Neural Regulation of Pancreatic Cancer: A Novel Target for Intervention

The tumor microenvironment is known to play a pivotal role in driving cancer progression and governing response to therapy. This is of significance in pancreatic cancer where the unique pancreatic tumor microenvironment, characterized by its pronounced desmoplasia and fibrosis, drives early stages of tumor progression and dissemination, and contributes to its associated low survival rates. Several molecular factors that regulate interactions between pancreatic tumors and their surrounding stroma are beginning to be identified. Yet broader physiological factors that influence these interactions remain unclear. Here, we discuss a series of preclinical and mechanistic studies that highlight the important role chronic stress plays as a physiological regulator of neural-tumor interactions in driving the progression of pancreatic cancer. These studies propose several approaches to target stress signaling via the β-adrenergic signaling pathway in order to slow pancreatic tumor growth and metastasis. They also provide evidence to support the use of β-blockers as a novel therapeutic intervention to complement current clinical strategies to improve cancer outcome in patients with pancreatic cancer.

A promotora de salud CVD intervention: Participant responses after Su Corazon, Su Vida education

In this study we sought to identify and understand feelings, benefits and barriers to making heart healthy behavioral changes by reviewing and analyzing participant responses to a follow-up telephone survey conducted as part of the HEART project (Health Education Awareness Research Team). Individuals who participated in HEART attended classes and received “Su Corazon, Su Vida” education. The HEART follow-up telephone survey was conducted only on those participants who were part of the experimental group. A total of 93 individuals from this group were successfully contacted for participation in the telephone survey after the classes ended. Quantitative data regarding ‘feelings’ and ‘difficulty making heart healthy behavioral changes’ were analyzed by calculating frequencies of each category of response for post-intervention weeks 9, 13, and 15. In addition, Wilcoxon rank-sum tests were conducted for post-intervention at weeks 9, 13, and 15 to measure associations between feelings and difficulties making heart healthy behavioral changes. Changes in responses over time for feelings and difficulties making heart healthy behavioral changes were looked at by counting differences in responses between pairs of follow up weeks. Qualitative responses to the survey were analyzed by categorizing content of responses under themes in order to identify factors related to feelings and difficulties making heart healthy behavioral changes. Telephone survey participants showed positive attitudes towards making nutritional and physical activity changes. Out of the 93 telephone survey respondents, 53 (57%) reported some type of physical activity change during the follow-up period while 46 (49%) reported specific changes in nutrition. Data from the “difficulty to making changes” responses were categorized under constructs from the Health Belief Model, perceived benefits and barriers. Overall, the barriers for physical activity were health issues, individual habits and time. Barriers to eating healthy were family support, individual habits, and knowledge. This study suggests that with respect to nutritional knowledge barriers, educational programs should explore other ways of teaching and familiarizing individuals with information sources that may be more appropriate for those populations not accustomed to them. For example, nutrition labels, portions, recipes, and use of photonovelas. Our findings of the barriers to changes in food preparation due to lack of family support may also suggest the need for the development of programs where influential partners or relatives are involved in order to create a more supportive environment which may provide more opportunity for change toward healthier lifestyle behaviors. Finally, the physical activity barriers found suggest that it may be beneficial to recommend appropriate exercises for those with specific health problems or those with time restrictions due to work or travel so that physical activity is not completely avoided.^

Process evaluation of intervention program for prevention of early sexual activity and alcohol use among Hispanic teenagers

