Parents and Children Together: Design and Implementation of Two Healthy Marriage Programs

The Parents and Children Together (PACT) evaluation, conducted by Mathematica Policy Research for the Office of Research, Planning, and Evaluation, Administration for Children and Families (ACF), U.S. Department of Health and Human Services, is examining a set of Healthy Marriage (HM) and Responsible Fatherhood (RF) grantees funded by ACF's Office of Family Assistance (OFA) in 2011. Recognizing that grantees' programs continue to grow and develop, the PACT evaluation aims to provide foundational information to guide ongoing and future program design and evaluation efforts, and to build the evidence base for programming

The Enhanced Brief Structured Observation Model: Efficiently Assess Trainee Competence and Provide Feedback.

Introduction: The regular observation of trainees is essential to ascertain trainee proficiency in competency-based assessments. Unfortunately, observation of residents is not frequent enough to facilitate entrustment decisions, and the busy clinician-educator may not have the tools or time to conduct effective and efficient observations. Methods: We created a hands-on faculty development workshop utilizing an enhanced variation of the brief structured observation (BSO) technique to train both primary care and subspecialty pediatric faculty on how to effectively and efficiently observe trainees. The workshop has provided faculty a practical approach to observing trainees in a focused fashion and providing effective feedback on clinical skills based on their observation. In the workshop, faculty had an opportunity to observe residents taking an unrehearsed history from a medical student simulating an acutely ill patient, culminating in feedback on the residents\u27 performance using the subjective, objective, assessment, and plan (SOAP) format. Results: This faculty development workshop has been presented to more than 100 faculty both locally and nationally, and feedback has been uniformly positive, with three institutions incorporating this model into their programs to date. Discussion: This enhanced BSO workshop promotes a model that streamlines the observations of trainees and provides faculty with the tools to encourage more observations

Integrated safety studies of the urate reabsorption inhibitor lesinurad in treatment of gout.

ObjectiveLesinurad (LESU) is a selective urate reabsorption inhibitor approved at 200 mg daily for use with a xanthine oxidase inhibitor (XOI) to treat hyperuricaemia in gout patients failing to achieve target serum urate on XOI. The aim of the study was to investigate the long-term safety of LESU + XOI therapy.MethodsSafety data were pooled from three 12-month phase III (core) trials evaluating LESU 200 and 400 mg/day combined with an XOI (LESU200+XOI and LESU400+XOI), and two 12-month extension studies using descriptive statistics. To adjust for treatment duration, treatment-emergent adverse events (TEAEs) were expressed as exposure-adjusted incidence rates (patients with events per 100 person-years).ResultsIn the core studies, exposure-adjusted incidence rates for total and total renal-related TEAEs were comparable for XOI alone and LESU200+XOI but higher with LESU400+XOI. Exposure-adjusted incidence rates for serum creatinine (sCr) elevations ⩾1.5×baseline were 2.9, 7.3 and 18.7, respectively. Resolution (sCr ⩽1.2×baseline) occurred in 75-90% of all events, with 66-75% occurring without any study medication interruption. Major adverse cardiovascular events were 3, 4 and 9 with XOI, LESU200+XOI and LESU400+XOI, respectively. Longer exposure in core+extension studies did not increase rates for any safety signals.ConclusionAt the approved dose of 200 mg once-daily combined with an XOI, LESU did not increase renal, cardiovascular or other adverse events compared with XOI alone, except for sCr elevations. With extended exposure in the core+extension studies, the safety profile was consistent with that observed in the core studies, and no new safety concerns were identified

Slocum gliders provide accurate near real-time estimates of baleen whale presence from human-reviewed passive acoustic detection information

© The Author(s), 2020. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Baumgartner, M. F., Bonnell, J., Corkeron, P. J., Van Parijs, S. M., Hotchkin, C., Hodges, B. A., Thornton, J. B., Mensi, B. L., & Bruner, S. M. Slocum gliders provide accurate near real-time estimates of baleen whale presence from human-reviewed passive acoustic detection information. Frontiers in Marine Science, 7, (2020):100, doi:10.3389/fmars.2020.00100.Mitigating the effects of human activities on marine mammals often depends on monitoring animal occurrence over long time scales, large spatial scales, and in real time. Passive acoustics, particularly from autonomous vehicles, is a promising approach to meeting this need. We have previously developed the capability to record, detect, classify, and transmit to shore information about the tonal sounds of baleen whales in near real time from long-endurance ocean gliders. We have recently developed a protocol by which a human analyst reviews this information to determine the presence of marine mammals, and the results of this review are automatically posted to a publicly accessible website, sent directly to interested parties via email or text, and made available to stakeholders via a number of public and private digital applications. We evaluated the performance of this system during two 3.75-month Slocum glider deployments in the southwestern Gulf of Maine during the spring seasons of 2015 and 2016. Near real-time detections of humpback, fin, sei, and North Atlantic right whales were compared to detections of these species from simultaneously recorded audio. Data from another 2016 glider deployment in the same area were also used to compare results between three different analysts to determine repeatability of results both among and within analysts. False detection (occurrence) rates on daily time scales were 0% for all species. Daily missed detection rates ranged from 17 to 24%. Agreement between two trained novice analysts and an experienced analyst was greater than 95% for fin, sei, and right whales, while agreement was 83–89% for humpback whales owing to the more subjective process for detecting this species. Our results indicate that the presence of baleen whales can be accurately determined using information about tonal sounds transmitted in near real-time from Slocum gliders. The system is being used operationally to monitor baleen whales in United States, Canadian, and Chilean waters, and has been particularly useful for monitoring the critically endangered North Atlantic right whale throughout the northwestern Atlantic Ocean.Funding for this project was provided by the Environmental Security Technology Certification Program of the U.S. Department of Defense and the U.S. Navy’s Living Marine Resources Program

