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Mobile health technology offers promise for reducing disparities in pediatric asthma care and outcomes by helping parents more effectively communicate with their children's primary care providers and manage their children's asthma. This study tested the impact of a text messaging program on emergency department utilization and asthma morbidity.A randomized controlled trial enrolled 221 parents of Medicaid-insured children visiting the emergency departments of 2 urban children's hospitals in the Pacific Northwest for an asthma-related concern between September 2015 and February 2019. Standardized surveys were administered to parents at baseline and 12 months later to assess the primary outcomes of emergency department utilization and morbidity as well as primary care utilization, parent communication self-efficacy, and asthma self-management knowledge. The intervention group received brief in-person education on partnering with primary care providers, followed by 3 months of educational text messages.Participants were mostly female, English speakers, of minority race and ethnicity, and living below 200% of the federal poverty level. Negative binomial and linear regressions indicated no significant group differences in annual number of emergency department visits, morbidity, parent communication self-efficacy, or asthma self-management knowledge at 12 months' follow-up, adjusting for baseline covariates. Average annual rate of primary care visits for asthma was 35% higher in the intervention group compared to control group at follow-up (95% confidence interval 1.03-1.76, P = .03).This parent-focused text message intervention did not impact emergency department utilization or asthma morbidity; however, results suggest its potential for enhancing use of primary care for management of pediatric chronic conditions.

Improv comedy is a small subset of improvisation, which has been under-researched. This study aims to investigate if the benefits agents experience match previous research. Literature discusses positivity, community, social and communication skills, and relaxation. The survey gained 128 global respondents answering a series of questions related to their improv experiences (as per stated literature topics), including in-depth demographic information. Improv has added value to most people’s lives, provided improvements to their socialization, and improved their communication. The respondents felt that they enjoyed the company of others, and they wanted the same. Most people trust their scene partner more often than not and felt that they were relaxed in their own group and as a guest. Variations within the global population are examined. The survey functions both reliably and validly, finding that past research fits the global population of those engaged in improv. Most respondents agree to the domains presented and trust their scene partner. Performing improv breeds trust and trust can lead to increased benefits in the domains. Nonetheless, there are no differences in represented groups of respondents on their experience of the benefits of improv.

BACKGROUND Migraine is a common major cause of disability, poor quality of life, and high health care utilization. Access to evidence-based migraine care is limited and projected to worsen. Novel health care delivery models including mHealth app-based tools may mitigate these challenges. OBJECTIVE We developed an electronic health record (EHR) integrated mobile app-based migraine interactive care plan (MICP) to remotely monitor, deliver education and facilitate care team communication for patients with migraine. This multi-method study describes the MICP and pilot evaluation of its feasibility, usability, and impact on care teams in a community neurology practice. METHODS Consecutive enrollees between 9/1/2020 and 2/16/2022 were assessed in a single arm observational study. Usability was defined by ≥ 75% of patients completing ≥ 1 assigned task. Task response rates, rate and type of care team escalations, and patient reported clinical outcomes were summarized. Feasibility was defined by equal-to or fewer downstream face-to-face visits, telephone contacts, and electronic messages. From 9/1/2020 to 9/1/21 eligible patients were prospectively recruited and randomly assigned to routine care with or without the MICP. Demographic data and occurrence of face-to-face visits, telephone contacts, electronic messages were extracted from the EHR. The Wilcoxon ranked summed test was used to compare continuous variables and the Chi-square test for categorical variables for those with at least 3 months of follow-up. RESULTS A total of 171 patients enrolled and 127 (74.3%) completed ≥ 1 MICP assigned task. Mean escalations per patient per month was 0.9 (SD 0.37; range 0-1.7). Patient confirmed understanding of educational materials ranged from 26.7% to 56.3%. Initial mean headache days per week was 4.54 days (SD 2.06) and trended down to 2.86 days (SD 1.87) at week 26. Baseline mean total MIDAS score was 110 (SD 107; range 3-452) with a response rate of 59% (n=100/170). The percentage of patients reporting favorable satisfaction increased from a baseline of 35% to 59% (response rate of 30-41%) over the first 6 months. A total of 121 with MICP were compared to 62 patients in the control group. No differences were observed in the rate of telephone contacts or electronic messages. Fewer face-to-face visits were observed in the MICP cohort (n=13/121, 10.7%) compared to controls (n=26/62, 42%; P < .001). CONCLUSIONS We describe successful implementation of an EHR integrated mobile app-based interactive care plan for migraine in a community neurology practice. Our findings suggest that the MICP holds potential for improving patient access and reducing healthcare utilization without increasing care team work. Additional studies are needed to assess the impact on utilization and outcomes in other settings such as primary care. Our findings also suggest the need for direct patient input from diverse populations to improve the MICP and sustain patient-engagement.