Hispanic teens are a high-risk population for initiation of early sexual activity and alcohol use which in turn has numerous social and health consequences. One strategy to address prevention of these behaviors is to implement a capacity building intervention that promotes parent child communication, encompasses their cultural values and community participation. This study describes the process evaluation of a pilot intervention program amongst Hispanic teens and their families living along the Texas-Mexico border. “Girls Lets Talk” is a small group intervention with 10-14 year old teens and their female adult family members that involves education regarding effects of alcohol use and sexual activity as well as activities for monitoring and refusal skills to prevent risky behaviors. Two waves of the program each consisting of at least seven mother daughter dyads were conducted. During the designing process, community advisory board meetings and focus groups were held to review course materials and ensure they were appropriate to the Mexican American culture. Parent and adolescent surveys were administered at the beginning and end of the intervention to assess for psychosocial outcome variables. All sessions received high mean satisfactory scores (mean of 4.00 or better on a five point scale) for both adult and adolescent participants. Qualitative feedback was obtained via debriefing sessions to evaluate experience as well as alter recruitment strategies. A Wilcoxon Sign Rank analysis of the pre and post intervention surveys was done that showed significant changes in some outcome variables such as intentions and confidence for monitoring behaviors for adults and beliefs regarding sexual activity. “Girls Lets Talk” is a promising example of how a process evaluation plan can help develop a theory based health promotion program using the community based participatory research approach. The intervention may also be effective in altering intentions and enhancing self-efficacy among parents and teens in order to decrease risky behaviors such as early sexual activity and alcohol use.^

Procedure for the identification of population characteristics for targeting intervention services on the basis of outcome-goal priorities: Case management services for the chronic mentally ill

Although the processes involved in rational patient targeting may be obvious for certain services, for others, both the appropriate sub-populations to receive services and the procedures to be used for their identification may be unclear. This project was designed to address several research questions which arise in the attempt to deliver appropriate services to specific populations. The related difficulties are particularly evident for those interventions about which findings regarding effectiveness are conflicting. When an intervention clearly is not beneficial (or is dangerous) to a large, diverse population, consensus regarding withholding the intervention from dissemination can easily be reached. When findings are ambiguous, however, conclusions may be impossible.^ When characteristics of patients likely to benefit from an intervention are not obvious, and when the intervention is not significantly invasive or dangerous, the strategy proposed herein may be used to identify specific characteristics of sub-populations which may benefit from the intervention. The identification of these populations may be used both in further informing decisions regarding distribution of the intervention and for purposes of planning implementation of the intervention by identifying specific target populations for service delivery.^ This project explores a method for identifying such sub-populations through the use of related datasets generated from clinical trials conducted to test the effectiveness of an intervention. The method is specified in detail and tested using the example intervention of case management for outpatient treatment of populations with chronic mental illness. These analyses were applied in order to identify any characteristics which distinguish specific sub-populations who are more likely to benefit from case management service, despite conflicting findings regarding its effectiveness for the aggregate population, as reported in the body of related research. However, in addition to a limited set of characteristics associated with benefit, the findings generated, a larger set of characteristics of patients likely to experience greater improvement without intervention. ^

A Young Child's Anxiety and Math Performance: Enhancing Cognitive Behavioral Intervention with Conjoint Behavioral Consultation

Partnering with families, school personnel, and community resources is an important step to supporting the child and family, especially when children might suffer from debilitating anxiety concerns. However, little research examines the impact of anxiety on math performance for young children participating in school-based interventions enhanced by family components. The following research questions were addressed in the study: 1a) Will a young child with elevated levels of anxiety show a decrease in anxiety symptoms with a Cognitive Behavioral framework intervention program for children? 1b) Will anxiety be reduced with the addition of a Conjoint Behavioral Consultation with the family and teacher? 2a) Will a young child show an increase in math performance after participation in a Cognitive Behavioral framework intervention program for children? 2b) Will math performance be increased with the addition of a Conjoint Behavioral Consultation with the family and teacher? A single-subject staggered baseline across situations intervention study addressed whether the Coping Cat, an evidenced-based child-focused intervention now widely used in schools and clinics to treat childhood anxiety, combined with family and school consultation will decrease elevated anxiety levels and improve math performance in an elementary-aged student. The objective was to support mental health development and math performance with an eight-year-old, female elementary student through a collaborative effort of stakeholders in the student's life. Baseline data was collected with repeated measures of anxiety and math performance, and was compared to two intervention phases: first, a child-focused intervention and second, a family and school consultation. The study tested the theory that the Cognitive Behavioral intervention and Conjoint Behavioral Consultation intervention will influence, positively, the anxiety levels and math performance for an elementary-aged student. Results indicate that the child participant with elevated levels of anxiety showed a reduction in symptoms with the introduction of a Cognitive Behavioral framework intervention when compared to her baseline data. The participant showed further reduction in symptoms across the school and home settings with the implementation of Conjoint Behavioral Consultation when compared to baseline and the first intervention phase. Math performance began to increase with the introduction of the Cognitive Behavioral intervention, and continued to improve with the implementation of the Conjoint Behavioral Consultation. Findings suggest that consultation should begin immediately when an intervention is implemented in order to enhance outcomes.

