Background Managing Type 1 diabetes (T1D) during adolescence can be challenging, and there is a need for accessible interventions to help adolescents cope with diabetes-related stress. Objectives The aim of this study was to compare an Internet coping skills training (TEENCOPE) intervention to an Internet educational intervention (Managing Diabetes) for adolescents with T1D. Moderators of program efficacy were evaluated. Methods The study was a multisite clinical trial (n = 320) with data collected at baseline, 3 months, and 6 months. Data were collected on the primary outcomes of physiologic (A1C) and psychosocial (quality of life) and on the secondary outcomes of behavioral (self-management) and psychosocial (stress, coping self-efficacy, social competence, family conflict) variables consistent with the conceptual framework. Data were analyzed using mixed-model analyses with an intent-to-treat approach. Results There were no significant between-group treatment effects 6 months postintervention on primary outcomes. The Managing Diabetes youth showed a significant increase in social competence compared to the TEENCOPE youth. There were significant time effects for TEENCOPE (decreased stress and increased coping) and Managing Diabetes (improved diabetes quality of life). Discussion Youth with T1D transitioning to adolescence may need both structured diabetes education and coping skills to improve health outcomes. There may be a higher potential to reach adolescents with Type 1 diabetes of varying race and ethnicity via Internet interventions.

the evaluation found that implementation of the RAI was associated with significant improvements in a variety of measures of process quality, resident functional outcomes and reduced hospitalization. Other uses of the RAI data in the USA-including payment using resident classification systems and, with RAI-based outcome-oriented quality indicators, quality assurance activities-and the status of RAI use in other countries are also summarized.

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The authors in this consensual qualitative research study explored the dissertation experiences of 42 graduates (27 counselor educators, 13 counselors, 2 administrators) from 4 midwestern states. Identified domains included impact of environment, competing influences, personality traits, chair influence, committee function, and barriers to completion. An emergent theory reflected the interconnectedness of the dissertation process across internal, relational, and professional factors. Implications related to motivation, personal traits, and identification of barriers in the dissertation process are provided.

Objective Develop and validate a prognostic model for clinical deterioration or death within days of pulmonary embolism (PE) diagnosis using point-of-care criteria. Methods We used prospective registry data from six emergency departments. The primary composite outcome was death or deterioration (respiratory failure, cardiac arrest, new dysrhythmia, sustained hypotension, and rescue reperfusion intervention) within 5 days. Candidate predictors included laboratory and imaging right ventricle (RV) assessments. The prognostic model was developed from 935 PE patients. Univariable analysis of 138 candidate variables was followed by penalized and standard logistic regression on 26 retained variables, and then tested with a validation database (N = 801). Results Logistic regression yielded a nine-variable model, then simplified to a nine-point tool (PE-SCORE): one point each for abnormal RV by echocardiography, abnormal RV by computed tomography, systolic blood pressure < 100 mmHg, dysrhythmia, suspected/confirmed systemic infection, syncope, medico-social admission reason, abnormal heart rate, and two points for creatinine greater than 2.0 mg/dL. In the development database, 22.4% had the primary outcome. Prognostic accuracy of logistic regression model versus PE-SCORE model: 0.83 (0.80, 0.86) vs. 0.78 (0.75, 0.82) using area under the curve (AUC) and 0.61 (0.57, 0.64) vs. 0.50 (0.39, 0.60) using precision-recall curve (AUCpr). In the validation database, 26.6% had the primary outcome. PE-SCORE had AUC 0.77 (0.73, 0.81) and AUCpr 0.63 (0.43, 0.81). As points increased, outcome proportions increased: a score of zero had 2% outcome, whereas scores of six and above had ≥ 69.6% outcomes. In the validation dataset, PE-SCORE zero had 8% outcome [no deaths], whereas all patients with PE-SCORE of six and above had the primary outcome. Conclusions PE-SCORE model identifies PE patients at low- and high-risk for deterioration and may help guide decisions about early outpatient management versus need for hospital-based monitoring.

