2-phase Treatment Research Articles

Utilization of recycled concrete aggregates in LDPE-bonded cementless paver blocks

This study investigates the utilization of recycled concrete aggregates (RCA) in waste low-density polyethylene (LDPE)-bonded, non-traffic cementless paver blocks. RCA is incorporated at varying percentages (0%, 25%, 50%, 75%, and 100%) to replace virgin coarse aggregates. Differential scanning calorimetry (DSC), thermal gravimetric analysis (TGA), and melt flow index (MFI) were performed to characterize the thermal and physical properties of LDPE. RCA was treated using a 2-phase treatment technique to incorporate its efficient utilization. Four types of LDPE-to-aggregate mixes, namely, A (1:2.5), B (1:3), C (1:3.5), and D (1:4), were prepared to determine the optimal ratio and the quality control parameters through trial mixes. Paver blocks were evaluated based on their compressive strength, density, water absorption, and thermal strength stability. The results indicate that performing a double-treatment on RCA, optimized mix ratios, and identifying quality control parameters enhances the overall performance of paver blocks. A 35 MPa strength is achieved with 75% replacement, 1:3.5 LDPE-to-aggregate ratio, 30:70 coarse to fine aggregate ratio, and 50 mm depth, with a melt mixing temperature of 180–210°C. Microstructure analysis reveals a strong inter-transition zone (ITZ) for 75% replacement. The ANOVA, followed by a post-hoc analysis, was performed to validate the significance of these results.

Indian Board of Orthodontics Case Report: Management of Class II Skeletal Malocclusion Using 2-Phase Treatment

KL, a 12-year-old boy, presented with a class II Div I malocclusion on a class II skeletal base (retrognathic mandible) with a 7-mm overjet and a horizontal growth pattern. He had a convex profile, incompetent lips, lip trap, deep mentolabial sulcus, everted lower lip, and positive visual treatment objective (VTO). KL had a CS2 cervical maturation stage, which indicates 65% to 85% adolescent growth remaining. Treatment involved growth modification using a removable Twin Block with midpalatal expansion screw. This was followed by upper and lower fixed appliance using 0.022” × 0.028” slot Mclaughlin Bennet and Trevisi (MBT) prescription. The retention protocol involved upper wrap around and lower lingual bonded retainer.

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Three-dimensional condylar changes from Herbst appliance and multibracket treatment: A comparison with matched Class II elastics

The purpose of this study was to quantify and qualify the 3-dimensional (3D) condylar changes using mandibular 3D regional superimposition techniques in adolescent patients with Class II Division 1 malocclusions treated with either a 2-phase or single-phase approach. Twenty patients with Herbst appliances who met the inclusion criteria and had cone-beam computed tomography (CBCT) images taken before, 8weeks after Herbst removal, and after the completion of multibracket appliance treatment constituted the Herbst group. They were compared with 11 subjects with Class II malocclusion who were treated with elastics and multibracket appliances and who had CBCT images taken before and after treatment. Three-dimensional models generated from the CBCT images were registered on the mandible using 3D voxel-based superimposition techniques and analyzed using semitransparent overlays and point-to-point measurements. The magnitude of lateral condylar growth during the orthodontic phase (T2-T3) was greater than that during the orthopedic phase (T1-T2) for all condylar fiducials with the exception of the superior condyle (P<0.05). Conversely, posterior condylar growth was greater during the orthopedic phase than the subsequent orthodontic phase for all condylar fiducials (P<0.05). The magnitude of vertical condylar development was similar during both the orthopedic (T1-T2) and orthodontic phases (T2-T3) across all condylar fiducials (P<0.05). Posterior condylar growth during the orthodontic phase (T2-T3) of the 2-phase approach decreased for all condylar fiducials with the exception of the posterior condylar fiducial (P<0.05) when compared with the single-phase approach. Two-phase treatment using a Herbst appliance accelerates condylar growth when compared with a single-phase regime with Class II elastics. Whereas the posterior condylar growth manifested primarily during the orthopedic phase, the vertical condylar gains occurred in equal magnitude throughout both phases of the 2-phase treatment regime.

