Integrating a positive youth development framework into physical activity programming has become popular as it is believed that this integration can create the development of both physical and psychosocial skills. However, there has been a lack of intervention fidelity research within the field of positive youth development.The Girls Just Wanna Have Fun program was designed in response to increased calls for physical activity programs for female youth and is a theoretically-grounded physical activity-based life skills program that aims to empower female youth. The purpose of this paper was to provide a detailed description of the program and a process evaluation of the first year of program implementation. From interviews with youth and leaders, as well as documentation from the leaders’ weekly online log of each implemented session, themes emerged regarding the successes.Findings from this study indicated that program goals were attained and it appears that the program was implemented, for the most part, as designed. The themes related to successes included using activities to facilitate relational time, providing intentional opportunities for leadership, having communicative program leaders who supported one another, and engaging youth in different types of physical activity. The themes related to challenges included difficulties with facility and transportation, some activities being too much like schoolwork, and social distractions and cliques. Included in the paper is a discussion of practical implications and recommendations for community programmers, as well as future directions for the program.Overall, this process evaluation represents an important step in responding to calls for increased evaluation in community-based programs and aids in understanding the process in which positive youth development programs can be effectively implemented. In order to achieve these three goals, the GJWHF program was based primarily on and Hellison’s , 2011 TPThe TPSR model was developed from work with at-risk youth in after-school sport and physical education programming in schools. This model focuses on developing a strong instructor-participant relationship that allows for the gradual empowerment of youth  always occurred. Additionally, there was one session where a photographer was brought in to take the girls’ pictures to help them develop a portfolio of themselves to increase confidence and empower the girls. In this session, no specific sport or PA was integrated because of this unique opportunity. In addition, a session was conducted on hygiene as the program leaders thought this was a critical element to discuss with the female youth between the ages of 11 and 14 as they were beginning to go through puberty and to experience changes to their body. Finally, the last three weeks of the program were designed around leadership. The girls were responsible for planning, developing, and implementing PA games and life skill activities to younger youth within the BGC. The girls worked in groups of two or three and had two weeks of planning within their small groups. The following session involved the girls presenting and teaching their younger peers (6 to 9 years old) at the BGC what they had learned from the program.From September 2011 to May 2012, female youth ages 11 to 14  from two BGC locations met at one clubhouse once per week for a 75 minute program. The BGC decided to open the program to female youth from two different clubhouses. The girls were from low income families in a major city in Eastern Ontario. In addition, as this was the first year that the GJWHF program was run, all female youth were participating for the first time; however, their length of involvement at the BGC ranged from two months to nine years.The program took place at one clubhouse and free transportation was provided to and from the program for youth from the second clubhouse. Either a BGC bus or taxi picked the youth up at their home clubhouse and then dropped them back to their home clubhouse after the program ended for the night. The average attendance rate was 10.4 youth per session; however, this number did fluctuate from five youth (during March break) to 14 youth  and all had completed or were in the midst of attaining a degree in the fields of Human Kinetics or Social Work. The primary leader, who is the first author and aided in program development and implementation, was a graduate student at the local university. The leaders outside of the BGC had less experience working with youth and therefore were required to complete the standardized volunteer training at the BGC. Furthermore, all leaders took part in a one day training program that was run by a professor with expertise in the field of program implementation and youth development before the start of the program. Training consisted of outlining the progression of the program by going over the manual and addressing how each session would be structured, based on the TPSR model. The leaders also met 30 minutes before the start of each program session to discuss the plan for the session and at the end of each session a 15 minute debriefing period was held to discuss what went well, what could be improved, and plans for the following week. In addition, the primary leader was responsible for sending out weekly emails of session plans and facilitating the session debrief with the co-leaders post-session. All five leaders participated in this study.One critical component of this program was the large leader support, as on any given night of the program, there was a minimum of four leaders present, and on most evenings all five leaders were present.Typically, a process evaluation measures fidelity of program implementation  and participants’ receptivity and enjoyment of the program . Due to the time constraints of the program, the youth were interviewed at their home clubhouse within one week of the conclusion of the program. As mentioned above, some of the youth dropped out of the program. Although it was planned to interview the youth who had stayed in the program as well as those who dropped out, arranging interviews with the youth who had dropped out proved to be very difficult. Therefore only the 10 youth that participated for the entire program were interviewed. The leaders were also interviewed outside of program time at a place and time convenient for them. Two separate interview guides were developed, one for youth and one for program leaders. The interview guide for the youth was designed to understand their experiences in the program as well as their perceptions of how participation in the program may have impacted their personal development. Questions included: ‘What did you like and not like about the program?’; ‘What did you learn in the program?; ‘What was your experience like working with the program leaders?’; ‘What did you learn by being involved in the program?’; ‘What do you believe has impacted you the most during this program?’; ‘Is there anything you hoped would have happened in or after the program that did not happen?’