Objectives Fibromyalgia (FM) symptoms are a common comorbidity in systemic lupus erythematosus (SLE), contributing to increased pain, fatigue, and insomnia. These symptoms can significantly impair physical and cognitive function, making it harder to perform daily activities, exercise, and tasks requiring concentration. This study examines the effect of FM symptoms on function and explores how various treatment approaches can moderate these effects through a multicenter cross-sectional analysis of SLE patients from 7 Canadian clinics. Methods Data on disease burden metrics (FM symptoms, pain areas, disease activity, and irreversible damage), medication use (antimalarials, corticosteroids, immunosuppressants, biologics and narcotics), and sociodemographic factors were collected. Linear mixed-effects models evaluated the effect of FM symptoms and other disease burden variables on 5 functional outcomes: fatigue severity (FSS), cognitive dysfunction (PDQ), disability (WHODAS), depression (BDI), and work role functioning (WRF). Moderation models were used to assess if SLE treatments ameliorated the effect of these variables on function, while correcting for multiple testing. Results The models established that a higher number of reported fibromyalgia symptoms was the strongest predictor of functional impairment, being significantly associated with increased fatigue (β = 1.06, p < 0.001), cognitive dysfunction (β = 1.21, p < 0.001), and higher disability (β = 0.68, p < 0.001), and depression scores (β = 0.73, p < 0.001). Conversely, irreversible damage scores were uniquely linked to worsened work role functioning (β = −4.41, p = 0.020). Building on these models, moderation analyses revealed that certain treatments lowered the effect of the disease burden metrics on various function metrics (Figure 1). Immunosuppressants moderated the impact of organ damage on disability from β = 2.62 to β = 0.45 (p = 0.022) and perceived deficits from 2.28 to −0.84 (p = 0.041). Corticosteroids attenuated the association between FM symptoms and cognitive dysfunction falling from β = 1.42 to β = 0.14 in users (p = .024). Figure 1. Simple Slopes of Effects of Immunosuppressants and Corticosteroids Conclusion This study demonstrates that the reported number of fibromyalgia symptoms is the dominant factor driving functional burden across nearly all measured domains in SLE, surpassing the impact of disease activity. Most significantly, we provide evidence that certain SLE treatments act as functional shields: corticosteroids protecting cognition from FM effects and immunosuppressants mitigating disability linked to damage. These moderation effects strongly support tailoring treatment not only to disease activity but also to the patient’s functional risk profile, moving clinical practice closer to truly personalized medicine. Supported by a CIORA grant

Through grounded theory, the authors sought to answer how mental health counselors (N = 20) provide counseling to clients who self-diagnose via the Internet and social media. The data collected from participant interviews informed a theoretical model, which includes six themes: (a) origins of self-diagnosis; (b) factors impacting treatment-seeking; (c) counselor identity; (d) therapeutic collaboration; (e) therapeutic interventions; and (f) outcomes of therapeutic exploration of self-diagnosis. Our findings inform professional counseling practice, with implications for future research and clinical applications related to client self-diagnosis via the Internet and social media.

