Implementing Adolescent Wellbeing and Health Programs in Schools: Insights from a Mixed Methods and Multiple Informant Study.

Determining the factors that influence implementation of school-based wellbeing and health programs is essential for achieving desired program effects. Using a convergent mixed-methods, multiple informant design, this study considered factors that influence implementation of health programs for ninth grade students and in what ways implementation is differentially perceived by multiple informants (i.e., participants, instructors, and independent observers). Two types of programs-mindfulness and health education-were implemented with ninth graders (N = 70) in three schools situated in low-resourced urban neighborhoods. Study outcomes were derived from four data sources: (1) focus group participants (N = 45); (2) program instructor fidelity ratings; (3) independent observer fidelity ratings and notes; and (4) instructor open-ended session responses. Using thematic and mixed methods integration analyses, we identified themes related to implementation promoting or challenging factors. Theme names differed when data sources were separately analyzed by informant. Mixed methods integration analysis indicated that four themes were common across all informant groups: (1) competent, attentive, and engaging instructors are essential; (2) programs should involve interactive components (e.g., physical activities, applied learning opportunities); (3) adequate time for program delivery is key for student exposure and engagement; and (4) students' availability and preferences should guide program scheduling. A fifth theme, unique to instructor and observer perspectives, was that program implementation was negatively impacted by distractions from multiple sources, including instructors, students, and settings. Recommendations from students, instructors, and observers for implementation optimization are discussed.

Mass Trapping and Larval Source Management for Mosquito Elimination on Small Maldivian Islands.

Globally, environmental impacts and insecticide resistance are forcing pest control organizations to adopt eco-friendly and insecticide-free alternatives to reduce the risk of mosquito-borne diseases, which affect millions of people, such as dengue, chikungunya or Zika virus. We used, for the first time, a combination of human odor-baited mosquito traps (at 6.0 traps/ha), oviposition traps (7.2 traps/ha) and larval source management (LSM) to practically eliminate populations of the Asian tiger mosquito Aedes albopictus (peak suppression 93.0% (95% CI 91.7-94.4)) and the Southern house mosquito Culex quinquefasciatus (peak suppression 98.3% (95% CI 97.0-99.5)) from a Maldivian island (size: 41.4 ha) within a year and thereafter observed a similar collapse of populations on a second island (size 49.0 ha; trap densities 4.1/ha and 8.2/ha for both trap types, respectively). On a third island (1.6 ha in size), we increased the human odor-baited trap density to 6.3/ha and then to 18.8/ha (combined with LSM but without oviposition traps), after which the Aedes mosquito population was eliminated within 2 months. Such suppression levels eliminate the risk of arboviral disease transmission for local communities and safeguard tourism, a vital economic resource for small island developing states. Terminating intense insecticide use (through fogging) benefits human and environmental health and restores insect biodiversity, coral reefs and marine life in these small and fragile island ecosystems. Moreover, trapping poses a convincing alternative to chemical control and reaches impact levels comparable to contemporary genetic control strategies. This can benefit numerous communities and provide livelihood options in small tropical islands around the world where mosquitoes pose both a nuisance and disease threat.

"It's a place to feel like part of the community": Counterspace, inclusion, and empowerment in a drop-in center for homeless and marginalized women.

In the context of rising inequality and eroding safety nets for marginalized communities, research is needed to demonstrate the ways in which settings can facilitate community, agency, and capabilities for low-income women. The purpose of this study is to examine if and how an organizational setting designed to support homeless, low-income, and other marginalized women can facilitate empowering changes and increased wellbeing among the women who participate. A thematic analysis of interviews conducted with 22 participants who attend a women's day center identified three ways in which the organizational setting impacted women's lived experiences: (a) increasing a sense of agency through acceptance, active and participatory roles, and ownership over the physical environment, (b) promoting a sense of community through rituals of care and attentiveness, alleviated social isolation, and mutual relationships, and (c) improving life circumstances by offering a safe environment, access to basic resources such as housing, and support for health and wellbeing. Findings highlight the setting features and psychosocial processes that foster flourishing and resist patterns of exclusion and devaluation imposed on marginalized women by dominant neoliberal values, institutions, and policies.

Implementation of 'sign-off' mentorship: different perspectives.

Students who entered nurse training from September 2007 onwards are required to have a sign-off mentor (SOM) in their final clinical placement. The sign-off mentor is responsible for confirming to the Nursing and Midwifery Council (NMC) that a student nurse has met all the requirements of pre-registration clinical assessment and can be registered as a nurse. This became mandatory in September 2010, and this article describes how one acute NHS foundation Trust implemented and managed this process, with contributions from practice education facilitators, an SOM and a student.

Diagnosis of left-ventricular non-compaction in patients with left-ventricular systolic dysfunction: time for a reappraisal of diagnostic criteria?

AIMS: Left-ventricular non-compaction (LVNC) is characterized by excessive and prominent left-ventricular (LV) trabeculations and may be associated with systolic dysfunction in advanced disease. We sought to determine the proportion of patients fulfilling LVNC criteria in an adult population referred to a heart failure clinic using current diagnostic criteria. METHODS AND RESULTS: One hundred and ninety-nine patients [age 63.5 +/- 15.9 years, 124 (62.3%) males] with LV systolic impairment were studied. All underwent clinical examination, electrocardiography, and 2-D echocardiography. The number of patients fulfilling diagnostic criteria for LVNC was retrospectively determined using three published definitions. Results were compared with 60 prospectively evaluated normal controls (age 35.7 +/- 13.5 years; 31 males, 30 blacks). Forty-seven patients (23.6%) fulfilled one or more echocardiographic definitions for LVNC. Patients fulfilling LVNC criteria were younger (P = 0.002), had larger LV end-diastolic dimension (P < 0.001), and smaller left atrial size (P = 0.01). LVNC was more common in black individuals (35.5 vs. 16.2%, P = 0.003). Five controls (four blacks) fulfilled one or more LVNC criteria. CONCLUSIONS: This study demonstrates an unexpectedly high percentage of patients with heart failure fulfilling current echocardiographic criteria for LVNC. This might be explained by a hitherto underestimated cause of heart failure, but the comparison with controls suggests that current diagnostic criteria are too sensitive, particularly in black individuals.