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BACKGROUND Hydroxyurea is an evidence-based disease-modifying therapy for sickle cell disease (SCD) but is underutilized. The Integration of Mobile Health (mHealth) into Sickle Cell Disease Care to Increase Hydroxyurea Utilization (meSH) multi-center study leveraged mHealth to deliver targeted interventions to patients and providers to foster hydroxyurea utilization. SCD studies often under enroll, and unanticipated events can negatively impact enrollment, making it important to study strategies that ensure adequate study accrual. OBJECTIVE This paper describes the challenges and adaptive strategies used to secure participant enrollment in the meSH study. Adaptive strategies were crucial to alleviate enrollment disruptions due to the COVID-19 pandemic. METHODS Recruitment was anticipated to last 2 months for providers and 6 months for patients. The recruitment strategies used with patients and providers, new recruitment strategies, and recruitment rates were captured and compared. To document recruitment adaptations and their reasons, study staff responsible for recruitment completed an open-ended 9-item questionnaire eliciting challenges to recruitment and strategies used. Themes were extrapolated using thematic content analysis. RESULTS In total, 89 providers and 293 patients enrolled across seven sites. Recruitment duration ranged from 2 to 7 for providers and 7 to 10 months for patients across sites. The study acceptance rate was 86% for both patients and providers. Patients mostly declined participation due to a lack of time and interest in research. Providers declined because of self-perceived high levels of SCD expertise, believing they did not need the intervention. Initially, recruitment involved an in-person invitation to participate during clinic visits (patients and providers), staff meetings (providers), or within the office (providers). Recruitment challenge themes included: 1) lack of interest in research, 2) lack of human resources (e.g., shortage of study staff due to layoffs or resignations during the COVID-19 pandemic), 3) unavailable physical space for recruitment activities due to in-person activity restrictions, and 4) lack of documentation to verify eligibility. Because recruitment was slower than projected, strategies were adapted to include remote approaching and consenting (e.g., telehealth, email and telephone) for patients and providers. Additionally, for patients, recruitment was enriched by simplification of enrollment procedures (e.g., directly approaching patients without a referral from the provider) and a multi-touch method (i.e., warm introductions with flyers, text and patient portal messages). For patients, recruitment rates were similar between the in-person and adapted (virtual with multi-touch) approaches (83.5% and 88.1%, respectively, P=0.23). For providers, however, recruitment rate was higher for in-person versus remote recruitment (96.0% and 70.7%, respectively, P CONCLUSIONS The adapted recruitment strategies, implemented in response to the COVID-19 pandemic, secured a high recruitment rate, which was maintained among patients with SCD using an assortment of enriched remote recruitment strategies. For provider participants, e-mail-alone recruitment methods may not be sufficient to secure study enrollment. INTERNATIONAL REGISTERED REPORT RR2-10.2196/16319

The Infant Toddler Activity Card Sort (ITACS) is a new measure that engages caregivers in goal development by measuring participation in early childhood. Initial evaluation of the ITACS is required to assess its psychometric properties. To evaluate test–retest reliability, concurrent validity, and between-group differences of the ITACS. Caregivers ( N = 208) of children 0–3 years, who were typically developing (TD) or had a developmental delay (DD), completed the ITACS and Pediatric Evaluation of Disability Inventory–Computer Adaptive Test (PEDI-CAT) with repeat assessment after 2 weeks later ( n = 117). The ITACS demonstrated moderate concurrent validity with the PEDI-CAT. Children with DD had significantly more activity concerns on the ITACS than TD. Adequate test–retest reliability was not achieved. The ITACS is a useful tool for identifying caregiver concerns in activity engagement; interventions can be tailored to address concerns and increase participation in childhood routines.

Sickle cell disease (SCD) is a genetic disorder predominantly affecting people of African descent and is associated with significant morbidity and mortality. To improve SCD outcomes, the National Heart Lung and Blood Institute funded eight centers to participate in the SCD Implementation Consortium. Sites were required to each recruit 300 individuals with SCD, over 20 months. We aim to describe recruitment strategies and challenges encountered. Participants aged 15–45 years with confirmed diagnosis of SCD were eligible. Descriptive statistics were used to analyze the effectiveness of each recruitment strategy. A total of 2432 participants were recruited. Majority (95.3%) were African American. Successful strategies were recruitment from clinics (68.1%) and affiliated sites (15.6%). Recruitment at community events, emergency departments and pain centers had the lowest yield. Challenges included saturation of strategies and time constraints. Effective recruitment of participants in multi-site studies requires multiple strategies to achieve adequate sample sizes.

