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© The Author(s), 2021. Child labourers are at risk of poorer mental health and once rescued require urgent mental health interventions to ameliorate the long-term impact. In our review, only two published scientific studies evaluated custom-made interventions; other programmes were obtained from non-governmental organisations (NGOs), which need rigorous trial evaluation. We also sought the viewpoints of stakeholders working directly with rescued young people, as well as consulting young people with lived experiences of child labour. We propose that psychoeducational interventions aimed at employees working directly with young people could represent a fruitful approach for low- and middle-income countries in the Asia-Pacific region but also more generally. UK Medical Research Council (MR/N006194/1); Department of Biotechnology, India (BT/IN/DBT-MRC/DFID/20/RP/2015-16).

Quantifying solid tumor margins with fluorescence-guided surgery approaches is a challenge, particularly when using near infrared (NIR) wavelengths due to increased penetration depths. An NIR dual wavelength excitation fluorescence (DWEF) approach was developed that capitalizes on the wavelength-dependent attenuation of light in tissue to determine fluorophore depth. A portable dual wavelength excitation fluorescence imaging system was built and tested in parallel with an NIR tumor-targeting fluorophore in tissue mimicking phantoms, chicken tissue, and in vivo mouse models of breast cancer. The system showed high accuracy in all experiments. The low cost and simplicity of this approach make it ideal for clinical use.

Background Few exercise training studies in patients with heart failure (HF) report adherence to guideline-recommended 150 minutes of moderate-intensity exercise per week, and no studies have focused on a primary outcome of adherence. Methods and Results This randomized controlled trial evaluated the effect of a multicomponent intervention, Heart Failure Exercise and Resistance Training (HEART) Camp, on adherence to exercise (after 6, 12, and 18 months) compared with an enhanced usual care (EUC) group. Patients (n = 204) were 55.4% male, overall average age was 60.4 years, and 47.5% were nonwhite. The HEART Camp group had significantly greater adherence at 12 (42%) and 18 (35%) months compared with the EUC group (28% and 19%, respectively). No significant difference (P > .05) was found at 6 months. The treatment effect did not differ based on patient's age, race, gender, marital status, type of HF (preserved or reduced ejection fraction) or New York Heart Association functional class. Left ventricular ejection fraction (LVEF) significantly moderated the treatment effect, with greater adherence at higher LVEF. Conclusions The multicomponent HEART Camp intervention showed efficacy with significant effects at 12 months and 18 months. Adherence levels remained modest, indicating a need for additional research to address methods and strategies to promote adherence to exercise in patients with HF.

Background Few studies report objective accelerometer-measured daily physical activity levels in patients with heart failure (HF). Objective We examined baseline accelerometer-measured physical activity from the Heart Failure Exercise and Resistance Training Camp trial, a federally funded (R01-HL112979) 18-month intervention study to promote adherence to exercise in patients with HF. Factors associated with physical activity levels were also explored. Methods Patients with diagnosed HF (stage C chronic HF confirmed by echocardiography and clinical evaluation) were recruited from 2 urban medical centers. Physical activity energy expenditure and the number of minutes of moderate or vigorous physical activity (MVPA) were obtained from 7 full days of measurement with the accelerometer (Actigraph Model GT3X, Pensacola, Florida) for 182 subjects who met minimum valid wear time parameters. Additional measures of health-related factors were included to explore the association with physical activity levels. Results Subjects had 10.2 ± 10.5 minutes of MVPA per day. Total physical activity energy expenditure was 304 ± 173 kcal on average per day. There were 23 individuals (12.6%) who met the recommended goal of 150 minutes of MVPA per week. Men, whites, New York Heart Association class II, and subjects with better physical function had significantly higher levels of activity. Conclusions Consistent with previous research, patients with HF are not meeting recommended guidelines for 150 minutes of MVPA per week.

Intervention fidelity in behavioral interventions is complicated by their dynamic and interactive nature. Translation of the outcomes to practice may be diminished by lack of fidelity. The purpose of this paper is to describe a systematic, evidence-based intervention fidelity approach in a complex, multi-component behavioral change study. The NIH-funded randomized controlled trial was designed to evaluate the effect of an adherence to exercise intervention. Two hundred forty-six heart failure patients from two sites were enrolled. This description of the study-specific standardized protocol, the data collection methods employed, findings from the plan, and the discussion of the successes and challenges contributes to the advancement of intervention fidelity implementation science.

