Multisite Examination Research Articles

Slowing Down Reinvolvement in the System: A Multi-Site Examination of the Effects of COVID on Time Until Readmission into Jail

Slowing Down Reinvolvement in the System: A Multi-Site Examination of the Effects of COVID on Time Until Readmission into Jail

A Multi-site Examination of Relationship Violence Intervention Program Attrition for Male and Female Clients

The current study addresses the paucity of research on relationship violence intervention program (RVIP) attrition examining both male and female clients and risk factors for attrition across gender. Bivariate comparison tests and logistic regression were used to examine gender differences among participants from four RVIPs in Maryland that serve both male and female clients ( n = 1,307). Findings showed significant bivariate differences by gender for 14 of the factors examined. Less than half of clients (48%) completed RVIP, and women were significantly more likely to complete than men. A greater number of factors predicted attrition for male clients, but unemployment was the strongest predictor of attrition for both men and women. Implications for integrating gender-responsive practices into RVIP are discussed.

Sustaining the collaborative chronic care model in outpatient mental health: a matrixed multiple case study.

Sustaining evidence-based practices (EBPs) is crucial to ensuring care quality and addressing health disparities. Approaches to identifying factors related to sustainability are critically needed. One such approach is Matrixed Multiple Case Study (MMCS), which identifies factors and their combinations that influence implementation. We applied MMCS to identify factors related to the sustainability of the evidence-based Collaborative Chronic Care Model (CCM) at nine Department of Veterans Affairs (VA) outpatient mental health clinics, 3-4years after implementation support had concluded. We conducted a directed content analysis of 30 provider interviews, using 6 CCM elements and 4 Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) domains as codes. Based on CCM code summaries, we designated each site as high/medium/low sustainability. We used i-PARIHS code summaries to identify relevant factors for each site, the extent of their presence, and the type of influence they had on sustainability (enabling/neutral/hindering/unclear). We organized these data into a sortable matrix and assessed sustainability-related cross-site trends. CCM sustainability status was distributed among the sites, with three sites each being high, medium, and low. Twenty-five factors were identified from the i-PARIHS code summaries, of which 3 exhibited strong trends by sustainability status (relevant i-PARIHS domain in square brackets): "Collaborativeness/Teamwork [Recipients]," "Staff/Leadership turnover [Recipients]," and "Having a consistent/strong internal facilitator [Facilitation]" during and after active implementation. At most high-sustainability sites only, (i) "Having a knowledgeable/helpful external facilitator [Facilitation]" was variably present and enabled sustainability when present, while (ii) "Clarity about what CCM comprises [Innovation]," "Interdisciplinary coordination [Recipients]," and "Adequate clinic space for CCM team members [Context]" were somewhat or less present with mixed influences on sustainability. MMCS revealed that CCM sustainability in VA outpatient mental health clinics may be related most strongly to provider collaboration, knowledge retention during staff/leadership transitions, and availability of skilled internal facilitators. These findings have informed a subsequent CCM implementation trial that prospectively examines whether enhancing the above-mentioned factors within implementation facilitation improves sustainability. MMCS is a systematic approach to multi-site examination that can be used to investigate sustainability-related factors applicable to other EBPs and across multiple contexts.

Provider Use of, Attitudes Towards, and Self-efficacy with Key Measurement-based Care Practices in Youth Mental Health Treatment: A Multi-site Examination

Provider Use of, Attitudes Towards, and Self-efficacy with Key Measurement-based Care Practices in Youth Mental Health Treatment: A Multi-site Examination

Slowing Down Reinvolvement in the System: a Multi-site Examination of the Effects of COVID on Time Until Readmission Into Jail

Slowing Down Reinvolvement in the System: a Multi-site Examination of the Effects of COVID on Time Until Readmission Into Jail

372 A Retrospective Multisite Examination of Chronic Kidney Disease Using Longitudinal Laboratory Results and Metadata to Inform Value Based Care

372 A Retrospective Multisite Examination of Chronic Kidney Disease Using Longitudinal Laboratory Results and Metadata to Inform Value Based Care

In vivo animal study of the magnetic navigation system for capsule endoscope manipulation within the esophagus, stomach, and colorectum.

