Three-phase Study Research Articles

Toxic Absence: Why Leader Presence Matters in Times of Crisis

Aims. This study examines the importance of senior-leader presence on the “frontline” in times of crisis. Background. The COVID-19 pandemic placed unprecedented demands on nurses charged with delivering critical care. Extant research suggests that the active presence of ward-level leaders has an important role to play in supporting frontline staff and mediating the negative impacts of stress and burnout. There is little evidence on the impact of senior leader presence or absence on the experience of frontline critical care nurses, particularly at times of crisis. Methods. A three-phase qualitative interview study of critical care nurses in the UK and Ireland. A total of 107 semistructured interviews with 54 nurses representing 38 different healthcare units. Results. Senior-leader presence at the time of crisis serves as an important symbol of organisational support. Where senior leaders are not meaningfully present, they risk allowing the necessary pain of difficult work situations to become toxic. Toxicity is manifested with increased staff stress, emotional ills, absence, and turnover. Conclusions. Senior leaders must balance their responsibilities for strategy and structures with the frontline presence required to shape a positive emotional climate. Implications for Nursing Management. Senior managers should consider supplementing their strategic focus with punctuated returns to the floor. Symbolically, leaders who get their hands dirty embody a sense of mutual struggle and practical support. Managerially, time on the floor increases the opportunities for collecting primary data to improve decision-making and support.

Enhancing the hospital at home experience

Background Hospital at Home programs have demonstrated to be safe, feasible and cost effective. However, challenges such as infection control, cleanliness, space constraints and insufficient resources may hamper the adoption and effectiveness of such programs. Aims To understand the challenges of providing and receiving healthcare in the community, design a solution to meet the challenges, and to pilot and evaluate the solution. Methods This is a three-phase mixed method study. Phase 1, nurses, patients and caregivers were surveyed to understand their challenges in providing or receiving healthcare at home. Results of the survey in Phase 1 were used in Phase 2 to design a solution. In phase 3, an integrated structure was designed and piloted for stakeholders’ evaluation. Results Twenty nurses and 50 patient-caregiver dyads responded to Phase 1 survey. Physical home environment was most cited by the nurses as their main challenge, particularly the lack of a dedicated and clean space to conduct nursing procedures. Medication management was the greatest challenge faced by the patient-caregiver dyads. Based on these findings, a prototype of an integrated structure was fabricated in Phase 2. Ten patient-caregiver dyads and nine community nurses tested the prototype in Phase 3. The participants found the structure useful to store and organize their healthcare items, and there was ample clean workspace to carry out nursing procedures. Conclusion An integrated structure that can fulfil the physical, spatial and interpersonal needs at an affordable price could be useful in facilitating the delivery of hospital care in the home setting. Patient Contribution Patient-caregiver dyads were key stakeholders in our study. They provided valuable feedback and suggestions on the prototype and design of the integrated structure.

Designing and Evaluating a Nutrition Recommender System for Improving Food Security in a Developing Country.

Due to the increased price of foods in recent years and the diminished food security in Iran, nutrition recommender systems can suggest the most suitable and affordable foods and diets to users based on their health status and food preferences. Objective: The present study aimed to design and evaluate a recommender system to suggest healthy and affordable meals and provide a tele-nutrition consulting service. This applied three-phase study was conducted in 2020. In the first stage, the food items' daily prices were extracted from credible sources, and accordingly, meals were placed in three price categories. After conducting a systematic review of similar systems, the requirements and data elements were specified and confirmed by 10 nutritionists and 10 health information management and medical informatics experts. In the second phase, the software was designed and developed based on the findings. In the third phase, system usability was evaluated by four experts based on Nielsen's heuristic evaluation. Initially, 72 meals complying with nutritional principles were placed in three price categories. Following a literature review and expert survey, 31 data elements were specified for the system, and the experts confirmed system requirements. Based on the information collected in the previous stage, the Web-based software TanSa in the Persian language was designed, developed, and presented on a unique domain. During the evaluation, the mean severity of the problems associated with Nielsen's 10 principles was 1.2, which is regarded as minor. To promote food security, the designed system recommends healthy, nutritional, and affordable meals to individuals and households based on user characteristics.

