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Interactive multimedia interventions delivered over the Internet appear to be uniquely suited to provide low-cost, effective, convenient, individually tailored programs that present educational information, cognitive and behavioral skills, and affective learning opportunities. This makes Web-based multimedia a promising avenue for work-life balance programs, employee-assistance providers, and organizations interested in improving family caregiver health and well-being.

Growth layers were examined in teeth collected from free-ranging bottlenose dolphins, Tursiops truncatus, from Florida that have been part of a long-term study begun in 1970; 26 of the dolphins were of known or approximately known age, and 19 were of minimum known age. A second tooth was extracted from 6 animals for examination of growth that had taken place in the interval following the initial extraction. The teeth were read for age estimates without knowledge of any data pertaining to the animals. Most of the estimated ages were the same as or close to the known and approximately known ages of the animals, ranging from 2 to 16 yr. We conclude that the structures we define as dentinal growth layer groups (GLGs) are annual, we describe sources of error in age estimates, and we provide a description of the GLG pattern that can be used by others to estimate age for dolphins.

BackgroundNonspecific low back pain (NLBP) is the diagnosis for individuals with back pain that has no underlying medical cause (eg, tumor, infection, fracture, herniated disc, spinal stenosis). The American College of Physicians (ACP) and American Pain Society (APS) recommend multidisciplinary treatments for NLBP that lasts more than 4 weeks. This approach, however, is impractical for many physicians to implement, and relatively few providers offer NLBP treatment that meets the joint ACP-APS guidelines.ObjectiveThis study evaluated the efficacy of a mobile-Web intervention called “FitBack” to help users implement self-tailored strategies to manage and prevent NLBP occurrences.MethodsA total of 597 adults were recruited, screened, consented, and assessed online at baseline, at 2 months (T2), and at 4 months (T3). After baseline assessments, participants were randomized into three groups: FitBack intervention, alternative care group that received 8 emails urging participants to link to six Internet resources for NLBP, and control group. The FitBack group also received weekly email reminder prompts for 8 weeks plus emails to do assessments. The control group was only contacted to do assessments.ResultsUsers of the FitBack program showed greater improvement compared to the control group in every comparison of the critical physical, behavioral, and worksite outcome measures at 4-month follow-up. In addition, users of the FitBack program performed better than the alternative care group on current back pain, behavioral, and worksite outcomes at 4-month follow-up. For example, subjects in the control group were 1.7 times more likely to report current back pain than subjects in the FitBack group; subjects in the alternative care group were 1.6 times more likely to report current back pain at 4-month follow-up. Further, the users of the FitBack program showed greater improvement compared to both the control and alternative care groups at 4-month follow-up on patient activation, constructs of the Theory of Planned Behavior, and attitudes toward pain.ConclusionsThis research demonstrated that a theoretically based stand-alone mobile-Web intervention that tailors content to users’ preferences and interests can be an effective tool in self-management of low back pain. When viewed from the RE-AIM perspective (ie, reach, efficacy/effectiveness, adoption, implementation fidelity, and maintenance), this study supports the notion that there is considerable value in this type of intervention as a potentially cost-effective tool that can reach large numbers of people. The results are promising considering that the FitBack intervention was neither supported by professional caregivers nor integrated within a health promotion campaign, which might have provided additional support for participants. Still, more research is needed on how self-guided mobile-Web interventions will be used over time and to understand factors associated with continuing user engagement.Trial RegistrationClinicaltrials.gov NCT01950091; http://clinicaltrials.gov...

BackgroundPhysical activity (PA) for older adults has well-documented physical and cognitive benefits, but most seniors do not meet recommended guidelines for PA, and interventions are lacking.ObjectivesThis study evaluated the efficacy of a 12-week Internet intervention to help sedentary older adults over 55 years of age adopt and maintain an exercise regimen.MethodsA total of 368 sedentary men and women (M=60.3; SD 4.9) were recruited, screened, and assessed online. They were randomized into treatment and control groups and assessed at pretest, at 12 weeks, and at 6 months. After treatment group participants rated their fitness level, activity goals, and barriers to exercise, the Internet intervention program helped them select exercise activities in the areas of endurance, flexibility, strengthening, and balance enhancement. They returned to the program weekly for automated video and text support and education, with the option to change or increase their exercise plan. The program also included ongoing problem solving to overcome user-identified barriers to exercise.ResultsThe multivariate model indicated significant treatment effects at posttest (P=.001; large effect size) and at 6 months (P=.001; medium effect size). At posttest, intervention participation showed significant improvement on 13 of 14 outcome measures compared to the control participants. At 6 months, treatment participants maintained large gains compared to the control participants on all 14 outcome measures.ConclusionsThese results suggest that an online PA program has the potential to positively impact the physical activity of sedentary older adult participants. More research is needed to replicate the study results, which were based on self-report measures. Research is also needed on intervention effects with older populations.

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Objectives-Evaluate Internet training to help Nurse Aides decrease resident aggression.Design-Randomized treatment and control design; pre-post assessment.Setting-The study was conducted entirely on the Internet. Participants-Nurse Aides; N=62Intervention-Internet based interactive training using video modeling and mastery learning instructional design.Measurements-Video situations testing and assessment of psycho-social constructs associated with behavior change; follow-up interviews with a sample of treatment participants.Results-MANCOVA analysis showed positive results (p=.001) for knowledge, attitudes, self efficacy, and behavioral intention, with large effect sizes; it was well received by the users.Conclusions-Interactive training is an effective approach to shaping appropriate staff reactions to aggressive resident behaviors. The training can effectively be delivered on the Internet. In this research, it was both valued and well received by study participants.Keywords resident aggression; training; Internet; Nurse Aides; long term care; interactive Violence and assaults by residents against staff or other residents in the long-term care system are a major public health concern 1-5 . Direct care workers in long-term care facilities (LTCs) are the workers at highest risk to suffer from workplace violence 6 (e.g., grabs, chokes, hair pulls, kicks, hits, bites, etc,) and injury due to interactions with residents. Aggressive behavior in the form of threats, harassment, and assaults by residents often occurs daily in LTCs and is widely accepted as part of the job by Nurse Aides (NAs) 4,7-10 . Aggressive resident behaviors can take a physical and emotional toll on both NAs and residents 8,11 , impacting the quality of care provided 4 , and potentially making workers more prone to aggressive responses towards residents 12,13 . The frequency of assaults has been poorly documented, but in a recent study, 138 NAs reported an average of 4.69 assaults during 80 hours of work with a range of 0-67 assaults 14 . Morgan, Stewart, D'Arcy, Forbes, and Lawson 15 reported that 73.4% of NAs in Conflict of interest: None of the authors has a conflict of interest related to this research.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. An interactive multimedia (IMM) training approach that links video presentations with the interactive capabilities of computers has the potential to solve many of these problems 42,43 . IMM programs potentially can blend video modeling vignettes and testimonials, graphics and text, and test questions into a criterion-referenced mastery learning ins...