Implementation Evaluation of an Education Program in Pediatric Clinics

Background: A public health approach to child maltreatment prevention relies on programs that impact the underlying drivers of maltreatment and that can easily be implemented. Stress in the family, mental illness, unrealistic expectations, and lack of knowledge have all been shown to be preceding factors in maltreatment risk. To help address some of these risks, an education program consisting of the Period of PURPLE crying, a social and economic stressor questionnaire, and the Parenting Action Plan was designed for maternal caregivers of newborns at pediatric clinics. This paper explores implementation challenges and successes of the education program, and describes strategies to implement such a program for maternal caregivers of newborns in pediatric clinics. Methods: The education program was delivered at 4 pediatric clinics serving low-income families in Houston, Texas. Each clinic received a program orientation, topic specific training for implementing staff, and technical assistance as needed. The implementation evaluation of the education program focused on responses from key informant interviews with 18 staff members from the 4 pediatric clinics. Interview data was recorded through note taking then transcribed and coded relying on the grounded theory approach using inductive reasoning for analysis. Results: A majority of the 18 study staff interviewed across all four clinics expressed the need for and benefits of providing an education program to maternal caregivers of newborn during well-child visits. Key themes that emerged were (1) maternal caregivers were receptive to an education program for support during well-child visits and staff saw its benefits, (2) motivational interviewing was helpful in engaging caregivers in conversations, and (3) it is important to establish a workflow that can accommodate the maternal caregivers and clinic needs alike. Conclusions: An education program in pediatric clinics is a valuable resource to support maternal caregivers and their families. This type of program can be achievable when key factors are in place including: leadership and staff buy-in by having program transparency, efficient workflow that carefully considers maternal caregivers and staff time, and willingness of the organization is invest into the program. However, there is no one-size fits-all approach to successfully implement an education program into a routine part of pediatric care. It is vital to understand the organizational and structural strengths of each implementing clinic and leverage personnel in order to implement the program components with the highest fidelity

Adopting and growing a community-based early language program: Challenges and solutions for implementation success

The number of interventions focused on early language development in young children has increased over the past decade. There is a paucity of research on the adoption and implementation of these programs in real-world community settings. This study presents findings from qualitative interviews with leadership, staff, and past participants of a community-based early language development intervention. Themes related to program implementation challenges and solutions are presented. Previous program participants (n=16) identified facilitators and barriers to successful program implementation and provided specific recommendations for program improvements. Interviews with the program leadership and staff (n=6) revealed two main themes: Servant leadership and implementation facilitators. Servant leadership, perseverance and dedication to the families and community, was the premise on which the majority of the program successes could be attributed. The curriculum and structure of the program are important, but based upon the leadership and staff interviews, it is apparent that beyond the content and curriculum, relationships and addressing needs of participants are critical to achieving the goals of the program. Implementation in real-world contexts may require adaptations and enhancements of community-based programs, while maintaining fidelity to core program components, to successfully reach the targeted population and achieve program related outcomes

Brighter Sights: Using Photovoice for a Process Evaluation of a Food Co-op Style Nutrition Intervention

Access to healthy food is a critical factor impacting childhood obesity. Brighter Bites is a school-based program that addresses the issue of fresh food access among low-income families living in food deserts using a food co-op model. The aim of this study is to evaluate initial parent participant reactions to the ongoing Brighter Bites program using Photovoice. A predominately Hispanic, economically disadvantaged, urban school was chosen as the site for the Photovoice project. A total of seven Brighter Bites parent participants were enrolled and six completed the study. The participants developed research questions, took documentary photographs, completed a group analysis of the resulting photos, selected key images and created accompanying captions for a community event. During analysis of the photographs by the group, eight major themes emerged including: impact on the family food budget, produce quality, exposure to unknown fruits and vegetables, socializing with other parents, strategies to use/get children to eat produce, child curiosity of program, and children having fun helping with produce. These themes informed researchers of possible target areas for future program development and quality improvement. The positive nature of most photographs and comments suggests the program is being accepted in the community and impacting local families with regard to food access, food security and healthy eating behaviors

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Youth-focused empowerment evaluation using Photovoice

The Carrera-Children\u27s Aid Society of New York model is a proven model of teen pregnancy prevention. There is a need to evaluate the effect that the model has had on the participants as individuals. Brighter Futures is a replication of the Carrera-Children\u27s Aid Society of New York youth development model operated by Planned Parenthood of Houston and Southeast Texas. A qualitative youth-focused Empowerment Evaluation was initiated to determine the individual impact of the achieved program outcomes. The Empowerment Evaluation assessed what impact the Brighter Futures program has had on the students. The youth used Community-based Participatory Research (CBPR) approaches, such as Photovoice, in conjunction with guided writing and participatory groups to conduct this evaluation with in the framework of Empowerment Evaluation. Additionally, a semi-structured CBPR exercise was used to evaluate the effectiveness of the feasibility of Photovoice methodology with urban youth

