Pilot implementation of an electronic patient-reported outcome measure for planning and monitoring participation-focused care in early intervention.

BACKGROUND: Family-centered care is a valued approach to improving child and family outcomes in early intervention (EI), yet there is need to implement interventions that support information exchange for shared decision-making when planning and monitoring EI care. This study aims at estimating the feasibility, acceptability, and value of implementing the Young Children's Participation and Environment Measure (YC-PEM), a valid electronic patient-reported outcome (e-PRO) that is designed to support family engagement when planning care and monitoring outcomes of care. METHODS: Data were gathered from caregivers (N = 139) that were enrolled in a Phase 1 trial of the YC-PEM e-PRO as implemented within 1 month of their child's next EI evaluation of progress. YC-PEM e-PRO feasibility was estimated according to enrollment and completion rates, and mean completion time. Chi-square tests were used to examine parent perceptions of YC-PEM e-PRO acceptability by caregiver education and family income. Caregiver feedback via open-ended responses were content coded to inform intervention and protocol optimizations. YC-PEM e-PRO value was estimated via composite and item-level scores to capture the extent of participation difficulty in home and community activities, and common areas of need regarding caregivers desired change in their child's participation. RESULTS: Feasibility of implementing the YC-PEM e-PRO in routine EI care was mixed, as evidenced by low enrollment rates (21.0-29.2%), a high completion rate (85.3%), and limited missing data (80.6% of completed cases contained no missing data). More than half of the participants reported that the completion of the YC-PEM e-PRO was at least somewhat helpful, regardless of family income or caregiver education, providing support for its acceptability. As for its value, the YC-PEM e-PRO results were viewed by 64% of caregivers, whose desire for change most often pertained to the child's participation in non-discretionary activities at home and structured activities in the community. CONCLUSIONS: Results may support the implementation of YC-PEM e-PRO as a feasible, acceptable, and valued option for engaging families in planning the child's EI care. Results also inform select intervention and protocol optimizations prior to undertaking a multi-site pragmatic trial of its effectiveness on family engagement and shared decision-making within an EI clinical workflow. TRIAL REGISTRATION: Trial number: NCT03904797 . Trial registered at Clinicaltrials.gov . Registered 22 March 2019. Retrospectively registered.

Early intervention service intensity and young children's home participation.

BACKGROUND: Young children with developmental disabilities and delays spend significant amounts of time at home, show decreased participation in home-based activities, and receive home-based early intervention services to improve participation in activities. Yet, knowledge about the relationship between EI service use and children's home participation in activities remains poorly understood but needed for program improvement. The purpose of this study was to understand the relationships between EI service use and children's home participation. METHODS: In a cross-sectional design, data were gathered from caregivers (N = 139) who enrolled in a pilot trial of the Young Children's Participation in Environment Measure (YC-PEM) electronic patient-reported outcome (e-PRO), as implemented within 1 month of their child's next EI progress evaluation. A series of path analytic models were used to estimate EI service intensity as a predictor of parent-reported young children's home participation 1) frequency, 2) level of involvement, and 3) desired change, adjusting for family and child social and functional characteristics. Models included caregiver perceptions of home environmental support to test its indirect (i.e., mediation) effects on the relationship between EI service intensity and each of the three home participation dimensions. RESULTS: All three models fit the data well (comparative fit index = 1.00). EI service intensity was not a significant predictor of participation frequency. However, EI service intensity had a significant direct effect on a child's participation according to level of involvement and desired change, explaining between 13.3-33.5% of the variance in home participation. Caregiver perceptions of environmental support had a small yet significant indirect effect on the relationship between EI service intensity and level of involvement and desired change; these models explained between 18.5-38.1% of the variance in home participation. CONCLUSIONS: EI service intensity has important links with involvement in and desired change for home-based activities. Caregiver perceptions of environmental support appears to be a factor in the relationship between EI service intensity and home participation. Results warrant longitudinal replication with a control group, which would be possible with the implementation of the YC-PEM e-PRO in a routine EI clinical workflow. TRIAL RETROSPECTIVELY REGISTERED: NCT03904797 .

Differential immediate early gene activity revealed by playback of male and female incomplete chick-a-dee calls.

In both humans and animals, biological differences between males and females has long been a topic of research. In songbirds, sexual dimorphisms can be seen in many species' plumage and heard in some species' songs. However, not all songbirds have such overt phenotypic sexual differences, leading to the question: are all vocalizations dimorphic? One of the most used and versatile vocalizations of the black-capped chickadee (Poecile atricapillus) is their namesake chick-a-dee call, that is produced by both sexes. This call is composed of four note types: A, B, C (together chick-a), and D (dee). Previous research has found that A notes contain information regarding the sex of the caller. However, chickadees do not categorize full chick-a-dee calls, or altered chick-a calls, based on the sex of the caller. Here we presented both male and female chickadees with altered chick-a calls (dee portion removed) of both sexes and measured the number of ZENK labeled cells in auditory nuclei. We found that calls produced by males and females had more ZENK labeled cells than the control condition; however, there was no significant difference in ZENK labeled cells between male and female listeners. Overall, our results suggest that black-capped chickadees do not perceive sexual differences in the production of chick-a calls.

