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• 371. [Article] The Role of Emotional Support Consistency and Child Risk Factors in Predicting Pre-K Cognitive and Social-Emotional Development

  The quality of children's daily experiences in preschool classrooms is predictive of their school readiness and later achievement (Duncan et al., 2007; La Paro & Pianta, 2000). One particularly important ...

  Citation × Citation Citation Abstract Copy Title: The Role of Emotional Support Consistency and Child Risk Factors in Predicting Pre-K Cognitive and Social-Emotional Development Author: Cannell-Cordier, Amy Lynn Year: 2015 The quality of children's daily experiences in preschool classrooms is predictive of their school readiness and later achievement (Duncan et al., 2007; La Paro & Pianta, 2000). One particularly important aspect of these experiences is the quality of emotional support provided by teachers and peers in the classroom (Hamre & Pianta, 2005; Howes et al., 2008; Mashburn, 2008; National Center on Quality Teaching and Learning, 2012). Traditionally, emotional support quality has been calculated as the average of ratings taken across the school year and is meant to represent children's average daily experience, without regard to any variability which exists within the ratings over time. The bioecological model of development (Bronfenbrenner & Morris, 1998; 2006) points out the necessity of considering in what ways learning experiences occur over time when drawing links between children's daily lives and later outcomes. In addition, attachment theory (Bowlby, 1973; Ainsworth, 1979) highlights the foundational nature of caregivers' consistency of emotional responses over time in helping young children develop skills and competencies. This study continues a line of research focused on investigating the stability of high-quality interactions as a possible mechanism through which children's optimal cognitive and social-emotional development occurs in preschool classrooms (Curby, Brock, & Hamre, 2013; Curby et al., 2011; Zinsser, Bailey, Curby, Denham, & Bassett, 2013). The current study examined the role of children's socioeconomic and behavioral risk factors, teachers' mean emotional support, and teachers' emotional support consistency in predicting children's cognitive and social-emotional development in preschool. Children's socioeconomic and behavioral risk factors (socioeconomic status, gender, age, race, ethnicity, English Language Learner status, and self-regulation) negatively predicted both baseline scores and development over the course of the year on the cognitive measures (early math and language and literacy). Low levels of teacher-rated student self-regulation at the beginning of the year significantly negatively predicted baseline scores and development on all academic and social-emotional measures. Contrary to most previous research, teachers' mean emotional support was not found to be a significant contributor to children's development when considered with child risk factors, except in the case of receptive vocabulary. The consistency of teachers' emotional support, however, was predictive of several measures of children's development of academic skills when controlling for child risk factors. A significant interaction between English Language Learner status and emotional support consistency was found in predicting development of expressive vocabulary skills. Multilevel models combining child characteristics, mean emotional support, and emotional support consistency suggest that child risk factors and emotional support consistency predict language and literacy development, above and beyond mean emotional support. Follow-up analyses also suggest that, under conditions of relatively high emotional support, consistency is especially important in predicting children's development of cognitive and social-emotional skills. Title: The Role of Emotional Support Consistency and Child Risk Factors in Predicting Pre-K Cognitive and Social-Emotional Development Author: Cannell-Cordier, Amy Lynn Year: 2015 The quality of children's daily experiences in preschool classrooms is predictive of their school readiness and later achievement (Duncan et al., 2007; La Paro & Pianta, 2000). One particularly important aspect of these experiences is the quality of emotional support provided by teachers and peers in the classroom (Hamre & Pianta, 2005; Howes et al., 2008; Mashburn, 2008; National Center on Quality Teaching and Learning, 2012). Traditionally, emotional support quality has been calculated as the average of ratings taken across the school year and is meant to represent children's average daily experience, without regard to any variability which exists within the ratings over time. The bioecological model of development (Bronfenbrenner & Morris, 1998; 2006) points out the necessity of considering in what ways learning experiences occur over time when drawing links between children's daily lives and later outcomes. In addition, attachment theory (Bowlby, 1973; Ainsworth, 1979) highlights the foundational nature of caregivers' consistency of emotional responses over time in helping young children develop skills and competencies. This study continues a line of research focused on investigating the stability of high-quality interactions as a possible mechanism through which children's optimal cognitive and social-emotional development occurs in preschool classrooms (Curby, Brock, & Hamre, 2013; Curby et al., 2011; Zinsser, Bailey, Curby, Denham, & Bassett, 2013). The current study examined the role of children's socioeconomic and behavioral risk factors, teachers' mean emotional support, and teachers' emotional support consistency in predicting children's cognitive and social-emotional development in preschool. Children's socioeconomic and behavioral risk factors (socioeconomic status, gender, age, race, ethnicity, English Language Learner status, and self-regulation) negatively predicted both baseline scores and development over the course of the year on the cognitive measures (early math and language and literacy). Low levels of teacher-rated student self-regulation at the beginning of the year significantly negatively predicted baseline scores and development on all academic and social-emotional measures. Contrary to most previous research, teachers' mean emotional support was not found to be a significant contributor to children's development when considered with child risk factors, except in the case of receptive vocabulary. The consistency of teachers' emotional support, however, was predictive of several measures of children's development of academic skills when controlling for child risk factors. A significant interaction between English Language Learner status and emotional support consistency was found in predicting development of expressive vocabulary skills. Multilevel models combining child characteristics, mean emotional support, and emotional support consistency suggest that child risk factors and emotional support consistency predict language and literacy development, above and beyond mean emotional support. Follow-up analyses also suggest that, under conditions of relatively high emotional support, consistency is especially important in predicting children's development of cognitive and social-emotional skills. Close

• 372. [Article] Empiric Deworming and CD4 Count Recovery in HIV-Infected Ugandans Initiating Antiretroviral Therapy

  Background: There is conflicting evidence on the immunologic benefit of treating helminth co-infections (‘‘deworming’’) in HIV-infected individuals. Several studies have documented reduced viral load and ...