Background: Children with sickle cell disease (SCD), a genetic blood disorder, are at increased risk of developmental delays but are not routinely referred to Early Intervention (EI). The study aimed to understand the need for and acceptability and feasibility of screening and providing EI services to children with SCD. Methods: Eleven EI partners and eight caregivers of children aged 3 to 5 years with SCD completed semi-structured interviews and short surveys. Results: Three main themes emerged from interviews and surveys: (a) awareness of disparities and moderate caregiver knowledge of child development, (b) high acceptability of screening for EI, and (c) the need for partner education to increase buy-in and feasibility of potential programming. Conclusion: Partners identified a clear need for EI screening and referral for children with SCD and indicated that a future program would be acceptable and feasible. However, education and incentives are needed to encourage providers to change current practice patterns.

Background/Aims: Recruitment is often a barrier in clinical trials that include minoritized populations, such as individuals with sickle cell disease. In the United States, the majority of people with sickle cell disease identify as Black or African American. In sickle cell disease, 57% of the United States trials that ended early did so due to low enrollment. Thus, there is a need for interventions that improve trial enrollment in this population. After lower-than-expected recruitment during the first 6 months of the Engaging Parents of Children with Sickle Cell Anemia and their Providers in Shared-Decision-Making for Hydroxyurea trial, a multi-site study for young children with sickle cell disease, we collected data to understand barriers and used the Consolidated Framework for Implementation Research to categorize them and guide the development of targeted strategies. Methods: Study staff used screening logs and coordinator and principal investigator calls to identify recruitment barriers that were then mapped onto Consolidated Framework for Implementation Research constructs. Targeted strategies were implemented during Months 7–13. Recruitment and enrollment data were summarized before (Months 1–6) and during the implementation period (Months 7–13). Results: During the first 13 months, 60 caregivers ( M = 30.65 years; SD = 6.35) enrolled in the trial. Most caregivers primarily self-identified as female ( n = 54, 95%) and African American or Black ( n = 51, 90%). Recruitment barriers mapped onto three Consolidated Framework for Implementation Research constructs: (1) Process barriers (i.e. no identified “site champion” and poor recruitment planning at several sites); (2) Inner setting barriers (i.e. limited communication, low relative study priority at several sites); and (3) Outer setting barriers (i.e. poor patient attendance at clinic appointments). Targeted strategies to improve recruitment included (1) principal investigator site visits and retraining on recruitment procedures to address process barriers; (2) increased frequency of communication through all coordinator, site principal investigator, and individual site calls to address inner setting barriers; and (3) development and implementation of no-show procedures for clinic appointments to address outer setting barriers. After implementation of the recruitment strategies, the number of caregivers identified for pre-screening increased from 54 to 164, and enrollment more than tripled from 14 to 46 caregiver participants. Conclusion: Consolidated Framework for Implementation Research constructs guided the development of targeted strategies that increased enrollment. This reflective process reframes recruitment challenges as the responsibility of the research team rather than characterizing minoritized populations as “difficult” or “hard to reach.” Future trials including patients with sickle cell disease and minoritized populations may benefit from this approach.

AIM To summarize developmental delay among infants and toddlers with sickle cell disease (SCD). METHOD This systematic review included studies that reported developmental outcomes of children with SCD between 0 months and 48 months of age and followed standards set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Ten studies were included, describing 596 unique developmental assessments. The rate of developmental delay ranged from 17.5% to 50% and increased with age. Cognition was the only domain included in all studies and the most frequently identified delay. One study reported that more severe SCD genotypes predicted worse development, while five studies reported no difference in rates of developmental delay across genotypes. INTERPRETATION These findings emphasize the need for standardized screening to identify children with SCD at risk of delay at a young age to facilitate appropriate referrals for therapeutic intervention. Frequent and comprehensive developmental screening is necessary among all SCD genotypes.