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The Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys collect standardized information about patient experiences of care from nationally representative samples of people with Medicare to support consumers’ enrollment choices and enable the Centers for Medicare & Medicaid Services to monitor care quality and incentivize high quality patient-centered care. Since 2007, protocols for data collection, analysis, and reporting have evolved to address expanded Medicare coverage options and a shift from a single survey vendor to a model in which health plans hire approved vendors to administer the survey. During that time, response rates for all types of surveys have declined; increasing effort has gone toward increasing survey participation, especially among people whose preferred language is not English. In this paper, we describe the history, goals, and current use of the Medicare CAHPS surveys. We also summarize key methodological issues, such as sample design, field implementation and data cleaning, adjustment, scoring, and report production. Additionally, we discuss issues that may arise more generally in managing a large, annual national survey that has direct impact on policy, and consider how a long-running survey of this nature may need to evolve to reflect changes in health care delivery and promote standardization in survey administration while maintaining survey content.

Background Studies incorporating staff-rated or observational measures of practice leadership have\ud shown that where practice leadership is stronger, active support is better implemented. The study\ud aim was to compare measures of practice leadership used in previous research to determine the\ud extent of their correspondence.\ud Method A subset of data from a longitudinal study regarding 29 front-line managers working across\ud 36 supported accommodation services in Australia was used. An observed measure of practice\ud leadership, based on an interview and observation of a front-line manager, was compared with\ud ratings of practice leadership completed by staff. The quality of active support was rated after a\ud 2-hour structured observation.\ud Results Correlations between staff-rated and observed measures were non-significant. Only the\ud observed measure was correlated with the quality of active support.\ud Conclusions This study provides evidence to support using an observational measure of practice\ud leadership rather than reliance on staff ratings.

Introduction: Children with food insecurity (FI) experience adverse health outcomes due to inadequate quantity or quality of food. Food insecurity may be high among families seeking emergency care. The Hunger Vital Sign (HVS) is a two-question validated tool used to screen families for FI. Our goal in this study was to assess prevalence of FI among emergency department (ED) patients, patient-level risk factors for FI, and the feasibility of screening. Methods: This was a cross-sectional analysis of FI in the ED. Parents or guardians of ED patients and adult patients (18 years or older) were approached for screening using the HVS during screening periods spanning weekdays/weekends and days/evenings. All ED patients were eligible, excluding siblings, repeat visits, critically ill patients, minors without a guardian, and families that healthcare staff asked us not to disturb. Families answered the HVS questions verbally or in writing, based on preference. Families with positive screens received information about food resources. We summarized patient and visit characteristics and defined medical complexity using a published algorithm. Multivariable logistic regression was used to assess FI risk factors. Results: In July-August 2019, 527 patients presented during screening periods: 439 agreed to screening, 18 declined, 19 met exclusions, and 51 were missed. On average the screening tool required five minutes (range 3-10 minutes) to complete. Most families (328; 75%) preferred to answer in writing rather than verbally. Overall, 77 participants (17.5%) screened positive for FI. In regression analyses, FI was associated with self-reported race/ethnicity (combined variable) of African American or Black (odds ratio [OR] 5.21, 95% confidence interval [CI], 2.13-12.77), Hispanic (OR 3.47, 95% CI, 1.48-8.15), or mixed/other (OR 3.81, 95% CI, 1.54-9.39), compared to non-Hispanic white. FI was also associated with public insurance type (OR 5.74, 95% CI, 2.52-13.07, reference: private insurance), and each year of increasing patient age (OR 1.05, 95% CI, 1.01-1.09). There were no associations between FI and medical complexity or preferred language. Conclusion: Food insecurity was common among our ED patients. Race and ethnicity, insurance status, and increasing patient age were associated with increased odds of FI. Efforts to include universal FI screening for ED patients with immediate connection to resources will enhance overall care quality and address important health needs.