Magnetic navigation capsule endoscopy (MNCE) is considered to be an important means to realize the controllable and precise examination of capsule endoscopy (CE) in the unstructured gastrointestinal (GI) tract. For the current magnetic navigation system (MNS), due to the limitation of workspace, driving force, and control method of the CE, only clinical application in the stomach has been realized, whereas the examination of other parts of the GI tract is still in the experimental stage. More preclinical studies are needed to achieve the multisite examination of the GI tract. Based on the MNS (Supiee) developed in the laboratory, an X-ray imaging system with magnetic shielding and a commercial CE are integrated to form the MNCE system. Then, in vivo GI tract experiments with a porcine model are performed to verify the clinical feasibility and safety of this system. Moreover, the effects of different control modes on the efficiency and effect of GI tract examination are studied. Animal experiments demonstrate that with the MNCE system, it is convenient to achieve steering control in any direction and multiple reciprocating movements of CE in the GI tract. Benefiting from the flexibility of the three basic control modes, the achieved swing movement pattern of CE can effectively reduce the inspection time. It is demonstrated that the esophageal examination time can be reduced from 13.2 to 9.2min with a maximum movement speed of 5mm/s. In this paper, the feasibility, safety, and efficacy of the MNCE system for a one-stop examination of the in vivo GI tract (esophagus, stomach, and colorectum) is first demonstrated. In addition, complex movement patterns of CE such as the swinging are proved to effectively improve examination efficiency and disease detection rates. This study is crucial for the clinical application of the MNCE system.

Examining sediment infill dynamics at Naracoorte cave megafauna sites using multiple luminescence dating signals

Relatively little is known about the long-term sediment accumulation dynamics of Naracoorte Cave Complex (NCC) solution pipe cavities, and many of the megafauna-bearing infill deposits at this globally significant Australian Pleistocene fossil locality remain partially dated or lack any numerical age control. In this study, we assess the suitability of three different luminescence dating signals for improving existing chronologies at six Late and Middle Pleistocene NCC sites (n = 22 samples), and we undertake multi-site examinations of NCC sediment infill dynamics spanning the last 550 thousand years (ka). Modern analogue samples collected from above and beneath two active cave entrances confirm that single-grain OSL, single-grain TT-OSL and multi-grain pIR-IRSL signals can be reset down to insignificant residual levels (<10−1–100 Gy) when compared with the natural dose ranges of interest for most NCC palaeontological applications. Replicate luminescence dating comparisons performed at six NCC fossil sites (n = 15 samples) reveal consistent ages for twenty-eight out of thirty-one paired OSL–TT-OSL, OSL–pIR-IRSL and TT-OSL–pIR-IRSL datasets. Nineteen of the twenty Middle to Late Pleistocene samples analysed from the NCC sites produce homogeneous OSL, TT-OSL and pIR-IRSL De datasets suggesting that the NCC solution pipe deposits considered here are generally not affected by syn-depositional mixing complications that can take place within closed karst cavities (i.e., the remobilisation of unbleached grains from pre-existing cave floor sediments, and their subsequent translocation and incorporation into deposits within deeper parts of the cavity along with externally bleached, allochthonous grain populations). Detailed examination of solution pipe dynamics at Smoke Tortoise Cave (SMT) reveals a complex accumulation history focused on the marine isotope stage (MIS) 9 and MIS 7 interglacial complexes, as well as the MIS 8e interstadial. The SMT case study highlights that NCC solution pipes are not simply associated with short-lived opening and sediment accumulation events, but may involve multiple, discontinuous deposition episodes and reactivation events. An initial multi-site examination of all published NCC infill chronologies (n = 70) appears to suggest statistically significant, preferential solution pipe development during the relatively wet parts of interglacial or interstadial cycles. The non-uniform infill age distribution implies that NCC solution pipe dynamics may have exerted taphonomic biases on fossil accumulation, which should be taken into consideration when reconstructing long-term palaeoecological histories from NCC solution pipe cavities.

