Evaluating the My Life self-determination model for older youth in foster care: Establishing efficacy and exploring moderation of response to intervention.

Limited rigorous research has been conducted to evaluate the impact of interventions designed to promote the successful transitions of young people exiting foster care. The current study builds on previous experimental evaluations of the My Life Model (MLM) for self-determination enhancement, which demonstrated effectiveness in improving educational and transition-to-adulthood outcomes for youth in foster care with disabilities, including those with mental health challenges. The model features one-on-one youth-directed coaching and near-peer mentoring to increase self-determination and goal achievement. The current study was the first to test the impact of the model with a diverse population-based cohort of youth aged 16.5-18.5 in foster care (N=293), including those with and without disabilities, on key model outcome indicators of self-determination and self-efficacy. This study also explored potential moderation by disability status, trauma symptoms, placement stability, and placement restrictiveness. Findings show that, compared to the randomized control group, the treatment group had greater post-intervention and one-year follow-up gains on several indicators of self-determination. Moderation analysis demonstrated no difference in intervention effectiveness for youth with or without disabilities, suggesting the universality of this approach. Findings also suggest that foster youth participants with low-to-average risks in terms of placement stability, placement restrictiveness, and traumatic stress levels seem to benefit most from the intervention, although youth who are at higher risk due to low placement stability, high placement restriction, and high traumatic stress still showed some benefit of participating in the intervention on some measures. My Life is one of only a few intervention models with experimental evidence of effectiveness with older youth in foster care. This validation study establishes that the approach has benefits for both youth with and without disabilities, as well as providing the first information available on the influence of critical barriers facing many youth in care.

Perspectives of Youth in Foster Care on Essential Ingredients for Promoting Self-determination and Successful Transition to Adult Life: My Life Model.

Research clearly documents the serious challenges and poor outcomes experienced by many young people exiting foster care, as well as compounded disparities for the high percentage of youth in care who are identified with disabilities and/or mental health challenges. However, very little research has been conducted to specify or validate effective models for improving the transition trajectories of youth exiting care. Evidence suggests the My Life self-determination enhancement model offers a promising approach for supporting youths' self-determined and positive transition to adulthood. The model includes youth-directed, experientially oriented coaching in the application of self-determination skills to achieve youth-identified transition goals, coupled with peer mentoring workshops that provide opportunities for learning, networking and fun. This in depth qualitative study of 10 youth who completed the My Life intervention focused on investigating coaching and mentoring elements and processes that youth participants identify as most important to their success, with the intention of informing the further development of youth-directed approaches to supporting young people who are transitioning to adulthood. Themes emerged around the centrality of youth self-direction, important processes in the coaching relationship, the essential value of experiential activities and self-determination skill development, and peer mentoring experiences that youth identified as fostering their success. Implications are discussed for research and practice in supporting youth exiting foster care.

Comparison of the effect of glycerol and triamcinolone acetonide on cumulative skin irritation in a randomized trial.

BACKGROUND: So-called anti-irritants are added to cosmetic formulations because of their alleged beneficial effect on irritated skin. Documentation for these claims is often limited. However, glycerol has shown anti-irritant properties in experimentally induced irritation from sodium lauryl sulfate and nonanoic acid (NON). This study was designed to further substantiate that glycerol added to cosmetic formulations has an anti-irritant effect on experimentally induced skin irritation. OBJECTIVE: We sought to compare glycerol with triamcinolone acetonide as treatments for cutaneous irritation in human volunteers. METHODS: Irritation was induced by 3 daily arm washes for a week with 10% sodium lauryl sulfate on one arm and 30% NON on the other. To maintain irritation, for the next 12 days volunteers washed their arms twice daily with the irritants. Treatments were applied immediately after washing. The treatments (including vehicle and no treatment) were randomized to sites using a Latin square design. The reactions were evaluated clinically and instrumentally. LIMITATIONS: Study was designed to only detect potent anti-irritants. CONCLUSION: Glycerol reduced the irritant effect of both sodium lauryl sulfate and NON, whereas triamcinolone acetonide appeared to have beneficial effect only on the irritation induced by NON. The study provided experimental documentation for the claim that glycerol has anti-irritant effect in a cosmetic formulation.

Anti-irritants II: Efficacy against cumulative irritation.

So-called anti-irritants (AI) are widely used in cosmetic formulations, with the aim of reducing irritation from substances in the formulation. It may also be claimed that they are 'soothing' and 'healing' ingredients. However, the proof for these claims is circumstantial. The dose-response effect of 4 alleged AI (nifedipine, (-)-alpha-bisabolol, canola oil and glycerol) was studied on experimentally induced acute irritation in healthy volunteers, and only glycerol showed dose-related response and effects potentially better than no treatment. The acute irritation model only allowed a small window of opportunity in which to demonstrate efficacy. Therefore, the effect of AI was studied in a cumulative irritation model by inducing irritant dermatitis with 10 min daily exposures for 5+4 days (no irritation on weekend) to 1% sodium lauryl sulfate on the right and 20% nonanoic acid on the left volar forearm. AI ointments were applied twice daily. Clinical scoring was performed daily, evaporimetry (Trans Epidermal Water Loss), hydration and colourimetry were measured at baseline (D0), in the middle and at the end of treatment. The glycerol ointment was the only treatment statistically better than both 'no treatment' and vehicle.

Anti-irritants I: Dose-response in acute irritation.

