Self-Coding of Fidelity as a Potential Active Ingredient of Consultation to Improve Clinicians’ Fidelity

A key goal for implementation science is the identification of evidence-based consultation protocols and the active ingredients within these protocols that drive clinician behavior change. The current study examined clinicians’ self-coding of fidelity as a potential active ingredient of consultation for the Attachment and Biobehavioral Catch-up (ABC) intervention. It also examined two other potential predictors of clinician fidelity in response to consultation: dosage of consultation and working alliance. Twenty-nine clinicians (97% female, 62% White, M age?=?34 years) participated in a year of weekly fidelity-focused ABC consultation sessions, for which clinicians self-coded fidelity and received consultant feedback on both their coding and their fidelity. Data from the ABC fidelity measure were available for 1067 sessions coded by consultants, and clinicians’ self-coding accuracy was calculated from 1044 sessions coded by both clinicians and consultants. Alliance was measured with the Working Alliance Inventory—Trainee and Supervisor Versions. The study was observational, and fidelity and self-coding accuracy were modeled across time using hierarchical linear modeling. Clinicians’ ABC fidelity, as well as their self-coding accuracy, increased over the course of consultation. Clinicians’ self-coding accuracy predicted their initial fidelity and growth in fidelity. Working alliance was also linked to fidelity and self-coding accuracy. These results suggest that clinician self-coding should be further examined as an active ingredient of consultation. The study has important implications for the design of consultation procedures and fidelity assessments.

     

Inhibition of prostaglandin synthesis reduces cyclic AMP levels and inhibits chondrogenesis in cultured chick limb mesenchyme

The present study investigated effects of inhibiting the synthesis of prostaglandins (PGs) on cyclic AMP concentrations and chondrogenesis in cultured chick limb mesenchyme. Indomethacin produced concentration-dependent inhibition of both PGE₂ synthesis and chondrogenesis over a concentration range of 50--200 M. Half maximal inhibition of PGE₂ was achieved with 50 M concentrations of the drug which also produced visibly reduced amounts of cartilage matrix in cell cultures as evaluated by Alcian green staining on day 6 of culture. The inhibitory effects of indomethacin on chondrogenesis were largely reversed by addition of 1 mM dibutyryl cAMP, indicating that cells could still respond to cyclic AMP stimulation. Endogenous levels of cyclic AMP, which increased by 6 fold during the six days of culture in control cells, did not increase significantly from dissociated cells at the time of plating (day 0) in indomethacin-treated cultures. The results indicate that inhibition of the prechondrogenic rise in PGE₂ concentrations in limb mesenchyme prevents the increase in cyclic AMP levels which occur during this same period resulting in inhibition of chondrogenesis. The data provide further support for the hypothesis that PGE₂, through its effects on the adenylate cyclase-cAMP system, plays an important role in the differentiation of cartilage.     

The Influence of Vehicle Gavage on Seasonality of Immune System Parameters in the B6C3F1 Mouse

Seasonal hyporesponsiveness and other immune system variationswere observed in female B6C3F1 mice during routine screeningtests for immunomodulation. In a retrospective assessment, 4years of data from over 1200 naive, vehicle, and immunosuppressed(cyclophosphamide-treated) control mice were compiled and analyzedfor uniformity and significant circannual pattern of immuneresponse. Endpoints included body, spleen, and thymus weightsand an immunotoxicity assessment which enumerates specific antibodyplaque-forming cells (PFC) in the spleen following immunizationwith sheep red blood cells. Dosing vehicles were water, cornoil, or 1% methyl cellulose instilled by oral gavage in a 5–20ml/kg volume once daily for 5 days. Four days later, terminalorgan and body weights were recorded and PFC were quantitated.Upon analysis, individual datapoints were arrayed in consistentcircannual and seasonal patterns. In naive mice, the yearlypeak response in circannual rhythm (acrophase) for body weightand PFC parameters occurred in the summer, with acrophases forspleen and thymus weights located in the spring. Vehicle gavagemodulated the circannual/seasonal means and acrophases of allmeasured endpoints in distinct patterns which varied by vehicle.Body weight was the endpoint least affected by vehicle treatmentCorn oil was the vehicle resulting in the most dramatic effectson natural rhythm. As expected, the naive mice receiving anip injection of cyclophosphamide exhibited significant decreases(p 0.05) in circannual mean values for PFC response and relativeorgan weights when compared to naive controls and the eliminationof significant expression of rhythm for PFC parameters. Ourresults indicate that dosing vehicles alter normal seasonalpatterns of biological responses in the mouse. These effectson natural rhythms should be considered in toxicity evaluations,especially when comparing datapoints collected at differenttimes of the year.     