An evaluation of education and implementation of psychosocial interventions within one UK mental healthcare trust.

Psychosocial interventions (PSI), though recommended in the NICE guidelines for schizophrenia and bipolar affective disorder, are not routinely available to people with a serious mental illness in the UK. Education and training initiatives to equip mental health professionals with skills in PSI have grown over the last decade; yet the literature indicates serious problems in implementation of PSI in routine service provision. This paper examines on a local level the factors which support and limit the education and practice of PSI in one UK mental healthcare trust. It reports on a survey of trainees and their managers which aims to evaluate the impact of a PSI training programme and practice development strategy on staff, managers and service provision. The key findings are: a high rate of implementation of PSI by PSI-trained staff in the Trust; a strong association between PSI training and career progression for staff; and the support mechanisms which are most effective in the education and implementation of PSI. The paper concludes that certain measures and support mechanisms have facilitated the successful implementation of PSI with positive outcomes for staff and service provision. Further recommendations are made identifying measures which facilitate the implementation of PSI through an integrated education and practice development strategy owned by all stakeholders.

Aragonite crystallization in primary cell cultures of multicellular isolates from a hard coral, Pocillopora damicornis.

The foundation of marine coral reef ecosystems is calcium carbonate accumulated primarily by the action of hard corals (Coelenterata: Anthozoa: Scleractinia). Colonial hard coral polyps cover the surface of the reef and deposit calcium carbonate as the aragonite polymorph, stabilized into a continuous calcareous skeleton. Scleractinian coral skeleton composition and architecture are well documented; however, the cellular mechanisms of calcification are poorly understood. There is little information on the nature of the coral cell types involved or their cooperation in biocalcification. We report aragonite crystallization in primary cell cultures of a hard coral, Pocillopora damicornis. Cells of apical coral colony fragments were isolated by spontaneous in vitro dissociation. Single dissociated cell types were separated by density in a discontinuous Percoll gradient. Primary cell cultures displayed a transient increase in alkaline phosphatase (ALP) activity, to the level observed in intact corals. In adherent multicellular isolate cultures, enzyme activation was followed by precipitation of aragonite. Modification of the ionic formulation of the medium prolonged maintenance of isolates, delayed ALP activation, and delayed aragonite precipitation. These results demonstrate that in vitro crystallization of aragonite in coral cell cultures is possible, and provides an innovative approach to investigate reef-building coral calcification at the cellular level.

Rapid transition in the structure of a coral reef community: the effects of coral bleaching and physical disturbance.

Coral reef communities are in a state of change throughout their geographical range. Factors contributing to this change include bleaching (the loss of algal symbionts), storm damage, disease, and increasing abundance of macroalgae. An additional factor for Caribbean reefs is the aftereffects of the epizootic that reduced the abundance of the herbivorous sea urchin, Diadema antillarum. Although coral reef communities have undergone phase shifts, there are few studies that document the details of such transitions. We report the results of a 40-month study that documents changes in a Caribbean reef community affected by bleaching, hurricane damage, and an increasing abundance of macroalgae. The study site was in a relatively pristine area of the reef surrounding the island of San Salvador in the Bahamas. Ten transects were sampled every 3-9 months from November 1994 to February 1998. During this period, the corals experienced a massive bleaching event resulting in a significant decline in coral abundance. Algae, especially macroalgae, increased in abundance until they effectively dominated the substrate. The direct impact of Hurricane Lili in October 1996 did not alter the developing community structure and may have facilitated increasing algal abundance. The results of this study document the rapid transition of this reef community from one in which corals and algae were codominant to a community dominated by macroalgae. The relatively brief time period required for this transition illustrates the dynamic nature of reef communities.

The effects of local progesterone on stilbestrol-associated vaginal adenosis.

PIP: Because stilbestrol (DES)-associated vaginal adenosis appears shortly after onset of puberty, this study was undertaken to assess the effectiveness of local treatment with progesterone as an inhibitor of ovarian estrogens, the possible etiological agents of vaginal adenosis. 5 teen-age women were studied; the mother of each had received varying amounts of DES during the patient's time in utero. The biopsy-proven adenosis cases were marked by redness, squamous pegs, and chronic inflammation before treatment with 20-mg progesterone suppositories, inserted vaginally, 2 times/day. (9 figures depict the cytological appearance of the subjects' vaginas before and after therapy.) Regression of the adenosis occurred in all 5 subjects; regression was marked clinically by gradual elimination of redness of the vaginal mucosa as well as reduction of inflammation, as observed microscopically. In 3 of the 5 patients, no evidence of vaginal adenosis was found on biopsy post-therapy. In the other 2 patients, residual adenosis was confined to the cervical area. Serum progesterone concentrations were measured throughout the study by radioimmunoassay and were found to be low in the 1st half of the cycle (.75-2.3 ng/ml), but the levels increased to high luteal-phase values by the 2nd half of the cycle (8.7-24.5 ng/ml). No alterations in menstrual patterns were seen. Local progesterone application may have great value in treatment of vaginal adenosis, particularly that associated with DES exposure in utero. Therapy with progesterone resulted in regression of disease without interfering with ovulatory patterns.^ieng