Purpose The aim of this study was to evaluate the use of patient-selected exercise adherence strategies following cardiac rehabilitation (CR). Design Twenty patients with heart failure (HF) were recruited and randomly assigned to the intervention or control group at completion of CR. Methods The intervention included the use of six adherence strategies (logs, graphs, pedometers, phone follow-up, education, and a letter from CR staff), which were provided for 6 weeks post CR and during home-based exercise. After 6 weeks, the intervention group selected strategies to continue, and only those were provided for the last 6 weeks. At 12 weeks, patients were retested. Findings Patients with HF demonstrated improvement in distance walked and less HF symptoms and adhered to exercise at levels recommended during CR. Conclusion Inclusion of patient-selected adherence strategies supports continued exercise and helps to sustain physiological improvements. Clinical relevance Results from this study have implications for CR programs serving HF patients and provide insight into adherence strategies.

PURPOSE The purpose of this study was to compare an Exercise Training Group (EX) with an Attention-Control Group (AT-C) to more specifically assess the impact of exercise training on individuals with heart failure (HF). METHODS Forty-two individuals with HF were randomized to AT-C or EX that met with the same frequency and format of investigator interaction. Baseline, 12- and 24-week measurements of B-type naturetic peptide (BNP), 6-minute walk test (6-MWT), and the Kansas City Cardiomyopathy Questionnaire (KCCQ) were obtained. RESULTS BNP tended to increase in the AT-C while remaining stable in the EX over time. A clinically significant increase in 6-MWT was demonstrated by the EX but not the AT-C. The EX achieved a clinically significant change on the KCCQ at 12 weeks, with further improvement by 24 weeks, while the AT-C demonstrated a clinically significant change at 24 weeks. CONCLUSIONS Attention alone was inadequate to positively impact BNP levels or 6-MWT distances, but did have a positive impact on quality of life after 24 weeks. Although exercise offers enhanced benefits, individuals with HF unable to participate in an exercise program may still gain quality of life benefits from participation in a peer-support group that discusses topics pertinent to HF.

This study measured the impact of the Exercise Adherence Management Program (EAMP) provided to 20 patients with heart failure (HF) who participated in a combined resistance and aerobic exercise training program during two 12-week phases. The EAMP included strategies designed to support exercise self-efficacy and adherence. Results indicate that an improvement in exercise self-efficacy occurred during the study period, whereas exercise adherence declined during the unsupervised phase. The highest rated adherence strategy for helpfulness and self-efficacy was group sessions. The study supports the use of adherence strategies based on self-efficacy in exercise programs for patients with HF.

Background This study tested the effects of a multicomponent exercise training intervention called “Heart Failure Exercise And Training Camp” (HEART CAMP). The intervention was theoretically derived from Bandura's social cognitive theory. Methods An experimental repeated-measures design was used. Participants were randomized to the HEART CAMP intervention group (n = 22) or the attention control group (n = 20). Participants were compared on self-efficacy for exercise, symptoms, physical function, and quality of life over 12 weeks. Results The intervention group had a 31% increase in cardiac exercise self-efficacy and significantly fewer symptoms compared with the attention control group. Quality of life increased significantly in both groups. Conclusion A theory-based intervention improved self-efficacy for exercise and symptoms in patients with heart failure.

The registered nurse (RN) shortage threatens rural health care quality and economic vitality. Educational institutions have the opportunity to collaborate with rural communities in building pipelines for a more highly educated, sustainable nursing workforce. Leaders from 19 Midwestern rural counties approached a university about their regional nurse workforce issues and a desire to locate a nursing campus in their community. This article describes the partnership between a university and a rural community and the process for addressing their concerns and determining program feasibility. A Task Force of faculty and community leaders used the Determining Program Feasibility model to frame data collection and analysis. The Task Force met regularly with a Community Advisory Board for problem-solving and formative feedback. The sound methodology and transparent process facilitated a successful collaboration and resulted in a final report outlining the significant opportunities and challenges to overcome. Plans are underway for a new rural nursing campus and the community has raised monies for the new facility. The state legislature will address needed start-up funds.

The purpose of this pilot study was to test the adjunctive effects of a 12-week exercise training intervention vs. standard pharmacologic therapy on quality of life, functional status, and mood in heart failure patients. A randomized, two-group repeated measures design was used to test outcomes at baseline and 12 weeks in 23 subjects (ejection fraction

The purpose of this investigation was to test the effectiveness of an adherence facilitation intervention consisting of goal setting, graphic feedback, and provider guidance to support adherence to home exercise in a sample of patients with heart failure who had completed a supervised exercise program. The sample consisted of 13 patients with an ejection fraction of 40% or less who were randomly assigned to either the exercise only group (n=6) or the exercise with adherence facilitation group (n=7). The format of the intervention was graphic depiction of each patient's exercise goals in comparison to each patient's exercise participation. Graphs were mailed at 3-week intervals for 12 weeks. Results indicate that patients who received the intervention demonstrated higher exercise adherence and greater confidence in continuing to exercise in the future. The adherence facilitation intervention may be helpful to heart failure patients in adapting to a program of home exercise. (c)2002 CHF, Inc.