Stop, Drop, and Pivot: An Action Researcher's Lived Experience through the COVID-19 Interruption

This article chronicles the experience of an action researcher who was conducting a study in a post-secondary setting when COVID-19 swept across the globe and interrupted the research. The researcher set out to understand the aspects that promote and increase student investment in the classroom, and what she could do to positively impact student investment. This was accomplished through a three-phase action research study that was interrupted by COVID-19. The onset of the COVID-19 pandemic necessitated a pivot in the setting of the study and the last phase of the action research plan. The purpose of this article is to focus on the researcher’s perspective as a co-participant in the study while examining the changes brought about by the pandemic, and to address the implications of the findings and directions for future research. Of the three data sources in the study, the personal reflection journal of the researcher and co-participant feature heavily in expressing the lived experience of the researcher.

Self-fermented agro-wastes as antioxidant enriched maize grain replacer for sustainable animal feeding

Piles of agro-wastes resulting from quantum agro-industrial growth can be best utilized as animal feed, reducing envionmental impact by 50–95% depending on their nutritive value. However, palatability issues have limited their use, which can be addressed by combining them based on their nutritional value. Thus present three-phase study aimed to utilize these waste materials as animal feed by utilizing a self-fermentation approach. Six combinations of apple pomace (AP), spent mushroom compost (SMC) and wheat straw were self-fermented and analysed for quality in phase-I. Phase-II assessed the best combination obtained from phase-I as an antioxidant-enriched maize replacer (AEMR) by replacing maize (0–32%) in total mixed ration (TMR) under in-vitro ruminal conditions and two best TMR were assessed for nutrient utilization under metabolic trial. In phase-III, the three-month feeding effect of AEMR on the overall growth performance of male Gaddi goat kids was assessed. Findings showed that 85:7.5:7.5 proportion had optimal pH (3.92), significantly higher lactic acid (5.29 g 100−1 g DM), water soluble carbohydrates (2.29 g 100−1 g DM) and oxidative and microbial stability (Lactobacillus: 8.38 log10 cfu g−1). Fermentation also resulted in significant increase in antioxidant activities. AEMR exhibited a significant reduction in CH4 and NH3–N and higher volatile fatty acid production under in-vitro conditions at 32% level with no adverse effects on nutrient utilization. AEMR feeding also exhibited significantly improved feed conversion ratio (FCR) and serum lipid and oxidative profiles. In conclusion, AP and SMC in combined form can be utilized as an AEMR through self-fermentation at 32% level in TMR which may serve as a promising and sustainable approach for reducing environmental footprints and boosting eco-friendly livestock production.

Barriers to the use of three-month Paliperidone Palmitate formulation: a study from an Italian real-world setting

ABSTRACT Background Long-acting injectable paliperidone can improve adherence in psychotic patients and reduce relapses and healthcare resource utilization (HRU). This study compares the effectiveness of the three-monthly paliperidone palmitate (PP3M) with the one-monthly formulation (PP1M) and investigates reasons that hinder the use of PP3M in real-world settings. Methods The authors conducted a three-phase observational study. For subjects recruited from six psychiatric services in Milan, HRU outcomes of PP3M prescription were evaluated through a 12-month mirror-image design (phase 1) and a comparison of HRU of PP1M-only subjects and PP3M subjects during the year prior to PP3M initiation (phase 2). Lastly, they conducted a survey among physicians concerning reasons for not switching to PP3M (phase 3). Results A total of 119 subjects (61 on PP3M and 58 on PP1M) were included. One year after PP3M initiation, outpatients’ visits decreased significantly. Comparing PP3M with PP1M subjects, no significant difference was found in HRU. Perception of patient’s unstable clinical condition was the main reason for maintaining PP1M (32.8%), followed by the need for monthly monitoring (19.7%). Conclusion PP3M initiation was associated with an overall HRU reduction. Subjects switched to PP3M had similar HRU when compared to those who did not, suggesting similar clinical conditions in both groups.

