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The purpose of this chapter is to examine engagement strategies used in a large, multisite evaluation study through the lens of Estrada, Woodcock, and Schultzs (2014) tailored panel management. The evaluation, called the Enhance Diversity Study (EDS), is part of an effort funded by the National Institutes of Health (NIH) to increase diversity in NIH-funded research. The chapter discusses engagement with a large national cohort of student participants and outlines survey administration complexities, tailored engagement approaches, and annual survey response trends. It shows how the EDS expanded Estrada and colleagues concepts of credibility by integrating branding strategies that permeated all aspects of the study. The resulting practices, as modified over time, extend knowledge of how to increase survey response rates across a multisite, multiprogram, longitudinal evaluation. As data collection continues, subsequent analysis may provide more clarity on the impact of these strategies on retention. Future researchers should explore the impacts of incorporating fully developed branding strategies to enhance study commitment and cohort retention. While past research has guided surveys through phone, mail, and multimodal distribution, more research is needed to understand how to engage participants and retain them in an increasingly competitive and digital world.

ObjectivesTo develop a process of goal-setting and measurement of goal attainment in a dementia care management program.DesignObservational.SettingDementia care management program in an urban academic medical center.ParticipantsPersons with dementia (N=101) and their caregivers; nurse practitioner dementia care managers (N=5).InterventionSpecification of a personalized health goal and action plan and measurement of goal attainment using goal attainment scaling in a clinical care visit.MeasurementsGoal attainment at 6 and 12 months; focus groups of 5 dementia care managers.ResultsEighty-four percent of participant goals were nonmedical, 47% were related to quality of life, and 29% were caregiver support goals. Eighty-eight percent of participants felt that the goal they set was meaningful and 74% that the goal-setting process captured something different from usual care, and 85% found the process helpful in planning for future care. At 6 months, 74% of dyads had achieved or exceeded their expected level of goal attainment. Dementia care managers felt that the goal-setting process improved their understanding of what was most important to the patient, helped set expectations about disease progression and care needs, and provided positive reinforcement when goals were accomplished and an opportunity for revision when goals were not met.ConclusionGoal setting using goal attainment scaling can be incorporated into the care of persons with dementia to establish and attain person-centered goals. Research is needed to further develop personalized goal attainment as an outcome measure for dementia care. J Am Geriatr Soc 66:2120-2127, 2018.

PurposeMost health outcome measures for chronic diseases do not incorporate specific health goals of patients and caregivers. To elicit patient-centered goals for dementia care, we conducted a qualitative study using focus groups of people with early-stage dementia and dementia caregivers.MethodsWe conducted 5 focus groups with 43 participants (7 with early-stage dementia and 36 caregivers); 15 participants were Spanish-speaking. Verbatim transcriptions were independently analyzed line-by-line by two coders using both deductive and inductive approaches. Coded texts were grouped into domains and developed into a goal inventory for dementia care.ResultsParticipants identified 41 goals for dementia care within five domains (medical care, physical quality of life, social and emotional quality of life, access to services and supports, and caregiver support). Caregiver goals included ensuring the safety of the person with dementia and managing caregiving stress. Participants with early-stage dementia identified engaging in meaningful activity (e.g., work, family functions) and not being a burden on family near the end of life as important goals. Participants articulated the need to readdress goals as the disease progressed and reported challenges in goal-setting when goals differed between the person with dementia and the caregiver (e.g., patient safety vs. living independently at home). While goals were similar among English- and Spanish-speaking participants, Spanish-speaking participants emphasized the need to improve community education about dementia.ConclusionsPatient- and caregiver-identified goals for care are different than commonly measured health outcomes for dementia. Future work should incorporate patient-centered goals into clinical settings and assess their usefulness for dementia care.

This study developed and then tested the feasibility, acceptability and initial efficacy of a 3-session, culturally adapted, intervention combining motivational enhancement therapy (MET) and strengths-based case management (SBCM) delivered by promotoras in Spanish to reduce heavy drinking among male, Latino day laborers. A pilot two-group randomized trial (N=29) was conducted to evaluate the initial efficacy of MET/SBCM compared to brief feedback (BF). Alcohol-related measures were assessed at 6, 12 and 18weeks after baseline. Most intervention group participants (12/14) attended all counseling sessions and most participants (25/29) remained in the study at 18weeks. Alcohol related measures improved in both groups over time with no statistically significant differences observed at any of the time points. However the comparative effect size of MET/SBCM on weekly drinking was in the large range at 6-weeks and in the moderate range at 12-weeks. Post hoc analyses identified a statistically significant reduction in number of drinks over time for participants in the intervention group but not for control group participants. Despite the extreme vulnerability of the population, most participants completed all sessions of MET/SBCM and reported high satisfaction with the intervention. We feel our community partnership facilitated these successes. Additional studies of community-partnered and culturally adapted interventions are needed to reduce heavy drinking among the growing population of Latinos in the U.S.