Management of a Skeletal Class II Malocclusion Using 2-Phase Treatment: An Indian Board of Orthodontics Case Report

PK, a 12-year-old female patient, was diagnosed with skeletal Class II due to retrognathic mandible, average growth pattern, Angle’s Class II, Division I malocclusion with Class II canine relation, mild upper anterior spacing, upper anterior proclination, uprighted lower anterior, lingually tipped 35, increased overjet and overbite, scissor bite Irt 24, 25, acute nasolabial angle, tongue thrust habit, incompetent lips, and lower lip trap. The nonextraction approach to orthodontic treatment was involved. The skeletal malocclusion was corrected using the twin-block appliance, followed by upper and lower pre-adjusted edgewise appliances (0.022 × 0.028 slot) with the MBT prescription.

Outcomes of early versus late treatment of severe Class II high-angle patients

The aim of this work was to compare the skeletal and dental outcomes of 1- versus 2-phase treatment in Class II subjects with difficult-to-treat high-angle severe Class II malocclusions. The sample of 120 cases was collected from the private offices of 3 experienced clinicians. The following selection criteria were used: (1) ANB ≥6°, (2) SN-GoGn ≥37° or mandibular plane to Frankfort horizontal plane ≥30°; and (3) overjet ≥6mm. Patients were classified into either the early or the late treatment group according to dental age (early Tx: ≥5 primary teeth; late Tx: otherwise). Thirty-four angular, linear, and proportional measurements were determined for each patient. Statistical significance was assessed with the use of a 2-tailed t test, analysis of covariance test, and chi-square test. The results showed that early 2-phase treatment for severe Class II high-angle patients offered no skeletal anteroposterior advantages over late 1-phase treatment. Severe high-angle Class II patients also showed similar dental anteroposterior outcomes with the use of both approaches. Vertically there was a higher frequency of increased mandibular plane angles and extrusion of upper incisors and lower molars in the late treatment group. Early 2-phase treatment for severe Class II high-angle patients offered no skeletal or dental advantage over late 1-phase treatment.

Raymond George Sr, 1939-2018

Raymond George was a mountain of a man, larger than life, and, truth be told, often a walking, talking contradiction. He was one of a kind. He was forceful and steadfast in his beliefs, but also sensitive, exuding thoughtfulness. He was smart and always prepared for any event or discussion. A man who could deliver a perfectly executed presentation before the AAO, only to come home later, throw on tattered clothes, and weed his strawberry patch on his hands and knees for hours until he was filthy and dripping with sweat. Dr George received his DMD degree from Tufts University School of Dental Medicine, Cum Laude, in 1964 and his Certificate in Orthodontics from Boston University Graduate School of Dental Medicine in 1966. He served 2 years as a Captain in the U.S. Army Dental Corps. In 1969, he began his private practice in East Providence, Rhode Island. One could wonder how Ray had time to serve in such an incredible number of positions as President: for the Rhode Island Association of Orthodontists, Northeastern Society of Orthodontists, Rhode Island Dental Association, American Association of Orthodontists Foundation, Eastern Component of the Angle Society, American Association of Orthodontists, and College of Diplomates of the American Board of Orthodontics, among others. He also served for years as a director of the AAO Insurance Company. Dr George lectured nationally and internationally on many subjects, including functional appliances, surgical orthodontics, TMJ treatment, and the value of 2-phase orthodontic treatment. In addition, he wrote scientific articles that were published in professional peer-reviewed journals. During Ray's orthodontics career, he received many awards, including the U.S. Army Meritorious Service Award, Boston University School of Dental Medicine Alumni Award, Massachusetts Association of Orthodontists Frederick M. Moynihan Memorial Award, and Massachusetts Dental Society James W. Etherington Award. Above all else, Ray loved his family. His 3 children, Semia, Christiaan, and Chafic, are all highly accomplished in their chosen fields. They could have done no less with the guidance and example set by their parents. Dr Raymond George Jr, the son with whom he practiced orthodontics, died in 2013. Ray always found time to play with his 3 grandchildren, and “kvelled” in their presence. But he saved his almost incomprehensible love for the woman who stole his heart so many years ago, his wife Sonjia. He made it perfectly clear that he felt that she had more style, class, and grace than any other woman he knew. And those of us lucky enough to be touched by Sonjia would probably agree. Ray was passionate, determined, intelligent, generous, inspiring, and loving and possessed the greatest work ethic of any man I knew. But do you know what else he was? He was suffering. His body was riddled with intractable pain and fatigue, caused by a failed back surgery, a congenital heart condition, and a blood dyscrasia. The only thing that eases my anguish, is knowing he is no longer wincing in pain, no longer trying to find the strength to walk to the kitchen. In summary, despite Dr George's extremely busy private practice, he found the time and fortitude to contribute so much to the leadership of organized dentistry. He told me once that he couldn't imagine not living his life as an orthodontist. He said that he felt it was so very important to him to give back to the profession. He has fulfilled his wish. Rest in peace, my brother.