  Citation × Citation Citation Abstract Copy Title: Empiric Deworming and CD4 Count Recovery in HIV-Infected Ugandans Initiating Antiretroviral Therapy Author: Lankowski, Alexander J., Tsai, Alexander C., Kanyesigye, Michael, Bwana, Mwebesa B., Haberer, Jessica E., Wenger, Megan, Martin, Jeffrey N., Bangsberg, David, Hunt, Peter W., Siedner, Mark J. Year: 2014 Background: There is conflicting evidence on the immunologic benefit of treating helminth co-infections (‘‘deworming’’) in HIV-infected individuals. Several studies have documented reduced viral load and increased CD4 count in antiretroviral therapy (ART) naive individuals after deworming. However, there are a lack of data on the effect of deworming therapy on CD4 count recovery among HIV-infected persons taking ART. Methodology/Principal Findings: To estimate the association between empiric deworming therapy and CD4 count after ART initiation, we performed a retrospective observational study among HIV-infected adults on ART at a publicly operated HIV clinic in southwestern Uganda. Subjects were assigned as having received deworming if prescribed an anti-helminthic agent between 7 and 90 days before a CD4 test. To estimate the association between deworming and CD4 count, we fit multivariable regression models and analyzed predictors of CD4 count, using a time-by-interaction term with receipt or nonreceipt of deworming. From 1998 to 2009, 5,379 subjects on ART attended 21,933 clinic visits at which a CD4 count was measured. Subjects received deworming prior to 668 (3%) visits. Overall, deworming was not associated with a significant difference in CD4 count in either the first year on ART (b = 42.8; 95% CI, 22.1 to 87.7) or after the first year of ART (b =29.9; 95% CI, 224.1 to 4.4). However, in a sub-analysis by gender, during the first year of ART deworming was associated with a significantly greater rise in CD4 count (b = 63.0; 95% CI, 6.0 to 120.1) in females. Conclusions/Significance: Empiric deworming of HIV-infected individuals on ART conferred no significant generalized benefit on subsequent CD4 count recovery. A significant association was observed exclusively in females and during the initial year on ART. Our findings are consistent with recent studies that failed to demonstrate an immunologic advantage to empirically deworming ART-naive individuals, but suggest that certain sub-populations may benefit. Title: Empiric Deworming and CD4 Count Recovery in HIV-Infected Ugandans Initiating Antiretroviral Therapy Author: Lankowski, Alexander J., Tsai, Alexander C., Kanyesigye, Michael, Bwana, Mwebesa B., Haberer, Jessica E., Wenger, Megan, Martin, Jeffrey N., Bangsberg, David, Hunt, Peter W., Siedner, Mark J. Year: 2014 Background: There is conflicting evidence on the immunologic benefit of treating helminth co-infections (‘‘deworming’’) in HIV-infected individuals. Several studies have documented reduced viral load and increased CD4 count in antiretroviral therapy (ART) naive individuals after deworming. However, there are a lack of data on the effect of deworming therapy on CD4 count recovery among HIV-infected persons taking ART. Methodology/Principal Findings: To estimate the association between empiric deworming therapy and CD4 count after ART initiation, we performed a retrospective observational study among HIV-infected adults on ART at a publicly operated HIV clinic in southwestern Uganda. Subjects were assigned as having received deworming if prescribed an anti-helminthic agent between 7 and 90 days before a CD4 test. To estimate the association between deworming and CD4 count, we fit multivariable regression models and analyzed predictors of CD4 count, using a time-by-interaction term with receipt or nonreceipt of deworming. From 1998 to 2009, 5,379 subjects on ART attended 21,933 clinic visits at which a CD4 count was measured. Subjects received deworming prior to 668 (3%) visits. Overall, deworming was not associated with a significant difference in CD4 count in either the first year on ART (b = 42.8; 95% CI, 22.1 to 87.7) or after the first year of ART (b =29.9; 95% CI, 224.1 to 4.4). However, in a sub-analysis by gender, during the first year of ART deworming was associated with a significantly greater rise in CD4 count (b = 63.0; 95% CI, 6.0 to 120.1) in females. Conclusions/Significance: Empiric deworming of HIV-infected individuals on ART conferred no significant generalized benefit on subsequent CD4 count recovery. A significant association was observed exclusively in females and during the initial year on ART. Our findings are consistent with recent studies that failed to demonstrate an immunologic advantage to empirically deworming ART-naive individuals, but suggest that certain sub-populations may benefit. Close

• 373. [Article] Know Your Audience: Predictors of Success for a Patient-Centered Texting App to Augment Linkage to HIV Care in Rural Uganda

  Background: Despite investments in infrastructure and evidence for high acceptability, few mHealth interventions have been implemented in sub-Saharan Africa. Objective: We sought to (1) identify predictors ...