Background: Adherence to the Heart Failure Society of America (HFSA) 2010 guidelines recommending 30 minutes of supervised moderate intensity exercise five days per week is difficult for patients with heart failure (HF). Innovative programs are needed to assist HF patients to adhere to long-term exercise. The objective of this prospective randomized two-group repeated measures experimental design is to determine the efficacy of a behavioral exercise training intervention on long-term adherence to exercise at 18 months in patients with heart failure. Methods/Design: A sample size of 246 subjects with heart failure will be recruited over a 3 year period. All subjects receive a cardiopulmonary exercise test and 9 supervised exercise training sessions during a 3 week run-in period prior to randomization. Subjects completing at least 6 of 9 training sessions are randomized to the HEART Camp Intervention group (HC) or to a standard care (SC) exercise group. The HC intervention group receives cognitive-behavioral strategies that address the intervention components of knowledge, attitudes, self-efficacy, behavioral self-management skills and social support. The SC group is provided access to the exercise facility and regular facility staff for the 18 month study period. The primary aim is to evaluate the effect of HEART Camp on adherence to exercise, with our central hypothesis that the HC group will have significantly better adherence to exercise at 18 months. Secondary aims include evaluating which components of the HEART Camp intervention mediate the effects of the intervention on adherence; evaluating the effect of HEART Camp on specific health outcomes; exploring selected demographic variables (race, gender, age) as potential moderators of the effect of the HEART Camp intervention on adherence; and exploring the perceptions and experiences that contextualize exercise adherence. Discussion: The HEART Camp intervention is the first to test a multi-component intervention designed to improve long-term adherence to exercise behavior in patients with HF. Improving long-term adherence to exercise is the logical first step to ensure the required dose of exercise that is necessary to realize beneficial health outcomes and reduce costs in this burdensome chronic illness. Trial registration: Clincaltrials.gov NCT01658670.

The purpose of this study was to compare selected baccalaureate program outcomes for a traditional, specialty-based curriculum (TC) to a concept-based curriculum (CBC). Outcomes included NCLEX-RN licensure pass rates, graduation rates, national assessment of critical thinking, and program satisfaction. Student self-efficacy for performing nursing activities also was measured to assess the impact of the curriculum change on student confidence. The sample included 240 students enrolled in the two curricula during the last semester of the two baccalaureate nursing curricula. The TC sample ( n = 104) included three cohort graduating classes, and the CBC sample ( n = 136) included two cohort graduating classes. Findings indicated few differences on outcomes between the two curricula. Lack of a negative impact on program outcomes observed in this study may encourage other nursing colleges to implement newer curriculum models. Further study is needed on ways to evaluate the impact of curriculum change. [ J Nurs Educ . 2015;54(3, Suppl.):S16–S20.]

Background: Student clinical and work-related experiences are available at many healthcare organizations, but little is known about how these experiences contribute to the employer/nurse work relationship that begins after graduation. This study examined the relationship of senior BSN students' past employer experience in describing first-year employer commitment and turnover. Methods: The sample was 63 senior BSN students. Experience factors measured included job selection factors, pre- and one-year commitment, organizational climate, employer support, and first-year turnover. Results: Organizational climate was the experience-related factor most important in explaining first-year commitment. Conclusion: Findings suggest the importance of supportive work environments to new nurses both before and after accepting the first graduate nurse position.

The purpose of this study was to describe psychological effects and exercise adherence during a multicomponent exercise training intervention.A sample of 42 patients with heart failure were randomized into an exercise (INV) group (n = 22) and an attention control (AC) group (n = 20). The exercise protocol included two 12-week phases, a structured phase and a self-managed phase. The psychological responses assessed were mood states and exercise self-efficacy. To meet the second purpose of the study, the exercise group was dichotomized based on the number of sessions completed to create two adherence subgroups.Results indicate self-efficacy improved for the INV group and was maintained during the self-management phase. The adherence subgroups demonstrated different patterns for weekly exercise. Depression and confusion scores improved for the high-adherence group in contrast to worsening for the low-adherence group.Results suggest a need for further study of the psychological responses of exercise adherence for patients with heart failure.The study indicates the importance of continuous assessment of exercise participation and longer term adherence support for patients with heart failure.