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 1. Disease Burden and Principles of Care.

The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. This section is the first of six guidelines articles. In Canada, the annual and lifetime prevalence of MDD was 4.7% and 11.3%, respectively. MDD represents the second leading cause of global disability, with high occupational and economic impact mainly attributable to indirect costs. DSM-5 criteria for depressive disorders remain relatively unchanged, but other clinical dimensions (sleep, cognition, physical symptoms) may have implications for depression management. e-Mental health is increasingly used to support clinical and self-management of MDD. In the 2-phase (acute and maintenance) treatment model, specific goals address symptom remission, functional recovery, improved quality of life, and prevention of recurrence. The burden attributed to MDD remains high, whether from individual distress, functional and relationship impairment, reduced quality of life, or societal economic cost. Applying core principles of care, including comprehensive assessment, therapeutic alliance, support of self-management, evidence-informed treatment, and measurement-based care, will optimize clinical, quality of life, and functional outcomes in MDD.

A Randomized Controlled Study Comparing Reverse Hybrid Therapy and Standard Triple Therapy for Helicobacter pylori Infection.

Reverse hybrid therapy is an 1-step 2-phase treatment for Helicobacter pylori (H. pylori) infection with less cost than standard triple therapy. We conducted a randomized, controlled study to compare the efficacies of standard triple therapy and reverse hybrid therapy in the treatment of H. pylori infection.From October 2012 to March 2015, consecutive H. pylori-infected subjects were randomly allocated to receive either a reverse hybrid therapy (pantoprazole plus amoxicillin for 12 days and clarithromycin plus metronidazole for the initial 7 days) or a standard triple therapy (pantoprazole plus amoxicillin and clarithromycin for 12 days). H. pylori status was assessed 6 weeks after treatment. Additionally, antibiotic resistances and host CYP2C19 genotypes were examined and analyzed.A total of 440 H. pylori-infected patients were randomly assigned to receive either a reverse hybrid (n = 220) or a standard triple therapy (n = 220). The reverse hybrid group had a higher eradication rate than standard triple group either by intention-to-treat (93.6% vs. 86.8%; P = 0.016) or per-protocol analysis (95.7% vs. 88.3%; P = 0.005). The 2 patient groups exhibited similar frequencies of overall adverse events (14.1% vs. 9.5%) and drug compliance (96.8% vs. 98.6%). Clarithromycin resistance was an independent risk factor predicting eradication failure in standard triple group (P < 0.001), but not in reverse hybrid group. CYP2C19 genotypes did not affect the eradication rates in both groups.Reverse hybrid therapy can be considered for first-line treatment of H. pylori infection since the new therapy achieves a higher eradication rate than standard triple therapy with similar tolerability and less pharmaceutical cost.

Early orthodontic treatment for Class II malocclusion reduces the chance of incisal trauma: Results of a Cochrane systematic review.

In this article, we summarize the most clinically relevant findings of our recently updated Cochrane systematic review into the treatment of Class II Division 1 malocclusion. A systematic review of the databases was performed to identify all randomized controlled trials evaluating early treatment with functional appliances to correct Class II Division 1 malocclusion. Three early treatment studies with data from 353 participants were included in this review. The results showed no significant difference for any outcomes, except new incidence of incisor trauma, which was significantly less for the early treatment group. The risk ratio analysis for new incisor trauma showed that providing early treatment reduced the risk of trauma by 33% and 41% in the functional and headgear groups, respectively. However, when the numbers needed to treat were calculated, early treatment with functional appliances prevents 1 incidence of incisal trauma for every 10 patients (95% CI, 5-174), and headgear treatment prevents 1 incidence of incisal trauma for every 6 patients (95% CI, 3-23). Orthodontic treatment for young children, followed by a later phase of treatment when the child is in early adolescence, appears to reduce the incidence of new incisal trauma significantly compared with treatment that is provided in 1 phase when the child is in early adolescence. However, these data should be interpreted with caution because of the high degree of uncertainty. There are no other advantages in providing 2-phase treatment compared with 1 phase in early adolescence.