  Citation × Citation Citation Abstract Copy Title: Know Your Audience: Predictors of Success for a Patient-Centered Texting App to Augment Linkage to HIV Care in Rural Uganda Author: Siedner, Mark J., Santorino, Data, Haberer, Jessica E., Bangsberg, David Year: 2015 Background: Despite investments in infrastructure and evidence for high acceptability, few mHealth interventions have been implemented in sub-Saharan Africa. Objective: We sought to (1) identify predictors of uptake of an mHealth application for a low-literacy population of people living with HIV (PLWH) in rural Uganda and (2) evaluate the efficacy of various short message service (SMS) text message formats to optimize the balance between confidentiality and accessibility. Methods: The trial evaluated the efficacy of a SMS text messaging app to notify PLWH of their laboratory results and request return to care for those with abnormal test results. Participants with a normal laboratory result received a single SMS text message indicating results were normal. Participants with an abnormal test result were randomized to 1 of 3 message formats designed to evaluate trade-offs between clarity and privacy: (1) an SMS text message that stated results were abnormal and requested return to clinic (“direct”), (2) the same message protected by a 4-digit PIN code (“PIN”), and (3) the message “ABCDEFG” explained at enrollment to indicate abnormal results (“coded”). Outcomes of interest were (1) self-reported receipt of the SMS text message, (2) accurate identification of the message, and (3) return to care within 7 days (for abnormal results) or on the date of the scheduled appointment (for normal results). We fit regression models for each outcome with the following explanatory variables: sociodemographic characteristics, CD4 count result, ability to read a complete sentence, ability to access a test message on enrollment, and format of SMS text message. Results: Seventy-two percent (234/385) of participants successfully receiving a message, 87.6% (219/250) correctly identified the message format, and 60.8% (234/385) returned to clinic at the requested time. Among participants with abnormal tests results (138/385, 35.8%), the strongest predictors of reported message receipt were the ability to read a complete sentence and a demonstrated ability to access a test message on enrollment. Participants with an abnormal result who could read a complete sentence were also more likely to accurately identify the message format (AOR 4.54, 95% CI 1.42-14.47, P=.01) and return to clinic appropriately (AOR 3.81, 95% CI 1.61-9.03, P=.002). Those who were sent a PIN-protected message were less likely to identify the message (AOR 0.11, 95% CI 0.03-0.44, P=.002) or return within 7 days (AOR 0.26, 95% CI 0.10-0.66, P=.005). Gender, age, and socioeconomic characteristics did not predict any outcomes and there were no differences in outcomes between those receiving direct or coded messages. Conclusions: Confirmed literacy at the time of enrollment was a robust predictor of SMS text message receipt, identification, and appropriate response for PLWH in rural Uganda. PIN-protected messages reduced odds of clinic return, but coded messages were as effective as direct messages and might augment privacy. Trial Registration: Clinicaltrials.gov NCT 01579214; https://clinicaltrials.gov/ct2/show/NCT01579214 (Archived by WebCite at http://www.webcitation.org/6Ww8R4sKq). Title: Know Your Audience: Predictors of Success for a Patient-Centered Texting App to Augment Linkage to HIV Care in Rural Uganda Author: Siedner, Mark J., Santorino, Data, Haberer, Jessica E., Bangsberg, David Year: 2015 Background: Despite investments in infrastructure and evidence for high acceptability, few mHealth interventions have been implemented in sub-Saharan Africa. Objective: We sought to (1) identify predictors of uptake of an mHealth application for a low-literacy population of people living with HIV (PLWH) in rural Uganda and (2) evaluate the efficacy of various short message service (SMS) text message formats to optimize the balance between confidentiality and accessibility. Methods: The trial evaluated the efficacy of a SMS text messaging app to notify PLWH of their laboratory results and request return to care for those with abnormal test results. Participants with a normal laboratory result received a single SMS text message indicating results were normal. Participants with an abnormal test result were randomized to 1 of 3 message formats designed to evaluate trade-offs between clarity and privacy: (1) an SMS text message that stated results were abnormal and requested return to clinic (“direct”), (2) the same message protected by a 4-digit PIN code (“PIN”), and (3) the message “ABCDEFG” explained at enrollment to indicate abnormal results (“coded”). Outcomes of interest were (1) self-reported receipt of the SMS text message, (2) accurate identification of the message, and (3) return to care within 7 days (for abnormal results) or on the date of the scheduled appointment (for normal results). We fit regression models for each outcome with the following explanatory variables: sociodemographic characteristics, CD4 count result, ability to read a complete sentence, ability to access a test message on enrollment, and format of SMS text message. Results: Seventy-two percent (234/385) of participants successfully receiving a message, 87.6% (219/250) correctly identified the message format, and 60.8% (234/385) returned to clinic at the requested time. Among participants with abnormal tests results (138/385, 35.8%), the strongest predictors of reported message receipt were the ability to read a complete sentence and a demonstrated ability to access a test message on enrollment. Participants with an abnormal result who could read a complete sentence were also more likely to accurately identify the message format (AOR 4.54, 95% CI 1.42-14.47, P=.01) and return to clinic appropriately (AOR 3.81, 95% CI 1.61-9.03, P=.002). Those who were sent a PIN-protected message were less likely to identify the message (AOR 0.11, 95% CI 0.03-0.44, P=.002) or return within 7 days (AOR 0.26, 95% CI 0.10-0.66, P=.005). Gender, age, and socioeconomic characteristics did not predict any outcomes and there were no differences in outcomes between those receiving direct or coded messages. Conclusions: Confirmed literacy at the time of enrollment was a robust predictor of SMS text message receipt, identification, and appropriate response for PLWH in rural Uganda. PIN-protected messages reduced odds of clinic return, but coded messages were as effective as direct messages and might augment privacy. Trial Registration: Clinicaltrials.gov NCT 01579214; https://clinicaltrials.gov/ct2/show/NCT01579214 (Archived by WebCite at http://www.webcitation.org/6Ww8R4sKq). Close

• 374. [Article] Mean CD4 Cell Count Changes in Patients Failing a First-line Antiretroviral Therapy in Resource-limited Settings

  Background: Changes in CD4 cell counts are poorly documented in individuals with low or moderate-level viremia while on antiretroviral treatment (ART) in resource-limited settings. We assessed the impact ...