The term 'anti-irritant' (AI) was coined in 1965 by Goldemberg to describe a diverse group of topical product ingredients, which were able to reduce the irritation potential of other more irritating ingredients in the same product. 'AIs' are being added to cosmetic formulations in order, allegedly, to benefit tolerability of the products and allow claims such as 'soothing' and 'healing' ingredients. Limited documentation in favour of the efficacy of AIs is published. We studied the dose-related effect of 4 alleged AIs (nifedipine, (-)-alpha-bisabolol, canola oil and glycerol) on experimentally induced acute irritation in healthy volunteers. Each AI was used in 3 concentrations. Acute irritation was induced by occlusive tests with 1% sodium lauryl sulfate and 20% nonanoic acid in N-propanol. The irritant reactions were treated twice daily with AI-containing formulations from the time of removal of the patches. Evaluation of skin irritation and efficacy of treatments were performed daily for 4 days using clinical scoring, evaporimetry (transepidermal water loss), hydration measurement and colourimetry. Only glycerol showed dose-response and effects potentially better than no treatment. There was no significant effect and no difference between the three other AIs.

The potential of the essential fatty acid-deficient hairless rat as a psoriasis screening model for topical anti-proliferative drugs.

The objective of this study was to establish essential fatty acid deficiency (EFAD) in hairless rats and investigate the potential of this model as a psoriasis screening model by testing the effects of calcipotriol and dithranol on differentiation and proliferation in the epidermis. Hairless rats were fed with a fat-free diet lacking linoleic acid. The EFAD condition was established within 8 weeks. In order to ensure that this condition had been established, several parameters were measured and observed, i.e. animal weight, water consumption, transepidermal water loss, clinical skin symptoms, histology of the epidermis and fatty acid analysis of serum and skin. Immediately after the EFAD condition had been established, the animals were treated with dithranol ointment or different concentrations of calcipotriol solution. A reduction in epidermal thickness of 15-20% was seen after the treatment with calcipotriol. Dithranol and its coal tar-containing vehicle also showed a reductive effect on epidermal thickness. EFAD hairless rats possess various histological changes resembling psoriasis. These histological changes normalise during treatment with anti-psoriatic drugs as calcipotriol, dithranol and coal tar. The results of the present study indicate that the EFAD rat may be a useful model for studies of anti-psoriatic drugs affecting cell proliferation.

Skin irritation typing and grading based on laser Doppler perfusion imaging.

BACKGROUND/AIMS: Vasodilation with increased cutaneous perfusion is an essential part of an irritant inflammatory response. The aim of the present study was to investigate the usefulness of the high-resolution laser Doppler perfusion imaging (HR-LDPI) technique for investigating irritant skin reactions. Irritants may elicit clinically different reactions due to different skin penetration profiles and different modes of irritant action on the exposed METHODS: Twelve subjects were tested on the forearms using 24 h occlusive application of three concentrations of the irritants sodium lauryl sulphate (SLS) and nonanoic acid (NON) and with the topical acne drug all-trans retinoic acid (RA). Cutaneous blood flow at baseline, the increase in cutaneous blood flow and the skin area having increased perfusion were measured on day 2, day 3 and day 5. RESULTS: Based both on measurement of mean perfusion and area with increased perfusion, it was possible to differentiate between different clinical irritation grades on any study day. The area with increased perfusion exceeded the area with clinically visible skin reactions for irritant reactions of grade 1/2 and above. Irritant reactions for individual irritants could furthermore be typed using HR-LDPI. It was possible to differentiate between vehicle treatment and the different dose levels of the irritant compounds. A correlation was found between clinical scores for the individual irritants and the mean flow and the area with increased flow. The individual irritants could be differentiated due to different time courses of their skin irritation. CONCLUSION: Laser Doppler imaging was found to be an important new method for characterization and grading of the inflammatory response of single exposure irritant reactions. However, standardised study procedures cannot be emphasised enough in order to obtain reliable and useful data.

Studies of cutaneous blood flow of normal forearm skin and irritated forearm skin based on high-resolution laser Doppler perfusion imaging (HR-LDPI).

BACKGROUND/AIMS: High resolution laser Doppler perfusion imaging (HR-LDPI) is a non-touch method used for mapping cutaneous microcirculation. The aim of the present study was to investigate the usefulness of this technique for studies of cutaneous blood flow of normal untreated forearm skin and for the assessment of weak irritant reactions induced by exposure to sodium lauryl sulphate (SLS). METHODS: 12 healthy volunteers participated in the study. Initially, basal flow was measured for 6 selected test areas on the right forearm. 24h occlusive application of 0%; 0.125%; 0.25%; 0.50% and 1.0% SLS was performed. An untreated skin area was also included. Test sites were clinically evaluated and the cutaneous blood flow was measured using HR-LDPI on days 2, 3 and 5. RESULTS AND CONCLUSIONS: The results of the present study show that HR-LDPI is a useful technique for assessing the mean cutaneous blood flow of both normal and irritated forearm skin. The rectangular region of interest (R-ROI) method was found to be superior to the threshold region of interest (T-ROI) method in image analysis of the mean blood flow of individual scans. The results showed that even though spatial variation within a skin region may be considerable, no intraregional differences or daily variations in mean basal flow of selected skin areas on the forearm could be found. Due to the low variability, it should not generally be necessary to include an untreated control site as each site should act as its own control. The temporal variation in skin perfusion was minor compared with the spatial variation. This was found both for normal and irritated skin. Therefore, one scan of each area of interest should normally be sufficient. Clinical irritation scores on day 3 were more evenly distributed than those on days 2 and 5. An increase in mean perfusion, as a function of the clinical irritation score, was found. However, no statistical differences could be found in mean perfusion for the selected dose levels of SLS.