from those derived standardly in clinical settings but noted that "all random" protocols could not be used to evaluate the usefulness of the T-score difference between the first half (F1) and the second half (F2) of the MMPI-A test booklet. Following up on this issue, this study extended the methodology of previous research by examining the hit rate, positive predictive power, negative predictive power, sensitivity, and specificity of VRIN, F, F1, F2 and the absolute value of the T-score difference between F1 and F2 (denoted as IF1-F21) in 5 samples varying in the degree of protocol randomness. One of the samples consisted of 100 adolescent inpatients administered the MMPI-A under standard instructions, and another sample consisted of 100 protocols randomly generated by computer. The additional 3 samples of 100 protocols each contained varying degrees of computer-generated randomness introduced in the latter half of the MMPI-A item pool. Over- all, the results generally indicate that several MMPI-A validity scales are useful in detecting protocols that are largely random, but all of these validity scales are more limited in detecting partially random responding that involves less than half the total item pool located in the second half of the test booklet. Clinicians should be particularly cautious concerning validity inferences based on the observed T-score difference that occurs for the F1 and F2 subscales and current findings do not support the clinical usefulness of this index.

The Resilient Children Making Healthy Choices (RCMHC) Project is an early childhood prevention initiative designed to promote health and social competence in young children by training their teachers in skills aimed at nurturing children's resilient development. Through a model program implemented in ten Head Start and other community-based preschool classrooms, teachers were trained in the use and integration of resiliency-based substance abuse/violence prevention strategies in their teaching practices. Analysis of outcome data from a pre-post comparison group design revealed increases in teacher interactional skills designed to enhance children's resiliency, and improvements in children's prosocial behaviors.

Context.—Aperio Technologies, Inc (Vista, California) provides a new immunohistochemistry (IHC) HER2 Image Analysis (IA) system that allows tuning of the intensity thresholds of the HER2/neu scoring scheme to adapt to the staining characteristics of different reagents. Objective.—To compare the trainable IHC HER2 IA system for different reagents to conventional manual microscopy (MM) in a multisite study. Design.—Two hundred sixty formalin-fixed, paraffin-embedded breast cancer specimens from 3 clinical sites were assayed: 180 specimens stained with Dako's HercepTest (Carpinteria, California), and 80 specimens stained with Ventana's PATHWAY HER-2/neu (Tucson, California). At each site, 3 pathologists performed a blinded reading of the glass slides with the use of a light microscope. The glass slides were then scanned and after a wash-out period and randomization, the same pathologists outlined a representative set of tumor regions to be analyzed by IHC HER2 IA. Each of the methods, MM and IA, was evaluated separately and comparatively by using κ statistics of negative HER2/neu scores (0, 1+) versus equivocal HER2/neu scores (2+) versus positive HER2/neu scores (3+) among the different pathologists. Results.—κ Values for IA and MM were obtained across all sites. MM: 0.565–0.864; IA: 0.895–0.947; MM versus IA: 0.683–0.892 for site 1; MM: 0.771–0.837; IA: 0.726–0.917; MM versus IA: 0.687–0.877 for site 2; MM: 0.463–0.674; IA: 0.864–0.918; MM versus IA: 0.497–0.626 for site 3. Conclusion.—Aperio's trainable IHC HER2 IA system shows substantial equivalence to MM for Dako's HercepTest and Ventana's PATHWAY HER-2/neu at 3 clinical sites. Image analysis improved interpathologist agreement in the different clinical sites.

A multisite study was conducted to assess the performance of the Aperio digital pathology system (Aperio Technologies, Vista, CA) for reading estrogen receptor (ER) and progesterone receptor (PR) slides on a computer monitor. A total of 520 formalin-fixed breast tissue specimens were assayed at 3 clinical sites for ER and PR (260 each). Percentage and average staining intensity of positive nuclei were assessed. At each site, 3 pathologists performed a blinded reading of the glass slides using their microscopes initially and later using digital images on a computer monitor. Comparable percentages of agreements were obtained for manual microscopy (MM) and manual digital slide reading (MDR) (ER, percentage of positive nuclei with cutoffs: MM, 91.3%–99.0%/MDR, 91.3%–100.0%; PR, percentage of positive nuclei with cutoffs: MM, 83.8%–99.0%/MDR, 76.3%–100.0%). Reading ER and PR slides on a computer monitor using the Aperio digital pathology system is equivalent to reading the slides with a conventional light microscope.