BackgroundDevelopment is rapid in the first years of life. Developmental delays appearing during this critical period have the potential to persist throughout the child’s life. Available standardized assessments for this age record a child’s ability to successfully complete discrete skills but fail to capture whether the child incorporates those skills into daily routines that are meaningful to the child and family. The Infant Toddler Activity Card Sort (ITACS) is a newly developed photograph-based early intervention tool to measure the participation-related concept of activity competence using caregiver report. The purpose of the present study was to use Rasch analysis to determine if ITACS items comprehensively measure the construct of child activity competence.ResultsA total of 60 child/caregiver dyads participated. The dichotomous caregiver-reported responses (present vs. absent) on the 40 individual ITACS items were used in Rasch analysis, and three iterations of the model were completed. The final model included 51 child/caregiver dyads and 67 ITACS assessments with a good spread of individual ability measure (6.47 logits). All items demonstrated adequate infit except for “sleeping” (range 0.68–1.54). Five items (sleeping, eating at restaurants, brushing teeth, crawling, and interact with pets) demonstrated high Mean Square (MNSQ) outfit statistics and one (take a bath) demonstrated low MNSQ outfit. ITACS items demonstrated a good spread of item difficulty measures (6.27 logits), and a clear ceiling was observed. Three activity items (smiling, breastfeeding, and playing with adults) were rarely endorsed as concerns. The activities most likely to be reported as challenging were “crying/communicating” and “going to school”. Person and item reliability statistics were adequate (0.79 and 0.80, respectively). The separation between individuals and between items were adequate to good (1.96 and 1.99, respectively).ConclusionsFindings indicate that ITACS items are measuring a unidimensional construct--activity competence in early childhood. The Rasch analysis of caregiver responses suggest that some activities are more likely to be considered challenging and may be important targets for intervention. These results provide evidence to further validate the ITACS as a caregiver report measure and support its use in the early intervention setting to facilitate caregiver driven goal development.

Individuals with cancer are at high risk for restricted participation in meaningful life activities such as work, school, and social activities. Evaluating participation in life activities is identified as a critical component of rehabilitation referral and triage systems. This scoping review investigates what assessments are used to measure participation in life activities in individuals with cancer. Six databases were systematically searched using keywords and controlled vocabulary through February 2020. Eligible studies used the term participation in the context of life situations and had an assessment with at least 5 participation-specific questions. A total of 4604 unique articles were identified and screened for eligibility. Thirty-two studies were included; 20 unique assessments of participation were identified. Assessments were developed with the primary purpose of measuring participation (n = 8); global or physical function (n = 9); community integration (n = 1); social activity (n = 1); or occupational gaps (n = 1). Most assessments (12/20) were not developed with the purpose of measuring participation and only 4 assessments measured key components of participation other than frequency. Measuring participation in life activities is a developing area in oncology research. Most studies do not accurately or comprehensively measure this construct. The heterogeneity in assessments used indicates no clear consensus on a gold-standard participation measure for use among cancer survivors. Comprehensively measuring participation will help identify individuals in need of rehabilitation services and is an essential first step to inform the development of targeted interventions to enhance participation.

Date Presented 04/13/21 Children with cancer treated with platinum-based chemotherapy are at risk for developing hearing impairment (HI), one of several late effects associated with treatment. HI is associated with decreased socioemotional development, academic performance, and quality of life (QOL) among survivors of central nervous system (CNS) tumors. This is the first study to examine the impact of ototoxic HI on cognition and QOL among a cohort of survivors of pediatric non-CNS cancers. Primary Author and Speaker: Taniya Easow Varughese Contributing Authors: Julia Ferringer, Emily Grambo, Hannah Murkens, Jillian Smith, and Emily Scifo

Date Presented 04/22/21 Sickle cell disease (SCD) is a genetic blood disorder that is characterized by chronic anemia that can cause both serious physical and neurological complications. In this study, we analyze the deleterious effects that SCD can have on cognition and the importance of evaluations and interventions provided by OTs and the interprofessional team alike in working with this population. Primary Author and Speaker: Deborah Blady Additional Authors and Speakers: Huda Yousef, Hanan Khalil Contributing Authors: Khalid El-Salem, Ziad Hawamdeh, and Patrícia Almeida