La légalité de l'intervention militaire française au Mali : contribution à l’étude du cadre juridique de la lutte armée contre le terrorisme international

Mémoire récipiendaire de la mention "Excellent", avec les félicitations du jury.

Les pratiques d’intervention policières auprès des personnes en crise ou atteintes de troubles mentaux : le cas des agents de réponse en intervention de crise du Service de police de la Ville de Montréal

Cette recherche porte sur les pratiques d’intervention des agents de réponse en intervention de crise (RIC), de leur partenaire fixe et des agents en attente de la formation du Service de police de la Ville de Montréal (SPVM) auprès des personnes en crise ou atteintes de troubles mentaux. Les agents RIC sont des patrouilleurs de première ligne qui ont reçu une formation complète sur les principes d’intervention en contexte de crise ou de santé mentale. Ce modèle de réponse spécialisée est une solution proactive qui a pour but d’améliorer l’action policière en situation de crise et de veiller à une meilleure prise en charge de ces personnes par les ressources institutionnelles. La désinstitutionnalisation des soins et des services psychiatriques a eu pour effet une augmentation du nombre de personnes atteintes de troubles mentaux dans la communauté. Par conséquent, cet accroissement a engendré des rapports plus fréquents entre les services policiers et cette clientèle. Les interventions en contexte de crise ou de santé mentale sont particulières et complexes, de même qu’elles requièrent un niveau supérieur de compréhension des crises humaines. Les autorités policières ont admis que ces interventions représentent une part significative de leur travail et que la formation policière traditionnelle ne les prépare pas suffisamment pour intervenir adéquatement auprès de cette population. En réponse à ces considérations et dans l’objectif d’améliorer leur capacité d’agir, les forces policières se sont dotées de modèles de réponse policière spécialisée en intervention de crise. L’approche la plus répandue est l’équipe d’intervention de crise (« crisis intervention team » ou « CIT »), aussi appelée le modèle de Memphis. Il existe plusieurs variantes de ce modèle, mais les composantes principales, c’est-à-dire la formation avancée et la consolidation d’un partenariat avec le système de santé demeurent dans l’ensemble de ces structures. L’objectif de cette recherche consiste à sonder les perceptions des agents RIC, de leur partenaire fixe et des agents en attente de la formation afin de comprendre et de contraster leurs visions et leurs pratiques d’intervention en contexte de crise ou de santé mentale. Chaque groupe a apporté des précisions intéressantes. Nous avons conduit 12 entrevues qualitatives avec des policiers du SPVM. De façon générale, les participants rapportent que leurs pratiques d’intervention auprès des personnes en crise ou atteintes de troubles mentaux sont davantage ancrées dans une perspective de relation d’aide. Ils mentionnent également que la communication, l’écoute et la confiance doivent être privilégiées avant tout autre stratégie dans les situations qui les permettent et que la force doit être employée seulement lorsqu’elle est nécessaire, c’est-à-dire lorsque leur sécurité ou celle d’autrui est en péril ou lorsque la communication n’est pas possible. Puis, ils admettent que le recours à l’expertise des intervenants en santé mentale permet une analyse plus approfondie de la situation et de l’état mental de la personne visée par l’intervention. D’autre part, en ce qui concerne les limites de la formation policière traditionnelle, les candidats ont soulevé qu’il y a un manque de connaissances en matière de santé mentale ainsi qu’une difficulté associée à l’évaluation de l’état de la personne et du besoin de transport ont été soulevés. Sur le plan des apprentissages, les agents RIC disent avoir une compréhension plus globale de la problématique de santé mentale, de meilleures habiletés communicationnelles, une analyse plus approfondie de la situation, de plus grandes connaissances juridiques, une compréhension du fonctionnement des services hospitaliers ainsi qu’une appréciation particulière pour le partage de savoirs et les principes d’endiguement. Ils font part également de l’importance des rapports pour documenter l’évolution de l’état mental d’une personne et ils ajoutent que la dimension temporelle joue un rôle clé dans la résolution définitive de la problématique. Au sujet des partenaires, ils évoquent des retombées similaires. Toutefois, à la suite de la formation, ils reconnaissent davantage l’importance de leur rôle dans la sécurité de leur partenaire et ils y accordent dorénavant une attention marquée lors de ces interventions. Enfin, les agents non formés formulent des attentes relatives au développement d’outils et de compétences, ce qui leur sera rendu dans la formation RIC. Globalement, les agents RIC et les partenaires interviewés ont modifié leurs pratiques pour les arrimer avec la philosophie des interventions en contexte de crise ou de santé mentale. Ils ont également davantage confiance en leurs capacités et habiletés d’intervention auprès des personnes en crise ou atteintes de troubles mentaux grâce aux connaissances acquises dans la formation.