PurposeUnderstanding reactions to health communication campaigns is essential to designing effective messaging. Multi-year campaigns through The Helping to End Addiction Long-term® Initiative (HEALing) Communities Study (HCS) were implemented from April 2020 - June 2022. Responses to HCS campaign messages and statewide campaign messages were evaluated.DesignCross-sectional, self-reported surveys of different respondents at 3 timepoints.SettingN = 33 communities across Kentucky, Ohio, Massachusetts, and New York.SubjectsN = 2368 respondents recruited from Facebook/Instagram.MeasuresMessage acceptability survey items assessed attention, understandability, and visuals/text match. Message influence items assessed whether the message made the respondent want to carry naloxone, learn more about medications for opioid use disorder (MOUD), or seek help for OUD. Items were scaled from 1 (strongly disagree) to 5 (strongly agree).AnalysisAll outcomes were analyzed using linear mixed models adjusted for community as a random effect.ResultsAmong naloxone campaigns, HCS message acceptability was higher than statewide messages (3.98, 95% CI = 3.94-4.02 vs 3.93, 95% CI = 3.89-3.97, P = 0.002). HCS message influence was also higher than those of statewide messages (3.44, 95% CI = 3.38-3.50 vs 3.40, 95% CI = 3.34-3.46, P = 0.034). Among HCS campaigns, naloxone messaging had the highest acceptability (3.96, 95% CI = 3.92-4.00), followed by MOUD stigma (3.73, 95% CI = 3.70-3.77) and MOUD awareness (3.71, 95% CI = 3.68-3.75, P < 0.001). The HCS naloxone campaign was also highest rated in terms of influence (3.47, 95% CI = 3.43-3.51, P < 0.001).ConclusionThis analysis provides insight into acceptability and potential influence of locally-tailored, opioid-related health campaign messaging.This work was performed under the HEALing Communities Study, ClinicalTrials.gov Identifier: NCT04111939, https://clinicaltrials.gov/study/NCT04111939.

Systemic lupus erythematosus (SLE) has a significant and long-lasting impact on work outcomes, is a source of long-lasting work disability, and presents challenges with participation in activities of daily living. This study aimed to create a functional profile for patients with SLE. A functional profile is defined as activities of daily living and those related to work functioning (activities of daily living). A cross-sectional investigation was carried out across 6 Canadian facilities, comprising 6 academic institutions and 1 community-based facility. Clinical measurements were obtained, including the SLEDAI-2K and ACR/SLICC Damage Index (SDI) and patients’ medications. Patients completed the Work Role Functioning Questionnaire v2.0 (WRFQ), the World Health Organization—Disability (WHO-DAS) Assessment Schedule 2.0 (WHO-DAS), and the Beck Depression Inventory (BDI-II). Descriptive and inferential statistics were computed for the demographic, clinical, and functional outcomes. Univariate and multivariate regression analyses to study the association with WHO-DAS and WRF were performed. 404 patients were studied; mean age was 47.0±13.71 years and 91.8%% were female (64.7% White, 12.4% Black, 6.7% Chinese and 16.2% other races) with a mean SLE duration of 15.7 ±11.8 years. The total mean score for the WRFQ was 71.51.8±23.5. The WRFQ subscale mean scores were also reported for work scheduling demands (66.8±28.8), work output demands (71.1±25.6), physical demands (67.3±27.9), mental and social demands (74.4±22.8) and flexibility demands (75.0±24.7) (Figure 1). Comparison to the general working population). The WHO-DAS 2.0 total mean score was 25.1±9.71, representing approximately the 93.8th population percentile, meaning that only about 6.1% of the population scored higher (more disabled) than our sample. In the multivariate analysis, sex (Female), damage (SDI), prednisone dose, fatigue severity score, Work Role Functioning total scores, presence of fibromyalgia, Role Emotinal SF-36, depression and pain were associated with increased disability. Similarly, fatigue severity score, depression, and pain were associated with decreased WRF total scores. This Canadian study confirmed that patients with SLE suffers from high level of disability and functional decline and as measured by WHO-DAS and WRF. Several factors were associated with disability and functional decline including accrued damage, presence of fatigue and fibromyalgia, depression, pain and prednisone dose. Developing the initial functional profile of work disability will facilitate a multidisciplinary approach to enhance the care and management of work disabilities and related functional outcomes. Supported by a CIORA grant. Best Abstract on Quality Care Initiatives in Rheumatology Award

