ADRESSING THE DYNAMICS OF PATERNAL INVOLVEMENT IN PRENATAL CARE: CHALLENGES & RECOMMENDATIONS

There is a gap between the growing presence of fathers in the lives of their children and their inclusion within the prenatal process. The healthcare system fails to acknowledge fathers by not addressing their needs, issues or concerns programmatically or within the clinical setting. This topic is of public health relevance because a father's contribution to the health of his child may optimize the child's overall health and well-being. The presence of fathers during labor and delivery is common place in today's society, however little is known about their birthing expectations and needs. Furthermore, the literature on this topic is sparse. Maternal child health is the phrase used for the study of women and children, interestingly, paternal child health is invisible, and the phrase is non-existent. This research study seeks to address this gap by looking at programs that engage fathers in order to make recommendations in the prenatal health care sector. Interviews were conducted with fathers to assess their experiences throughout the prenatal process. The mother-baby dyad has a historical context, but as the dynamics of our society has changed, the healthcare system cannot afford to remain stagnant. The dyad must evolve to include fathers' in-order to provide the services and information they need to parent their children as well as support mothers in the process

Assessing the Psychoeducational Approach to Transcendence and Health (PATH) program : an intervention to foster self-transcendence and well-being in community-dwelling older adults.

The late-life developmental process of self-transcendence shapes elders’ perspectives on self, others, the nature of this world, and of a dimension beyond the here and now. This qualitative pilot study evaluated the Psychoeducational Approach to Transcendence and Health (PATH) Program, a psychoeducational intervention to promote self-transcendence and well-being in community-dwelling women at a senior center. The intervention involved eight weekly group sessions using group processes, mindfulness practices, creative experiences, and independent at-home practice. The findings supported the underlying theory-based structure and content of the intervention and indicated the intervention may empower elders to attend to self-care, develop acceptance, and learn new skills associated with health and well-being, thus merits further study. Based on insights gained from facilitators’ and participants’ experiences and perceptions, the intervention will be revised and strengthened

An evidence-based co-occurring disorder intervention in VA homeless programs: outcomes from a hybrid III trial

BACKGROUND: Evidence-based treatment for co-occurring disorders is needed within programs that serve homeless Veterans to assist with increasing engagement in care and to prevent future housing loss. A specialized co-occurring disorders treatment engagement intervention called Maintaining Independence and Sobriety Through Systems Integration, Outreach and Networking - Veterans Edition (MISSION-Vet) was implemented within the Housing and Urban Development - Veterans Affairs Supportive Housing (HUD-VASH) Programs with and without an implementation strategy called Getting To Outcomes (GTO). While implementation was modest for the GTO group, no one adopted MISSION in the non-GTO group. This paper reports Veteran level outcome data on treatment engagement and select behavioral health outcomes for Veterans exposed to the MISSION-Vet model compared to Veterans without access to MISSION-Vet. METHODS: This hybrid Type III trial compared 81 Veterans in the GTO group to a similar group of 87 Veterans with mental health and substance use disorders from the caseload of staff in the non-GTO group. Comparisons were made on treatment engagement, negative housing exits, drug and alcohol abuse, inpatient hospitalizations, emergency department visits and income level over time, using mixed-effect or Cox regression models. RESULTS: Treatment engagement, as measured by the overall number of case manager contacts with Veterans and others (e.g. family members, health providers), was significantly higher among Veterans in the GTO group (B = 2.30, p = .04). Supplemental exploratory analyses between Veterans who received higher and lower intensity MISSION-Vet services in the GTO group failed to show differences in alcohol and drug use, inpatient hospitalization and emergency department use. CONCLUSIONS: Despite modest MISSION-Vet fidelity among staff treating Veterans in the GTO group, differences were found in treatment engagement. However, this study failed to show differences in alcohol use, drug use, mental health hospitalizations and negative housing exits over time among those Veterans receiving higher intensity MISSION-Vet services versus low intensity services. This project suggests that MISSION-Vet could be used in HUD-VASH to increase engagement among Veterans struggling with homelessness, a group often disconnected from care. TRIAL REGISTRATION: Clinicaltrials.gov, registration number: NCT01430741 , registered July 26, 2011

Using Getting To Outcomes to facilitate the use of an evidence-based practice in VA homeless programs: a cluster-randomized trial of an implementation support strategy