La légalité de l'intervention militaire française au Mali : contribution à l’étude du cadre juridique de la lutte armée contre le terrorisme international.

Mémoire récipiendaire de la mention "Excellent", avec les félicitations du jury.

Les pratiques d’intervention policières auprès des personnes en crise ou atteintes de troubles mentaux : le cas des agents de réponse en intervention de crise du Service de police de la Ville de Montréal

Cette recherche porte sur les pratiques d’intervention des agents de réponse en intervention de crise (RIC), de leur partenaire fixe et des agents en attente de la formation du Service de police de la Ville de Montréal (SPVM) auprès des personnes en crise ou atteintes de troubles mentaux. Les agents RIC sont des patrouilleurs de première ligne qui ont reçu une formation complète sur les principes d’intervention en contexte de crise ou de santé mentale. Ce modèle de réponse spécialisée est une solution proactive qui a pour but d’améliorer l’action policière en situation de crise et de veiller à une meilleure prise en charge de ces personnes par les ressources institutionnelles. La désinstitutionnalisation des soins et des services psychiatriques a eu pour effet une augmentation du nombre de personnes atteintes de troubles mentaux dans la communauté. Par conséquent, cet accroissement a engendré des rapports plus fréquents entre les services policiers et cette clientèle. Les interventions en contexte de crise ou de santé mentale sont particulières et complexes, de même qu’elles requièrent un niveau supérieur de compréhension des crises humaines. Les autorités policières ont admis que ces interventions représentent une part significative de leur travail et que la formation policière traditionnelle ne les prépare pas suffisamment pour intervenir adéquatement auprès de cette population. En réponse à ces considérations et dans l’objectif d’améliorer leur capacité d’agir, les forces policières se sont dotées de modèles de réponse policière spécialisée en intervention de crise. L’approche la plus répandue est l’équipe d’intervention de crise (« crisis intervention team » ou « CIT »), aussi appelée le modèle de Memphis. Il existe plusieurs variantes de ce modèle, mais les composantes principales, c’est-à-dire la formation avancée et la consolidation d’un partenariat avec le système de santé demeurent dans l’ensemble de ces structures. L’objectif de cette recherche consiste à sonder les perceptions des agents RIC, de leur partenaire fixe et des agents en attente de la formation afin de comprendre et de contraster leurs visions et leurs pratiques d’intervention en contexte de crise ou de santé mentale. Chaque groupe a apporté des précisions intéressantes. Nous avons conduit 12 entrevues qualitatives avec des policiers du SPVM. De façon générale, les participants rapportent que leurs pratiques d’intervention auprès des personnes en crise ou atteintes de troubles mentaux sont davantage ancrées dans une perspective de relation d’aide. Ils mentionnent également que la communication, l’écoute et la confiance doivent être privilégiées avant tout autre stratégie dans les situations qui les permettent et que la force doit être employée seulement lorsqu’elle est nécessaire, c’est-à-dire lorsque leur sécurité ou celle d’autrui est en péril ou lorsque la