Reducing burden and building goodwill for practice-embedded trials: Results of rapid qualitative methods in the preimplementation phase of a community paramedic trial to reduce hospitalizations.

Pragmatic trials aim to generate timely evidence while ensuring feasibility, minimizing practice burden, and maintaining real-world conditions. We conducted rapid-cycle qualitative research in the preimplementation period of a trial evaluating a community paramedic program to shorten and prevent hospitalizations. Between December 2021 and March 2022, interviews (n = 30) and presentations/discussions (n = 17) were conducted with clinical and administrative stakeholders. Two investigators analyzed interview and presentation data to identify potential trial challenges, and team reflections were used to develop responsive strategies. Solutions were implemented prior to the commencement of trial enrollment and were aimed at bolstering feasibility and building ongoing practice feedback loops.

Growing old: Do women and men age differently?

Aging of the head and especially the face has been studied intensively, yet questions remain about the timing and rates of aging throughout adulthood and about the extent to which aging differs between men and women. Here we address these issues by developing statistical models of craniofacial aging to describe and compare aging through the life course in both sexes. We selected cranial surface meshes from 254 females and 252 males, aged from 20 to 90 years from the Headspace project, Liverpool, UK. Sixteen anatomical landmarks and 59 semilandmarks on curves and surfaces were used to parameterize these. Modes and degrees of aging throughout adulthood were assessed and compared among sexes using Procrustes-based geometric morphometric methods. Regression analyses of form through the whole age range indicate that age accounts for a small proportion of total variance in both sexes, but form is significantly related to age and males and females age in significantly different ways. Further analyses indicate that aging differs in character, timing, and rates in both sexes between early and later phases of adulthood. Sexual differences in aging are evident in the early and later phases of adulthood. The study adds to knowledge of the aging of adult craniofacial form and sexual dimorphism. It is based on a local population and so the findings are directly applicable to that population. Further studies are needed to assess generalizability and provide better data on population differences to facilitate clinical assessment and treatment planning.

3D Modeling of craniofacial ontogeny and sexual dimorphism in children.

BACKGROUND: The range of normal variation of growth and development of the craniofacial region is of direct clinical interest but incompletely understood. Here we develop a statistical model of craniofacial growth and development to compare craniofacial ontogeny between age groups and sexes and pilot an approach to modeling that is relatively straightforward to apply in the context of clinical research and assessment. METHODS: The sample comprises head surface meshes captured using a 3dMD five-camera system from 65 males and 47 females (range 3-20 years) from the Headspace project, Liverpool, UK. The surface meshes were parameterized using 16 anatomical landmarks and 59 semilandmarks on curves and surfaces. Modes and degrees of growth and development were assessed and compared among ages and sexes using Procrustes based geometric morphometric methods. RESULTS: Regression analyses indicate that 3-10 year olds undergo greater changes than 11-20 year olds and that craniofacial growth and development differs between these age groups. The analyses indicate that males extend growth allometrically into larger size ranges, contributing substantially to adult dimorphism. Comparisons of ontogenetic trajectories between sexes find no significant differences, yet when hypermorphosis is accounted for in the older age group there is a significant residual sexual dimorphism. CONCLUSIONS: The study adds to knowledge of how adult craniofacial form and sexual dimorphism develop. It was carried out using readily available software which facilitates replication of this work in diverse populations to underpin clinical assessment of deformity and the outcomes of corrective interventions.

Guidelines for the diagnosis and treatment of neuroangiostrongyliasis: updated recommendations.

A subcommittee of the Hawaii Governor's Joint Task Force on Rat Lungworm Disease developed preliminary guidelines for the diagnosis and treatment of neuroangiostrongyliasis (NAS) in 2018 (Guidelines, 2018). This paper reviews the main points of those guidelines and provides updates in areas where our understanding of the disease has increased. The diagnosis of NAS is described, including confirmation of infection by real-time polymerase chain reaction (RTi-PCR) to detect parasite DNA in the central nervous system (CNS). The treatment literature is reviewed with recommendations for the use of corticosteroids and the anthelminthic drug albendazole. Long-term sequelae of NAS are discussed and recommendations for future research are proposed.

Earlier school start times are associated with higher rates of behavioral problems in elementary schools.

BACKGROUND: Early school start times may curtail children's sleep and inadvertently promote sleep restriction. The current study examines the potential implications for early school start times for behavioral problems in public elementary schools (student ages 5-12 years) in Kentucky. METHOD: School start times were obtained from school Web sites or by calling school offices; behavioral and disciplinary problems, along with demographic information about schools, were obtained from the Kentucky Department of Education. Estimated associations controlled for teacher/student ratio, racial composition, school rank, enrollment, and Appalachian location. RESULTS: Associations between early school start time and greater behavioral problems (harassment, in-school removals, suspensions, and expulsions) were observed, although some of these associations were found only for schools serving the non-Appalachian region. CONCLUSIONS: Findings support the growing body of research showing that early school start times may contribute to student problems, and extend this research through a large-scale examination of elementary schools, behavioral outcomes, and potential moderators of risk.

Relations between mothers' daily work, home, and relationship stress with characteristics of mother-child conflict interactions.

This study examined whether daily variations in levels of mothers' work, home, and relationship stress were related to collaborative and oppositional qualities of mother-child conflict interactions across 1 week. Mothers reported on 1 specific conflict interaction with their 5- to 8-year-old child and their work, home, and relationship stress through online surveys each day for 7 consecutive days. Diary data from 142 mothers were analyzed in 6 multilevel models, each including within- and between-family levels of a stressor predicting collaborative or oppositional conflict qualities. Results suggested that families in the sample differed from each other, and also varied during the week, in collaborative and oppositional conflict qualities as well as stress in all 3 domains. Mothers reported a greater degree of oppositional conflict qualities on days characterized by higher perceptions of home chaos. Additionally, mothers who reported higher average levels of negativity in romantic relationships endorsed oppositional conflict qualities to a greater extent than mothers with lower relationship negativity. Two multilevel models including all 3 stressors in relation to collaborative and oppositional conflict revealed that for mothers managing multiple roles, average romantic relationship stress was the most important unique contributor to mother-child conflict qualities and daily relationship stress was particularly influential among mothers with sons compared to those with daughters. Results support the spillover hypothesis of stress within the family system and are discussed in terms of mothers' coping mechanisms and emotional engagement. (PsycINFO Database Record