Multisite examination of depression screening scores and correlates among adolescents and young adults with type 2 diabetes

Abstract Objectives Our aim was to evaluate self-reported depressive symptoms and clinical outcomes during routine screening for adolescents and young adults with type 2 diabetes (T2D), and examine associations among depressive symptoms and demographic and clinical characteristics. Methods The Patient Health Questionnaire (PHQ) was administered to 197 adolescents and young adults with T2D using the PHQ-2 or PHQ-9 in routine pediatric diabetes care at 4 academic medical centres. Data from electronic health records were extracted from the screening date and 12 months earlier. Results Adolescents and young adults with T2D (mean age, 16.85 years; 57% male; 77.2% non-Caucasian) completed the PHQ as part of routine diabetes care. On the PHQ, 19.3% of adolescents and young adults endorsed elevated depressive symptoms (PHQ score ≥10) and, among a subsample with item-level data (n=53), 18.9% endorsed thoughts of self-harm. Subsequently, 50.0% of those with depressive symptoms had a documented referral for mental health treatment in the electronic health record after the positive screening outcome. Older age, shorter diabetes duration, higher glycated hemoglobin level, being non-Hispanic white, more blood glucose checks per day and being prescribed oral medications were significantly associated with more depressive symptoms. Conclusions Screening for depressive symptoms identifies individuals in need of referral for mental health treatment. A focus on self-harm assessment, standardized methods for documentation of symptoms and mental health referrals and increased referral resources are needed.

Multisite Examination of Depression Screening Scores and Correlates Among Adolescents and Young Adults With Type 2 Diabetes

ObjectivesOur aim was to evaluate self-reported depressive symptoms and clinical outcomes during routine screening for adolescents and young adults with type 2 diabetes (T2D), and examine associations among depressive symptoms and demographic and clinical characteristics. MethodsThe Patient Health Questionnaire (PHQ) was administered to 197 adolescents and young adults with T2D using the PHQ-2 or PHQ-9 in routine pediatric diabetes care at 4 academic medical centres. Data from electronic health records were extracted from the screening date and 12 months earlier. ResultsAdolescents and young adults with T2D (mean age, 16.85 years; 57% male; 77.2% non-Caucasian) completed the PHQ as part of routine diabetes care. On the PHQ, 19.3% of adolescents and young adults endorsed elevated depressive symptoms (PHQ score ≥10) and, among a subsample with item-level data (n=53), 18.9% endorsed thoughts of self-harm. Subsequently, 50.0% of those with depressive symptoms had a documented referral for mental health treatment in the electronic health record after the positive screening outcome. Older age, shorter diabetes duration, higher glycated hemoglobin level, being non-Hispanic white, more blood glucose checks per day and being prescribed oral medications were significantly associated with more depressive symptoms. ConclusionsScreening for depressive symptoms identifies individuals in need of referral for mental health treatment. A focus on self-harm assessment, standardized methods for documentation of symptoms and mental health referrals and increased referral resources are needed.

Faith in Fat: A Multisite Examination of University Students' Perceptions of Fat in the Diet.

Despite recent relaxation of restrictions on dietary fat consumption in dietary guidelines, there remains a collective “fear of fat”. This study examined college students’ perceptions of health among foods with no fat relative to foods with different types of fats (unsaturated and saturated). Utilizing a multisite approach, this study collected data from college students at six university dining halls throughout the United States. Data were available on 533 students. Participants were 52% male and consisted largely of first-year students (43%). Across three meal types, the no-fat preparation option was chosen 73% of the time, the unsaturated fat option was selected 23% of the time, and the saturated fat option was chosen 4% of the time. Students chose the no-fat option for all meal types 44% of the time. Findings suggest that college students lack knowledge regarding the vital role played by the type and amount of fats within a healthy diet. Nutrition education and food system reforms are needed to help consumers understand that type of fat is more important than total amount of fat. Efforts across various sectors can encourage incorporating, rather than avoiding, fats within healthy dietary patterns.