BACKGROUND: Incorporating evidence-based integrated treatment for dual disorders into typical care settings has been challenging, especially among those serving Veterans who are homeless. This paper presents an evaluation of an effort to incorporate an evidence-based, dual disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) into case management teams serving Veterans who are homeless, using an implementation strategy called Getting To Outcomes (GTO). METHODS: This Hybrid Type III, cluster-randomized controlled trial assessed the impact of GTO over and above MISSION-Vet Implementation as Usual (IU). Both conditions received standard MISSION-Vet training and manuals. The GTO group received an implementation manual, training, technical assistance, and data feedback. The study occurred in teams at three large VA Medical Centers over 2 years. Within each team, existing sub-teams (case managers and Veterans they serve) were the clusters randomly assigned. The trial assessed MISSION-Vet services delivered and collected via administrative data and implementation barriers and facilitators, via semi-structured interview. RESULTS: No case managers in the IU group initiated MISSION-Vet while 68% in the GTO group did. Seven percent of Veterans with case managers in the GTO group received at least one MISSION-Vet session. Most case managers appreciated the MISSION-Vet materials and felt the GTO planning meetings supported using MISSION-Vet. Case manager interviews also showed that MISSION-Vet could be confusing; there was little involvement from leadership after their initial agreement to participate; the data feedback system had a number of difficulties; and case managers did not have the resources to implement all aspects of MISSION-Vet. CONCLUSIONS: This project shows that GTO-like support can help launch new practices but that multiple implementation facilitators are needed for successful execution of a complex evidence-based program like MISSION-Vet. TRIAL REGISTRATION: ClinicalTrials.gov NCT01430741

Promoting self-transcendence and well-being in community-dwelling older adults : a pilot study of a psychoeducational intervention.

Self-transcendence changes how older adults perceive themselves, their relationships with others, the material world, and the metaphysical or spiritual dimension. It is associated with multiple indicators of well-being. The purpose of this pilot study (N = 20) was to examine the feasibility and effectiveness of a psychoeducational intervention to increase self-transcendence and well-being of older adults. Data were analyzed using generalized estimating equations. All variables trended in the directions hypothesized. Self-transcendence increased in the intervention group and decreased in the control group but not significantly. The group × time interaction for life satisfaction was significant (z = 2.89, p = .004). This feasibility study supports further investigation to assess the effectiveness of the intervention in a larger sample

A cluster randomized Hybrid Type III trial testing an implementation support strategy to facilitate the use of an evidence-based practice in VA homeless programs

BACKGROUND: The Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program is one of the largest initiatives to end Veteran homelessness. However, mental health and substance use disorders continue to reduce client stability and impede program success. HUD-VASH programs do not consistently employ evidence-based practices that address co-occurring mental health and substance use disorders. This paper presents a study protocol to evaluate the implementation of an evidence-based, co-occurring disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) in HUD-VASH using an implementation strategy called Getting To Outcomes (GTO). METHODS/DESIGN: In three large VA Medical Centers, this Hybrid Type III trial will randomize case managers and their clients by HUD-VASH sub-teams to receive either MISSION-Vet Implementation as Usual (IU-standard training and access to the MISSION-Vet treatment manuals) or MISSION-Vet implementation augmented by GTO. In addition to testing GTO, effectiveness of the treatment (MISSION-Vet) will be assessed using existing Veteran-level data from the HUD-VASH data monitoring system. This project will compare GTO and IU case managers and their clients on the following variables: (1) fidelity to the MISSION-Vet intervention; (2) proportion of time the Veteran is housed; (3) mental health, substance use, and functional outcomes among Veterans; and (4) factors key to the successful deployment of a new treatment as specified by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model. DISCUSSION: This project is an important step for developing an implementation strategy to increase adoption of evidence-based practice use in VA homeless programs, and to further examine efficacy of MISSION-Vet in HUD-VASH. This project has important implications for program managers, policy makers, and researchers within the homelessness field. VA Central IRB approval for this study was granted in October 2011. The three sites were trained on MISSION-Vet and GTO in the first half of 2013. The first GTO planning meetings began after training occurred, between January 2013 and November 2013, across the three sites. The data collection-via a fidelity measure embedded into the VA Computerized Patient Record System-began as each site initiated MISSION-Vet, between April 2013 and January 2014. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01430741

