Predicting Treatment Success in Child and Parent Therapy Among Families in Poverty

Behavior problems are prevalent in young children and those living in poverty are at increased risk for stable, high-intensity behavioral problems. Research has demonstrated that participation in child and parent therapy (CPT) programs significantly reduces problematic child behaviors while increasing positive behaviors. However, CPT programs, particularly those implemented with low-income populations, frequently report high rates of attrition (over 50%). Parental attributional style has shown some promise as a contributing factor to treatment attendance and termination in previous research. The authors examined if parental attributional style could predict treatment success in a CPT program, specifically targeting low-income urban children with behavior problems. A hierarchical logistic regression was used with a sample of 425 families to assess if parent- and child-referent attributions variables predicted treatment success over and above demographic variables and symptom severity. Parent-referent attributions, child-referent attributions, and child symptom severity were found to be significant predictors of treatment success. Results indicated that caregivers who viewed themselves as a contributing factor for their child\u27s behavior problems were significantly more likely to demonstrate treatment success. Alternatively, caregivers who viewed their child as more responsible for their own behavior problems were less likely to demonstrate treatment success. Additionally, more severe behavior problems were also predictive of treatment success. Clinical and research implications of these results are discussed

Screening for Significant Behavior Problems in Diverse Young Children Living in Poverty

The development and use of first line screening instruments is an essential first step in assessing behavior disorders in very young children. The Early Childhood Behavior Screen (ECBS) is a parent-report measure for behavior disorders and is normed on young children (1–5 years old) living in poverty. The current study presents psychometric support for the discriminative validity of the ECBS’s 10-item Challenging Behavior Scale (CBS) as a first-line screener for externalizing behavior problems for preschool aged-children in poverty. The study’s sample included 673 participants (M age years = 2.81; 63.2 % male; 65.8 % African American) that all met the federal definitional standard for living in poverty. A confirmatory factor analysis was run to provide support for the ECBS factor structure. Receiver operating characteristics (ROC) curve analyses were used to test the CBS’s ability to distinguish between 428 clinic-referred children and 245 non-clinic-referred children. Results showed an acceptable fit model for the ECBS, providing further evidence of its construct validity. Optimal cut-scores by child age derived from the ROC curve analyses were provided with corresponding levels of sensitivity, specificity, and positive and negative predictive values. Sensitivity rates for cut scores ranged from 0.76 to 0.83 and specificity rates ranged from 0.88 to 0.95. Acceptable test–retest reliability and good internal consistency also was observed. The CBS quickly identifies young children from low-income, urban, diverse populations that may be at-risk for developing significant behavior disorders and should be considered by health care professionals who work with very young children

Early Pathways Therapy for Young Children in Poverty: A Randomized Controlled Trial

Early Pathways is a home-based, parent and child therapy program for the treatment of disruptive behaviors among young children living in poverty. In this study, 199 clinically referred children were randomly assigned to an immediate treatment (IT) or wait-list control (WL) conditions. Results indicated that parents in the IT condition reported significant improvements in their child’s disruptive and prosocial behaviors and increased nurturing and decreased use of corporal and verbal punishment by their parents compared to the WL families. Gains were maintained for children in both the IT and WL conditions at 3-month follow-up

Treatment Outcomes for At-Risk Young Children With Behavior Problems: Toward a New Definition of Success

This study examined the outcomes of Early Pathways (EP), an in-home parent–child therapy program with 447 at-risk children younger than 5 years of age who were referred for severe behavior and emotional problems, such as aggression, oppositional behavior, and separation anxiety. EP emphasized parent-directed training of child behavior strategies including psychoeducation regarding child development, child-led play, and cognitive-behavioral techniques. Outcomes were assessed using a unique 2-dimensional definition of treatment completion, which consisted of treatment duration and an assessment of reliable change for the primary outcome measure of child behavior problems. Results showed that the majority of children (63.4%) met or exceeded treatment completion. In addition, repeated-measures multivariate analyses of variance at pretest, posttest, and follow-up revealed increased child prosocial behaviors, reduced child behavior problems, improved caregiver nurturing, an increase in parents’ developmentally appropriate expectations of children, improved parent–child relationships, and a decrease in clinical diagnoses following treatment. This study offers guidance for developing effective early-intervention services for families in poverty to enhance outcomes for their young children. Along with its existing large-scale, community-based effectiveness studies, future research should establish additional statistical support including a randomized, waitlist control design of EP

Ram Opportunity

RAM Opportunity is a self-sustaining mentoring and experiential learning program designed to serve high school students in the local community through programs led by graduate student mentors. RAM Opportunity operates using a plug-and-play structure that can be implemented in the arts, business, education, humanities, sciences, or any other discipline. Partnerships will be formed with local high schools and their guidance counseling services to develop a pipeline for potential students to participate in the program. The program benefits VCU by enhancing engagement with the local community, generating interest in high school students pursuing post-secondary education at VCU, and developing graduate students by providing professional development funding and real-world teaching and mentoring experience