Understanding the audience in framing research: empirical evidence from three studies examining HIV framing in China.

Guided by framing theory, this three-phase mixed-methods study explored (a) how Chinese government-sponsored newspapers frame HIV and (b) framing effects on people's HIV beliefs. A content analysis of two government-sponsored newspapers and a survey of 210 readers showed discrepancies in frame and frame valence. In-depth follow-up interviews with 15 media and public health experts revealed that the discrepancies were related to people's attitudes toward the media and beliefs about HIV, which could further be explained by the political environment, media ecology, historical framing, and cultural identities in China. We discuss theoretical implications for framing theory and practical implications for HIV media coverage.

A prospective study on body image disturbances during pregnancy and postpartum: the role of cognitive reappraisal.

During pregnancy, body size rapidly modifies over a relatively short period. Literature emphasizes the need to identify the factors that influence body image during peripartum as the extent of women's adaptation to these changes has significant repercussions on both mother's and newborn's health. Emotion regulation strategies (i.e., expressive suppression and cognitive reappraisal) were linked to body image in the general and clinical population, but no studies were conducted in the peripartum. The present study aims to investigate the longitudinal impact of prepartum body image disturbances on postpartum body image disturbances and to evaluate the mediational role of emotional regulation strategies. A total of 133 pregnant women completed a three-phase longitudinal study. Women answered online questionnaires during the second (T1) and the third (T2) trimesters of pregnancy, and at about 6 months postpartum (T3). Findings indicated that body image disturbances at T1 were a significant predictor of body image disturbances in the postpartum (1 year after the first assessment). Moreover, cognitive reappraisal measured at T2 partially mediated this relationship: body image disturbances in the second trimester of pregnancy were linked to less use of cognitive reappraisal in the third trimester of pregnancy, and this, in turn, was associated with worse body image disturbances at 6 months after birth. Findings of this longitudinal study highlight the importance of assessing body image disturbances during pregnancy to early identify women at risk, and suggest cognitive reappraisal as a possible target intervention.

Domestic electricity consumers and the interactive bill: design intervention for improved energy literacy and empowerment

Domestic electricity consumption has been the subject of numerous interventions that address environmental, economic, social, and technical issues, with the primary objective of reducing the consumed kilowatt per hour (kWh). Taking a mixed-method approach, this research explores a design intervention through a prototype of a digital interactive electricity bill. This innovative bill had a dual purpose: 1. A design probe for improving usability, usefulness, and user experience; and 2. A research tool for generating knowledge and understanding of the perceptions, attitudes, and behaviors of domestic electricity consumers. This three-phase study involved domestic electricity consumers, who explored and interacted with the prototype. Findings show that the interactive bill is more understandable and useful compared to the current printed or e-document bill, and thus may enhance users' empowerment, sense of control, curiosity to seek additional information and energy literacy. The study provides a direction for further research, toward establishing a connection between design and smarter energy consumption.

Care bundle for the prevention of peripheral venous catheter blood stream infections at a secondary care university hospital: Implementation and results.

