Examining Treatment Fidelity in Motivational Interviewing

Objective: Childhood obesity is a significant health concern, especially in lower income African Americans within the United States. Previous research suggests that programs developed to promote healthy eating and exercise habits have been effective in reducing childhood obesity. One strategy that has been impactful in facilitating those changes is Motivational Interviewing (MI), a brief, patient-centered counseling style used to explore and resolve ambivalence about behavior change. Recent studies have shown that MI has its advantages, such as increasing patients’ sense of control when making healthy choices and promoting overall wellness; however, less research examines treatment fidelity and its impact on program adherence which may limit the interpretation of the results. Treatment fidelity is defined as the methodological strategies used to monitor and enhance the reliability and validity of behavioral intervention. NOURISH+ is a parent-focused intervention for overweight children ages 5-11 years (Nourishing Our Understanding of Role-Modeling to Increase Support and Health: PI: Mazzeo). We are currently implementing an adjunctive, MI-based treatment to investigate if MI can improve treatment adherence and effectiveness of NOURISH+ (NOURISH+MI; PI: Bean). We describe treatment fidelity methods and preliminary feasibility data in the NOURISH+MI trial. Methods: Prior to study onset, raters were trained extensively on use of the MITI 3.1 (Motivational Interviewing Treatment Integrity Code), a validated coding system designed to measure adherence to MI. Satisfactory interrater reliabilities (determined using intraclass correlations; [ICC]) were established prior to study onset. Raters also used the MITI 3.1 to examine MI competency of study interventionists, to indicate readiness to begin treatment. Participants who consent to NOURISH+MI complete two MI sessions prior to the onset of the group-based treatment. Session 1 (T1) occurs over the telephone and Session 2 (T2) is in-person. All sessions are audio recorded and independently coded by two raters. ICCs are continually assessed throughout the study duration to identify rater drift and indicate areas in need of retraining. MITI ratings also determine interventionists’ competence and adherence to MI. Raters and interventionists attend bi-weekly to address. Results: To date, 80 MI sessions (T1=46, T2=34) have been conducted and coded using the MITI for MI adherence. Interventionists met or exceeded competency with a M of 100% MI adherence, 1.8 reflection to question ratio, and 4.8 Global spirit. Rater ICC’s ranged from 0.6 to 1.0 across MI global scores and behavior counts. Discussion: Interventionists met or exceeded competency thresholds, demonstrating excellent treatment fidelity. While overall ICCs were adequate, the limited response ranges for the global scores contributed to lower ICCs in those domains. Overall reliabilities were adequate suggesting high fidelity to the MITI 3.1 and reliable ratings among independent raters. Data suggest that the NOURISH+MI trial is being implemented with high treatment integrity. Thus, if study results suggest that MI is deemed effective, this intense protocol for establishing and maintaining treatment fidelity enhances confidence in treatment effects and furthers scientific research examining MI and pediatric obesity treatments.https://scholarscompass.vcu.edu/uresposters/1062/thumbnail.jp

Deconstructing Local Adaptation Plans for Action (LAPAs) - Analysis of Nepal and Pakistan LAPA initiatives

This paper analyses the organizational and implementation design strategies of two ongoing Local Adaptation Plan for Action (LAPA) initiatives in Nepal and Pakistan. LAPA is considered an answer for institutionalized local-level adaptation planning that aims to capture local needs and direct resources to where, when and by whom these are most needed. While both Nepal and Pakistan LAPAs have similar objectives of bottom-up planning, the operational and structural designs of the two LAPAs are very distinct, leading to different outcomes. Different internal and external factors such as age and size of LAPA, technology, local institutional arrangements, core process and environment also exert significant structural tensions on the planned organizational design of LAPAs that may inhibit delivery of their objectives

Tumor Associated Stromal Cells Play a Critical Role on the Outcome of the Oncolytic Efficacy of Conditionally Replicative Adenoviruses

The clinical efficacy of conditionally replicative oncolytic adenoviruses (CRAd) is still limited by the inefficient infection of the tumor mass. Since tumor growth is essentially the result of a continuous cross-talk between malignant and tumor-associated stromal cells, targeting both cell compartments may profoundly influence viral efficacy. Therefore, we developed SPARC promoter-based CRAds since the SPARC gene is expressed both in malignant cells and in tumor-associated stromal cells. These CRAds, expressing or not the Herpes Simplex thymidine kinase gene (Ad-F512 and Ad(I)-F512-TK, respectively) exerted a lytic effect on a panel of human melanoma cells expressing SPARC; but they were completely attenuated in normal cells of different origins, including fresh melanocytes, regardless of whether cells expressed or not SPARC. Interestingly, both CRAds displayed cytotoxic activity on SPARC positive-transformed human microendothelial HMEC-1 cells and WI-38 fetal fibroblasts. Both CRAds were therapeutically effective on SPARC positive-human melanoma tumors growing in nude mice but exhibited restricted efficacy in the presence of co-administered HMEC-1 or WI-38 cells. Conversely, co-administration of HMEC-1 cells enhanced the oncolytic efficacy of Ad(I)-F512-TK on SPARC-negative MIA PaCa-2 pancreatic cancer cells in vivo. Moreover, conditioned media produced by stromal cells pre-infected with the CRAds enhanced the in vitro viral oncolytic activity on pancreatic cancer cells, but not on melanoma cells. The whole data indicate that stromal cells might play an important role on the outcome of the oncolytic efficacy of conditionally replicative adenoviruses