Date Presented 04/9/21 Development in the first years of life is often characterized by a child’s aptitude to complete discrete tasks, such as walking or stacking blocks. True participation requires the child to incorporate skills into everyday activities. This presentation will provide an overview of the Infant Toddler Activity Card Sort, the initial psychometrics, and a Rasch analysis. Primary Author and Speaker: Catherine R. Hoyt Contributing Authors: Ching-Fan Sheu

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Rehabilitation practitioners (N = 98) indicate it is very important to have specialized therapists and programs for pediatric cancer rehabilitation, yet only 39% of hospitals have a specialized program. Therapists rarely receive education during academic or clinical training on working with children with cancer, resulting in a lack of consistency in services provided across institutions. A pediatric cancer rehabilitation certification program can help promote an evidence-based standard of care. Primary Author and Speaker: Molly Houdeshell Additional Authors and Speakers: Natalie Haffner Contributing Authors: Taniya Easow Varughese, Allison King, and Allison J L'Hotta

Objective Caregivers of young children with chronic illnesses are at high risk for elevated levels of stress and mental health symptoms. This study examined stress and mental health symptoms as well as the socioeconomic status (SES) and home environments of a cohort of caregivers of infants and toddlers with sickle cell disease (SCD). Methods Forty-two caregivers of infants and toddlers (aged 1–34 months) with SCD completed the Brief Symptom Inventory (BSI) and Parent Stress Index (PSI). The Home Observation for Measurement of the Environment (HOME) was used to assess family living environments. Results Compared to test norms, caregivers reported high levels of situational/demographic life stress [mean difference (MD) 5.7, p = .003] and child distractibility/hyperactivity (MD 3.62, p = .001) on the PSI. However, no significant differences in psychological symptoms of distress were noted on the BSI. Caregivers scored significantly lower than norms on PSI subdomains of acceptability (MD −1.88, p = .03), competence (MD −3.11, p = .002), depression (MD −3.94, p < .001), and the overall parent domain (MD −12.55, p = .005). Significant correlations were found between PSI scores and the HOME and between SES and the HOME. Conclusion Caregivers of infants and toddlers with SCD experience elevated levels of life stress but, in turn, endorse high acceptance of their child and self-competence in parenting. Although life stress may be high in this population, symptoms of psychological distress were not identified. Caregivers reporting elevated life and illness-specific stressors may benefit from environmental supports and interventions.

Early intervention (EI) therapy services aim to address family-centered goals to facilitate young children’s development and participation in meaningful life activities. Current methods to evaluate children in EI assess discrete developmental skills but provide little information on the child’s ability to successfully incorporate that skill in everyday life. Furthermore, traditional measures have limited opportunity for parent report, despite parent engagement being a critical component for successful implementation of EI services. A measure that involves parents in the therapeutic process to track family-driven EI goals related to a child’s occupational engagement in meaningful family activities and routines is desperately needed. Using a qualitative design and conventional content analysis, we identified 41 distinct activities of infant–toddlers from a cohort of 23 caregivers. Activity items were matched with photographs and validated with experts in pediatric rehabilitation using the Delphi method. The resulting 40 activity/photograph pairs were used to develop a new measure of pediatric occupational engagement, the Infant Toddler Activity Card Sort (ITACS).

Date Presented 03/29/20 Development in the first years of life is often characterized by a child’s aptitude for completing discrete tasks, such as walking or stacking blocks. Real-life participation requires the child to incorporate skills into everyday activities. The ITACS is a newly developed assessment that measures a child’s engagement in daily activities. This presentation will provide an overview of the ITACS and discuss its initial psychometrics. Primary Author and Speaker: Catherine Hoyt Contributing Authors: Ashley Chuck, Taniya Varughese, Laura Fisher, Regina Abel, Allison King

Supplemental material, Supplemental_Material_ for Information Needs Regarding Cognitive Late Effects of Caregivers of Central Nervous System Tumor Survivors by Kara Schuele, Andrea E. Bennett, Taniya Varughese, Regina Abel, Claire Reichenbacher, Karli Green and Allison A. King in OTJR: Occupation, Participation and Health