Venous catheterization for diagnostic and therapeutic purposes is part of routine hospital practice, as approximately 70% of hospitalized patients have a peripheral venous catheter (PVC). This practice, however, can lead to both local complications, (e.g., chemical, mechanical and infectious phlebitis) and systemic complications (e.g., PVC-related bloodstream infections [PVC-BSIs]). Surveillance data and activities are central to preventing nosocomial infections, phlebitis and improving patient care and safety. The aim of this study was to evaluate the impact of a care bundle on reducing PVC-BSI rates and phlebitis at a secondary care hospital in Mallorca, Spain. Three-phase intervention study targeting hospitalized patients with a PVC. The VINCat criteria were used to define PVC-BSIs and calculate incidence. In phase I (August-December 2015), we retrospectively analyzed baseline PVC-BSI rates at our hospital. In phase II (2016-2017), we conducted safety rounds and developed a care bundle with the goal of reducing PVC-BSI rates. In phase III (2018), we expanded the PVC-BSI bundle to prevent phlebitis and analyzed its impact. The incidence of PVC-BSIs decreased from 0.48 episodes per 1000 patient-days in 2015 to 0.17 episodes per 1000 patient-days in 2018. The 2017 safety rounds also detected a reduction in phlebitis (from 4.6% of 2.6%). Overall, 680 healthcare professionals were trained in catheter care and five safety rounds were conducted to assess bedside care. Implementation of a care bundle significantly reduced PVC-BSI rates and phlebitis at our hospital. Continuous surveillance programs are needed to adapt measures to improve patient care and guarantee safety.

Examining cultural differences in Airbnb naming convention and user reception: an eye-tracking study

ABSTRACT Listing titles significantly impact consumer behaviors on shared-economy platforms (e.g. Airbnb). Due to limited research on the length, informativeness, and creativity of titles in this context, this research investigates consumers’ responses and perceptions towards various types of listing titles by exploring their cognitive processes and conscious preferences. In a three-phase study design, this research analyzed Airbnb listing titles in China and America, conducted eye-tracking experiments, and collected surveys to evaluate the effects of title length and informativeness. The results revealed cultural differences in titles, but similar behaviors among Chinese and English-speaking consumers. Cultural assumptions, processing, and informativeness were discussed.

Creating year 7 bubbles to support primary to secondary school transition: a positive pandemic outcome?

ABSTRACTIn this paper, we explore the benefits of new forms of in-school grouping for children moving from primary to secondary school during the COVID-19 pandemic in England. Our three-phase study with over 400 students and teachers found that protective measures to limit COVID-19 though year group ‘bubbles’ generated an environment more aligned to children’s previous primary school experience. This natural experiment smoothed the process of transition by providing a better correspondence with students’ developmental needs, especially for those on the cusp of adolescence. We recommend that physical, administrative and pedagogical school structures are reimagined for this age group to this end.

Clinical benefit of AI-assisted lung ultrasound in a resource-limited intensive care unit

BackgroundInterpreting point-of-care lung ultrasound (LUS) images from intensive care unit (ICU) patients can be challenging, especially in low- and middle- income countries (LMICs) where there is limited training available. Despite recent advances in the use of Artificial Intelligence (AI) to automate many ultrasound imaging analysis tasks, no AI-enabled LUS solutions have been proven to be clinically useful in ICUs, and specifically in LMICs. Therefore, we developed an AI solution that assists LUS practitioners and assessed its usefulness in a low resource ICU.MethodsThis was a three-phase prospective study. In the first phase, the performance of four different clinical user groups in interpreting LUS clips was assessed. In the second phase, the performance of 57 non-expert clinicians with and without the aid of a bespoke AI tool for LUS interpretation was assessed in retrospective offline clips. In the third phase, we conducted a prospective study in the ICU where 14 clinicians were asked to carry out LUS examinations in 7 patients with and without our AI tool and we interviewed the clinicians regarding the usability of the AI tool.ResultsThe average accuracy of beginners’ LUS interpretation was 68.7% [95% CI 66.8–70.7%] compared to 72.2% [95% CI 70.0–75.6%] in intermediate, and 73.4% [95% CI 62.2–87.8%] in advanced users. Experts had an average accuracy of 95.0% [95% CI 88.2–100.0%], which was significantly better than beginners, intermediate and advanced users (p < 0.001). When supported by our AI tool for interpreting retrospectively acquired clips, the non-expert clinicians improved their performance from an average of 68.9% [95% CI 65.6–73.9%] to 82.9% [95% CI 79.1–86.7%], (p < 0.001). In prospective real-time testing, non-expert clinicians improved their baseline performance from 68.1% [95% CI 57.9–78.2%] to 93.4% [95% CI 89.0–97.8%], (p < 0.001) when using our AI tool. The time-to-interpret clips improved from a median of 12.1 s (IQR 8.5–20.6) to 5.0 s (IQR 3.5–8.8), (p < 0.001) and clinicians’ median confidence level improved from 3 out of 4 to 4 out of 4 when using our AI tool.ConclusionsAI-assisted LUS can help non-expert clinicians in an LMIC ICU improve their performance in interpreting LUS features more accurately, more quickly and more confidently.