Water sorption and hydration in spray-dried milk protein powders: Selected physicochemical properties

peer-reviewedLow and high protein dairy powders are prone to caking and sticking and can also be highly insoluble; with powder storage conditions an important factor responsible for such issues. The aim of this study focused on the bulk and surface properties of anhydrous and humidified spray-dried milk protein concentrate (MPC) powders (protein content ~40, 50, 60, 70 or 80%, w/w). Water sorption isotherms, polarized light and scanning electron micrographs showed crystallized lactose in low protein powders at high water activities. High protein systems demonstrated increased bulk diffusion coefficients compared to low protein systems. Glass transition temperatures, α-relaxation temperatures and structural strength significantly decreased with water uptake. CLSM measurements showed that humidified systems have slower real time water diffusion compared to anhydrous systems. Overall, the rate of water diffusion was higher for low protein powders but high protein powders absorbed higher levels of water under high humidity conditions

Glucocorticoid-induced polycystic kidney disease—A threshold trait

Glucocorticoid-induced polycystic kidney disease—A threshold trait. Administration of hydrocortisone acetate (250 mg/kg) to newborn mice caused polycystic kidney disease (PKD) of varying proportions in each of 18 different inbred strains; none of the injected controls were affected. All kidneys were histologically examined and scored for degree of cyst formation using a semi-continuous (0 to 4+) grading scheme. Results suggested that this condition is a multifactorial threshold trait. For each strain, estimates of the mean and standard deviation of normally distributed liability were determined by maximum likelihood methods. Concomitant analyses showed: 1) a significant environmental effect related to drug source; 2) a variation in thresholds ranging from 0.94 (N = 46) for the B10.M strain to -0.71 (N = 297) for the C57B1/6J strain; and 3) three groups of strains with different susceptibility to PKD. These results are consistent with a multifactorial basis for susceptibility to PKD. Quantitative analysis of thresholds and liability distributions reveals that genetic, environmental and random elements all contribute to the expression and extent of the cystic trait

Solar Effects on Tensile and Optical Properties of Hubble Space Telescope Silver-Teflon(Registered Trademark) Insulation

A section of the retrieved Hubble Space Telescope (HST) solar array drive arm (SADA) multilayer insulation (MLI), which experienced 8.25 years of space exposure, was analyzed for environmental durability of the top layer of silver-Teflon (DuPont) fluorinated ethylene propylene (Ag-FEP). Because the SADA MLI had solar and anti-solar facing surfaces and was exposed to the space environment for a long duration, it provided a unique opportunity to study solar effects on the environmental degradation of Ag-FEP, a commonly used spacecraft thermal control material. Data obtained included tensile properties, solar absorptance, surface morphology and chemistry. The solar facing surface was found to be extremely embrittled and contained numerous through-thickness cracks. Tensile testing indicated that the solar facing surface lost 60% of its mechanical strength and 90% of its elasticity while the anti-solar facing surface had ductility similar to pristine FEP. The solar absorptance of both the solar facing surface (0.155 plus or minus 0.032) and the anti-solar facing surface (0.208 plus or minus 0.012) were found to be greater than pristine Ag-FEP (0.074). Solar facing and anti-solar facing surfaces were microscopically textured, and locations of isolated contamination were present on the anti-solar surface resulting in increased localized texturing. Yet, the overall texture was significantly more pronounced on the solar facing surface indicating a synergistic effect of combined solar exposure and increased heating with atomic oxygen erosion. The results indicate a very strong dependence of degradation, particularly embrittlement, upon solar exposure with orbital thermal cycling having a significant effect

Benzodiazepine use among young attendees of an Irish substance treatment center

Objective: To describe the demographic characteristics of those service users attending Matt Talbot Services, and their current and past substance use, and to explore the use of benzodiazepines among this group. Method: There were 198 service users who attended a substance misuse treatment center in Cork, Ireland, between January 2005 and August 2011. Results: Benzodiazepines had ever been used by 51.0%, and of these, 55.8% were regular benzodiazepine users. The mean age of first use was 14.9 ± 1.4 years. Regular users of benzodiazepines were regular users of significantly more substances (3, interquartile range [IQR] = 2-3) when compared with nonregular benzodiazepine users (1, IQR = 1-2). Regular benzodiazepine users showed more behavioral signs (12, IQR = 10-14) than nonregular users (9, IQR = 7-12). Physical signs were significantly different between regular (8, IQR = 6-11) and nonregular (5, IQR = 3-10) users. Conclusions: The effects of benzodiazepine misuse affect the individual, their family, and society as a whole through hospitalization, substance treatment, and crime. Identifying regular benzodiazepine users can help reduce the burden of benzodiazepines