BACKGROUND:Systemic lupus erythematosus (SLE) disease symptoms that can significantly restrict work ability and work participation resulting in reduced mental well-being. This study investigates the significant impact of work participation and disability on the mental wellbeing, health-related quality of life, and disease-related outcomes in individuals with SLE. METHODS:With the objective of creating an SLE-related functional profile rooted in work disability (WD) prevention, 46 SLE patients were purposively recruited from Canadian medical centres. Through semi-structured interviews guided by a WD prevention framework, factors associated with WD and lived experiences of SLE-related WD were qualitatively explored. Braun and Clarke's six-stage inductive thematic analysis was used to organize the data. RESULTS:Most participants experienced some form of work disability across their employment history related to their clinical manifestations of SLE, including hospitalizations, physical limitations, fatigue, and neurocognitive symptoms (e.g. brain fog). Thematic analysis revealed three key themes: (a) the influence of illness experience on work, (b) the stigmatization of illness disclosure, and (c) the availability of workplace resources/accommodations. Participants emphasized the desirability of work with reduced physical and mental demands, increased personal control, and workplace flexibility to prevent WD. CONCLUSION:The study underscores the need for a collaborative, multi-component, and multidisciplinary intervention targeting psychosocial and workplace factors to establish a goal-oriented preventative framework, potentially improving WD outcomes in SLE individuals.

Sepsis and septic shock are two of the most prevalent disease states in today's medical intensive care units. Sepsis is a multi-system inflammatory response to infection that affects multiple organ systems, with the cardiovascular system being one of the most profoundly affected. Inflammatory mediators cause dilatation of the venous system, local tissue perfusion defects cause vasoconstriction of arterioles, and catecholamines cause increases in heart rate. Thus, nurses play a crucial role in assessing these clinical manifestations in the critically ill patient as noted through blood pressure, heart rate, capillary refill, and mentation. Invasive monitoring, such as arterial lines along with laboratory markers of perfusion also contribute to characterization of this clinical picture. Thus, early recognition and intervention are essential to prevent the progression to cardiovascular collapse and death. This article provides practical guidance for nurses in recognizing cardiovascular instability and implementing treatment strategies to help improve patient outcomes in the critical care setting.

Sepsis and septic shock are two of the most prevalent disease states in today's medical intensive care units. Sepsis is a multi-system inflammatory response to infection that affects multiple organ systems, with the cardiovascular system being one of the most profoundly affected. Inflammatory mediators cause dilatation of the venous system, local tissue perfusion defects cause vasoconstriction of arterioles, and catecholamines cause increases in heart rate. Thus, nurses play a crucial role in assessing these clinical manifestations in the critically ill patient as noted through blood pressure, heart rate, capillary refill, and mentation. Invasive monitoring, such as arterial lines along with laboratory markers of perfusion also contribute to characterization of this clinical picture. Thus, early recognition and intervention are essential to prevent the progression to cardiovascular collapse and death. This article provides practical guidance for nurses in recognizing cardiovascular instability and implementing treatment strategies to help improve patient outcomes in the critical care setting.

Technology in education is used to support and supplement core instruction, to help students stay engaged, and assist teachers with academic assessments. While there is support in the use of technology in instruction and intervention, researchers still urge caution when using it in assessment. Current evidence suggests that students perform differently when assessed using traditional methods compared to technology-based methods. Further, these differences may be exacerbated for students from low-income economically marginalized at-risk communities. There is a need to thoroughly explore student performance when responding to assessment materials through different modalities. The current investigation used a within subjects group design to replicate Reynolds et al. (2023) using an urban low performing population. Results demonstrate that, on average, students answered more digits correct per minute on probes administered via paper-pencil, however preferred to answer problems on the iPad using a keyboard. These results differ from the original study that used a higher performing suburban population. Future research, limitations, and implications for educators are discussed.

OBJECTIVE:To identify faith-based leaders' (FBLs') knowledge, perceptions, and questions about syringe services programs (SSPs). METHODS:We conducted a one-time, national online survey of 461 Christian FBLs August-September 2022. RESULTS:56% of FBLs agreed they support having SSPs in their communities; only 7% strongly disagreed. We identified 15 main questions FBLs have about SSPs. We found statistically significant differences based on FBL Protestant affiliations. Mainline FBLs are more knowledgeable about SSPs, likely to believe a larger number of SSP services would benefit their community, supportive of SSPs, interested in data related to SSPs, and likely to look to local public health officials to shape their opinions on SSPs compared with non-mainline FBLs. CONCLUSIONS:SSP advocates can address questions that FBLs have about SSPs before beginning outreach. By understanding common Protestant denominational affiliations, advocates can focus initial engagement efforts on FBLs in their communities who are more likely to support SSPs. Our findings suggest that local public health officials can influence FBLs' opinions about SSPs.