Participatory prioritisation of interventions to improve primary school food environments in Gauteng, South Africa

BackgroundIn South Africa, overweight and obesity affect 17% of children aged 15–18. School food environments play a vital role in children’s health, influencing dietary behaviours and resulting in high obesity rates. Interventions targeting schools can contribute to obesity prevention if evidence-based and context-specific. Evidence suggests that current government strategies are inadequate to ensure healthy school food environments. The aim of this study was to identify priority interventions to improve school food environments in urban South Africa using the Behaviour Change Wheel model.MethodsA three-phased iterative study design was implemented. First, we identified contextual drivers of unhealthy school food environments through a secondary framework analysis of 26 interviews with primary school staff. Transcripts were deductively coded in MAXQDA software using the Behaviour Change Wheel and the Theoretical Domains Framework. Second, to identify evidence-based interventions, we utilised the NOURISHING framework and matched interventions to identified drivers. Third, interventions were prioritised using a Delphi survey administered to stakeholders (n = 38). Consensus for priority interventions was defined as an intervention identified as being 'somewhat' or ‘very' important and feasible with a high level of agreement (quartile deviation ≤ 0.5).ResultsWe identified 31 unique contextual drivers that school staff perceived to limit or facilitate a healthy school food environment. Intervention mapping yielded 21 interventions to improve school food environments; seven were considered important and feasible. Of these, the top priority interventions were to: 1) “regulate what kinds of foods can be sold at schools”, 2) “train school staff through workshops and discussions to improve school food environment”, and affix 3) “compulsory, child-friendly warning labels on unhealthy foods”.ConclusionPrioritising evidence-based, feasible and important interventions underpinned by behaviour change theories is an important step towards enhanced policy making and resource allocation to tackle South Africa’s childhood obesity epidemic effectively.

(049) Why isn’t Women’s Sexual Health Part of the Conversation? The Case of Vulvodynia

Abstract Introduction Vulvodynia is a complex pelvic pain condition that affects up to one in four women at some time in their lives. Patients report that primary care providers lack knowledge essential to diagnosis and management of this condition. Objectives The aim of this three-phase study was to identify ways of addressing the barriers to diagnosis and management of vulvodynia for women living in rural, northern and remote communities in XX. This paper reports on the second phase and asked: 1) How do family physicians and nurse practitioners describe their awareness and experience with diagnosing and managing vulvodynia? and 2) How would they like to receive information that addresses this knowledge gap? Methods Phase two of this qualitative case study collected data using an intake survey and individual and group interviews with a purposive sample of family physicians and nurse practitioners practicing in Newfoundland and Labrador. Surveys were completed prior to interviews and gathered data about demographics and vulvodynia awareness. Interviews were conducted in person or via teleconference between October 2018 and April 2019 and using standardized open-ended prompts. Audio-taped interviews were transcribed, de-identified and coded thematically. Two researchers independently analyzed all data. Results Two major themes emerged: a) lack of awareness about the condition and b) four barriers to having a sexual health conversation (the dynamics of discomfort, making the time, generational differences between patient and provider, and the gendering of practitioner responsibilities). Primary care providers also identified their preferred methods for addressing gaps in their knowledge. Conclusions Diagnosis and management of vulvodynia requires skilled communication and specific knowledge of this pelvic pain condition. Providing primary care providers with a simple toolkit has the potential to address reported lack of awareness about vulvodynia and the identified barriers to initiating a sexual health conversation. Disclosure No.

