Objectives We examined the outcomes of a cognitive-behavioral therapy (CBT) intervention for pain in pediatric sickle cell disease (SCD) using smartphones as a novel delivery method. Methods Forty-six children with SCD received CBT coping skills training using a randomized, waitlist control design. The intervention involved a single-session of CBT training and home-based practice using smartphones for eight weeks. Pre-post questionnaires between the randomized groups were used to evaluate changes in active psychological coping and negative thinking using the Coping Strategies Questionnaire. Daily diaries completed by the full sample during the treatment period were used to assess if CBT skill use was related to reductions in next day pain intensity and increases in same day functional activity. Results The pre-post group comparison suggested that youth increased active psychological coping attempts with the intervention. Daily diary data indicated that when children used CBT skills on days with higher pain, there were reductions in next day pain intensity. There was no such association between skill use and functional activity. Discussion CBT coping skills training supported via smartphones can increase coping and reduce pain intensity for children with SCD; however, additions to the study protocols are recommended in future studies. Advantages and caveats of using smartphones are also discussed.

Context Individuals with a history of anterior cruciate ligament reconstruction (ACLR) demonstrate persistent reductions in physical activity (PA) volume that are not being addressed during rehabilitation. Currently, it is challenging for clinicians to prescribe exercise interventions that extend beyond in-person rehabilitative care in a manner that is responsive and acceptable to patients. Objective To investigate the feasibility of using a novel, technology-driven, personalized goal-setting intervention over a 2-month period among young individuals with a history of primary unilateral ACLR. Design Single-blinded feasibility study. Setting University community Patients or Other Participants Ten women and 2 men (age = 22.0 ± 3.0 years, time since surgery = 56.0 ± 36.3 months) with a history of primary unilateral ACLR. Intervention(s) All participants completed a 28-day PA observation period immediately followed by a 28-day individualized PA goal-setting intervention period delivered via a commercially available PA monitor. Main Outcome Measure(s) Primary feasibility outcomes were days of PA monitor wear compliance and days of goal achievement during the intervention period. Participants also completed the Knee Osteoarthritis Outcome Score (KOOS) at study enrollment and after the intervention period, and the individual change in the KOOS Quality of Life subscale was compared with the minimal detectable change (7.2 points). Results Average PA monitor wear compliance was 95.5% ± 7.3% during the observation period and 97.7% ± 2.9% during the intervention period. Median goal achievement was 31.5% ± 6.8% during the intervention period. Five participants demonstrated meaningful improvements in the KOOS Quality of Life subscale during the study period. Conclusions Individualized goal setting via mobile technology appears to be a feasible approach to PA promotion. However, based on the low rate of daily goal attainment during the intervention period, continued refinement of this intervention aproach would be beneficial before broad clinical implementation.

A fundamental task for sociology is to uncover the mechanisms that produce and reproduce social inequalities. While status characteristics theory is the favored account of how social status contributes independently to the maintenance of inequality, it hinges on an unobserved construct, expectation states, in the middle of the causal chain between status and behavior. Efforts to test the mediation mechanism have been complicated by the implicit, often unconscious, nature of status expectations. To solve this “black box” problem, we offer a new conceptualization and research approach that capitalizes on the accuracy and precision of neurological measurement to shed new light on the biasing role of expectations in the status–behavior relationship. Results from an experimental study provide a unique illustration of ways in which social status is inscribed in the brain and how, in turn, these inscriptions are related to behavioral inequalities that emerge during interaction.

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The Healthcare Quality Calculator determines financial impact of poor patient outcomes and the benefit of initiatives to improve quality. The calculator can identify quality issues that would provide the largest financial benefit if improved; however, it cannot identify specific interventions. The calculator provides a tool to improve transparency regarding both short- and long-term financial consequences of funding, or failing to fund, initiatives to close gaps in quality or improve patient outcomes.