Allergen immunotherapy in MASK-air users in real-life : Results of a Bayesian mixed-effects model

Background Evidence regarding the effectiveness of allergen immunotherapy (AIT) on allergic rhinitis has been provided mostly by randomised controlled trials, with little data from real-life studies. Objective To compare the reported control of allergic rhinitis symptoms in three groups of users of the MASK-air(R) app: those receiving sublingual AIT (SLIT), those receiving subcutaneous AIT (SCIT), and those receiving no AIT. Methods We assessed the MASK-air(R) data of European users with self-reported grass pollen allergy, comparing the data reported by patients receiving SLIT, SCIT and no AIT. Outcome variables included the daily impact of allergy symptoms globally and on work (measured by visual analogue scales-VASs), and a combined symptom-medication score (CSMS). We applied Bayesian mixed-effects models, with clustering by patient, country and pollen season. Results We analysed a total of 42,756 days from 1,093 grass allergy patients, including 18,479 days of users under AIT. Compared to no AIT, SCIT was associated with similar VAS levels and CSMS. Compared to no AIT, SLIT-tablet was associated with lower values of VAS global allergy symptoms (average difference = 7.5 units out of 100; 95% credible interval [95%CrI] = -12.1;-2.8), lower VAS Work (average difference = 5.0; 95%CrI = -8.5;-1.5), and a lower CSMS (average difference = 3.7; 95%CrI = -9.3;2.2). When compared to SCIT, SLIT-tablet was associated with lower VAS global allergy symptoms (average difference = 10.2; 95%CrI = -17.2;-2.8), lower VAS Work (average difference = 7.8; 95%CrI = -15.1;0.2), and a lower CSMS (average difference = 9.3; 95%CrI = -18.5;0.2). Conclusion In patients with grass pollen allergy, SLIT-tablet, when compared to no AIT and to SCIT, is associated with lower reported symptom severity. Future longitudinal studies following internationally-harmonised standards for performing and reporting real-world data in AIT are needed to better understand its 'real-world' effectiveness.Peer reviewe

Consistent trajectories of rhinitis control and treatment in 16,177 weeks : The MASK-air (R) longitudinal study

Introduction: Data from mHealth apps can provide valuable information on rhinitis control and treatment patterns. However, in MASK-air (R), these data have only been analyzed cross-sectionally, without considering the changes of symptoms over time. We analyzed data from MASK-air (R) longitudinally, clustering weeks according to reported rhinitis symptoms.Methods: We analyzed MASK-air (R) data, assessing the weeks for which patients had answered a rhinitis daily questionnaire on all 7days. We firstly used k-means clustering algorithms for longitudinal data to define clusters of weeks according to the trajectories of reported daily rhinitis symptoms. Clustering was applied separately for weeks when medication was reported or not. We compared obtained clusters on symptoms and rhinitis medication patterns. We then used the latent class mixture model to assess the robustness of results.Results: We analyzed 113,239 days (16,177 complete weeks) from 2590 patients (mean age +/- SD = 39.1 +/- 13.7 years). The first clustering algorithm identified ten clusters among weeks with medication use: seven with low variability in rhinitis control during the week and three with highly-variable control. Clusters with poorly-controlled rhinitis displayed a higher frequency of rhinitis co-medication, a more frequent change of medication schemes and more pronounced seasonal patterns. Six clusters were identified in weeks when no rhinitis medication was used, displaying similar control patterns. The second clustering method provided similar results. Moreover, patients displayed consistent levels of rhinitis control, reporting several weeks with similar levels of control.Conclusions: We identified 16 patterns of weekly rhinitis control. Co-medication and medication change schemes were common in uncontrolled weeks, reinforcing the hypothesis that patients treat themselves according to their symptoms.[GRAPHICS].Peer reviewe

Host genetic diversity enables Ebola hemorrhagic fever pathogenesis and resistance

Existing mouse models of lethal Ebola virus infection do not reproduce hallmark symptoms of Ebola hemorrhagic fever, neither delayed blood coagulation and disseminated intravascular coagulation, nor death from shock, thus restricting pathogenesis studies to non-human primates. Here we show that mice from the Collaborative Cross exhibit distinct disease phenotypes following mouse-adapted Ebola virus infection. Phenotypes range from complete resistance to lethal disease to severe hemorrhagic fever characterized by prolonged coagulation times and 100% mortality. Inflammatory signaling was associated with vascular permeability and endothelial activation, and resistance to lethal infection arose by induction of lymphocyte differentiation and cellular adhesion, likely mediated by the susceptibility allele Tek. These data indicate that genetic background determines susceptibility to Ebola hemorrhagic fever

ARIA-EAACI statement on asthma and COVID-19 (June 2, 2020)

Non peer reviewe