Quantification of titanium and zirconium elements in oral mucosa around healthy dental implants: a case–control pilot study

ObjectivesMetallic particles are detected in different sites of the oral cavity, mainly in patients with peri-implantitis lesions. The aim of this pilot study was to analyze the levels of titanium and zirconium elements in the oral mucosa around healthy implants and to investigate the impact of titanium exogenous contamination on the measurements.Materials and MethodsForty-one participants were included in this three-phase study. Two groups of subjects were defined according to presence of titanium or zirconia implants (n: 20) or without any implants nor metallic restorations (n:21). Thirteen patients (n: 5 with zirconia implant; n: 3 with titanium implants; n: 5 control group) took part to the first part designed to optimize and validate the method of detecting titanium (Ti) and zirconium (Zr) elements in the oral mucosa and gingival tissues by the Inductively Coupled Plasma Mass Spectrometry (ICPMS). The second phase compared the levels of Ti and Zr concentrations in patients with implants (n: 12) and without implants (n: 6) who were controlled for their intake of titanium dioxide (TiO2). The last step included ten control subjects without any metallic devices to measure the concentration of Ti and Zr before and after having candies containing TiO2.ResultsIn the first phase, concentrations of Ti and Zr were below the limit of detection (LOD) in most cases, 0.18 μg/L and 0.07 μg/L respectively. In the titanium group, two out of three subjects displayed concentrations above the LOD, 0.21 μg/L and 0.66 μg/L. Zr element was only found in patients with zirconia implants. After controlling the intake of TiO2, all concentrations of Ti and Zr were below the limit of quantification (LOQ). Moreover, in patients with no implants, the Ti concentration in gingiva cells was superior for 75% of the samples after having a TiO2 diet.ConclusionsZirconium was only found in patients with zirconia implants, whereas titanium was detected in all groups even in subjects with no titanium implants. Zirconium and titanium elements were not detected in patients who were controlled for their intake of food and their use of toothpaste irrespective of the presence of implants or not. For 70% of the patients, the titanium detection was directly influenced by the intake of TiO2 contained candies.Clinical relevanceWhen analyzing titanium particles, it is necessary to pay attention to the risk of contamination bias brought by external products. When this parameter was controlled, no titanium particles were detected around clinically healthy implants.

The Development of Recommendations for Healthcare Providers to Support Patients Experiencing Medication Self-Management Problems.

Medication self-management problems such as the inability to correctly obtain, understand, organize, administer or monitor medication can result in negative patient outcomes. However, supportive tools for healthcare providers to assist patients with medication self-management problems are lacking. This study aimed to develop recommendations for healthcare providers to support patients with polypharmacy who experience medication self-management problems. A three-phase study was conducted starting with (1) the mapping of medication self-management problems, followed by (2) a scoping review providing a list of relevant interventions and actions for each respective problem and (3) a three-round modified e-Delphi study with experts to reach consensus on the relevance and clarity of the recommended interventions and actions. The cut-off for consensus on the relevance and clarity of the recommendations was set at 80% expert agreement. Experts could propose additional recommendations based on their professional experience and expertise. The experts (n = 23) involved were healthcare professionals (i.e., nurses, pharmacists, and physicians) with specific expertise in medication management of patients with polypharmacy. Simultaneous with the second e-Delphi round, a panel of patients with polypharmacy (n = 8) evaluated the usefulness of recommendations. Results obtained from the patient panel were fed back to the panel of healthcare providers in the third e-Delphi round. Descriptive statistics were used for data analysis. Twenty medication self-management problems were identified. Based on the scoping review, a list of 66 recommendations for healthcare providers to support patients with the identified medication self-management problems was composed. At the end of the three-round e-Delphi study, the expert panel reached consensus on the relevance and clarity of 67 recommendations, clustered according to the six phases of the medication self-management model by Bailey et al. In conclusion, this study resulted in a guidance document including recommendations that can serve as a resource for healthcare providers to support patients with polypharmacy in case of medication self-management problems. Future research should focus on the evaluation of the feasibility and user-friendliness of the guide with recommendations in clinical practice.