Effects of sustained-release bupropion among persons interested in reducing but not quitting smoking

PURPOSE: To determine whether sustained-release bupropion promotes smoking reduction leading to smoking cessation among persons who wish to reduce their amount of smoking, but who are unwilling to quit or who perceive themselves as being unable to quit. METHODS: Current smokers were assigned randomly to receive either sustained-release bupropion (150 mg twice daily) or matching placebo. During an initial 6-month smoking reduction phase, those who were willing to quit entered a 7-week cessation phase, during which study medication was continued. RESULTS: Four-week continuous abstinence rates were 14% (41/295) in the bupropion group and 8% (25/299) in the placebo group (P = 0.02) during treatment. However, this benefit did not continue after treatment was stopped; subsequent continuous abstinence rates were 7% (20/295) in the bupropion group and 5% (16/299) in the placebo group (P = 0.50). Similar proportions of subjects entered the cessation phase in both treatment groups (38% [n = 113] of those in the bupropion group and 34% [n = 101] of those in the placebo group), although the time until a cessation attempt was shorter for those taking bupropion (median, 64 days vs. 118 days, P = 0.008). The extent of smoking reduction (measured by urinary cotinine concentrations) among the 327 subjects who did not enter the cessation phase was significantly greater (P <0.05) in those treated with bupropion during the reduction treatment phase, but not during the month 12 follow-up visit (P = 0.25). CONCLUSION: Sustained-release bupropion, when used in smokers initially not willing to make a cessation attempt, can help sustain smoking reduction while subjects are on active medication, reduce the time until the next cessation attempt, and increase short-term abstinence rates. However, these benefits were modest and not sustained after bupropion was discontinued.     

Images of a Healthy Worksite: A Group-Randomized Trial for Worksite Weight Gain Prevention With Employee Participation in Intervention Design

Objectives. We assessed the effects of a worksite multiple-component intervention addressing diet and physical activity on employees’ mean body mass index (BMI) and the percentage of employees who were overweight or obese.Methods. This group-randomized trial (n = 3799) was conducted at 10 worksites in the northeastern United States. Worksites were paired and allocated into intervention and control conditions. Within- and between-groups changes in mean BMIs and in the percentage of overweight or obese employees were examined in a volunteer sample.Results. Within-group mean BMIs decreased by 0.54 kilograms per meter squared (P = .02) and 0.12 kilograms per meter squared (P = .73) at the intervention and control worksites, respectively, resulting in a difference in differences (DID) decrease of 0.42 kilograms per meter squared (P = .33). The within-group percentage of overweight or obese employees decreased by 3.7% (P = .07) at the intervention worksites and increased by 4.9% (P = .1) at the control worksites, resulting in a DID decline of 8.6% (P = .02).Conclusions. Our findings support a worksite population strategy that might eventually reduce the prevalence of overweight and obesity by minimizing environmental exposures to calorically dense foods and increasing exposures to opportunities for energy expenditure within worksite settings.Sixty-eight percent of adults residing in the United States are overweight or obese,1 and these conditions affect more than 1.4 billion adults worldwide.2 Traditional obesity control strategies, which have focused on changing diet and physical activity (PA) behaviors, provide significant individual benefits3 but are considered insufficient to reduce population disease burdens,4,5 for which broad, population-based approaches are needed.6 In addition to individual biology and behaviors, the physical, social, and cultural environment appears to contribute to the upward trend in population estimates of overweight and obesity7,8 by facilitating high-energy, low-nutrient diets and reducing the need to be physically active to perform activities of daily life.9Worksites are feasible self-contained environments with established communication systems in which interventions manipulating the food and PA environment and the social marketing of lifestyle changes can be implemented. Given that 58.4% of the US population aged 16 years or older is employed,10 worksite interventions have the potential to reach large number of adults11 and can foster the participation of employees in project development and sustainability.12–14 Moreover, participatory worksite interventions address workers’ needs, priorities, and interests and allow strategies to be adapted to the realities of individual sites.13 There is also a business case for weight control programs. In comparison with their nonobese counterparts, overweight and obese employees have higher absenteeism rates, have more work limitations, and are less productive.15–18With these issues in mind, the National Heart, Lung, and Blood Institute developed the Obesity Prevention in the Worksite initiative, a population-based approach to promoting behavioral change through environmental interventions that address prevention and control of weight gain.19 Prior to this initiative, worksite trials were either limited scope interventions, targeting a few aspects of the food or PA environment,9,20–23 or broader scope efforts simultaneously targeting risk factors for cardiovascular disease and cancer (e.g., smoking, diet).24–28 In addition, few studies addressed environmental influences related to excessive weight gain.Here we report the results of Images of a Healthy Worksite, one of the studies that is part of the Obesity Prevention in the Worksite initiative; this comprehensive nutrition and PA intervention was designed to promote healthy lifestyles and to stop the shift to the right of the population body mass index (BMI) curve. In this study, worksites were designated to receive an environmental intervention, and employees participated in intervention design. We hypothesized that mean BMIs among employees at the intervention worksites and the percentages of employees who were overweight or obese would not increase over a 2-year period or would increase less than at control worksites.     