BACKGROUND Aperio provides a new image analysis (IA) solution for immunohistochemistry (IHC) as part of its digital pathology system. To be used in a clinical setting, substantial equivalence to scoring by manual microscopy (MM) needs to be shown. A multisite study was conducted to assess the performance of Aperio's IHC IA solution for estrogen receptor (ER) and progesterone receptor (PR). DESIGN A total of 260 formalin-fixed, paraffin-embedded breast tissue specimens were assayed at 2 clinical sites for ER and PR. The ability to score ER/PR slides in terms of (1) percentage of positive nuclei with cutoffs of 1%, 5%, and 10% and (2) average staining intensity as 0, 1+, 2+, and 3+ score was assessed. At each site, 3 pathologists performed a blinded read of the glass slides using their microscopes. The glass slides were then scanned, and after a wash-out period and randomization of the slides, the pathologists viewed the images on a computer monitor and outlined a representative set of tumor regions to be analyzed by IA. Each of the methods: MM and IA were evaluated separately and comparatively. RESULTS Comparable or higher percent agreements were obtained for IA compared with MM (ER--percent of positive nuclei with cutoffs: MM: 91.3% to 98.8%/IA: 93.8% to 98.8%/IA vs. MM: 92.5% to 97.5%, and intensity score: MM: 55.0% to 86.3%/IA: 88.8% to 90.0%/IA vs. MM: 63.8% to 86.3%; PR-percent of positive nuclei with cutoffs: MM: 83.8% to 99.0%/IA: 85.0% to 99.0%/IA vs. MM: 81.3% to 99.0%, and intensity score: MM: 58.8% to 88.0%/IA: 68.8% to 88.0%/IA vs. MM: 58.8% to 84.0%). CONCLUSIONS The study results show that Aperio's digital IHC IA solution for ER/PR is substantially equivalent to scoring by MM.

This paper describes sudden extreme drops in blood pressure in both experimental and clinical situations when a person is talking about or describing situations of hopelessness and helplessness. These changes are discussed in the context of historical perspectives about the cardiovascular system. A new perspective is introduced, one in which these blood pressure changes are seen as part of an unheard cry for understanding. It is hypothesized that such changes do not occur in response to a person's attempts to communicate a sense of hopelessness, but rather are the biological foundations of the hopelessness itself. Viewed from such a context an entirely new therapeutic approach is outlined regarding the treatment of patients suffering from a wide variety of psychosomatic as well as psychological disturbances.

The Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; Butcher et al., 1992) was released in 1992 and has rapidly become the most widely used objective personality assessment instrument with adolescents. Although the MMPI-A reduced or eliminated several problems associated with the use of the original MMPI (Hathaway & McKinley, 1943) with adolescents, the MMPI-A does produce a high frequency of within normal limits basic scale profiles for individuals with substantial psychopathology including adolescents in inpatient psychiatric settings. To better understand the reasons for this phenomenon, we compared the item endorsement frequencies for the MMPI-A normative sample with results from two adolescent clinical samples, and these results were contrasted to the item endorsement frequencies for the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) normative sample and a clinical sample of adult psychiatric inpatients. Results showed that the MMPI-A contains a substantial number of items that do not show a significant difference in item endorsement frequency between normative and clinical samples. Furthermore, MMPI-A basic and content scales generally show a much lower percentage of effective items than do the corresponding scales for the MMPI-2. We discuss the findings in relation to the frequent occurrence of low range MMPI-A profiles in clinical samples and the potential usefulness of these results in future efforts to develop viable short forms for the MMPI-A.

Objectives. A review of outcome research conducted between 1982 and 1992 revealed return-to-work rates for industrial rehabilitation programs that ranged from 50% to 88%. Variations in outcome statistics appeared to reflect discrepancies in factors such as type of research design, initial characteristics of the client sample, and clients excluded from the study group. Method. A work-hardening outcome study involving 36 programs was conducted by the Work Programs Special Interest Section to address questions left unanswered by existing studies regarding (a) rates of program nonacceptance or noncompletion, (b) basic client characteristics and outcome, (c) length of disability and outcome, (d) breakdown of client disposition after program completion, and (e) program characteristics and return to work. Results. Findings included the following: (a) 11.5% of clients were not accepted into work hardening and 24.6% did not complete the program; (b) outcome was not related to client age, gender, area of injury, or physical demand level of job before injury; (c) as duration of disability increased, return to work decreased significantly; (d) at discharge, 48.2% of clients returned to the usual and customary job and 30.5% to alternate or modified work, whereas 13.6% were referred to a vocational counselor; and (e) there was no relationship between number of visits or number of professionals seen and return to work. Conclusion. The authors suggest a need for uniform standards in collection of outcome data to establish a basis for comparison of efficacy among programs. Recommendations include tracking comparison or control groups, grouping clients in terms of length of disability, computing success rate on the basis of number of clients who completed their program, using relevant subcategories when reporting return to work, and consistency of the postdischarge interval for follow-up.

Occupational therapy practitioners focus on the individual's ability to participate in productive occupations throughout their life span. Through prevention, assessment, and intervention strategies, occupational therapy practitioners often collaborate with other members of the health care team and assist persons to optimize their ability to engage in purposeful occupation while facilitating a safe and successful entry into or return to work.

The authors identified relationships between quantitative academic variables--specifically, grade-point averages (GPAs) and Medical College Admission Test (MCAT) scores--and the admission decisions of 58 students from minority groups underrepresented in medicine. These students had participated in a summer enrichment program at the University of Virginia School of Medicine and had applied to medical school. A total of 49 of the students were offered admission, and ultimately enrolled in 17 different medical schools. Results of a stepwise multiple regression analysis indicated that scores on the Skills Analysis: Quantitative Subtest of the MCAT explained the greatest percentage of the variance related to medical school admission (26%); scores on the Skills Analysis: Reading Subtest contributed an additional 7% to the explained variance, and scores on the Physics Knowledge Subtest, another 5%. The overall GPAs did not contribute significantly to the explanation of the variance in admission decisions. These results differ from published findings based on data from minorities' admissions to individual institutions. Caution must therefore be exercised when using GPAs and MCATs as medical school admission predictors for students from minority groups.