Mindfulness and Cognitive Depletion Shape the Relationship between Moral Conviction and Intolerance of Dissimilar Others

When people vest a position with moral conviction, that is, a sense that the position is grounded in fundamental right or wrong, good or bad, they tend to be particularly intolerant of those who disagree. Psychological states that mitigate or augment the effect of moral conviction on tolerance are lesser known. The present research investigated the immediate consequences of mindfulness and mindlessness (cognitive depletion) on the relationship between moral conviction and preferred social distance. Consistent with hypotheses, moral conviction did not predict preferred social distance in a mindfulness condition (mindfulness meditation), predicted greater preferred social distance in a mindlessness condition (cognitive depletion), and predicted marginally greater preferred social distance in a control condition (no manipulation). Findings suggest that adopting a mindful orientation toward people with different moral views may foster acceptance, while adopting a mindless orientation may foster greater intolerance

Efficacy and safety during extended treatment of lesinurad in combination with febuxostat in patients with tophaceous gout: CRYSTAL extension study

Abstract Background In gout, long-term urate-lowering therapy (ULT) promotes dissolution of tissue urate crystal deposits. However, no studies using combined xanthine oxidase inhibition and uricosuric ULT have focused on clinical outcomes or adverse events (AEs) beyond 12 months of therapy. Our objective in the present study was to examine efficacy and long-term safety in patients with tophaceous gout receiving febuxostat plus lesinurad as combination therapy. Methods Patients receiving combined lesinurad and febuxostat in the 12-month core CRYSTAL study continued at the same doses in the extension study (“200CONT”, “400CONT”), whereas those receiving only febuxostat 80 mg were randomized to lesinurad 200 or 400 mg with febuxostat (“200CROSS”, “400CROSS”). The primary endpoint was the proportion of patients experiencing complete resolution (CR) of at least one target tophus by extension month (EM) 12. The key secondary endpoint was mean rate of gout flares requiring treatment from the end of EM 2 to the end of EM 12. Secondary endpoints included reduction in the sum of areas for all target tophi. Safety assessments included AEs and laboratory data for the entire extension study (median length of lesinurad exposure, 800 days). Results Of 235 patients completing the core study, 196 (83.4%) enrolled in the extension: 200CONT (n = 64), 200CROSS (n = 33), 400CONT (n = 65), and 400CROSS (n = 34). At EM 12, 59.6%, 43.5%, 66.7%, and 50.0% of patients, respectively, had CR of at least one target tophus. The sum of areas for all target tophi was reduced by 76.4%, 58.1%, 77.5%, and 62.8%, respectively. The adjusted mean (SE) rates of gout flares requiring treatment from the end of EM 2 to the end of EM 12 were 0.6 (0.19), 1.3 (0.48), 0.2 (0.08), and 1.9 (0.93), respectively. Target sUA < 5.0 mg/dl was achieved by 77.1%, 79.2%, 88.5%, and 71.4% of patients, respectively. Exposure-adjusted incidence rates of treatment-emergent adverse events (TEAEs) and renal-related TEAEs in the core study were not increased with prolonged lesinurad exposure in the extension study. Conclusions Patients receiving lesinurad plus febuxostat therapy for 2 years continued to be at sUA target. Patients exhibited a progressive increase in CR of at least one target tophus, progressive reduction in tophus size, and reduction of gout flares requiring treatment over the second year, with AEs consistent with those observed in the core study. Trial registration ClinicalTrials.gov , NCT01510769 . Registered on 13 January 2012.https://deepblue.lib.umich.edu/bitstream/2027.42/146783/1/13075_2018_Article_1788.pd

969-100 Changing Profile of the Cardiac Donor

AbstractAs the demand for organs for cardiac transplantation has increased, donor criteria have evolved. We reviewed the characteristics of 190 cardiac donors from 1983 to 1993 to identify trends in donor profile and to determine if recipient outcome were affected. Donors were divided into early(1983–1987; n=86) and late (1988-1993; n=104) groups according to operative era, While mean donor age has not changed significantly (24 ± 0.9 to 26 ± 1.3 years), the proportion of donors older than 40 years has increased from 1% (1/86) to 15% (16/104) (p&lt;0.001). Trauma was the cause of death in 93% (80/86) of the early group and 65% of the late group (68/104) (p&lt;0.001); in the total series, donors older than 40 years were less likely to have died from trauma 131%; 5/16) than younger donors (83%; 143/173) (p=0.001). The proportion of out-of-state donors has fallen from 71% (61/86) to 27% (28/104) (p&lt;0.001), while the proportion of ethnic minorities increased from 10% (9/86) to 25% (26/1041 (p&lt;0.001). There have been no significant changes in gender profile; males constituted 78% (67/86) of the early group and 72% (75/104) of the late group. Five year survival after transplant was not predicted by donor age, mode of donor death, recipient age, or recipient UNOS status. In summary, donors in the current era are more likely (1) to be older, (2) to be within the state, (3) to come from an ethnic minority, and (4) to have died from causes other than trauma when compared to donors from the earlier era