  Citation × Citation Citation Abstract Copy Title: Mean CD4 Cell Count Changes in Patients Failing a First-line Antiretroviral Therapy in Resource-limited Settings Author: Calmy, Alexandra, Balestre, Eric, Bonnet, Fabrice, Boulle, Andrew, Sprinz, Eduardo, Wood, Robin, Delaporte, Eric, Messou, Eugène, McIntyre, James, El Filali, Kamal Marhoum, Schechter, Mauro, Kumarasamy, N., Bangsberg, David, McPhail, Patrick, Van Der Borght, Stefaan, Zala, Carlos, Egger, Matthias, Thiébaut, Rodolphe, Dabis, François, ART-LINC of IeDEA Collaboration (Asia, South America, East, Southern and West Africa) Year: 2012 Background: Changes in CD4 cell counts are poorly documented in individuals with low or moderate-level viremia while on antiretroviral treatment (ART) in resource-limited settings. We assessed the impact of on-going HIV-RNA replication on CD4 cell count slopes in patients treated with a first-line combination ART. Method: Naïve patients on a first-line ART regimen with at least two measures of HIV-RNA available after ART initiation were included in the study. The relationships between mean CD4 cell count change and HIV-RNA at 6 and 12 months after ART initiation (M6 and M12) were assessed by linear mixed models adjusted for gender, age, clinical stage and year of starting ART. Results: 3,338 patients were included (14 cohorts, 64% female) and the group had the following characteristics: a median follow-up time of 1.6 years, a median age of 34 years, and a median CD4 cell count at ART initiation of 107 cells/μL. All patients with suppressed HIV-RNA at M12 had a continuous increase in CD4 cell count up to 18 months after treatment initiation. By contrast, any degree of HIV-RNA replication both at M6 and M12 was associated with a flat or a decreasing CD4 cell count slope. Multivariable analysis using HIV-RNA thresholds of 10,000 and 5,000 copies confirmed the significant effect of HIV-RNA on CD4 cell counts both at M6 and M12. Conclusion: In routinely monitored patients on an NNRTI-based first-line ART, on-going low-level HIV-RNA replication was associated with a poor immune outcome in patients who had detectable levels of the virus after one year of ART. Note: At the time of writing, David Bangsberg was affiliated with Immune Suppression Syndrome Clinic (ISS). Title: Mean CD4 Cell Count Changes in Patients Failing a First-line Antiretroviral Therapy in Resource-limited Settings Author: Calmy, Alexandra, Balestre, Eric, Bonnet, Fabrice, Boulle, Andrew, Sprinz, Eduardo, Wood, Robin, Delaporte, Eric, Messou, Eugène, McIntyre, James, El Filali, Kamal Marhoum, Schechter, Mauro, Kumarasamy, N., Bangsberg, David, McPhail, Patrick, Van Der Borght, Stefaan, Zala, Carlos, Egger, Matthias, Thiébaut, Rodolphe, Dabis, François, ART-LINC of IeDEA Collaboration (Asia, South America, East, Southern and West Africa) Year: 2012 Background: Changes in CD4 cell counts are poorly documented in individuals with low or moderate-level viremia while on antiretroviral treatment (ART) in resource-limited settings. We assessed the impact of on-going HIV-RNA replication on CD4 cell count slopes in patients treated with a first-line combination ART. Method: Naïve patients on a first-line ART regimen with at least two measures of HIV-RNA available after ART initiation were included in the study. The relationships between mean CD4 cell count change and HIV-RNA at 6 and 12 months after ART initiation (M6 and M12) were assessed by linear mixed models adjusted for gender, age, clinical stage and year of starting ART. Results: 3,338 patients were included (14 cohorts, 64% female) and the group had the following characteristics: a median follow-up time of 1.6 years, a median age of 34 years, and a median CD4 cell count at ART initiation of 107 cells/μL. All patients with suppressed HIV-RNA at M12 had a continuous increase in CD4 cell count up to 18 months after treatment initiation. By contrast, any degree of HIV-RNA replication both at M6 and M12 was associated with a flat or a decreasing CD4 cell count slope. Multivariable analysis using HIV-RNA thresholds of 10,000 and 5,000 copies confirmed the significant effect of HIV-RNA on CD4 cell counts both at M6 and M12. Conclusion: In routinely monitored patients on an NNRTI-based first-line ART, on-going low-level HIV-RNA replication was associated with a poor immune outcome in patients who had detectable levels of the virus after one year of ART. Note: At the time of writing, David Bangsberg was affiliated with Immune Suppression Syndrome Clinic (ISS). Close

• 375. [Article] Re-Engagement as a Process of Everyday Resilience

  Grounded in previous research on academic engagement and resilience, this study presents a clear conceptualization of re-engagement, defined as students' ability to bounce back from everyday academic challenges ...

  Citation × Citation Citation Abstract Copy Title: Re-Engagement as a Process of Everyday Resilience Author: Pitzer, Jennifer Rose Year: 2010 Grounded in previous research on academic engagement and resilience, this study presents a clear conceptualization of re-engagement, defined as students' ability to bounce back from everyday academic challenges and setbacks, as a process of everyday resilience in school, and examines how teacher support can promote it. Data from 1018 third through sixth grade students and their 53 teachers were used to examine the extent to which teacher autonomy support and involvement (individually and in combination) predicted changes from fall to spring of the same school year in students' re-engagement (behavioral and emotional). Overall, correlational results provided consistent support for study hypotheses. In terms of unique effects, teacher autonomy support (both student- and teacher-reported) was a unique predictor of both behavioral and emotional re-engagement, whereas involvement (both student- and teacher-reported) was a unique predictor for behavioral but not emotional re-engagement. In terms of predicting change over the school year, student perceptions of autonomy support predicted changes in both behavioral and emotional re-engagement, but teacher-reports predicted changes only in behavioral re-engagement; teacher-reported involvement showed the same pattern of effects. When both involvement and autonomy support (student-reported) were used as predictors of changes in re-engagement, both made unique contributions, although teacher-reports did not, due to multi-collinearity. Students' perceptions of teacher support were more closely related to their re-engagement than was teacher-reported support, and those perceptions acted as mediators between the teacher-reported support and students' re-engagement, partially mediating the relationship between teacher-reported support and students' behavioral re-engagement, and fully mediating the relationship between teacher-reported autonomy support and emotional re-engagement. The relationships between teacher support and student re-engagement played out similarly for students at all grades and both genders, with the exception that student perceptions of teacher autonomy support were more important predictors of behavioral re-engagement for boys than for girls. This study has implications for the conceptualization of re-engagement within a larger motivational model, for the importance of considering both teachers' and students' perspectives when studying teacher-student interactions, and for next steps in conceptualizing the construct of re-engagement as potentially encompassing separate behavioral and emotional components. Title: Re-Engagement as a Process of Everyday Resilience Author: Pitzer, Jennifer Rose Year: 2010 Grounded in previous research on academic engagement and resilience, this study presents a clear conceptualization of re-engagement, defined as students' ability to bounce back from everyday academic challenges and setbacks, as a process of everyday resilience in school, and examines how teacher support can promote it. Data from 1018 third through sixth grade students and their 53 teachers were used to examine the extent to which teacher autonomy support and involvement (individually and in combination) predicted changes from fall to spring of the same school year in students' re-engagement (behavioral and emotional). Overall, correlational results provided consistent support for study hypotheses. In terms of unique effects, teacher autonomy support (both student- and teacher-reported) was a unique predictor of both behavioral and emotional re-engagement, whereas involvement (both student- and teacher-reported) was a unique predictor for behavioral but not emotional re-engagement. In terms of predicting change over the school year, student perceptions of autonomy support predicted changes in both behavioral and emotional re-engagement, but teacher-reports predicted changes only in behavioral re-engagement; teacher-reported involvement showed the same pattern of effects. When both involvement and autonomy support (student-reported) were used as predictors of changes in re-engagement, both made unique contributions, although teacher-reports did not, due to multi-collinearity. Students' perceptions of teacher support were more closely related to their re-engagement than was teacher-reported support, and those perceptions acted as mediators between the teacher-reported support and students' re-engagement, partially mediating the relationship between teacher-reported support and students' behavioral re-engagement, and fully mediating the relationship between teacher-reported autonomy support and emotional re-engagement. The relationships between teacher support and student re-engagement played out similarly for students at all grades and both genders, with the exception that student perceptions of teacher autonomy support were more important predictors of behavioral re-engagement for boys than for girls. This study has implications for the conceptualization of re-engagement within a larger motivational model, for the importance of considering both teachers' and students' perspectives when studying teacher-student interactions, and for next steps in conceptualizing the construct of re-engagement as potentially encompassing separate behavioral and emotional components. Close

• 376. [Article] Objective Measurement of Gait Abnormalities in Huntington Disease using a Shoe-Worn Inertial Sensor (P5.291)

  OBJECTIVE: To evaluate the feasibility and utility of a shoe-worn inertial sensor to measure gait abnormalities in Huntington disease (HD) in the home setting. BACKGROUND: Clinical rating scales provide ...