Given the shift toward technology-based approaches to assessment and intervention and the growing popularity of virtual service delivery, practitioners must have data to inform whether student performance on curriculum-based measures (CBMs) is equivalent when administering assessments through different modalities. Reading CBMs are a widely used tool for benchmarking and monitoring student progress, but researchers have not thoroughly examined variations on CBM assessment modality (e.g., tablets, computers, video conferencing). The current study extends the research on CBM assessment modalities by comparing students’ oral reading fluency (ORF) scores across traditional (face-to-face, with paper probes) and virtual (via video conferencing, with probes presented on screen share) assessment sessions. Results from four students, using an alternating treatment design, show slight differences between modalities with traditional face-to-face administration yielding higher scores. Assessment integrity and interscorer agreement data were collected. Discussion focuses on limitations, directions for future research, and considerations for practitioners.

Word boxes (also known as sound boxes or Elkonin boxes) is a widely used intervention targeting basic literacy skills. The word/sound box intervention has been implemented across grades, settings, and student ability levels, but to date there has not been a quantitative analysis of the effects of the word/sound box intervention. The purpose of the current study was to evaluate the effectiveness of the word/sound box intervention through a systematic review and meta-analysis and determine if any moderator variables affected the effectiveness of the intervention. A systematic review and meta-analysis of single-case design studies on the word/sound box intervention was conducted. Results show that the word/sound box intervention was highly effective. Significant moderators included adherence to What Works Clearinghouse standards and grade level. Applications, limitations, and future directions for the word box intervention are discussed.

Tablet-based technology has become a conduit for the administration of curriculum-based measurement (CBM) tools. Using tablets to administer CBM probes has many advantages; however, little is known about how students perform on CBMs when administered via a tablet. The current investigation compared digits correct per minute obtained from 44 third-grade students on CBM addition fluency probes administered via three different modalities. Students completed the probes using traditional paper and pencil, a tablet using their fingers to write the answer, or a tablet application using a keyboard to type the answer. A within-subjects group design showed students performed significantly better on the tablet when using their finger to write the answer, even though most students (58%) indicated this was their least preferred modality. The discussion focuses on the implications for educators and the use of different CBM modalities for interindividual and intraindividual comparisons.

The Ohio Internship Program in School Psychology was forced to adapt abruptly to the changing circumstances brought on by the novel coronavirus (COVID-19) pandemic beginning in March 2020. The purpose of this study was to determine the extent to which the school psychology internship outcomes were negatively affected by the COVID-19 pandemic in terms of supervisors' ratings of intern competencies, the number of students served by interns, and the outcomes of academic and behavior interventions supported by interns. Findings of the annual evaluation of the Ohio Internship Program in School Psychology for the school year directly affected by the pandemic (2020-2021) were compared to the findings for the year the pandemic began (2019-2020) and the 3 years before the start of the pandemic. The results provide evidence of gains in professional competencies and positive outcomes for students served by interns. The results also highlight racial disparities in the counts of students provided school psychological services during the pandemic. Implications for school psychology graduate preparation and practice are discussed.

There are roughly 440,000 foster youth living in the United States. Coupled with experiences of child welfare inequalities, foster youth are at an increased risk to develop mental and behavioral health issues. Mental health counselors are trained to advocate for their client’s mental and emotional well-being. However, minimal research demonstrates a counselor’s ability to work with foster youth. The current study adds to the existing body of research surrounding clinical work with children living in foster care. Using a transcendental phenomenology study to explore the experiences of mental health counselors working with foster youth, participants ( N = 11) were interviewed about their knowledge, skills, and feelings of preparedness to work with children living within the foster care system. Implications for counseling practice, supervision, and counselor education are provided.