Membrane process enhancement of 2-phase and 3-phase olive mill wastewater treatment plants by photocatalysis with magnetic-core titanium dioxide nanoparticles

In this work, the benefit of using photocatalysis as a pretreatment step for a subsequent olive mill wastewater (OMW) treatment process by membranes will be discussed.Membrane processes appear to be suitable to purify aqueous wastewater streams polluted by organic matter such as OMW, but suffer severe fouling. In order to avoid fouling, the use of operating conditions below the boundary flux is suggested. The problem is that in many cases, boundary flux values are extremely low, making the process economically not feasible. In order to overcome this limitation, pretreatment steps are necessary to increase boundary flux values accordingly. Photocatalysis appears to be capable to achieve these requirements: on one hand, the process is capable to reduce the organic load of the feedstock and on the other hand, particle size distributions of the suspended organic matter are changed. Both principles are known in literature to lead to boundary flux value changes.In this paper the authors report the obtained results of the experimental work concerning photocatalysis and membrane performances.

Spirituality and religious coping in African-American youth with depressive illness

The research team completed a secondary data analysis of primary data from a 2-phase depression treatment engagement behavioural trial to assess African-American adolescents’ reported experiences of spiritual and religious coping when dealing with depression. The team utilised data collected from 28 youth who participated in focus groups or individual interviews. Qualitative data were analysed using thematic techniques for transcript-based analysis to identify the key patterns and elements of the study participants’ accounts and to extract six primary themes. The main themes are reported in this manuscript and include; “Religion as Treatment Incentive”, “Prayer & Agency”, “Mixed Emotions”, “Doesn't Hurt, Might Help”, “Finding Support in the Church”, and “Prayer and Church: Barriers to Treatment?” Overall, the data suggested that religion and spirituality play a key role in African-American adolescents’ experiences of depression. As well, it is surmised that these factors may be important for improving treatment-seeking behaviours and reducing racial mental health disparities in this population of youth.

Feasibility of Online Adaptive Planning Using an Onboard Magnetic-Resonance Image Guided Radiation Therapy (MR-IGRT) System

activity. In the experimental arms (EA) of both trials (C-ART-2 and DDE-2) patients receive a 3-phase adaptive treatment of 30 fractions in total. Biological image-guided dose painting by numbers is applied during the first two phases of C-ART-2. Re-imaging is performed twice during treatment and once after treatment. Deformable image coregistration is used for automatic region-of-interest propagation and dose summation of the three treatment plans. Patients in the control arm (CA) of C-ART-2 receive standard IMRT of 32 fractions, while patients in the CA of DDE-2 receive a 2-phase non-adaptive IMRT treatment of 30 fractions in total. Results: The Table shows the total cost (in , 2012) per patient and per activity for both trials. The cost of ART is 2,100 (DDE-2) to 2,963 (CART-2) higher than the cost of IMRT, based on the higher costs for treatment preparation. The small differences in the cost of ART between both trials are explained by the biological image-guided dose painting applied for C-ART-2. The CA of DDE-2 involves two phases, making treatment planning more expensive compared to the CA of C-ART-2. Conclusions: Even within an experienced center and with automated tools for image fusion and contour propagation, ART is 30-45% more expensive than non-adaptive IMRT for HNC. The cost in other centers adopting ART will be critically dependent of the departmental activity, available tools and experience. This extra cost will have to be weighed against the expected improvement in clinical outcome. Author Disclosure: B. Vanderstraeten: None. D. Berwouts: None. B. Goddeeris: None. F. Duprez: None. W. De Neve: None. Y. Lievens: None.