  Citation × Citation Citation Abstract Copy Title: Objective Measurement of Gait Abnormalities in Huntington Disease using a Shoe-Worn Inertial Sensor (P5.291) Author: Hogarth, Penelope, Lenahan, Arthur, Portillo, Alicia, Ramachandran, Ravi, Stenson, Katie, Legedza, Anna, Botfield, Martyn, Horak, Fay, McNames, James, El-Gohary, Mahmoud Ahmed Year: 2015 OBJECTIVE: To evaluate the feasibility and utility of a shoe-worn inertial sensor to measure gait abnormalities in Huntington disease (HD) in the home setting. BACKGROUND: Clinical rating scales provide only point assessments of disease-related impairments in HD, lack sensitivity, and require that a clinician experienced in the scale’s use evaluate the patient. A tool that would allow longitudinal, objective, quantitative measurement of impairments may offer advantages over standard clinical rating scales. DESIGN/METHODS: This was a pilot, single-blind, controlled observational study. Five ambulatory HD subjects and 5 age/gender-matched healthy controls wore inertial sensors manufactured by APDM, Inc. attached to each shoe during waking hours for 7 days. Gait parameters calculated from the sensors included stride length([percnt]height); stride velocity([percnt]height/sec); step duration(sec); double support time([percnt]); pitch at toe off (degrees) and heel strike (degrees); cadence(steps/min); and variability in each of these measures. Following blinded descriptive data analysis by APDM, independent samples t-tests were used to compare means for selected gait metrics between HD and control subjects, and Pearson correlation coefficients were used to interrogate the relationships between gait metrics, chorea score, and Total Functional Capacity (TFC, a measure of disease severity). RESULTS: Subjects were able to successfully apply, wear and charge the sensors. Blinded gait analysis correctly identified the HD and control subjects for 4/5 pairs. Significant differences were found between HD/control groups in mean(SD) stride length [53.96(9.25), 67.68(7.25), p=0.03]; mean(SD) variability per week (as measured by coefficient of variation) in stride length [28.57(5.54), 20.27(3.78), p=0.02] and pitch at toe off [25.57(4.00), 17.56(4.07), p=0.01]. Lower TFC scores correlated with greater variability in stride length[R=-0.82]; pitch at toe off[R=-0.80]; and increased double support time[R=-0.75]. Higher chorea scores correlated with shorter stride length[R=-0.76]. CONCLUSIONS: Inertial sensors may offer a feasible mechanism to objectively measure clinically-relevant gait abnormalities in HD. Title: Objective Measurement of Gait Abnormalities in Huntington Disease using a Shoe-Worn Inertial Sensor (P5.291) Author: Hogarth, Penelope, Lenahan, Arthur, Portillo, Alicia, Ramachandran, Ravi, Stenson, Katie, Legedza, Anna, Botfield, Martyn, Horak, Fay, McNames, James, El-Gohary, Mahmoud Ahmed Year: 2015 OBJECTIVE: To evaluate the feasibility and utility of a shoe-worn inertial sensor to measure gait abnormalities in Huntington disease (HD) in the home setting. BACKGROUND: Clinical rating scales provide only point assessments of disease-related impairments in HD, lack sensitivity, and require that a clinician experienced in the scale’s use evaluate the patient. A tool that would allow longitudinal, objective, quantitative measurement of impairments may offer advantages over standard clinical rating scales. DESIGN/METHODS: This was a pilot, single-blind, controlled observational study. Five ambulatory HD subjects and 5 age/gender-matched healthy controls wore inertial sensors manufactured by APDM, Inc. attached to each shoe during waking hours for 7 days. Gait parameters calculated from the sensors included stride length([percnt]height); stride velocity([percnt]height/sec); step duration(sec); double support time([percnt]); pitch at toe off (degrees) and heel strike (degrees); cadence(steps/min); and variability in each of these measures. Following blinded descriptive data analysis by APDM, independent samples t-tests were used to compare means for selected gait metrics between HD and control subjects, and Pearson correlation coefficients were used to interrogate the relationships between gait metrics, chorea score, and Total Functional Capacity (TFC, a measure of disease severity). RESULTS: Subjects were able to successfully apply, wear and charge the sensors. Blinded gait analysis correctly identified the HD and control subjects for 4/5 pairs. Significant differences were found between HD/control groups in mean(SD) stride length [53.96(9.25), 67.68(7.25), p=0.03]; mean(SD) variability per week (as measured by coefficient of variation) in stride length [28.57(5.54), 20.27(3.78), p=0.02] and pitch at toe off [25.57(4.00), 17.56(4.07), p=0.01]. Lower TFC scores correlated with greater variability in stride length[R=-0.82]; pitch at toe off[R=-0.80]; and increased double support time[R=-0.75]. Higher chorea scores correlated with shorter stride length[R=-0.76]. CONCLUSIONS: Inertial sensors may offer a feasible mechanism to objectively measure clinically-relevant gait abnormalities in HD. Close

• 377. [Article] Adjustment to College among Lower Division Students with Disabilities: An Exploratory Study

  This study utilized a quality of life framework of psychosocial adaptation to explore relationships among college stress, functional limitations, coping strategies, and perceived social support in adjustment ...