communication n’est pas possible. Puis, ils admettent que le recours à l’expertise des intervenants en santé mentale permet une analyse plus approfondie de la situation et de l’état mental de la personne visée par l’intervention. D’autre part, en ce qui concerne les limites de la formation policière traditionnelle, les candidats ont soulevé qu’il y a un manque de connaissances en matière de santé mentale ainsi qu’une difficulté associée à l’évaluation de l’état de la personne et du besoin de transport ont été soulevés. Sur le plan des apprentissages, les agents RIC disent avoir une compréhension plus globale de la problématique de santé mentale, de meilleures habiletés communicationnelles, une analyse plus approfondie de la situation, de plus grandes connaissances juridiques, une compréhension du fonctionnement des services hospitaliers ainsi qu’une appréciation particulière pour le partage de savoirs et les principes d’endiguement. Ils font part également de l’importance des rapports pour documenter l’évolution de l’état mental d’une personne et ils ajoutent que la dimension temporelle joue un rôle clé dans la résolution définitive de la problématique. Au sujet des partenaires, ils évoquent des retombées similaires. Toutefois, à la suite de la formation, ils reconnaissent davantage l’importance de leur rôle dans la sécurité de leur partenaire et ils y accordent dorénavant une attention marquée lors de ces interventions. Enfin, les agents non formés formulent des attentes relatives au développement d’outils et de compétences, ce qui leur sera rendu dans la formation RIC. Globalement, les agents RIC et les partenaires interviewés ont modifié leurs pratiques pour les arrimer avec la philosophie des interventions en contexte de crise ou de santé mentale. Ils ont également davantage confiance en leurs capacités et habiletés d’intervention auprès des personnes en crise ou atteintes de troubles mentaux grâce aux connaissances acquises dans la formation.

Report digest follow-up report Department of Human Services' Early Intervention Program /

"The audit was conducted pursuant to Public Act 92-307, which became effective on August 9, 2001. This audit was conducted in accordance with generally accepted government auditing standards and the audit standards promulgated by the Office of the Auditor General at 74 Ill. Adm. Code 420.310. The audit report is transmitted in conformance with Section 3-14 of the Illinois State Auditing Act."--Cover letter.

Report digest management audit Department of Human Services' Early Intervention Program /

"The audit was conducted pursuant to Legislative Audit Commission Resolution Number 122, which was adopted on June 26, 2001. This audit was conducted in accordance with generally accepted government auditing standards and the audit standards promulgated by the Office of the Auditor General at 74 Ill. Adm. Code-420-310. The audit report is transmitted in conformance with Section 3-14 of the Illinois State Auditing Act."--Cover letter.

Oral Health Experiences of Social Workers Serving Children in the Foster Care System: Assessing the Feasibility of a Social Worker-Driven Oral Health Intervention

Thesis (Master's)--University of Washington, 2016-06

Evaluation of a brief child-focused group-based intervention for anxiety-disordered children