ObjectiveTo describe and compare characteristics of older adults who drive after drinking and those who do not, whether an intervention addressing at-risk drinking reduces risk among those reporting driving after drinking, and reasons reported for driving after drinking.MethodsSecondary data analysis of a randomized trial testing the efficacy of a multifaceted intervention to reduce at-risk drinking among adults with a mean age of 68 years in primary care (N = 631).ResultsAlmost a quarter of at-risk drinkers reported driving after drinking (N = 154). Compared to those who did not drive after drinking, those who did were more likely to be younger, male, and working. They consumed a higher average number of drinks per week, had more reasons they were considered at-risk drinkers, and were more likely to meet at-risk drinking criteria due to amount of drinking and binge drinking. Those driving after drinking at baseline reduced the frequency of this behavior at 3 and 12 months and there were no statistically significant differences in the proportions of persons still engaging in driving after drinking among those who were assigned to intervention or control groups. Reasons for driving after drinking included not thinking that it was a problem and having to get home.ConclusionsDriving after drinking is common in this population of older, at-risk drinkers recruited in primary care settings and, like younger adults, men and those reporting binge drinking are more likely to engage in this behavior. Given that this behavior is dangerous and the population of older adults is fast growing, interventions addressing driving after drinking are needed.

ObjectivesTo determine the initial efficacy of a mailed screening and brief intervention to reduce at-risk drinking in persons aged 50 and older.DesignPilot randomized controlled trial.SettingUniversity of California at Los Angeles Department of Medicine Community Offices and Primary Care Network.ParticipantsIndividuals aged 50 and older who were identified as at-risk drinkers according to the Comorbidity Alcohol Risk Evaluation Tool (CARET) (N = 86).InterventionParticipants were assigned randomly to receive personalized mailed feedback outlining their specific risks associated with alcohol use, an educational booklet on alcohol and aging, and the National Institutes of Health Rethinking Drinking: Alcohol and Your Health booklet (intervention group) or nothing (control group).MeasurementsAlcohol-related assessments at baseline and 3 months; CARET-assessed at-risk drinking, number of risks, and types of risks.ResultsAt 3 months, fewer intervention group participants than controls were at-risk drinkers (66% vs 88%), binge drinking (45% vs 68%), using alcohol with a medical or psychiatric condition (3% vs 17%), or having symptoms of such a condition (29% vs 49%).ConclusionA brief mailed intervention may be an effective approach to intervening with at-risk drinkers aged 50 and older.

ObjectivesTo determine whether a program that improves the quality of care for falls reduces the number of episodes of care for serious fall-related injuries.DesignNonrandomized controlled trial.SettingFour community-based primary care practices.ParticipantsIndividuals aged 75 and older who screened positive for fall risk.InterventionA multicomponent quality improvement program (Assessing Care of Vulnerable Elders Practice Redesign for Improved Medical Care for Elders) involving face-to-face clinician education about falls and decision support to prompt primary care providers to implement appropriate care, including referral to appropriate community resources, in response to individuals screening positive for fall risk.MeasurementsEpisodes of care for selected fall-related injuries, based on healthcare claims.ResultsOf 1,791 individuals with data available for analysis, 1,187 were in the intervention group, and 604 were in the control group. Mean age was 83, and more than two-thirds of the sample were women. After adjusting for potential confounders, there were no statistically significant differences between intervention and control groups in episodes of care for fall-related injuries during the 12-month (incidence rate ratio (IRR) 1.27, 95% confidence interval (CI) = 0.93-1.73) or 24-month (IRR 1.18, 95% CI = 0.93-1.49) period after initiation of the intervention.ConclusionDespite improving the care of falls, this quality improvement initiative did not result in a change in the number of episodes of care for serious fall-related injuries. Future work in community-based settings should test higher-intensity interventions to reduce fall-related injuries.