  Citation × Citation Citation Abstract Copy Title: Adjustment to College among Lower Division Students with Disabilities: An Exploratory Study Author: McNulty, Kristy Lee Ann Year: 2014 This study utilized a quality of life framework of psychosocial adaptation to explore relationships among college stress, functional limitations, coping strategies, and perceived social support in adjustment to college among first-year and second-year undergraduate students with disabilities, based on specific hypothesized relations. College adjustment outcomes included: life satisfaction, academic performance, and psychosocial-emotional adjustment to college. A nonprobability sample of 103 first-year and second-year undergraduate college students with disabilities participated in the study. Respondents were registered with an office of support services for students with disabilities at a public, four-year university, located in the Pacific Northwest of the United States. Respondents were recruited by responding to an e-mail requesting participation in an online, web-based survey. Eight self-report measures included: (a) Participant Survey (developed by the researcher to collect socio-demographic information, (b) College Stress Inventory (CSI; Solberg, Hale, Villarreal, & Kavanagh, 1993), (c) Disability Functional Limitations Scale (DFLS) (developed by the researcher), (d) Brief COPE; Carver, 1997, (e) Social Support Appraisals-Revised (SSA-R) scale; Vaux et al., 1986), (f) Satisfaction with Life Scale (SWLS; Diener, Emmons, Larsen, & Griffin, 1985), (g) Grade Point Average-Scale (GPA-S; adapted by the researcher from a self-reported grading scale), and (h) Student Adaptation to College Questionnaire (SACQ; Baker & Siryk, 1999). Data were analyzed using descriptive and correlational procedures. Bivariate analysis suggested that all predictor variables (i.e., college stress, functional limitations, engagement coping, and perceived social support) were significantly associated with student adjustment to college. Hierarchical multiple regression suggested mostly direct (i.e., main) effects for engagement coping and perceived social support. No interacting role for either engagement-type coping or perceived social support was suggested, except for the following: Engagement-type coping moderated the relationship between disability-related functional limitations (as measured by increased restrictions in the ability to perform daily routines, activities, and life roles) and adaptation to college, as measured by life satisfaction. Analyses of socio-demographic variables revealed significant associations between chronological age, gender, hours employed, and adjustment to college. Lastly, hierarchical multiple regression analysis revealed disengagement coping accounting for as much as 53% of the variance in adjustment scores. This result suggested disengagement coping adding significant predictive utility for adaptation-associated college adjustment. In light of these findings, counseling professionals may wish to consider the beneficial role of engagement coping in promoting optimal adjustment to college for lower-division undergraduate students with disabilities. Title: Adjustment to College among Lower Division Students with Disabilities: An Exploratory Study Author: McNulty, Kristy Lee Ann Year: 2014 This study utilized a quality of life framework of psychosocial adaptation to explore relationships among college stress, functional limitations, coping strategies, and perceived social support in adjustment to college among first-year and second-year undergraduate students with disabilities, based on specific hypothesized relations. College adjustment outcomes included: life satisfaction, academic performance, and psychosocial-emotional adjustment to college. A nonprobability sample of 103 first-year and second-year undergraduate college students with disabilities participated in the study. Respondents were registered with an office of support services for students with disabilities at a public, four-year university, located in the Pacific Northwest of the United States. Respondents were recruited by responding to an e-mail requesting participation in an online, web-based survey. Eight self-report measures included: (a) Participant Survey (developed by the researcher to collect socio-demographic information, (b) College Stress Inventory (CSI; Solberg, Hale, Villarreal, & Kavanagh, 1993), (c) Disability Functional Limitations Scale (DFLS) (developed by the researcher), (d) Brief COPE; Carver, 1997, (e) Social Support Appraisals-Revised (SSA-R) scale; Vaux et al., 1986), (f) Satisfaction with Life Scale (SWLS; Diener, Emmons, Larsen, & Griffin, 1985), (g) Grade Point Average-Scale (GPA-S; adapted by the researcher from a self-reported grading scale), and (h) Student Adaptation to College Questionnaire (SACQ; Baker & Siryk, 1999). Data were analyzed using descriptive and correlational procedures. Bivariate analysis suggested that all predictor variables (i.e., college stress, functional limitations, engagement coping, and perceived social support) were significantly associated with student adjustment to college. Hierarchical multiple regression suggested mostly direct (i.e., main) effects for engagement coping and perceived social support. No interacting role for either engagement-type coping or perceived social support was suggested, except for the following: Engagement-type coping moderated the relationship between disability-related functional limitations (as measured by increased restrictions in the ability to perform daily routines, activities, and life roles) and adaptation to college, as measured by life satisfaction. Analyses of socio-demographic variables revealed significant associations between chronological age, gender, hours employed, and adjustment to college. Lastly, hierarchical multiple regression analysis revealed disengagement coping accounting for as much as 53% of the variance in adjustment scores. This result suggested disengagement coping adding significant predictive utility for adaptation-associated college adjustment. In light of these findings, counseling professionals may wish to consider the beneficial role of engagement coping in promoting optimal adjustment to college for lower-division undergraduate students with disabilities. Close

• 378. [Article] The force of manhood: The consequences of masculinity threat on police officer use of force

  Positive community-police relations, which are based on mutual trust, are key to equitable and just policing. Use of force that is perceived as unfair and biased can quickly undermine relations between ...