A prospective multisite examination of dynamic sexual violence risk: Extension and update to Olver, Nicholaichuk, Kingston, and Wong (2014).

The present study is an extension and update of Olver, Nicholaichuk, Kingston, and Wong's (2014) prospective multisite examination of sexual violence risk and treatment change on a large federal Canadian sample of 570 treated sexual offenders rated pretreatment and posttreatment on the Violence Risk Scale-Sexual Offense version (VRS-SO). The present study featured the clinical application of a risk assessment and treatment planning tool, the VRS-SO, with recidivism outcome data updated by 4 years to a total of 10.2 years. VRS-SO change scores, representing reductions in sexual violence risk from treatment or other change agents (e.g., aging), were reanalyzed in terms of their associations with community sexual, violent, and general recidivism postrelease. Recidivism base rates increased with the concordant increase in follow-up time. VRS-SO risk scores significantly predicted all recidivism outcomes, whereas change scores were consistently associated with decreases in sexual and violent recidivism after controlling for baseline risk through bivariate (d = -.24 to -.61) and Cox regression survival analyses (eB = .878 to .938). The results affirm the dynamic nature of sexual violence risk and demonstrate that structured assessments of change, linked to participation in sexual offense specific treatment, to be associated with decreases in future sexual offending as well as other recidivism outcomes. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

A retrospective multisite examination of depression screening practices, scores, and correlates in pediatric diabetes care.

Psychosocial guidelines recommend routine screening of depressive symptoms in adolescents and young adults (AYA) with diabetes. Best practices for screening in routine care and patient characteristics associated with depressive symptoms require further investigation. The purpose of this study was to examine psychometric properties of the Patient Health Questionnaire (PHQ-2 and PHQ-9); document rates of depressive symptoms and related clinical actions; and evaluate associations with patient characteristics. The Patient Health Questionnaire (PHQ-2 or PHQ-9) was administered at five pediatric academic medical centers with 2,138 youth with type 1 diabetes. Screening was part of routine clinical care; retrospective data from electronic health records were collected for the first screening date as well as 12 months prior. The PHQ demonstrated good psychometric properties. Evaluation of item-level PHQ-9 data identified 5.0% of AYA with at least moderate depressive symptoms who would not have been flagged for further screening using the PHQ-2 only. On the PHQ-9, 10.0% of AYA with type 1 diabetes endorsed elevated depressive symptoms and 7.0% endorsed thoughts of self-harm. Patients with moderate or greater depressive symptoms had a 43.9% documented referral rate for mental health treatment. Higher BMI, older age, public insurance, shorter diabetes duration, higher HbA1C, and a diabetic ketoacidosis (DKA) event in the past year were associated with depressive symptoms. The PHQ-9 identified AYA with elevated depressive symptoms that would not have been identified using the PHQ-2. Depressive symptoms were associated with negative diabetes indicators. To improve referral rates, standardized methods for provision and documentation of referrals are needed.

A Multisite Examination of Everyday Discrimination and the Prevalence of Spontaneous Preterm Birth in African American and Latina Women in the United States.

African American women have a higher risk of spontaneous preterm birth than White and Latina women. Although Latina women are exposed to similar social determinants of health, they have lower rates of spontaneous preterm birth. One theory for this difference is the maternal stress biological pathway, whereby lifetime stressors, such as racial discrimination, lead to a premature activation of parturition. We investigated the prevalence of self-reported discrimination and its association with the prevalence of spontaneous preterm birth. Using data from the Community Child Health Research Network Study, a multisite cohort study from 2008 to 2012, we conducted a cross-sectional analysis of 1,154 African American women and 578 Latina women. Adjusting for multiple risk factors, African American and Latina women who experienced the highest tertile of discrimination had a higher prevalence of preterm birth compared with those who experienced discrimination less than once per year, adjusted hazard ratio (aHR) = 1.5 (0.7-3.1) and 3.6 (0.9-14.4), respectively. In our cohort, we found a statistically significant association only in the medium discrimination group in Latina women, but we did not find a statistically significant association in African American women. Reduction in experienced discrimination may be an important intervention for reducing adverse pregnancy outcomes.