OBJECTIVES: To understand characteristics of older at-risk drinkers and reasons why they decide to change or maintain their alcohol consumption. DESIGN: Secondary analysis of data from a randomized controlled trial to reduce drinking in at-risk drinkers. SETTING: Three primary care sites in southern California. PARTICIPANTS: Six hundred thirty-one adults aged 55 and older who were at-risk drinkers at baseline, 521 of whom who completed a 12-month assessment. MEASUREMENTS: Sociodemographic and alcohol-related characteristics of 12-month assessment completers and noncompleters and among those completing the 12-month assessment by telephone or mail were compared using descriptive statistics. Reasons why respondents maintained or changed average alcohol consumption were asked of those who completed a 12-month assessment by telephone. Factors that might motivate at-risk drinkers to reduce drinking were asked about, and frequencies were calculated for these responses. RESULTS: Participants were primarily male, white, highly educated, and in good health. Those who responded to the 12-month assessment by mail were more likely to be working, to be in the intervention arm, and to drink more. Most who reduced alcohol consumption and heavy drinking did so because they thought it would benefit them. Those who did not thought that drinking was not a problem for them. Both groups cited their environment and circumstances as influencing their drinking. Remaining at-risk drinkers reported that medical evidence that alcohol was harming them would motivate them to reduce drinking. CONCLUSION: Older adults report that they reduce their drinking when they recognize that their drinking habits may be causing them harm; ones environment can hinder or help one to reduce drinking.

Alcohol screening and brief intervention for unhealthy alcohol use has not been consistently delivered in primary care as part of preventive healthcare.To explore whether telephone-based intervention delivered by a health educator is efficacious in reducing at-risk drinking among older adults in primary care settings.Secondary analyses of data from a randomized controlled trial.Subjects randomized to the intervention arm of the trial (n = 310).Personalized risk reports, advice from physicians, booklet about alcohol and aging, and up to three telephone calls from a health educator. All interventions were completed before the three-month follow-up.Risk outcomes (at-risk or not at-risk) at 3 and 12 months after enrollment.In univariate analyses, compared to those who remained at risk, those who achieved not at-risk outcome at 3 months were more likely to be women, Hispanic or non-white, have lower levels of education, consume less alcohol, drink less frequently, and have lower baseline number of risks. In mixed-effects logistic regression models, completing all three health educator calls increased the odds of achieving not at-risk outcome compared to not completing any calls at 3 months (OR 5.31; 95% CI 1.92–14.7; p = 0.001), but not at 12 months (OR 2.01; 95% CI 0.71–5.67; p = 0.18).Telephone-based intervention delivered by a health educator was moderately efficacious in reducing at-risk drinking at 3 months after enrollment among older adults receiving a multi-faceted intervention in primary care settings; however, the effect was not sustained at 12 months.

In 2007, the Multilingual/Multicultural Teacher Preparation Center, a teacher education program, was featured in a Teacher Education Quarterly, 34(4), special issue on diversifying the teaching workforce. Though this center has since ended due to the disbandment of the Bilingual/Multicultural Education Department, this commentary describes components of the program that remain and lessons that were learned., Introduction'The M/M Center: Meeting the Demand for Multicultural, Multilingual Teacher Preparation' (Wong et al., 2007) described a program that was part of the Bilingual/Multicultural Education Department (BMED) at California State [...]

BACKGROUND: Rare genetic variants and genetic variation at loci in an enhancer in SOX17 (SRY-box transcription factor 17) are identified in patients with idiopathic pulmonary arterial hypertension (PAH) and PAH with congenital heart disease. However, the exact role of genetic variants or mutations in SOX17 in PAH pathogenesis has not been reported. METHODS: SOX17 expression was evaluated in the lungs and pulmonary endothelial cells (ECs) of patients with idiopathic PAH. Mice with Tie2Cre-mediated Sox17 knockdown and EC-specific Sox17 deletion were generated to determine the role of SOX17 deficiency in the pathogenesis of PAH. Human pulmonary ECs were cultured to understand the role of SOX17 deficiency. Single-cell RNA sequencing, RNA-sequencing analysis, and luciferase assay were performed to understand the underlying molecular mechanisms of SOX17 deficiency-induced PAH. E2F1 (E2F transcription factor 1) inhibitor HLM00 6474 was used in EC-specific Sox17 mice. RESULTS: SOX17 expression was downregulated in the lung and pulmonary ECs from patients with idiopathic PAH. Mice with Tie2Cre-mediated Sox17 knockdown and EC-specific Sox17 deletion induced spontaneously mild pulmonary hypertension. Loss of endothelial Sox17 in EC exacerbated hypoxia-induced pulmonary hypertension in mice. Loss of SOX17 in lung ECs induced endothelial dysfunctions including upregulation of cell cycle programming, proliferative and antiapoptotic phenotypes, augmentation of paracrine effect on pulmonary arterial smooth muscle cells, impaired cellular junction, and BMP (bone morphogenetic protein) signaling. E2F1 signaling was shown to mediate the SOX17 deficiency-induced EC dysfunction. Pharmacological inhibition of E2F1 in Sox17 EC-deficient mice attenuated pulmonary hypertension development. CONCLUSIONS: Our study demonstrated that endothelial SOX17 deficiency induces pulmonary hypertension through E2F1. Thus, targeting E2F1 signaling represents a promising approach in patients with PAH. [ABSTRACT FROM AUTHOR]