Sickle cell disease (SCD) is the most common genetic condition in the world and disproportionately affects African Americans in families with lower household incomes. SCD is characterized by a variety of complications including episodes of severe pain, chronic anemia, and end-organ damage. Morbidity from SCD begins in infancy and increases in frequency and severity with age. Complications during childhood and adolescence, both critical learning periods for youth, substantially impact educational attainment and life outcomes. SCD-related hospitalizations are associated with social determinants of health, such as socioeconomic status (SES), depression, health literacy, and educational outcomes. In youth with SCD, family and neighborhood SES are predictors of pain level, pain frequency, and overall quality of life. In addition to the physiological impacts of SCD, individuals with SCD experience emotional and stress related effects of the disease that may impact daily quality of life and frequency and severity of pain. Studies have found that hospital admission frequency has limited or no impact on academic outcomes in youth with SCD. Few studies have explicitly examined the relationship between SCD-related pain and educational, socioeconomic, and mental health outcomes. This is a cross-sectional study of patient survey data from a single site in the Sickle Cell Disease Implementation Science Consortium (SCDIC). The primary objective was to identify a relationship between educational attainment, employment status, mental health, and the frequency, severity, or length of pain crises for individuals with SCD. Multivariate analysis was used to assess the impact of patients' educational attainment, employment status, annual household income (low = less than $25,000, high = $75,001 and above), and self-reported depression on the frequency, length, and severity of SCD-related pain. Our central hypothesis was that individuals with a history of depression, lower educational attainment, periods of unemployment, and lower incomes experience more frequent, more severe, and longer pain crises. A total of 307 participants were included. The mean age was 27.4 years (range 15 to 45), 58.3% were female, and 99% were African American. Sixty-two percent had Hgb SS, the most severe form of SCD. About half of all patients (50.5%) reported they take pain medication every day for SCD and majority were on some form of disease modification (64.2% on hydroxyurea (HU), 20.2% on chronic blood transfusion). Slightly less than half (48.9%) reported their highest level of education as a high school diploma or lower. Most were unemployed (15.3%), students (22.8%), or disabled (21.5%), and 59.2% reported an average annual household income less than $25,000. Univariate analysis revealed statistically significant associations between employment status as unemployed or disabled and frequency of pain (p < .001), employment status as unemployed or disabled and severity of pain (p < .001), and employment status as disabled and length of pain > 4 days. Relationships between depression and frequency and severity of pain were statistically significant at the p < .001 level, and between depression and length of pain > 1 week at the p < .01 level. Multivariate analysis revealed positive statistically significant relationships between depression and high pain frequency (p < .001), employment status as disabled and severe pain (p < .01), depression and severe pain (p < .01), and employment status as disabled and length of pain >4 days (p < .05), Table 1. Educational attainment did not demonstrate statistically significant relationships with pain outcomes. No variables demonstrated statistically significant relationships with length of pain > 1 week and length of pain > 2 weeks. The only significant association with pain outcomes was that HU users were less likely to take daily opioids. Individuals with SCD who are disabled or have a history of depression are more likely to report more severe and frequent pain. No relationship emerged between educational attainment and pain outcomes. As the results are limited to the cross-sectional design, we cannot make statements of causality. For now, we know that people with SCD and these risk factors need further study for interventions. We plan to further assess study participants across all eight SCDIC sites in the next phase of this work. Disclosures King: Bioline: Consultancy; Amphivena Therapeutics: Research Funding; Incyte: Consultancy; Cell Works: Consultancy; Celgene: Consultancy; Magenta Therapeutics: Membership on an entity's Board of Directors or advisory committees; Novimmune: Research Funding; RiverVest: Consultancy; Tioma Therapeutics (formerly Vasculox, Inc.):: Consultancy; WUGEN: Equity Ownership.