Background: Dialectical behavior therapy (DBT) is an evidence-based treatment for self-harm and emotion regulation difficulties. A modified version, DBT-Skills System (DBT-SS), has been developed i...

Background An elevated postprandial glycaemic and related physiological response is associated with diabetes and cardiovascular disease risk. Several factors, including genetics, may influence interpersonal differences in preprandial baseline markers and postprandial meal responses. This study examined the association between genetic variation and physiological outcomes during the preprandial and postprandial digestive responses in thirty healthy young men. Methods In this experimental study, thirty healthy men aged 20–34 consumed a standardised breakfast meal. Blood samples were collected before the meal and hourly for 4 hours after the meal to assess lipids and fatty acids (saturated and unsaturated fat, long-chain polyunsaturated fatty acids, cholesterol, low-density lipoprotein, high-density lipoprotein and triglycerides), nutrients (vitamin D, iron and zinc), glucose and insulin. Participants’ weight and height were collected to determine their body mass index (BMI). An online visual analogue 100-point scale was used to assess appetite changes upon arrival, immediately following meal consumption, 30 minutes after and hourly for 4 hours. Buccal swabs were collected and assessed for single nucleotide polymorphisms (SNPs). Data were analysed using multiple regression analysis. Results The insulin-receptor substrate 1 gene (IRS1) polymorphism rs2943641 significantly predicted elevated fasting insulin levels (R2 = 0.639, F (3,26) = 15.34, β = 6.376, P = γ2) polymorphism rs1801282 significantly predicted participants’ BMI (R2 = 0.261, F (2,27) = 4.759, β = -2.764, P = 0.007 and R2 = 0.200, F (2,27) = 3.371, β = 3.291, P = 0.024 respectively). The remaining SNPs did not appear to associate with our cohort’s related physiological or nutrient outcome. Conclusions According to the finding of this exploratory study, three SNPs significantly predicted participants’ fasting insulin levels and BMI.

Purpose The purpose of this paper is to provide a commentary on Banks et al. and sets the wider context. Design/methodology/approach It provides a brief narrative review of the literature on the factors that determine the quality of life of people with intellectual disabilities, including the impact of culture. Findings Key to ensuring good quality of life outcomes is support that is facilitative, enabling and empowering which can compensate for severity of disability and improve people’s experiences. This approach is called Active Support. Improving quality of life is a key part of preventing and responding to behaviours that challenge. Culture is an important factor in ensuring staff are motivated to work in such ways but is likely to be intertwined with many other factors. Originality/value This paper summarises the key literature on what is needed to improve outcomes for people with intellectual disabilities. It introduces the importance of exploring how the different dimensions of culture interact and how culture, practice, processes and structures might work in a much more complex and intertwined fashion than previously conceptualised.

Background: In controlled, clinical studies of the impact of psilocybin on patients with life-threatening cancers, Johns Hopkins and NYU researchers found that the “intensity of the mystical experience” induced by psychedelic-assisted psychotherapy was directly correlated with the alleviation of cancer-related mental distress. Objective: The purpose of this article is to explore the proposition that the combination of psychotherapeutic guided imagery and psychedelic-assisted psychotherapy could not only alleviate cancer-related psychological distress but also reduce or eliminate physiological tumors. Methods: The literature surrounding “mystical experience” is discussed; the modalities of psychedelic-assisted psychotherapy and guided imagery psychotherapy with cancer patients are compared; and the anecdotal outcomes of cancer remission among private therapy guided imagery patients are presented.