  Citation × Citation Citation Abstract Copy Title: The force of manhood: The consequences of masculinity threat on police officer use of force Author: Alston, Aurelia Terese Year: 2017 Positive community-police relations, which are based on mutual trust, are key to equitable and just policing. Use of force that is perceived as unfair and biased can quickly undermine relations between the police and the public. In an attempt to understand what psychological factors contribute to police use of force decisions and potentially racially biased use of force application, this study proposed masculinity threat as an important psychological factor that influences police behavior. Masculinity threat occurs when a man's status as a man is threatened, and threats to masculinity are often associated with increased aggression and dominance as a way of restoring the threatened status. Policing is a male-dominated field, and because most victims of officer use of force are men, the current research examines how threats to male police officers' masculinity, including verbal and physical manifestations of threat, contribute to officer force against civilians. Past research has explored how high levels of trait masculinity threat (as measured by the Male Gender Role Stress scale; Goff, Martin, & Gamson-Smiedt, 2012) in police officers is associated with higher levels of force against racial minority suspects, however, no such research has examined state level masculinity threat (e.g., in the moment threats) as they occur in real world police-suspect interactions. Focusing on understanding the associations between use of force and state level masculinity threat, it was predicted that officers who have their masculinity explicitly and publicly threatened by male suspects will use more force against suspects compared to interactions where no such masculinity threat has occurred. It was also predicted that minority suspects who threaten officers' masculinity will receive more force than White suspects. To test these hypotheses, reporting officers' (RO) narratives of use of force interactions (excluding lethal force) from a large police department on the West Coast were coded and analyzed. Contrary to the hypotheses, results suggest that masculinity threat within an officer-suspect interaction may relate to lower levels of average officer force and higher number of sequences (e.g., back and forth exchanges) between suspect and officer. While results are in the opposite direction of the hypotheses, they provide new information regarding the association between personal threats to officer manhood and their subsequent actions. Specifically, results suggest that masculinity threat has a more complicated relationship with force than previously predicted and future research would do well to investigate a potential interaction effect of trait level and state level masculinity on police use of force decisions. Several other areas of further research are outlined, such as the need to examine other suspect-level and officer-level variables such as age and tenure. Overall, the results of this study suggest the need for continued clarifying research. Title: The force of manhood: The consequences of masculinity threat on police officer use of force Author: Alston, Aurelia Terese Year: 2017 Positive community-police relations, which are based on mutual trust, are key to equitable and just policing. Use of force that is perceived as unfair and biased can quickly undermine relations between the police and the public. In an attempt to understand what psychological factors contribute to police use of force decisions and potentially racially biased use of force application, this study proposed masculinity threat as an important psychological factor that influences police behavior. Masculinity threat occurs when a man's status as a man is threatened, and threats to masculinity are often associated with increased aggression and dominance as a way of restoring the threatened status. Policing is a male-dominated field, and because most victims of officer use of force are men, the current research examines how threats to male police officers' masculinity, including verbal and physical manifestations of threat, contribute to officer force against civilians. Past research has explored how high levels of trait masculinity threat (as measured by the Male Gender Role Stress scale; Goff, Martin, & Gamson-Smiedt, 2012) in police officers is associated with higher levels of force against racial minority suspects, however, no such research has examined state level masculinity threat (e.g., in the moment threats) as they occur in real world police-suspect interactions. Focusing on understanding the associations between use of force and state level masculinity threat, it was predicted that officers who have their masculinity explicitly and publicly threatened by male suspects will use more force against suspects compared to interactions where no such masculinity threat has occurred. It was also predicted that minority suspects who threaten officers' masculinity will receive more force than White suspects. To test these hypotheses, reporting officers' (RO) narratives of use of force interactions (excluding lethal force) from a large police department on the West Coast were coded and analyzed. Contrary to the hypotheses, results suggest that masculinity threat within an officer-suspect interaction may relate to lower levels of average officer force and higher number of sequences (e.g., back and forth exchanges) between suspect and officer. While results are in the opposite direction of the hypotheses, they provide new information regarding the association between personal threats to officer manhood and their subsequent actions. Specifically, results suggest that masculinity threat has a more complicated relationship with force than previously predicted and future research would do well to investigate a potential interaction effect of trait level and state level masculinity on police use of force decisions. Several other areas of further research are outlined, such as the need to examine other suspect-level and officer-level variables such as age and tenure. Overall, the results of this study suggest the need for continued clarifying research. Close

• 379. [Article] A Unique Support for Sexual-Minority Identity Development: An Interpretative Phenomenological Analysis of a Long-Term Formal Mentoring Relationship Between an Adult and a Youth From the Gay Community

  An important need exists to build a baseline understanding of the phenomenon of formal mentoring relationships involving adults and youth from the gay community. During the formative years when gay adolescents ...

  Citation × Citation Citation Abstract Copy Title: A Unique Support for Sexual-Minority Identity Development: An Interpretative Phenomenological Analysis of a Long-Term Formal Mentoring Relationship Between an Adult and a Youth From the Gay Community Author: Rummell, Christian L. Year: 2013 An important need exists to build a baseline understanding of the phenomenon of formal mentoring relationships involving adults and youth from the gay community. During the formative years when gay adolescents navigate through the process of understanding, defining, accepting, and sharing their identity as a sexual minority, they are often faced with high levels of environmental risks, including victimization, stress, and negative social sanctions by others. Formal mentoring has been recommended as a potential strategy to offer unique one-to-one support to gay youth that can help to foster resilience and a range of positive outcomes, including strengthening processes involved in identity development; yet, no previous studies have captured insights about these relationships. Using Interpretative Phenomenological Analysis (IPA), this study investigated the following research questions: (a) What are the most important characteristics of long-term formal mentoring relationships between gay adults and gay youth from the perspectives of the participants? (b) How, if at all, do mentors and mentees perceive potential benefits and limitations for gay youth participating in long-term formal mentoring relationships with gay adults? (c) How, if at all, do mentors and mentees perceive their mentoring relationship uniquely contributing to sexual-minority identity development in gay youth? After a 2-year search for participants, a purposeful sample of one mentoring dyad was chosen. Semi-structured in-person interviews were conducted with the match at the 17-month and 22-month mark of their relationship. This study contained four assertions based on this study's findings: (a) This long-term mentoring relationship between an adult and a youth from the gay community shared numerous similarities with other high quality mentoring relationships; (b) This mentoring relationship offered insight into how to create individualized and long-term support for sexual-minority identity development in youth; (c) This mentoring relationship represented an important but unrealized type of support that can potentially be used to complement existing peers, internet, and community-based resources for gay youth; and (d) Complexity continues to exist in using language and self-labeling to define, inquire, and provide support to individuals from the gay community--especially youth. Recommendations for programming, policy, and future research are provided. Title: A Unique Support for Sexual-Minority Identity Development: An Interpretative Phenomenological Analysis of a Long-Term Formal Mentoring Relationship Between an Adult and a Youth From the Gay Community Author: Rummell, Christian L. Year: 2013 An important need exists to build a baseline understanding of the phenomenon of formal mentoring relationships involving adults and youth from the gay community. During the formative years when gay adolescents navigate through the process of understanding, defining, accepting, and sharing their identity as a sexual minority, they are often faced with high levels of environmental risks, including victimization, stress, and negative social sanctions by others. Formal mentoring has been recommended as a potential strategy to offer unique one-to-one support to gay youth that can help to foster resilience and a range of positive outcomes, including strengthening processes involved in identity development; yet, no previous studies have captured insights about these relationships. Using Interpretative Phenomenological Analysis (IPA), this study investigated the following research questions: (a) What are the most important characteristics of long-term formal mentoring relationships between gay adults and gay youth from the perspectives of the participants? (b) How, if at all, do mentors and mentees perceive potential benefits and limitations for gay youth participating in long-term formal mentoring relationships with gay adults? (c) How, if at all, do mentors and mentees perceive their mentoring relationship uniquely contributing to sexual-minority identity development in gay youth? After a 2-year search for participants, a purposeful sample of one mentoring dyad was chosen. Semi-structured in-person interviews were conducted with the match at the 17-month and 22-month mark of their relationship. This study contained four assertions based on this study's findings: (a) This long-term mentoring relationship between an adult and a youth from the gay community shared numerous similarities with other high quality mentoring relationships; (b) This mentoring relationship offered insight into how to create individualized and long-term support for sexual-minority identity development in youth; (c) This mentoring relationship represented an important but unrealized type of support that can potentially be used to complement existing peers, internet, and community-based resources for gay youth; and (d) Complexity continues to exist in using language and self-labeling to define, inquire, and provide support to individuals from the gay community--especially youth. Recommendations for programming, policy, and future research are provided. Close

• 380. [Article] The Effects of Race, Socioeconomic Status, and Religion on Formal End-of-Life Planning

  Individuals who are facing death today are doing so in an environment that is significantly different than it was in the past. Medical technology is increasingly able to keep people alive even with multiple ...

  Citation × Citation Citation Abstract Copy Title: The Effects of Race, Socioeconomic Status, and Religion on Formal End-of-Life Planning Author: Burdsall, Tina Dawn Lillian Year: 2013 Individuals who are facing death today are doing so in an environment that is significantly different than it was in the past. Medical technology is increasingly able to keep people alive even with multiple complex chronic conditions. While these advances in medicine are beneficial to many, it can also unnecessarily prolong inevitable deaths. Concerns over the ability to have a death that is in alignment with personal values has increased the interest in the use of formal end-of-life planning including writing an advance instructional directive and assigning a durable power of attorney for health care. Although research has indicated that the use of these formal planning strategies is beneficial, not everyone completes them. Using a current nationally representative sample, the three specific aims of this study were to examine whether there are racial and ethnic differences in formal end-of-life planning done by older African American, Hispanic, and White adults; to examine socioeconomic factors including education and income in formal end-of-life planning as well as assess the contribution of these factors in explaining racial and ethnic differences in formal end-of-life planning; and to examine the role of religiosity in formal end-of-life planning and to assess its influence on racial and ethnic differences in explaining formal end-of-life planning. Logistic regression was run on data from the Health and Retirement Study (HRS) in order to analyze the completion of formal end-of-life plans by African American, Hispanic, and White decedents. Exit interviews conducted with knowledgeable proxies in 2008 or 2010 were combined with data from earlier waves of the HRS survey in order to analyze the completion of formal end-of-life plans, race and ethnicity, socioeconomic status, and religion. Both Blacks and Hispanics were less likely to complete a written advance directive, assign a proxy, or complete both forms of formal planning than were Whites. Group differences remained after controlling for region of death and cause of death. Both Blacks and Hispanics were less likely to complete any form of formal planning than Whites. Group differences remained after additionally controlling for gender, age, marital status, whether the decedent had children, income, education, religious preference, importance of religion, and frequency of attending religious services. Higher levels of income and education both increased the odds that formal advance planning would take place. Religious preference was not significant, but decedents who had stated that religion was very important were less likely to plan while those that attended services frequently were more likely to plan. I speculate that the role of cultural capital may partially explain the persistent racial and ethnic disparities and the importance of income and education. Additionally the dominant religious doctrines of Christianity may have a greater influence than the different religious teachings of Protestant and Catholics around end-of-life medical care. Contrary to expected findings, reference groups of those who attend religious services frequently may assist in formal planning. These finding may help guide interventions that can diminish disparities in the end-of-life experience. Understanding who are completing formal plans can help ensure end-of-life care that is in alignment with personal beliefs and values. Title: The Effects of Race, Socioeconomic Status, and Religion on Formal End-of-Life Planning Author: Burdsall, Tina Dawn Lillian Year: 2013 Individuals who are facing death today are doing so in an environment that is significantly different than it was in the past. Medical technology is increasingly able to keep people alive even with multiple complex chronic conditions. While these advances in medicine are beneficial to many, it can also unnecessarily prolong inevitable deaths. Concerns over the ability to have a death that is in alignment with personal values has increased the interest in the use of formal end-of-life planning including writing an advance instructional directive and assigning a durable power of attorney for health care. Although research has indicated that the use of these formal planning strategies is beneficial, not everyone completes them. Using a current nationally representative sample, the three specific aims of this study were to examine whether there are racial and ethnic differences in formal end-of-life planning done by older African American, Hispanic, and White adults; to examine socioeconomic factors including education and income in formal end-of-life planning as well as assess the contribution of these factors in explaining racial and ethnic differences in formal end-of-life planning; and to examine the role of religiosity in formal end-of-life planning and to assess its influence on racial and ethnic differences in explaining formal end-of-life planning. Logistic regression was run on data from the Health and Retirement Study (HRS) in order to analyze the completion of formal end-of-life plans by African American, Hispanic, and White decedents. Exit interviews conducted with knowledgeable proxies in 2008 or 2010 were combined with data from earlier waves of the HRS survey in order to analyze the completion of formal end-of-life plans, race and ethnicity, socioeconomic status, and religion. Both Blacks and Hispanics were less likely to complete a written advance directive, assign a proxy, or complete both forms of formal planning than were Whites. Group differences remained after controlling for region of death and cause of death. Both Blacks and Hispanics were less likely to complete any form of formal planning than Whites. Group differences remained after additionally controlling for gender, age, marital status, whether the decedent had children, income, education, religious preference, importance of religion, and frequency of attending religious services. Higher levels of income and education both increased the odds that formal advance planning would take place. Religious preference was not significant, but decedents who had stated that religion was very important were less likely to plan while those that attended services frequently were more likely to plan. I speculate that the role of cultural capital may partially explain the persistent racial and ethnic disparities and the importance of income and education. Additionally the dominant religious doctrines of Christianity may have a greater influence than the different religious teachings of Protestant and Catholics around end-of-life medical care. Contrary to expected findings, reference groups of those who attend religious services frequently may assist in formal planning. These finding may help guide interventions that can diminish disparities in the end-of-life experience. Understanding who are completing formal plans can help ensure end-of-life care that is in alignment with personal beliefs and values. Close