What Does A Robot Look Like?: A Multi-Site Examination of User Expectations About Robot Appearance

Robot design is a critical component of human-robot interaction. A robot’s appearance shapes people’s expectations of that robot, which in turn affect human-robot interaction. This paper reports on an exploratory analysis of 155 drawings of robots that were collected across three studies. The purpose was to gain a better understanding of people’s a priori expectations about the appearance of robots across a variety of robot types (household, military, humanoid, generic, and AI). The findings suggest that people’s visualizations of robots have common features that can be grouped into five broad components. People seem to distinguish between human-like and machine-like robots, with a default visualization of robots having a human-like appearance. In addition, expectations about robot appearance may be dependent on application domain.

Advance Care Planning in Skilled Nursing Facilities: A Multisite Examination of Professional Judgments.

Lack of advance care planning (ACP) may increase hospitalizations and impact the quality of life for skilled nursing facility (SNF) residents, especially African American residents who may be less likely to receive ACP discussions. We examined the professional judgments of SNF providers to see if race of SNF residents and providers, and risk for hospitalization for residents influenced professional judgments as to when ACP was needed and feelings of responsibility for ensuring ACP discussions. Nurses and social workers (n = 350) within 29 urban SNFs completed surveys and rated vignettes describing eight typical SNF residents. Linear mixed modeling was used to examine factors that impacted ratings of need for ACP and responsibility for ensuring ACP. Neither the race of the provider, resident, nor the interaction of the two were associated with either outcome variable. In contrast, providers rated (on a 9-point scale) residents at high risk for hospitalization as more in need of ACP (estimate = 0.86, confidence interval [CI] 0.65, 1.07) and felt more responsible for ensuring ACP (estimate = 0.60, CI 0.42, 0.78). Research on ACP is continuing to evolve and these results show the primacy of disease trajectory variables on providers' judgments about ACP. Differences between providers indicate a need for stronger policies and education. Further, research comparing rural, suburban, and urban SNFs is needed to explore possible forms of structural racism such as residential and SNF segregation.

A multisite examination of sexual violence risk and therapeutic change.

We conducted a prospective multisite examination of sexual offender risk and treatment change on a large federal Canadian sample of 676 treated sex offenders followed up for an average of 6.31 years post release. The present study featured the clinical application of a risk assessment and treatment planning tool, the Violence Risk Scale-Sexual Offender version (VRS-SO; Wong, Olver, Nicholaichuk, & Gordon, 2003). The VRS-SO was rated pre- and posttreatment by sex offender treatment providers on the sample of men who were attending institutionally based sex offender programs across the 5 regions of the Correctional Service of Canada. The Static-99 (Hanson & Thornton, 1999) was also rated as part of routine services, and the Static-99R was used for substantive analyses. The VRS-SO dynamic factors and the Static-99R demonstrated significant predictive accuracy for sexual, violent, and general recidivism (area under the curve = .65 to .78). Significant pre-post changes on the VRS-SO dynamic factors were observed, ranging from small to moderate in magnitude (d = 0.22 to 0.62) across low, moderate, and high intensity programs. The change scores, in turn, were associated with decreases in the 3 recidivism outcomes; the majority of relationships examined attained significance after partialing out of pretreatment scores. Cox regression survival analyses, controlling for pretreatment risk, further demonstrated change scores to have associations with postrelease recidivism outcomes to varying degrees. The results are consistent with the dynamic nature of sexual violence risk and suggest that risk-relevant changes associated with participation in sexual offender treatment are linked to reductions in sexual offender recidivism.

Psychometric evaluation of the Fear of Positive Evaluation Scale in patients with social anxiety disorder.