Optimizing Beam Angles and Aperture Shapes Simultaneously for Station Parameter Optimized Radiation Therapy (SPORT)

activity. In the experimental arms (EA) of both trials (C-ART-2 and DDE-2) patients receive a 3-phase adaptive treatment of 30 fractions in total. Biological image-guided dose painting by numbers is applied during the first two phases of C-ART-2. Re-imaging is performed twice during treatment and once after treatment. Deformable image coregistration is used for automatic region-of-interest propagation and dose summation of the three treatment plans. Patients in the control arm (CA) of C-ART-2 receive standard IMRT of 32 fractions, while patients in the CA of DDE-2 receive a 2-phase non-adaptive IMRT treatment of 30 fractions in total. Results: The Table shows the total cost (in , 2012) per patient and per activity for both trials. The cost of ART is 2,100 (DDE-2) to 2,963 (CART-2) higher than the cost of IMRT, based on the higher costs for treatment preparation. The small differences in the cost of ART between both trials are explained by the biological image-guided dose painting applied for C-ART-2. The CA of DDE-2 involves two phases, making treatment planning more expensive compared to the CA of C-ART-2. Conclusions: Even within an experienced center and with automated tools for image fusion and contour propagation, ART is 30-45% more expensive than non-adaptive IMRT for HNC. The cost in other centers adopting ART will be critically dependent of the departmental activity, available tools and experience. This extra cost will have to be weighed against the expected improvement in clinical outcome. Author Disclosure: B. Vanderstraeten: None. D. Berwouts: None. B. Goddeeris: None. F. Duprez: None. W. De Neve: None. Y. Lievens: None.

Dentoskeletal Effects of 2-Phase Treatment Versus 1-Phase Treatment With Extraction of 4 First Premolars in Nonhypodivergent Class II Patients

The aim of this study was to compare the effectiveness of 2-phase (a first phase with Twin Block therapy immediately followed by a second phase with fixed appliance therapy with nonextraction) and 1-phase (fixed appliance therapy with extraction of 4 first premolars) treatment of class II division 1 malocclusion. Two groups of successfully treated subjects, aged 10 to 14 years with class II division 1 malocclusion, were evaluated: 2-phase group (n = 70) and 1-phase group (n = 76). Pretreatment and posttreatment lateral cephalograms were traced manually and subjected to Student t test. In the 2-phase group, the forward positioning of the mandible (Pg-Olp) was less than that of the extraction group. The sagittal mandibular forward growth (Pg-Olp) was, on average, 2.39 ± 0.4 mm in the 2-phase group and 4.56 ± 2.51 mm in the 1-phase group (P = 0.008, P < 0.05). In the vertical plane, the increases in lower facial height and mandibular plane angle were greater in the 2-phase treatment. In the 2-phase group, the lower anterior teeth proclined (Ii-MP) by 7.3 ± 2 degrees, and in the extraction treatment group, it changed -4.1 ± 3.6 degrees. The 1-phase group contributed more sagittal orthopedic effects than did the 2-phase group. The proclination of the mandibular incisors in the 2-phase group might restrain the mandibular bone from growing enough and cause the backward and downward rotation of the mandible.

Community and Treatment Engagement for Depressed African American Youth: The AAKOMA FLOA Pilot

This manuscript focuses on the recruitment efforts and pilot testing of a culturally tailored motivational interviewing intervention associated with the AAKOMA Project, a 2-phase treatment engagement intervention trial for depressed African American adolescents and families. The research team used strategic community engagement as reported in other research derived from AAKOMA. For the pilot study, the research team recruited 23 youth, enrolled 17 youth and randomized 16 of those youth to either the intervention or a delayed control group. Findings indicated that success in recruiting and retaining African American youth was sustained from earlier strategic engagement during Phase I of the project and that schools and self referrals were the largest referral sources. Pilot intervention findings highlight the preliminary utility of the intervention (100% of youth completing the intervention initiated depression treatment compared to 75% of the delayed control group) and factors that support the recruitment and engagement of a typically difficult to reach population (depressed African American youth and families). Overall, findings set the stage for further intervention development and testing in larger samples.

One-phase vs 2-phase treatment for developing Class III malocclusion: A comparison of identical twins

Despite the known influence of early treatment on the facial appearance of growing patients with skeletal Class III malocclusion, few comparative reports on the long-term effects of different treatment regimens (1-phase vs 2-phase treatment) have been published. Uncertainty remains regarding the effects of early intervention on jaw growth and its effectiveness and efficiency in the long term. In this case report, we compared the effects of early orthodontic intervention as the first phase of a 2-phase treatment vs 1-phase fixed appliance treatment in identical twins over a period of 11 years. Facial and dental changes were recorded, and cephalometric superimpositions were made at 4 time points. In spite of the different treatment approaches, both patients showed identical dentofacial characteristics in the retention phase. Through this case report, we intended to clarify the benefits of undergoing 1-phase treatment against 2-phase treatment protocols for treating growing skeletal Class III patients.

Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence: a 2-phase randomized controlled trial.

No randomized trials have examined treatments for prescription opioid dependence, despite its increasing prevalence. To evaluate the efficacy of brief and extended buprenorphine hydrochloride-naloxone hydrochloride treatment, with different counseling intensities, for patients dependent on prescription opioids. Multisite, randomized clinical trial using a 2-phase adaptive treatment research design. Brief treatment (phase 1) included 2-week buprenorphine-naloxone stabilization, 2-week taper, and 8-week postmedication follow-up. Patients with successful opioid use outcomes exited the study; unsuccessful patients entered phase 2: extended (12-week) buprenorphine-naloxone treatment, 4-week taper, and 8-week postmedication follow-up. Ten US sites. Patients A total of 653 treatment-seeking outpatients dependent on prescription opioids. In both phases, patients were randomized to standard medical management (SMM) or SMM plus opioid dependence counseling; all received buprenorphine-naloxone. Predefined "successful outcome" in each phase: composite measures indicating minimal or no opioid use based on urine test-confirmed self-reports. During phase 1, only 6.6% (43 of 653) of patients had successful outcomes, with no difference between SMM and SMM plus opioid dependence counseling. In contrast, 49.2% (177 of 360) attained successful outcomes in phase 2 during extended buprenorphine-naloxone treatment (week 12), with no difference between counseling conditions. Success rates 8 weeks after completing the buprenorphine-naloxone taper (phase 2, week 24) dropped to 8.6% (31 of 360), again with no counseling difference. In secondary analyses, successful phase 2 outcomes were more common while taking buprenorphine-naloxone than 8 weeks after taper (49.2% [177 of 360] vs 8.6% [31 of 360], P < .001). Chronic pain did not affect opioid use outcomes; a history of ever using heroin was associated with lower phase 2 success rates while taking buprenorphine-naloxone. Prescription opioid-dependent patients are most likely to reduce opioid use during buprenorphine-naloxone treatment; if tapered off buprenorphine-naloxone, even after 12 weeks of treatment, the likelihood of an unsuccessful outcome is high, even in patients receiving counseling in addition to SMM.

Stability of rapid maxillary expansion and facemask therapy: A long-term controlled study

The aim of this prospective controlled study was to evaluate the long-term effects of rapid maxillary expansion and facemask therapy in Class III subjects. Twenty-two subjects (9 boys, 13 girls; mean age, 9.2 years ± 1.6) with Class III disharmony were treated consecutively with rapid maxillary expansion and facemask therapy followed by fixed appliances. The patients were reevaluated at the end of the 2-phase treatment (mean age, 14.5 years ± 1.9) and then recalled about 8.5 years after the end of rapid maxillary expansion and facemask treatment (mean age, 18.7 years ± 2.1). Two groups of controls with untreated Class III malocclusion were used for statistical comparisons of the short-term and long-term intervals. Statistical comparisons were performed with the Mann-Whitney U test. In the long term, no significant differences in maxillary changes were recorded, whereas the treatment group showed significantly smaller increases in mandibular protrusion. The sagittal maxillomandibular skeletal variables maintained significant improvements in the treatment group vs the control groups. In the long term, rapid maxillary expansion and facemask therapy led to successful outcomes in about 73% of the Class III patients. Favorable skeletal changes were mainly due to significant improvements in the sagittal position of the mandible.

“Mama just won’t accept this”: Adult Perspectives on Engaging Depressed African American Teens in Clinical Research and Treatment

This manuscript focuses on qualitative data collected for AAKOMA Project, a 2-phase treatment engagement intervention trial for depressed African American adolescents and families. Data are presented from our phase I study of adult perspectives on African American adolescent depression, depression treatment, and research engagement. The research team conducted four focus groups (N=24) and generated major themes from the data including ideas regarding the manifestations of depression in African American youth and psychosocial barriers to participation in depression research and treatment. Findings indicate that success in recruiting and retaining African American youth in depression research and treatment may include using innovative means to overcome the culturally embedded attributions of depression to non-biological causes, beliefs about the cultural insensitivity of treatments and challenges in the logistics of obtaining care. Adults report that encouraging youth and familial involvement in treatments and research should include targeted, community-partnered activities involving diverse staff in leadership roles and including community members as equal partners.