In this study we assess the clinical and radiological outcomes after surgical fixation of unstable, extracapsular fractures of the proximal femur using two designs of short intramedullary nail. We reviewed 158 patients of which 131 had fixation using the Intra Medullary Hip Screw (IMHS original Richards Compression Hip Screw design) and 27 with the original design Proximal Femoral Nail (PFN Synthes). Outcome measures including non-union, peri-implant fracture, post-operative function and mortality were similar between groups. Proximal screw cut-out and consequently re-operation rate were significantly higher for the PFN. A number of variables may predispose a patient to develop screw cut-out including gender, experience of surgeon, fracture pattern, implant design and tip-apex distance. As such a multivariable logistic regression model was used to investigate the independent effects of these variables on proximal screw cut-out. Only tip-apex distance was found to have a significant association with proximal screw cut-out and differences between implant designs could be accounted for by surgical technique rather than implant design. The results of this study suggest that both implants have similar post-operative outcome measures and complication rates when implanted correctly.

Background and research objective The aim of this small-scale study was to explore the use of cluster analysis to identify subgroups of heart failure patients whose patterns of symptoms may help guide clinical management. The empirically derived clusters were compared on (1) demographics, (2) clinical characteristics, and (3) subscales of the Kansas City Cardiomyopathy Questionnaire. Subjects and methods A demographics questionnaire, the Kansas City Cardiomyopathy Questionnaire, and the investigator-developed Heart Failure Symptom Survey were mailed to a random sample of 300 patients at a Midwestern outpatient heart failure clinic. Results and conclusions Of 139 respondents, 33 (24%) were female and 106 (76%) were male. The mean (SD) age was 70.6 (9.7) years, and all were white, except for a single African American female. Most subjects were married (84%) with a median level of high school education, and 5% were New York Heart Association classification I, 38% class II, 52% class III, and 5% class IV. Hierarchical cluster analysis was used to derive a 3-cluster solution based on the presence or absence of 14 symptoms. Cluster 1 patients had significantly lower incidence of symptoms and were more likely to be New York Heart Association class I or class II, with lower body mass index and higher education levels compared with patients in the other clusters. Both clusters 2 and 3 were more symptomatic than cluster 1. Compared with cluster 3, patients in cluster 2 reported more shortness of breath under circumstances other than activity, and the majority reported difficulty sleeping. They also tended to report greater symptom severity and impact on physical activity and enjoyment of life. Additional differences included comorbidities and percentage of subjects on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Examination of the clusters suggested clinical implications related to pharmacological management and raised questions concerning potential influences of duration of the heart failure condition, presence of sleep-disordered breathing, and impact of educational level on self-management behavior and symptom patterns.

Background One of the main problems in conducting clinical trials is low participation rate due to potential participants' misunderstanding of the rationale for the clinical trial or perceptions of loss of control over treatment decisions. Objectives The objective of this study was to test an alternate informed consent process in cardiac rehabilitation participants that involved the use of a multimedia flip chart to describe a future randomized clinical trial and then asked, hypothetically, if they would participate in the future trial. Methods An attractive and inviting visual presentation of the study was created in the form of a 23-page flip chart that included 24 color photographs displaying information about the purpose of the study, similarities and differences between the two treatment groups, and the data collection process. We tested the flip chart in 35 cardiac rehabilitation participants. Participants were asked if they would participate in this future study on two occasions: immediately after the description of the flip chart and 24 hours later, after reading through the informed consent document. Participants were also asked their perceptions of the flip chart and consent process. Results Of the 35 participants surveyed, 19 (54%) indicated that they would participate in the future study. No participant changed his or her decision 24 hours later after reading the full consent form. The participation rate improved 145% over that of an earlier feasibility study where the recruitment rate was 22%. Most participants stated that the flip chart was helpful and informative and that the photographs were effective in communicating the purpose of the study. Discussion Participation rates could be enhanced in future clinical trials by using a visual presentation to explain and describe the study as part of the informed consent process. More research is needed to test alternate methods of obtaining informed consent.

The long-term economic potential for enhanced oil recovery (EOR) is large with more than 300 billion barrels of oil remaining in domestic reservoirs after conventional technologies reach their economic limit. Actual EOR production in the United States has never been very large, less than 10% of the total U. S. production even though a number of economic incentives have been used to stimulate the development and application of EOR processes. The U.S. DOE Reservoir Data Base contains more than 600 reservoirs with over 12 billion barrels of unrecoverable oil that are potential targets for microbially enhanced oil recovery (MEOR). If MEOR could be successfully applied to reduce the residual oil saturation by 10% in a quarter of these reservoirs, more than 300 million barrels of oil could be added to the U.S. oil reserve. This would stimulate oil production from domestic reservoirs and reduce our nation's dependence on foreign imports. Laboratory studies have shown that detergent-like molecules called biosurfactants, which are produced by microorganisms, are very effective in mobilizing entrapped oil from model test systems. The biosurfactants are effective at very low concentrations. Given the promising laboratory results, it is important to determine the efficacy of using biosurfactants in actualmore » field applications. The goal of this project is to move biosurfactant-mediated oil recovery from laboratory investigations to actual field applications. In order to meet this goal, several important questions must be answered. First, it is critical to know whether biosurfactant-producing microbes are present in oil formations. If they are present, then it will be important to know whether a nutrient regime can be devised to stimulate their growth and activity in the reservoir. If biosurfactant producers are not present, then a suitable strain must be obtained that can be injected into oil reservoirs. We were successful in answering all three questions. The specific objectives of the project were (1) to determine the prevalence of biosurfactant producers in oil reservoirs, and (2) to develop a nutrient regime that would stimulate biosurfactant production in the oil reservoir.« less

Physiological benefits of exercise training for heart failure (HF) patients have been demonstrated, however little is known about the effects of training on the symptoms of fatigue and dyspnea.The purpose of this study was to examine HF symptoms of fatigue and dyspnea in response to a 24-week exercise training intervention.This pilot study was a randomized, two-group repeated measures design. Fifteen subjects in the intervention group completed a combination of aerobic and resistance training three times per week in a standard cardiac rehabilitation setting. The control group consisted of 6 subjects who were instructed not to begin any formal exercise program during the 24-week intervention.Subjects (19 males and 2 females) had a mean age of 66.2+/-10.2 years and mean ejection fraction (EF) of 28.4+/-7.4%. Non-parametric Friedman Analysis of Variance by Ranks showed the exercise group significantly decreased sensory fatigue (Piper Fatigue Scale) over time (chi(2)=6.49, p=.04) while the control group did not change (chi(2)=0.93, p=.63). Dyspnea showed a non-significant decrease over time for the exercise group (chi(2)=4.16, p=.13) while the control group showed a decrease from baseline to 12 weeks but an increase to above baseline values by week 24 (chi(2)=0.18, p=.91).These results provide support for the beneficial effects of exercise training on symptoms of fatigue and dyspnea in HF patients. Larger studies to evaluate symptom response to exercise are needed.

The purpose of this study was to determine how an exercise adherence intervention affects the physiological, functional, and quality of life outcomes of patients with heart failure (HF). Sixteen HF patients were randomly assigned to an exercise-only group (n = 8) or to an exercise-with-adherence group (n = 8). Two of the 16 people died from nonexercise related causes during the study and were not included in the analysis. The intervention was tested over a 24-week period in which patients participated in a 12-week supervised exercise program (Phase 1) followed by 12 weeks of unsupervised home exercise (Phase 2). The intervention format was one of individualized graphic feedback on exercise goals and participation and problem-solving support by nurses. Results indicate that patients who received the intervention exercised more frequently and experienced improved outcomes during both phases. The adherence intervention may encourage HF patients to continue to exercise and thereby maintain the health benefits gained in both phases of an exercise program.

The purpose of this study was to examine the effects of an individual feedback intervention provided to nurses on selected patient outcomes related to postoperative pain management. Individual performance feedback served as the intervention. Thirty orthopedic staff nurses received feedback information on their past performance of recommended pain management practices. Data were collected preintervention and postintervention on selected patient pain outcomes from the medical records of 240 patients who had undergone total knee arthroplasty. The patient outcome measures were mean 4-hour pain intensity ratings, mean highest pain intensity ratings, mean number of times pain ratings exceeded patients’ acceptable level of pain, mean administered morphine equivalents, and mean pain ratings on reassessment following analgesia administration. An improvement was noted in all pain outcomes following the feedback intervention. Results indicate that providing nurses with feedback on their past performance of pain management practices may contribute to decreased postoperative pain.

The Continuum of Care clinical experience was developed to provide future nurses with practice in a managed care environment. Students see how the critical care patient's needs change during the recovery process and assist the patient with the transition to self-care at home. Patient and student evaluations indicate the experience increases students' understanding of the role of the nurse in managed care while facilitating patients' transition to the self-care environment.