Background: Sickle cell disease (SCD) is a genetic hematologic condition affecting more than 300,000 individuals worldwide. Most of the 100,000 individuals with SCD in the United States are African-American. An estimated 50% of those with the most severe genotype of SCD (HbSS) will have an overt or silent cerebral infarct (SCI) by age 30. While a significant number of studies have addressed the cognitive function and brain imaging of children with SCD, very few have included adults. As disease modification has increased over the last decade, a modern assessment of adults with SCD is needed. The aims of this study are to: 1. Determine the prevalence of cognitive impairment in adults with SCD 2. Determine if adults with SCD have deficits in functional task performance skills 3. Assess if and how cognitive function and task performance change over time Methods: This is a cross-sectional analysis of a prospective, observational cohort study. Adults, 18 years of age or older, with any form of SCD were recruited from the SCD clinics at Washington University in St. Louis. During baseline testing, participants completed the Wechsler Abbreviated Scale of Intelligence (WASI-II), National Institutes of Health Toolbox Cognition Battery (NIHTB-CB), and the Medication subtest of the Executive Function Performance Test (EFPT-M). The WASI-II and NIHTB-CB were repeated annually. Mean participant data from the baseline WASI-II and NIHTB-CB were compared with normative individual measure and composite scores using a one-sample t-test. The NIHTB-CB normative mean is a t-score of 50 with a SD of 10. Baseline results on Medication subtest of the EFPT were compared to previously tested control and stroke groups. Higher scores on the EFPT are indicative of greater executive dysfunction. Differences between Time 1 and Time 2 scores were evaluated using a paired-samples t-test. Univariate analyses were used to describe relationships between cognition and patient factors. Annual magnetic resonance imaging (MRI) was also conducted to assess infarct classification, with completion limited to 12-18 months from consent. Radiographical analyses were reviewed and recorded by the study neuroradiologists. Results: Forty participants were assessed at baseline; 9 completed Time 2 testing. Participant demographic information is presented in Table 1. Compared to the normative population, no significant differences were found on the WASI-II. On the NIHTB-CB, participants scored significantly lower on subtests measuring processing speed (Mean difference -13.8, p Of the 59 participants consented to yearly MRI evaluation, 45 have completed baseline imaging and 1 completed Time 2 imaging. Radiographical impressions reported: 1) overt strokes in 2 participants on transfusions (TF), 1 on hydroxyurea (HU), and 1 on no disease-modifying regimen (ND); 2) SCIs in 6 participants on TF, 6 on HU, and 4 on ND; 3) no infarct in 1 participant on TF, 18 on HU, and 9 on ND. Conclusion: Adults with SCD in this relatively highly educated cohort have marked deficits in executive function, attention, working memory, processing speed, and self-awareness. Cognitive deficits lead to difficulty completing everyday functional and disease-related activities, ranging from medication adherence to productivity in education and employment. Healthcare providers who treat individuals with SCD should be aware of the cognitive impairments in this population. Routine cognitive screening is needed to initiate referrals for cognitive rehabilitation. Disclosures King: Magenta Therapeutics: Membership on an entity's Board of Directors or advisory committees; Novimmune: Research Funding; RiverVest: Consultancy; Tioma Therapeutics (formerly Vasculox, Inc.):: Consultancy; WUGEN: Equity Ownership; Incyte: Consultancy; Amphivena Therapeutics: Research Funding; Cell Works: Consultancy; Bioline: Consultancy; Celgene: Consultancy.

Date Presented 04/06/19 While many pediatric assessments are based on developmental milestones, achievement of discrete skills may not truly capture their use in functional contexts. Difficulties in transferring skills to everyday life may manifest in specific activity deficits, creating a need for direct measures of participation. The Infant Toddler Activity Card Sort (ITACS) was created to fill this gap by summarizing occupational development in early childhood. Here, we describe the ITACS test-retest reliability. Primary Author and Speaker: Ashley Chuck Additional Authors and Speakers: Laura Pilney Contributing Authors: Catherine Hoyt, Taniya Varughese, Evelyn Shen, Allison King, Regina Abel, Hannah Manis, Kelly Baker, Emma Grandgeorge, Jianna Fernandez

Date Presented 04/06/19 Sickle cell disease is a debilitating chronic illness characterized by persistent anemia and increased risk for stroke and cognitive impairment. The current study presents findings on the cognitive and functional task performance deficits of adults with sickle cell disease. An opportunity exists for OTs to improve the long-term outcomes of this population by providing appropriate evaluation and cognitive intervention. Primary Author and Speaker: Taniya Varughese Additional Authors and Speakers: Mallory Varnum, Erica Hull Contributing Authors: Regina Abel, Allison King

Date Presented 04/04/19 Early intervention therapists rely on developmental milestone-focused assessments to identify deficits and justify services. However, these measures fail to assess a child’s ability to incorporate discrete skills into functional activities. The Infant Toddler Activity Card Sort (ITACS) will meet this need. Primary Author and Speaker: Catherine Hoyt Contributing Authors: Jianna Fernandez, Ashley Chuck, Laura Pilney, Taniya Varughese, Regina Abel, Allison King