Website redesign in a maternity setting: Co-designing a resource for consumer support and education

Women want to be informed about their healthcare. Google searches provide an accessible option for women during pregnancy, but the content is largely unmonitored. Women have expressed dissatisfaction and confusion about receiving conflicting information from clinicians across the maternity service. It is essential for providers to offer person-centred care and listen to the voices of consumers. If the aim is to provide a service women want to use, women must have the opportunity to voice what they want. The local health district (LHD) maternity website development project aimed to redesign maternity website pages over 12 months to meet community needs and increase hits to the site by 70% within six months. Consumers were approached to participate through maternity services in a regional Australian health district where approximately 3,500 babies are born yearly. In a three-phase participatory action research study, researchers identified the areas of concern for consumers, worked with them to co-design and implement a new website, and evaluated the changes. Almost 20% of women who birthed from January to March 2022 responded to the evaluation survey. Half of these had explored the website. After the upgrades, the number of hits to the district website service page increased by 875 (from 124 to 999). Post-development surveys showed that women who felt they received inconsistent information at the hospital during their pregnancy were more likely to visit the website for clarification (p = 0.009). Of women who visited the website, 78% found the information useful, and 73% said they would use it again. This study highlighted that women engaging in maternity services desire access to relevant, quality information through digital technology. Maternity website development improvements increased patient satisfaction and reduced confusion, providing a reliable source of accessible health information for consumers.

Understanding the Sensitivity of Mixture Cracking Performance Tests to Binder Properties and Long-Term Aging

The asphalt community is focused on the paradigm shift in mixture design from volumetrics to an optimization procedure based on performance tests called balanced mixture design (BMD). Laboratory performance tests are being assessed for their relationship to binder properties and field performance. However, existing BMD practice does not account for long-term oven aging (LTOA). This gap limits the appropriateness of thresholds and the potential of BMD for improving pavement performance. The Federal Highway Administration’s Asphalt Materials Research Program has launched a three-phase study to provide insights into relevant performance testing. Phase I compared seven cracking performance tests after short-term aging, whereas Phase II evaluated the sensitivity of selected performance tests to LTOA. Phase III, in which seven loose mixtures collected from Montana, Vermont, Ohio, and Florida were subjected to LTOA, is presented in this paper. The indirect tensile cracking, Illinois Flexibility Index, dynamic modulus, and cyclic fatigue tests were employed before and after two proposed LTOA conditioning protocols. Additionally, chemical, rheological, and fracture properties were obtained from extracted binders to obtain a better understanding of the impact of binder properties on mixture performance indices. Results illustrate that LTOA is critical for a comprehensive BMD framework and, thus, some of the testing protocols, indices, and thresholds need to be refined further.

A Pilot Study of an Educational Intervention to Increase Postpartum Medical Visit Attendance in Home-Visited Mothers.

Socioeconomically disadvantaged women experience barriers to attending postpartum medical visits (PMV). This three-phase pilot study explored the feasibility, acceptability, and preliminary effectiveness of an educational intervention to increase PMV attendance in mothers enrolled in early childhood home visiting. Phases 1 and 2 occurred prior to the COVID-19 pandemic, and Phase 3 occurred during the pandemic. Home visitor implementation of the intervention with mothers was feasible and acceptable in all phases. All mothers who received the intervention reported PMV attendance. Overall, 81% of mothers reported they discussed all questions with healthcare providers at the PMV. These findings provide preliminary effectiveness for a brief educational intervention in increasing PMV attendance in home-visited mothers.