Group Cognitive Rehabilitation and Exposure/Sorting Therapy: A Pilot Program

While cognitive-behavioral therapy for hoarding disorder (HD) has resulted in significant reductions in symptoms, most individuals continue to have significant hoarding symptoms following treatment. This investigation sought to extend the literature on the behavioral treatments for hoarding by examining (1) group cognitive rehabilitation and exposure/sorting therapy (CREST) and (2) group exposure therapy (ET) for hoarding. Participants in both studies reported significant decreases in hoarding symptom severity from baseline to post-treatment on all primary outcome measures using mixed-effects linear regression models with the intent to treat sample. Participants who received group CREST reported statistically significant reductions in anxiety, depression, and overall severity at post-treatment, while participants who received group ET did not. Results provide preliminary evidence for both group CREST and group ET as effective treatments for hoarding disorder.     

Breastfeeding and Exposure to Past,Current, and Neighborhood Violence

Objectives Breastfeeding has short- and long-term health benefits for children and mothers, but US breastfeeding rates are suboptimal. Exposure to violence may contribute to these low rates, which vary by race/ethnicity. We studied: (1) whether patterns of violence exposure differ by race/ethnicity and (2) whether these patterns are associated with breastfeeding outcomes. Methods We conducted a secondary analysis of data drawn from self-report surveys completed by a convenience sample of low-income postpartum women (n?=?760) in upstate New York. Latent class analysis was used to identify groups of women with similar responses to seven violence measures, including childhood physical and/or sexual violence, experience of partner violence during or just after pregnancy (physical, emotional, verbal), and neighborhood violence (perceived or by ZIP code). Logistic regression and survival analysis were utilized to determine if classes were associated with breastfeeding initiation, duration, and exclusivity, controlling for demographics. Results Exposure to at least one form of violence was high in this sample (87%). We identified 4 classes defined by violence exposure (combining current and historical exposures). Violence exposure patterns differed between racial/ethnic groups, but patterns were inconsistently associated with breastfeeding plans or outcomes. For White women, history of violence exposure increased the likelihood of earlier breastfeeding cessation. By contrast, among Black women, history of violence exposure increased the likelihood of having a breastfeeding plan and initiating breastfeeding. Conclusions for Practice Some differences between violence exposure classes are likely due to the correlation between race/ethnicity and socioeconomic status in the community studied. Additional studies are warranted to better understand how exposure to violence is related to breastfeeding and how best to support women making decisions about intention, initiation, and duration of breastfeeding.     

Site‐Specific Labeling of Proteins and Peptides with Trans‐cyclooctene Containing Handles Capable of Tetrazine Ligation

There is a growing library of functionalized non‐natural substrates for the enzyme protein farnesyltransferase (PFTase). PFTase covalently attaches these functionalized non‐natural substrates to proteins ending in the sequence CAAX, where C is a cysteine that becomes alkylated, A represents an aliphatic amino acid, and X is Ser, Met, Ala, or Gln. Reported substrates include a variety of functionalities that allow modified proteins to undergo subsequent bioconjugation reactions. To date the most common strategy used in this approach has been copper catalyzed azide‐alkyne cycloaddition (CuAAC). While being fast and bioorthogonal CuAAC has limited use in live cell experiments due to copper's toxicity.¹ Here, we report the synthesis of trans‐cyclooctene geranyl diphosphate. This substrate can be synthesized from geraniol in six steps and be enzymatically transferred to peptides and proteins that end in a CAAX sequence. Proteins and peptides site‐specially modified with trans‐cyclooctene geranyl diphosphate were subsequently targeted for further modification via tetrazine ligation. As tetrazine ligation is bioorthogonal, fast, and is contingent on ring strain rather than the addition of a copper catalyst, this labeling strategy should prove useful for labeling proteins where the presence of copper may hinder solubility or biological reactivity.