This paper presents a pilot study of a brief, group-based, cognitive-behavioural intervention for anxiety-disordered children. Five children (aged 7 to 13 years) diagnosed with a clinically significant anxiety disorder were treated with a recently developed 6-session, child-focused, cognitive-behavioural intervention that was evaluated using multiple measures (including structured diagnostic interview, self-report questionnaires and behaviour rating scales completed by parents) over four follow-up occasions (posttreatment, 3-month follow-up, 6-month follow-up and 12-month follow-up). This trial aimed to (a) evaluate the conclusion suggested by the research of Cobham, Dadds, and Spence (1998) that anxious children with non-anxious parents require a child-focused intervention only in order to demonstrate sustained clinical gains; and (b) to evaluate a new and more cost-effective child-focused cognitive-behavioural intervention. Unfortunately, the return rate of the questionnaires was poor, rendering this data source of questionable value. However, diagnostic interviews (traditionally the gold standard in terms of outcome in this research area) were completed for all children at all follow-up points. Changes in diagnostic status indicated that meaningful treatment-related gains had been achieved and were maintained over the full follow-up period. The results would thus seem to support the principle of participant-intervention matching proposed by Cobham et al. (1998), as well as the utility of the more brief intervention evaluated.

An analysis of the effectiveness of a behavioural based safety intervention in a UK paper mill

This research examines a behavioural based safety (BBS) intervention within a paper mill in the South East of England. Further to this intervention two other mills are examined for the purposes of comparison — one an established BBS programme and the other an improving safety management system through management ownership. BBS programmes have become popular within the UK, but most of the research about their efficacy is carried out by the BBS providers themselves. This thesis aims to evaluate a BBS intervention from a standpoint which is not commercially biased in favour of BBS schemes. The aim of a BBS scheme is to either change personnel behaviours or attitudes, which in turn will positively affect the organisation's safety culture. The research framework involved a qualitative methodology in order to examine the effects of the intervention on the paper mill's safety culture. The techniques used were questionnaires and semi structured interviews, in addition to observation and discussions which were possible because of the author's position as participant observer. The results demonstrated a failure to improve any aspect of the mill's safety culture, which worsened following the BBS intervention. Issues such as trust, morale, communication and support of management showed significant signs of negative workforce response. The paper mill where the safety management system approach was utilised demonstrated a significantly improved safety culture and achieved site ownership from middle managers and supervisors. Research has demonstrated that a solid foundation is required prior to successfully implementing a BBS programme. For a programme to work there must be middle management support in addition to senior management commitment. If a trade union actively distances itself from BBS, it is also unlikely to be effective. This thesis proposes that BBS observation programmes are not suitable for the papermaking industry, particularly when staffing levels are low due to challenging economic conditions. Observers are not available when there are high hazard situations and this suggests that BBS implementation is not the correct intervention for the paper industry.

A preliminary investigation into the effects of ocular lubricants on higher order aberrations in normal and dry eye subjects

Purpose: To study the effects of ocular lubricants on higher order aberrations in normal and self-diagnosed dry eyes. Methods: Unpreserved hypromellose drops, Tears Again™ liposome spray and a combination of both were administered to the right eye of 24 normal and 24 dry eye subjects following classification according to a 5 point questionnaire. Total ocular higher order aberrations, coma, spherical aberration and Strehl ratios for higher order aberrations were measured using the Nidek OPD-Scan III (Nidek Technologies, Gamagori, Japan) at baseline, immediately after application and after 60. min. The aberration data were analyzed over a 5. mm natural pupil using Zernike polynomials. Each intervention was assessed on a separate day and comfort levels were recorded before and after application. Corneal staining was assessed and product preference recorded after the final measurement for each intervention. Results: Hypromellose drops caused an increase in total higher order aberrations (p= <0.01 in normal and dry eyes) and a reduction in Strehl ratio (normal eyes: p= <0.01, dry eyes p= 0.01) immediately after instillation. There were no significant differences between normal and self-diagnosed dry eyes for response to intervention and no improvement in visual quality or reduction in higher order aberrations after 60. min. Differences in comfort levels failed to reach statistical significance. Conclusion: Combining treatments does not offer any benefit over individual treatments in self-diagnosed dry eyes and no individual intervention reached statistical significance. Symptomatic subjects with dry eye and no corneal staining reported an improvement in comfort after using lubricants. © 2013 British Contact Lens Association.