The Fear of Positive Evaluation Scale (FPES; J. W. Weeks, R. G. Heimberg, & T. L. Rodebaugh, 2008) was designed to assess fear of positive evaluation, a proposed cognitive component of social anxiety. Although previous findings on the psychometric properties of the FPES have been highly encouraging, only 1 previous study has examined the psychometric profile of the FPES in a sample of patients with social anxiety disorder (T. A. Fergus et al., 2009). The primary purpose of the present study was to conduct a large multisite examination of the psychometric profile of the FPES among patients with a principal diagnosis of social anxiety disorder (n = 226; generalized subtype = 97.8%). Responses of nonanxious control participants (n = 42) were also examined. The factorial validity, internal consistency, test-retest reliability, construct validity, and treatment sensitivity of the FPES were strongly supported by our findings. Furthermore, an FPES cutoff score was identified for distinguishing levels of fear of positive evaluation characteristic of patients with social anxiety disorder from those characteristic of the control group. Results provide additional support for the psychometric properties of the FPES in clinical samples.

Reliability and Responsiveness of an 18 Site, 10-g Monofilament Examination for Assessment of Protective Foot Sensation

Older persons including those with diabetes are at increased risk for loss of protective sensation in the feet. The 5.07 (10-g) monofilament is recognized as a valid instrument to test for the presence or absence of protective sensation in the foot. Few studies report reliability and no studies report responsiveness for a multisite examination using the 10-g monofilament. The purpose of this study was to determine the responsiveness and reliability for the 10-g monofilament in evaluating protective sensation in the feet. A convenience sample of 28 (20 women and 8 men) participants between the ages 50 and 78 years were recruited for the study. Sensory testing was performed on 18 different sites (9 per foot) by 3 testers for each participant using the 10-g monofilament. Participants were tested on 2 occasions with approximately 1 week between tests. Participants' eyes were closed for the duration of the examination to blind them to the tester. Testers were blinded to each other and previous test results. Intratester and intertester reliability were calculated using intraclass correlation coefficients (ICC). Intratester ICC (3, 1) and minimal detectable change at the 95% confidence level (MDC(95)) were calculated for each tester and then averaged yielding the following: ICC = 0.76 (95% CI: 0.68-0.84), MDC(95) = 2.83. Intertester ICC (2, 1) was 0.78 (95% CI: 0.64-0.88). MDC(95) was 2.81. This gives an MDC(95) for this test of 3 sites. The results of this study support the use of the 10-g monofilament as a reliable clinical tool to assess changes in protective sensation of the feet for our participant pool. An 18-site sensory examination using the 10-g monofilament must result in sensory change at 3 or more sites to indicate actual change in protective sensation.

Spiritual well-being and health-related quality of life in colorectal cancer: a multi-site examination of the role of personal meaning

Individuals diagnosed and treated for cancer often report high levels of distress, continuing even after successful treatment. Spiritual well-being (SpWB) has been identified as an important factor associated with positive health outcomes. This study had two aims: (1) examine the associations between SpWB (faith and meaning/peace) and health-related quality of life (HRQL) outcomes and (2) examine competing hypotheses of whether the relationship among distress, SpWB, and HRQL is better explained by a stress-buffering (i.e., interaction) or a direct (main effects) model. Study 1 consisted of 258 colorectal cancer survivors (57% men) recruited from comprehensive cancer centers in metropolitan areas (age, M=61; months post-diagnosis, M=17). Study 2 consisted of 568 colorectal cancer survivors (49% men) recruited from a regional cancer registry (age, M=67; months post-diagnosis, M=19). Participants completed measures of SpWB (functional assessment of chronic illness therapy-spiritual well-being (FACIT-Sp)) and HRQL (functional assessment of cancer therapy-colorectal) in both studies. Measures of general distress (profile of mood states-short form) and cancer-specific distress were also completed in study 1 and study 2, respectively. After controlling for demographic and clinical variables, faith and meaning/peace were positively associated with HRQL. However, meaning/peace emerged as a more robust predictor of HRQL outcomes than faith. Planned analyses supported a direct rather than stress-buffering effect of meaning/peace. This study provides further evidence of the importance of SpWB, particularly meaning/peace, to HRQL for people with colorectal cancer. Future studies of SpWB and cancer should examine domains of the FACIT-Sp separately and explore the viability of meaning-based interventions for cancer survivors.