Relaxation Acupressure Reduces Persistent Cancer-Related Fatigue

Persistent cancer-related fatigue (PCRF) is a symptom experienced by many cancer survivors. Acupressure offers a potential treatment for PCRF. We investigated if acupressure treatments with opposing actions would result in differential effects on fatigue and examined the effect of different “doses” of acupressure on fatigue. We performed a trial of acupressure in cancer survivors experiencing moderate to severe PCRF. Participants were randomized to one of three treatment groups: relaxation acupressure (RA), high-dose stimulatory acupressure (HIS), and low-dose stimulatory acupressure (LIS). Participants performed acupressure for 12-weeks. Change in fatigue as measured by the Brief Fatigue Inventory (BFI) was our primary outcome. Secondary outcomes were assessment of blinding and compliance to treatment. Fatigue was significantly reduced across all treatment groups (mean ± SD reduction in BFI: RA 4.0 ± 1.5, HIS 2.2 ± 1.6, LIS 2.7 ± 2.2), with significantly greater reductions in the RA group. In an adjusted analysis, RA resulted in significantly less fatigue after controlling for age, cancer type, cancer stage, and cancer treatments. Self-administered RA caused greater reductions in fatigue compared to either HIS or LIS. The magnitude of the reduction in fatigue was clinically relevant and could represent a viable alternative for cancer survivors with PCRF

Biogenic and terrigenous sedimetations at Ceara rise, western tropical Altantic, supports Pliocene - Pleistocene deep - water linkage between hemispheres

Calcium carbonate percentages at five Ceara Rise sites were estimated at 1- to 2-k.y. intervals over the past 5 m.y., using reflectance spectroscopy and magnetic susceptibility proxies. From these estimates and detailed correlations between sites, gradients of calcite and terrigenous sediment accumulation rates in a depth transect of sites reveal variations in local climate and calcite dissolution related to deep-water masses. Relative to shallow sites on the southern Ceara Rise, accumulation rates of terrigenous sediments at deeper sites near the Amazon Fan were higher during glacial periods. Analogous variations in terrigenous sedimentation before the expansion of Northern Hemisphere ice sheets ~3 m.y. ago suggests that tropical climate cycles occurred independently of polar glaciation. Decreasing accumulation rates of calcite with increasing water depth reveal patterns of carbonate dissolution, which varied on orbital time-scales (10- 100 k.y. periods) throughout the Pliocene-Pleistocene. Maximum dissolution at deep relative to shallow sites occurred in the transition from interglacial to glacial conditions, and maximum preservation occurred during global warming, at all orbital periods. If the local dissolution gradient is linked to relative contributions of North Atlantic Deep Water and Antarctic Bottom Water, this phasing of events confirms a key prediction of SPECMAP that deep-water adjustments may translate climate changes between hemispheres. Dissolution and preservation events, however, may also reflect a transient response to a net flux of organic matter between the continents and the oceans during ice-age climate transitions

Securing the legacy of TESS through the care and maintenance of TESS planet ephemerides

Much of the science from the exoplanets detected by the TESS mission relies on precisely predicted transit times that are needed for many follow-up characterization studies. We investigate ephemeris deterioration for simulated TESS planets and find that the ephemerides of 81% of those will have expired (i.e. 1$\sigma$ mid-transit time uncertainties greater than 30 minutes) one year after their TESS observations. We verify these results using a sample of TESS planet candidates as well. In particular, of the simulated planets that would be recommended as JWST targets by Kempton et al. (2018), $\sim$80% will have mid-transit time uncertainties $>$ 30 minutes by the earliest time JWST would observe them. This rapid deterioration is driven primarily by the relatively short time baseline of TESS observations. We describe strategies for maintaining TESS ephemerides fresh through follow-up transit observations. We find that the longer the baseline between the TESS and the follow-up observations, the longer the ephemerides stay fresh, and that 51% of simulated primary mission TESS planets will require space-based observations. The recently-approved extension to the TESS mission will rescue the ephemerides of most (though not all) primary mission planets, but the benefits of these new observations can only be reaped two years after the primary mission observations. Moreover, the ephemerides of most primary mission TESS planets (as well as those newly discovered during the extended mission) will again have expired by the time future facilities such as the ELTs, Ariel and the possible LUVOIR/OST missions come online, unless maintenance follow-up observations are obtained.Comment: 16 pages, 10 figures, accepted to AJ; main changes are cross-checking results against the sample of real TOIs, and addressing the impact of the TESS extended missio

Electronically available patient claims data improve models for comparing antibiotic use across hospitals: Results from 576 US facilities

BACKGROUND: The Centers for Disease Control and Prevention (CDC) uses standardized antimicrobial administration ratios (SAARs)-that is, observed-to-predicted ratios-to compare antibiotic use across facilities. CDC models adjust for facility characteristics when predicting antibiotic use but do not include patient diagnoses and comorbidities that may also affect utilization. This study aimed to identify comorbidities causally related to appropriate antibiotic use and to compare models that include these comorbidities and other patient-level claims variables to a facility model for risk-adjusting inpatient antibiotic utilization. METHODS: The study included adults discharged from Premier Database hospitals in 2016-2017. For each admission, we extracted facility, claims, and antibiotic data. We evaluated 7 models to predict an admission\u27s antibiotic days of therapy (DOTs): a CDC facility model, models that added patient clinical constructs in varying layers of complexity, and an external validation of a published patient-variable model. We calculated hospital-specific SAARs to quantify effects on hospital rankings. Separately, we used Delphi Consensus methodology to identify Elixhauser comorbidities associated with appropriate antibiotic use. RESULTS: The study included 11 701 326 admissions across 576 hospitals. Compared to a CDC-facility model, a model that added Delphi-selected comorbidities and a bacterial infection indicator was more accurate for all antibiotic outcomes. For total antibiotic use, it was 24% more accurate (respective mean absolute errors: 3.11 vs 2.35 DOTs), resulting in 31-33% more hospitals moving into bottom or top usage quartiles postadjustment. CONCLUSIONS: Adding electronically available patient claims data to facility models consistently improved antibiotic utilization predictions and yielded substantial movement in hospitals\u27 utilization rankings