Global coastal groundwater and subterranean estuary nutrients

These data were compiled from original and published datasets of coastal groundwater / subterranean estuary research efforts along global coastline (sites within 1km of shoreline). The dataset includes sampling site names, locations, original sample information, sample depth, temperature, salinity, dissolved nitrogen concentrations, and dissolved phosphorus concentrations. The data source or curator is also included in the dataset

Global subterranean estuaries modify groundwater nutrient loading to the ocean

Abstract: Terrestrial groundwater travels through subterranean estuaries before reaching the sea. Groundwater‐derived nutrients drive coastal water quality, primary production, and eutrophication. We determined how dissolved inorganic nitrogen (DIN), dissolved inorganic phosphorus (DIP), and dissolved organic nitrogen (DON) are transformed within subterranean estuaries and estimated submarine groundwater discharge (SGD) nutrient loads compiling > 10,000 groundwater samples from 216 sites worldwide. Nutrients exhibited complex, nonconservative behavior in subterranean estuaries. Fresh groundwater DIN and DIP are usually produced, and DON is consumed during transport. Median total SGD (saline and fresh) fluxes globally were 5.4, 2.6, and 0.18 Tmol yr−1 for DIN, DON, and DIP, respectively. Despite large natural variability, total SGD fluxes likely exceed global riverine nutrient export. Fresh SGD is a small source of new nutrients, but saline SGD is an important source of mostly recycled nutrients. Nutrients exported via SGD via subterranean estuaries are critical to coastal biogeochemistry and a significant nutrient source to the oceans

Failure of human rhombic lip differentiation underlies medulloblastoma formation

Medulloblastoma (MB) comprises a group of heterogeneous paediatric embryonal neoplasms of the hindbrain with strong links to early development of the hindbrain 1–4. Mutations that activate Sonic hedgehog signalling lead to Sonic hedgehog MB in the upper rhombic lip (RL) granule cell lineage 5–8. By contrast, mutations that activate WNT signalling lead to WNT MB in the lower RL 9,10. However, little is known about the more commonly occurring group 4 (G4) MB, which is thought to arise in the unipolar brush cell lineage 3,4. Here we demonstrate that somatic mutations that cause G4 MB converge on the core binding factor alpha (CBFA) complex and mutually exclusive alterations that affect CBFA2T2, CBFA2T3, PRDM6, UTX and OTX2. CBFA2T2 is expressed early in the progenitor cells of the cerebellar RL subventricular zone in Homo sapiens, and G4 MB transcriptionally resembles these progenitors but are stalled in developmental time. Knockdown of OTX2 in model systems relieves this differentiation blockade, which allows MB cells to spontaneously proceed along normal developmental differentiation trajectories. The specific nature of the split human RL, which is destined to generate most of the neurons in the human brain, and its high level of susceptible EOMES +KI67 + unipolar brush cell progenitor cells probably predisposes our species to the development of G4 MB

Genome-wide association study identifies multiple risk loci for chronic lymphocytic leukemia

Genome-wide association studies (GWAS) have previously identified 13 loci associated with risk of chronic lymphocytic leukemia or small lymphocytic lymphoma (CLL). To identify additional CLL susceptibility loci, we conducted the largest meta-analysis for CLL thus far, including four GWAS with a total of 3,100 individuals with CLL (cases) and 7,667 controls. In the meta-analysis, we identified ten independent associated SNPs in nine new loci at 10q23.31 (ACTA2 or FAS (ACTA2/FAS), P = 1.22 × 10-14), 18q21.33 (BCL2, P = 7.76 × 10-11), 11p15.5 (C11orf21, P = 2.15 × 10 -10), 4q25 (LEF1, P = 4.24 × 10-10), 2q33.1 (CASP10 or CASP8 (CASP10/CASP8), P = 2.50 × 10-9), 9p21.3 (CDKN2B-AS1, P = 1.27 × 10-8), 18q21.32 (PMAIP1, P = 2.51 × 10 -8), 15q15.1 (BMF, P = 2.71 × 10-10) and 2p22.2 (QPCT, P = 1.68 × 10-8), as well as an independent signal at an established locus (2q13, ACOXL, P = 2.08 × 10-18). We also found evidence for two additional promising loci below genome-wide significance at 8q22.3 (ODF1, P = 5.40 × 10-8) and 5p15.33 (TERT, P = 1.92 × 10-7). Although further studies are required, the proximity of several of these loci to genes involved in apoptosis suggests a plausible underlying biological mechanism. © 2013 Nature America, Inc. All rights reserved