Community and State Systems Change Associated with the Healthy Transitions Initiative

People engaged in efforts to improve services to emerging adults with serious mental health challenges have reached the conclusion that service change at the program or agency level is not sustainable without related changes at the systems or policy level. This article focuses on one set of efforts to create intentional system change at both the community and state levels. These changes were pursued by states and communities that received grants under the federally funded Healthy Transitions Initiative (HTI), with the aim of creating more effective services for emerging adults with serious mental health conditions. The article reviews the development of a measure to assess systems change efforts at the state and community levels and describes the findings that emerged when the measure was used to assess the change that occurred in the HTI sites over a period of approximately three and a half years

Finding the Missing Links: A Comparison of Social Network Analysis Methods

Too many students leave school without even the essential skills (ACT, 2011), and many others are so drained by the experience they lack a desire to continue on to a post-secondary education. Academic engagement has emerged as a construct representing students’ personal investment in school (Greenwood, Delquadri, & Hall, 1984), and may be a psychological variable which can be intervened on. However, interventions must occur as quickly as possible to maximize their efficiency (Heckman, 2007). Students’ peer groups may be a particularly potent venue of intervention, however several options exist for how to go about measuring their social networks. In this thesis, social networking data of the only middle school of a small town in the north-eastern United States is analyzed to determine the properties of two collection methods (self-reported networks and participant observations) and four network identification methods (probability scores, reciprocal nominations, factor-analyses, and rule-based). Analyses overwhelmingly supported participant observations as a more inclusive, less biased data collection method than self-reports. Meanwhile, hypothesis tests were somewhat mixed on the most inclusive, least biased network identification method, but after a consideration of the findings and the structural properties of each network, the probability score method was deemed the most useful network. Implications, future research, strengths, and limitations are discussed

Pulmonary Function in Extremely Low Birth Weight Infants with Bronchopulmonary Dysplasia Before Hospital Discharge.

Objective To compare pulmonary function in extremely low birth weight (ELBW) infants with bronchopulmonary dysplasia (BPD) studied at 34–36 weeks postmenstrual age (PMA) with a reference group of “healthy” infants born at 34–36 weeks. We hypothesized that ELBW infants have decreased functional residual capacity (FRC) and respiratory compliance (Crs). Study design Pulmonary function testing was performed at 34–36 weeks PMA in infants with BPD and within 96 h of age in infants delivered at 34–36 weeks. Results Twenty BPD patients and 20 healthy infants were studied. FRC (18.9 versus 26.2 mL/kg; adjusted 95% CI 5.0, 10.9; P \u3c 0.001) and Crs (0.80 versus 1.29-mL/cm H2O/kg; 95% CI 0.31, 0.71; P \u3c 0.001) were decreased in BPD patients. Respiratory resistance was increased in BPD patients. Conclusions ELBW infants with BPD have decreased pulmonary function compared to healthy infants delivered at 34–36 weeks. This suggests that infants with BPD have smaller lung volumes

Hair and nail nicotine levels of mothers and their infants as valid biomarkers of exposure to intrauterine tobacco smoke.

IntroductionTobacco use remains the single most modifiable cause of adverse pregnancy outcomes. It is crucial to be able to accurately quantify the burden of tobacco exposure on both the mother and fetus to have better measures of efficacy with interventions being studied.MethodsThis is a descriptive and exploratory study conducted within a randomized controlled trial. Pregnant smoking and non-smoking women were followed from ≤22 weeks' gestation through delivery with monthly maternal smoking questionnaires, urine cotinine levels, and collection of maternal and infant hair and nail samples, at delivery. Nicotine was extracted and measured (ng/mg) using high-performance liquid chromatography with electrochemical detection.ResultsForty-six mother-infant dyads (34 pregnant smokers and 12 pregnant non-smokers) had successful completion of maternal and infant hair and nails samples. The median hair nicotine levels of the smoking mothers and their infants was significantly higher than those of the non-smokers (1.015 vs 0.037 ng/ mg, p<0.05 for the mothers; 0.445 vs 0.080 ng/mg, p<0.01 for the infants). Similarly, the median nail nicotine levels for smoking mothers and their infants were significantly higher than the non-smokers (2.130 vs 0.056 ng/mg, p<0.01 for the mothers; 0.594 vs 0.132 ng/mg, p<0.05 for the infants). We found a moderate but significant correlation between maternal hair and nail nicotine (r=0.64, p<0.001), infant hair and nail nicotine (r=0.64; p<0.001), maternal and infant hair nicotine (r=0.61, p<0.001), and maternal and infant nail nicotine levels (r=0.58, p<0.001).ConclusionsOur study shows that both infant hair and nail nicotine levels are valid biomarkers of intrauterine tobacco smoke exposure, and can be used to identify prenatal smoke exposure, correlating well with the level of maternal nicotine exposure