There has long existed the argument that science teachers' self-efficacy directly correlates with instruction. Regarding self-efficacy for culturally responsive instruction (CRI), a promising equit...

OBJECTIVES: Asymptomatic transmission of coronavirus disease 2019 (COVID-19) in health care settings is not well understood. In this study, we aimed to determine the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibodies in health care and hospital workers (HCHWs) and assess how antibody levels change over time. METHODS: Cross-sectional study of employed HCHWs at a freestanding, urban pediatric tertiary care hospital. Employed HCHWs ≥18 years old who were asymptomatic and worked in clinical hospital locations were eligible to participate. Participants completed blood draws and surveys at baseline (between May 4, 2020, and June 2, 2020) and 2 months later (between July 6, 2020, and August 7, 2020). Surveys collected demographic information, SARS-CoV-2 exposures, and previous COVID-19 diagnosis. RESULTS: In total, 530 participants enrolled in and completed baseline study activities. The median age was 37 years (range 19–67 years); 86% identified as female, and 80% identified as white. Two months later, 481 (91%) HCHWs completed another survey and blood draw. Four of 5 (0.9%) seropositive subjects at baseline remained seropositive at 2 months, although 3 had decreasing IgG indices. Five (1.0%) seropositive individuals, including 4 who were previously seropositive and 1 newly seropositive, were detected 2 months later. History of positive SARS-CoV-2 polymerase chain reaction testing results (P < .001) and history of COVID-19 exposure (P < .001) were associated with presence of SARS-CoV-2 antibodies. CONCLUSIONS: SARS-CoV-2 antibodies were detected in 1% of HCHWs in an urban pediatric hospital in a city with moderate SARS-CoV-2 prevalence. Participants with a known previous COVID-19 diagnosis showed a decline or loss of IgG antibodies over 2 months. These results have implications for identifying those with previous exposure and for ongoing public health recommendations for ensuring workplace safety.

Primary Subject area Public Health and Preventive Medicine Background Visits to pediatric emergency departments have decreased up to 75% during the pandemic, with corresponding increases in high acuity visits, inpatient admissions, and intensive care unit admissions compared to historical cohorts. Objectives To determine if caregivers of children presenting to pediatric emergency departments (EDs) during the COVID-19 pandemic are delaying presenting to care for fear of contracting COVID-19. Secondary objectives were to: a) evaluate potential predictors of delay; b) describe the proportion of children whose symptoms worsened during time to presentation. Design/Methods A multicentre cross-sectional survey study of caregivers accompanying their children aged 0-19 years old to 16 pediatric EDs in 6 countries, from May-June 2020. An anonymous online survey, completed by caregivers via RedCAP, included caregiver and child demographics, presenting complaints, if they delayed presentation and whether symptoms worsened during this interval, as well as caregiver concerns about the child or caregiver having COVID-19 at the time of ED visit. Results Of 1543 caregivers completing the survey, 287 (18.6%) reported a delay in seeking ED care due to concerns of contracting COVID-19 in the hospital. Of those, 124 (43.2%) stated their child’s symptoms worsened during the waiting interval. Caregiver relationship to child [mother] (OR 1.85, 95% CI 1.27-2.76), presence of chronic illness in child (OR 1.78. 95% CI 1.14-2.79), younger age of caregiver (OR 0.965, 95% CI 0.943-0.986), and caregiver concerns about lost work during the pandemic (OR 1.08, 95% CI 1.04-1.12), were independently associated with a COVID-19-related delayed presentation in multivariate regression analysis. Conclusion Almost one in five caregivers reported delaying ED presentation for their ill or injured child, specifically due to fear of contracting COVID-19 while in hospital. Mothers, younger caregivers, caregivers of children with chronic illness, and those concerned about lost work were at highest risk for delay.