In contexts of exposure to atypical stress or adversity, individual and collective resilience refers to the process of sustaining wellbeing by leveraging biological, psychological, social and environmental protective and promotive factors and processes (PPFPs). This multisystemic understanding of resilience is generating significant interest but has been difficult to operationalize in psychological research where studies tend to address only one or two systems at a time, often with a primary focus on individual coping strategies. We show how multiple systems implicated in human resilience can be researched in the same study using a longitudinal, six-phase transformative sequential mixed methods study of 14- to 24-year-olds and their elders in two communities dependent on oil and gas industries (Drayton Valley, Canada, and Secunda/eMbalenhle, South Africa). Data collection occurred over a 5-year period, and included: (1) community engagement and the identification of youth health and well-being priorities; (2) participatory youth-centric qualitative research using one-on-one semi-structured interviews and arts-based methods; (3) survey of 500 youth at three time points to assess psychosocial health indicators and outcomes; (4) collection of hair samples to assess stress biomarkers (cortisol and dehydroepiandrosterone-DHEA) over time; (5) youth-led ecological data collection and assessment of historical socio-economic development data; and (6) community resource mapping with community elders. Analyzing data from these multiple systems will allow us to understand the interrelationship and impact of PPFPs within and across systems. To date, we have undertaken thematic and narrative qualitative analyses, and descriptive analyses of the preliminary ecological and survey data. As we proceed, we will combine these and grounded theory approaches with innovative techniques such as latent transition analysis and network analysis, as well as modeling of economic conditions and spatial analysis of human geographies to understand patterns of PPFPs and their inter-relationships. By analyzing the complexity of data collected across systems (including cultural contexts) we are demonstrating the possibility of conducting multisystemic resilience research which expands the way psychological research accounts for positive development under stress in different contexts. This comprehensive examination of resilience may offer an example of how the study of resilience can inform socially and contextually relevant interventions and policies.

SUMMARY The process‐oriented treatment (PORA) approach is a time‐limited programme aimed at increasing the kinaesthetic performance of children with mild motor problems in order to improve their motor performance. The approach was compared with a traditional or general motor approach and with no treatment in a randomized clinical trial of 75 children with developmental co‐ordination disorder. The children were assessed before and after treatment and after a six‐week follow‐up period. The results were mixed. The study provides evidence of the severity of so‐called “mild” motor problems of children referred to occupational therapy. The data suggest that these children do not improve spontaneously, and that their motor problems are very resistant to treatment. The data also suggest that an appropriate treatment strategy might be one that involves direct, repetitive training of a specific skill. RÉSUMÉ Essai clinique d'une approche par proce'de' de traitement oriente clwz les enfants avec trouble développemental de la coordination. L' approche par procédé de traitement oriente (PORx) est un programme limité dans le temps visant a accroître les performances kinesthésiques d'enfants présentant des problèmes moteurs modérés pour améliorer les performances motrices. Cettc approche a été compareée à une approche traditionnelle ou globale de rééducation motrice, et avec une absence dc traitement dans un essai clinique distribué au hasard, chez 75 enfants presentant un trouble de coordination. Une évaluation des enfants fut faite avant et après traitement. et après un suivi de six semaines. Les résultats furent miligés. l'étude démontre la gravité des problèmes moteurs des enfants adressés en ergothérapie, appelés à tort légers. Les données suggèrent que ces enfants nc progressent pas spontanément et que leurs problèmes moteurs résistent au traitement. Les données suggèrent également qu'une stratégic thérapeutique appropriée pourrait être cele qui implique un apprentissage direct, répétilif d'une tâche spécifique. ZUSAMMENFASSUNG Ein klinischer Versuch eines Prozeß‐orientierien‐Behandlungsansatzes bei Kindern mit Koordinationsstörungen Der Versuch einer Prozeß‐orientierten‐Behandlung (PORx) ist ein zeitlich begrenztes Programm mit dem Ziel die kinaesthetischen Fähigkeiten bei Kindern mit leichtcn motorisehen Problemen zu steigern und dadurch ihre motorisehen Fähigkeiten zu verbessern. Dieser Ansatz wurde in einer randoinisiertcn klinischen Studie an 75 Kindern mit Koordinationsstörungen mit einer traditionellen oder allgemeinen motorisehen Therapie, sowie ohne Behandlung verglichen. Die Kinder wurden vor und nach der Therapie und nach weiteren sechs Wochen untersucht. Die Ergebnisse waren gemischt. Durch die Studie wird der Schweregrad der sogenannten ‘leichten’ motorisehen Störungen bei Kindern deutlich, denen Beschäftigungstherapie verordnet wurde. Die Daten zeigen, daß sich diese Kinder nicht spontan bessern und daß ihre motorisehen Probleme sehr Therapie‐resistent sind. Außerdem lassen die Daten erkennen. Daß die richti...

Background Artificial intelligence (AI) has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential for advancing health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping review addresses the following question: What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective? Methods Eight electronic databases were searched for peer reviewed and grey literature published before April 2018 using the concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data charting form, and a descriptive and thematic analysis was performed. Results Upon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability and responsibility, and bias. Largely missing from the literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries (LMICs). Conclusions The ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere.