Migraine is a complex neurovascular disorder of the brain characterized by episodes of severe head pain and dysfunction of the autonomic nervous system with or without aura. Migraine affects nearly 324 million people worldwide and causes severe disability in women during the most productive years of life. The World Health Organization considers severe migraine to be as disabling as quadriplegia and terminal stage cancer. Healthcare professionals often perceive migraine headaches as minor complaints, resulting in poorly acknowledged physical, emotional, and economic burdens contributing to diminished quality of life in women with migraine disorder. Approximately 10 million people suffer from migraines in the United States, yet evidence suggests that management of migraine is suboptimal. The purpose of the thesis is to educate healthcare professionals on the screening, diagnosis, and treatment of migraine disorders to enhance care of patients and improve quality of life. An interdisciplinary review of research was completed using the online databases Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE- EBSCOhost, Academic Search Premier, and PubMed. Findings concluded that migraines impact quality of life in the physical, psychological, social, and spiritual dimensions of well-being. Nursing implications for improving migraine management and quality of life include advocating for clients with migraines, seeking continuous education in regards to migraine management, educating clients and their families about managing migraines, and competently caring for clients with migraines.

Attachment is a psychological connection between two or more individuals. Paternal -infant attachment is significant to the social and physical health of the infant and father. There is a gap in the literature regarding the importance of attachment between father and infant. The purpose of this thesis was to review the available literature about paternal-infant attachment and to determine promising nursing interventions to promote successful paternal-infant attachment. An integrative review of research was performed using the Cumulative Index of Nursing and Allied Health Literature (CINAHL). MEDLINE, PsychINFO, PsychArticles and Academic Search Premier. The key terms that were used to search the databases were: paternal, father, infant, newborn, bonding, attachment, feelings and relationship. Ten studies were examined in detail. Nursing interventions found to improve paternal-infant attachment are based on education, improving the psychological well-being of both the father and infant and decreasing anxiety or stress the father may feel before and after the birth process. Multiple methods to improve overall paternal-infant attachment are recommended.

As the structure of the American family changes, it is becoming more common for children to be raised by their grandparents. In fact, over the past 40 years, there has been a 50% increase in grandparent-headed homes in the US (Ellis and Simmons, 2014). Custodial grandparents, who provide primary caregiving responsibilities for their grandchildren, often become responsible for their grandchildren due to distressing situations and report many social-emotional, physical, and psychological difficulties (e.g., Hayslip and Kaminski, 2005). Additionally, children of custodial grandparents have been found to have significantly more emotional and behavioral problems than non-custodial grandchildren (Smith and Palmieri, 2007). The main parenting resource for this population is often support-groups, which often do not provide needed assistance with discipline and behavior management. The overall purpose of this study was to adapt Parent Child Interaction Therapy (PCIT) to custodial grandparents, using a consumer-oriented approach. The study was completed in three discrete stages. During Stage 1, qualitative interviews with custodial grandparents were completed to collect further information about custodial grandparents' experience parenting their grandchildren, use of parenting resources, and opinion of parenting strategies and PCIT. Findings from this stage indicated that custodial grandparents were amenable to PCIT procedures, but experienced significant barriers in accessing parenting services. Due to these barriers, a service delivery adaptation was developed and an online intervention was created (Stage 2) to transcend treatment barriers. Finally, during Stage 3, this online intervention was tested in a small single-subject design pilot study. Multiple metrics supported the feasibility, accessibility, satisfaction, and initial treatment efficacy of this intervention. All participants demonstrated clinically significant reductions in at least two symptom measures and reported satisfaction with the online intervention. Overall, results provide preliminary support for the use of online interventions to teach PCIT strategies and support future research on online interventions for this population. / Ph. D. / The overall purpose of this study was to adapt Parent Child Interaction Therapy (PCIT) to custodial grandparents, using a consumer-oriented approach. The study was completed in three stages. During Stage 1, interviews with custodial grandparents were completed to collect further information about custodial grandparents’ experience parenting their grandchildren, use of parenting resources, and opinion of parenting strategies and PCIT. Findings from this stage indicated that custodial grandparents were amenable to PCIT procedures, but experienced significant barriers to accessing parenting services. Due to these barriers, a service delivery adaptation was developed, and an online intervention was created (Stage 2) to transcend treatment barriers. Finally, during Stage 3, this online intervention was tested in a small pilot study. Multiple metrics supported the feasibility, accessibility, satisfaction, and initial treatment efficacy of this intervention. Overall, results provide preliminary support for the use of online interventions to teach PCIT strategies and support future research on online interventions for this population.

Emerging clinical evidence implicates cellular senescence in the pathogenesis of various inflammatory conditions including inflammatory bowel diseases (IBDs), demonstrating that the intestinal stem cell crypts of patients with early Crohn’s disease exhibit markers positive for cell cycle inhibitor proteins. This phenomenon coupled with chronic systemic inflammation, a term coined “inflammaging," triggers many age-related pathologies and accelerates mortality. Our research evaluates the efficacy of interventions that target these death-resistant senescent cells to improve overall health and vitality. Particularly, we investigated the effects of Fisetin, a potent flavanoid with senolytic properties, in a dextran sodium sulfate (DSS) induced mouse model of colitis. Our findings reveal that Fisetin significantly inhibits senescence and inflammation in the colon while simultaneously enhancing the relative abundance of beneficial microbes, especially Akkermansia muciniphila, showcasing its potential for managing IBDs. Additionally, given the profound restoration of the microbiome and the central role of resident microbes in the production of metabolites essential for facilitating immunomodulation, we extended our investigations to further explore the effects of fecal microbiota transplant (FMT) from long-living Ames dwarf mice, characterized by low inflammatory status, into normal mice. Our results show notable shifts in microbial diversity, indicating that FMT may combat dysbiosis, a precursor to several conditions, including autoimmune, metabolic, and neurodegenerative diseases. Lastly, our exploration of potential anti-aging pharmacological interventions including Metformin (MF) and Trodusquemine (MSI-1436) during the postnatal window has demonstrated robust transcriptomic alterations of key biomarkers in the GH/Igf1 axis, such as Pi3k, Akt, and Mtor, suggesting delayed aging and improved liver function in young mice. These epigenetic changes underscore that early-life pharmacological interventions may forestall the onset of age-related metabolic disorders. All in all, there remains an urgent need for breakthroughs that can enhance healthspan to ensure that the rapidly growing population of older adults enjoys life in these extended years

The literature shows that school attendance matters. Time engaged with instruction is highly correlated to student achievement (Brophy, 1988; Fisher et al., 2015; Northwest Regional Educational Laboratory, 2001). However, students who are suspended and expelled from school lose instructional time in the classroom (Belway, Hodson, Losen, Keith II, and Morrison, 2015; Scott and Barrett, 2004). Suspensions result in decreased student attendance by removing the student from the learning environment (Noltemeyer, Ward, and Mcloughlin, 2015). The use of in-school suspension (ISS), out-of-school suspension (OSS), and expulsion are referred to as exclusionary discipline (Belway et al., 2015). Educational leaders are unintentionally contributing to the achievement gaps that the No Child Left Behind (NCLB) legislation intended to close by not addressing student suspensions and expulsions (Belway et al., 2015). This study used quantitative data with an ex post facto design to determine if the implementation of school-wide positive behavioral interventions and supports (PBIS) resulted in a change in student absences, office discipline referrals, and suspensions in one middle school and to determine what difference, if any, was there in student absences, office discipline referrals, and suspensions between a school implementing PBIS and a school not implementing PBIS. Two suburban middle schools in one Virginia school division were included in this study. Following the conceptual framework for this study, it was anticipated that implementation of PBIS would decrease student absences, office discipline referrals, and suspensions. The results of the study revealed that there was a reduction in office discipline referrals following the first year of implementation in the PBIS Middle School. When comparing a school that implemented PBIS to one that did not, this study found that student suspensions decreased by the second year of implementation in the school that implemented PBIS. This study also yielded other findings that were inconsistent with existing research. The results of this study are of significance for education leaders who want to decrease student office discipline referrals and suspensions / Ed. D. / The literature shows that school attendance matters where time engaged with instruction is highly correlated to student achievement (Brophy, 1988; Fisher et al., 2015; Northwest Regional Educational Laboratory, 2001). However, a common means of dealing with student misbehavior in school is the issuance of a referral to the office that may result in a student suspension (Belway, Hodson, Losen, Keith II, & Morrison, 2015; Scott & Barrett, 2004). Office discipline referrals and suspensions result in decreased student attendance by removing the student from the learning environment (Noltemeyer, Ward, & Mcloughlin, 2015). Educational leaders are unintentionally contributing to gaps in student achievement by removing students from the learning environment. This study investigated whether the implementation of a behavioral framework, school-wide positive behavioral interventions and supports (PBIS), resulted in a change in student absences, office discipline referrals, and suspensions in one middle school and explored what difference, if any, was there in student absences, office discipline referrals, and suspensions between a school implementing PBIS and a school not implementing PBIS. Two suburban middle schools in one Virginia school division were included in this study. It was anticipated that implementation of PBIS would decrease student absences, office discipline referrals, and suspensions. The results of the study revealed that there was a reduction in office discipline referrals following the first year of implementation in the school implementing PBIS. When comparing a school that implemented PBIS to one that did not, this study found that student suspensions decreased in the PBIS school by the second year of implementation. This study also yielded other findings that were inconsistent with existing research. The results of this study are of significance for education leaders who want to decrease student office discipline referrals and suspensions.

<p dir="ltr">Providing parents of autistic children, or children at an increased likelihood of an autism spectrum disorder (ASD) diagnosis, with tools to foster their child's social communication can help promote positive development. This study explored the role of promoting parents’ social communication behaviors using a minimally intensive intervention, a Family Routines Intervention (FRI), in two modalities: book-based or clinic-based. FRI is an eight-week-long intervention that focuses on common family routines to promote social communication. Given previous parent-mediated intervention studies, we hypothesize greater changes in parent social communication behaviors within the clinic-based group. Participants in this study were parents of children who had or were at an elevated likelihood of an ASD diagnosis. Parents enrolled in the clinic-based (<i>n</i> = 29) or book-based (<i>n</i> = 15) modality. Video data were collected during two home visits (pre- and post-FRI) to evaluate changes in parent social communication behaviors across four family contexts: play, mealtime, bedtime, and diaper/clothing change. Parent-child interactions were coded for parent social communication behaviors. Results showed that our hypotheses were not supported – the clinic-based group did not have notable changes in social communication behaviors in any context after participating in FRI. Mealtime was the only context where there was an interaction of time and modality on parent social communication <i>F</i>(1,62) = 4.07, <i>p</i> = 0.048. However, it did not support our hypothesis that parents in the clinic-based modality would have greater increases in parent social communication totals in the mealtime context, rather we found parents in the book-based group showed improvements. Despite the lack of significant findings, our study examined family routines that are not commonly explored in the literature, such as bedtime and diaper/clothing routines. We anticipate that our investigation into these overlooked family routines will encourage researchers to examine family routines other than play when assessing parent-mediated interventions.</p>

No

Yes / The prevalence of dementia is rising worldwide and many people will die with the disease. Symptoms towards the end of life may be inadequately managed and informal and professional carers poorly supported. There are few evidence-based interventions to improve end-of-life care in advanced dementia. To develop an integrated, whole systems, evidence-based intervention that is pragmatic and feasible to improve end-of-life care for people with advanced dementia and support those close to them. Design: A realist-based approach in which qualitative and quantitative data assisted the development of statements. These were incorporated into the RAND/UCLA appropriateness method to achieve consensus on intervention components. Components were mapped to underlying theory of whole systems change and the intervention described in a detailed manual. Setting/participants: Data were collected from people with dementia, carers and health and social care professionals in England, from expert opinion and existing literature. Professional stakeholders in all four countries of the United Kingdom contributed to the RAND/UCLA appropriateness method process. Results: A total of 29 statements were agreed and mapped to individual, group, organisational and economic/political levels of healthcare systems. The resulting main intervention components are as follows: (1) influencing local service organisation through facilitation of integrated multi-disciplinary care, (2) providing training and support for formal and informal carers and (3) influencing local healthcare commissioning and priorities of service providers. Conclusion: Use of in-depth data, consensus methods and theoretical understanding of the intervention components produced an evidence-based intervention for further testing in end-of-life care in advanced dementia.

Yes / This systematic review of reviews aims to investigate how brief interventions (BIs) are defined, whether they increase physical activity, which factors influence their effectiveness, who they are effective for, and whether they are feasible and acceptable. We searched CINAHL, Cochrane database of systematic reviews, DARE, HTA database, EMBASE, MEDLINE, PsycINFO, Science Citation Index-Expanded and Social Sciences Citation Index, and Scottish Intercollegiate Guidelines Network from their inception until May 2015 to identify systematic reviews of the effectiveness of BIs aimed at promoting physical activity in adults, reporting a physical activity outcome and at least one BI that could be delivered in a primary care setting. A narrative synthesis was conducted. We identified three specific BI reviews and thirteen general reviews of physical activity interventions that met the inclusion criteria. The BI reviews reported varying definitions of BIs, only one of which specified a maximum duration of 30 min. BIs can increase self-reported physical activity in the short term, but there is insufficient evidence about their long-term impact, their impact on objectively measured physical activity, and about the factors that influence their effectiveness, feasibility and acceptability. Current definitions include BIs that are too long for primary care consultations. Practitioners, commissioners and policy makers should be aware of this when interpreting evidence about BIs, and future research should develop and evaluate very brief interventions (of 5 min or less) that could be delivered in a primary care consultation. / This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0608-10079). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The funder had no role in study design, data collection, data analysis, data interpretation, the writing of the manuscript, and decision to submit the manuscript for publication.

Yes / Recruiting isolated older adults to clinical trials is complex, time-consuming and difficult. Previous studies have suggested querying existing databases to identify appropriate potential participants. We aim to compare recruitment techniques (general practitioner (GP) mail-outs, community engagement and clinician referrals) used in three randomised controlled trial (RCT) studies assessing the feasibility or effectiveness of two preventative interventions in isolated older adults (the Lifestyle Matters and Putting Life In Years interventions). Methods: During the three studies (the Lifestyle Matters feasibility study, the Lifestyle Matters RCT, the Putting Life In Years RCT) data were collected about how participants were recruited. The number of letters sent by GP surgeries for each study was recorded. In the Lifestyle Matters RCT, we qualitatively interviewed participants and intervention facilitators at 6 months post randomisation to seek their thoughts on the recruitment process. Results: Referrals were planned to be the main source of recruitment in the Lifestyle Matters feasibility study, but due to a lack of engagement from district nurses, community engagement was the main source of recruitment. District nurse referrals and community engagement were also utilised in the Lifestyle Matters and Putting Life In Years RCTs; both mechanisms yielded few participants. GP mail-outs were the main source of recruitment in both the RCTs, but of those contacted, recruiting yield was low (< 3%). Facilitators of the Lifestyle Matters intervention questioned whether the most appropriate individuals had been recruited. Participants recommended that direct contact with health professionals would be the most beneficial way to recruit. Conclusions: Recruitment to the Lifestyle Matters RCT did not mirror recruitment to the feasibility study of the same intervention. Direct district nurse referrals were not effective at recruiting participants. The majority of participants were recruited via GP mail-outs, which may have led to isolated individuals not being recruited to the trials. Further research is required into alternative recruitment techniques, including respondent-driven sampling plus mechanisms which will promote health care professionals to recruit vulnerable populations to research. / Medical Research Council (grant number G1001406); Sheffield Health and Social Research Consortium; National Institute for Health Research Public Health Research programme (project number 09/ 3004/01)