This chapter focuses on writing culturally and linguistically responsive IEPs for multilingual learner students with disabilities (MLSwD). It provides an overview of relevant laws and discusses the intersection of needs between multilingual students, students with disabilities, and MLSwD. Disproportional representation of MLSwD in special education services is described to provide context for the importance of culturally and linguistically appropriate IEP goals. The key components of the IEP are delineated including a description of the present level of academic and functional performance, and writing observable, measurable IEP goals and objectives using the SMART format (specific, measurable, attainable, relevant, and time bound). Accommodations, transition services, and assistive technology are discussed.

This chapter focuses on specially designed instruction (SDI) for multilingual learners with disabilities (MLSwD) aligned with their individual education programs (IEP) and language support needs. First, multilingual students (MLs) and the services they receive within general education are described. Then, the features of effective instruction for MLs using a culturally and linguistically responsive multi-tiered systems of support (CLR MTSS) framework are delineated. Next, the chapter describes the development of SDI that considers MLSwD disability-related needs and cultural and linguistic backgrounds for students who qualify for special education services. The chapter concludes with examples of instructional planning using the PLUSS framework to address their unique cultural backgrounds and linguistic and educational needs.

Background: A growing body of evidence attests to the disproportionate impact of COVID-19 on persons with intellectual and developmental disabilities (IDD) during the pandemic. This study asked caregivers about their perceptions of how COVID-19 impacted them and the people they support. Method: An online survey was conducted in 12 countries during August-September 2020 and sought information on demographics, support practices, information and training, experiences of COVID-19, social distancing, and wellbeing, as measured by the DASS12. This study reports on 3,754 family members, direct support professionals, and managers who participated in the survey. Results: Caregivers observed increases in depression/anxiety, stereotyped behaviours, aggression towards others and weight gain in the person(s) they supported. They also reported difficulties supporting the person(s) to access healthcare. Families reported reducing or ceasing employment and absorbed additional costs when supporting their family member. Direct support professionals experienced changes in staff shifts, staff absences, increased workload and hiring of casual staff. Caregivers’ wellbeing revealed high levels of stress, depression, and less so anxiety. The strongest predictor of wellbeing among families was observation of changes in mood in the person(s) they supported, while for direct support professionals, the strongest predictors of wellbeing were reorganisation of staff shifts and increases in new direct support staff. Discussion: Findings support the contention of this population experiencing a disproportionate burden during the COVID-19 pandemic, reflecting historical inequities in access to healthcare and other human rights violations which are now protected under the United Nations Convention on the Rights of Persons with Disabilities.

The coronavirus disease 2019 (COVID-19) pandemic has taken an unprecedented global toll and vaccination is needed to restore healthy living. Timely inclusion of children in vaccination trials is critical. We surveyed caregivers of children seeking care in 17 Emergency Departments (ED) across 6 countries during the peak of the pandemic to identify factors associated with intent to participate in COVID-19 vaccine trials. Questions about child and parent characteristics, COVID-19 expressed concerns and parental attitudes toward participation in a trial were asked. Of 2768 completed surveys, 18.4% parents stated they would enroll their child in a clinical trial for a COVID-19 vaccine and 14.4% would agree to a randomized placebo-controlled study. Factors associated with willingness to participate were parents agreeing to enroll in a COVID-19 vaccine trial themselves (Odds Ratio (OR) 32.9, 95% Confidence Interval (CI) (21.9–51.2)) having an older child (OR 1.0 (1.0–1.01)), having children who received all vaccinations based on their country schedule (OR 2.67 (1.35–5.71)) and parents with high school education or lower (OR 1.79 (1.18–2.74)). Mothers were less likely to enroll their child in a trial (OR 0.68 (0.47–0.97)). Only one fifth of families surveyed will consider enrolling their child in a vaccine trial. Parental interest in participation, history of vaccinating their child, and the child being older all are associated with parents allowing their child to participate in a COVID vaccine trial. This information may help decision-makers and researchers shape their strategies for trial design and participation engagement in upcoming COVID19 vaccination trials.