. The program leader interview guide was designed to understand their experiences implementing the program and their perceptions of program impact. Questions included: ‘How was the GJWHF program perceived by the youth?’; ‘What successes and challenges did you experience related to implementing the GJWHF program?’; ‘What strategies did you use to keep the youth engaged in GJWHF? Which strategies were the most effective?’; ‘What suggestions do you have for improving the GJWHF program club?’. Probes were also used to explore areas of the participants’ experiences further. All of the interviews were recorded using an audio-recorder. The youth interviews ranged from 15 to 42 minutes, while the leader interviews ranged from 25 to 45 minutes.The youth interviews were conducted by the lead researcher who was also a program leader. It is recognized that having the researcher also be a leader in the program could introduce bias; however, several studies within the field of youth programming have used this approach in the past . The interview transcripts and the GJWHF online logbook were analyzed using an inductive thematic analysis . For example, the identification code L-4 would indicate that the individual was a leader and was interviewed fourth.The first section presents the results focused on fidelity of implementation which was documented based on the analysis of the Leader Logbook. This is followed by the results of the thematic analysis which revealed two overarching themes: successes and challenges. These two themes were comprised of seven sub-themes.They give you the option of if you wanted to play first or have snacks or do the lesson. I think it was nice because they’d give you the choice of what you feel comfortable doing and they’d make you feel more comfortable and give you more expression. (Y-5)As noted in Table I liked how it was sort of our own thing. It was run by the leaders, but we would pitch ideas and [the leaders] would try to do them. With other groups I’ve been in, it’s sort of like they do all the planning; they pitch the ideas and we do them. I like this part. (Y-3)Lastly, one youth discussed that having a program that was youth-driven was ideal compared to other programs: Therefore, it appears that GJWHF was implemented as designed which may help explain the successes outlined below.Four themes emerged related to program successes which included using ‘Rose and Thorn’ to facilitate relational time, providing intentional opportunities for leadership, having communicative program leaders who supported one another, and engaging youth in different types of physical activity. These themes are highlighted in greater detail below.Now they [the youth] all come in and it’s like ‘I have a good rose today’, or ‘I have three roses’ and it’s something that they definitely look forward to and they know it’s coming at the beginning—they’ve come to expect it…so we’ve kept it going all year, and I guess it gives the kids some time to reflect on how their week’s been going or some of the problems they’ve been having at school. And they’ll chat about it with you, so it’s good to kind of talk through things with them and then it kind of sets the tone for the rest of the session too. So that’s been a really cool highlight. (L-5)The importance of using an activity like ‘Rose and Thorn’ was recognized by both youth and leaders as having a positive impact and an effective means of connecting with each other. Originally, the ‘Rose and Thorn’ activity was planned to be an ice breaker at the start of the program, but it was soon understood that the youth enjoyed this time to share with each other. As a result, the ‘Rose and Thorn’ activity was implemented at the beginning of every session during relational time. This activity allowed time for the girls to talk with each other, listen to each other and relate to each other, as well as facilitate a relationship with the leaders. As one leader explained: In ‘Rose and Thorns’ we get to speak out and say we have a problem, we get to tell people the problem and they’d actually listen…I like ‘Rose and Thorn’ because you got to share what’s going on in your week. I felt like other people would understand what was happening, and what I did and stuff. Like say I was mad at something, they would understand, and not bombard me. (Y-4)The youth also felt supported by their peers and leaders in this activity as highlighted by these two quotations: “I liked the ‘Roses and Thorns’. You get to tell what happened, like you can share with everyone what happened in your life. And it kind of helped…like if you don’t have anyone to talk to” (Y-9) and: Similarly, the youth felt that this activity helped increase their relationships with the leaders: “I think the ‘Rose and Thorn’ activity is nice—it makes me feel as if they [the leaders] want to know what’s going on and it makes me actually feel more comfortable with them” (Y-5).I think it is important, and we don’t want to downplay that. Originally, it was used as an ice-breaker, but the youth definitely get a lot of skills out of it like communication skills, listening to others, respecting others when they’re talking, problem solving, someone’s having an issue at school, some of the kids will open and be like, ‘oh, that happened to me too, and this is what I did’. So I think there’s definitely value in that. (L-1)Some youth shared that the ‘Rose and Thorn’ activity also helped them to increase their confidence throughout the year: “I can speak out louder in front of them and show my ‘Rose and Thorn’ now. At the first day, I couldn’t do it because I was too shy. Now I’m comfortable sharing in front of everyone” (Y-8). In addition, the leaders discussed that the youth respected and listened to their peers, problem solved, and appreciated each other. Two leaders discussed the importance of having decided as a group to keep the ‘Rose and Thorn’ activity as part of the relational time at the beginning of every session: “That’s what the girls really enjoy and in and of itself – learning to listen to each other, appreciating each other, contributing to the group – that’s what ‘Rose and Thorn’ does and those are life skills too” (L-2) and: Finally, one of the girls explained that ‘Rose and Thorn’ helped the youth feel like others care. “I liked the talking, just getting to know how people’s days were…so I like the fact that we do ‘Roses and Thorns’ to see how everybody’s week has been. It kind of shows us that we do care” (Y-3). As seen by the above quotations, the girls seemed to thoroughly enjoy the ‘Rose and Thorn’ activity which provided a supportive environment and fostered relational bonds between youth, as well as between youth and leaders.The youth took great ownership and pride in teaching their activity, even during the practice run the week before. They were well-spoken in their explanations to the group and showed a lot of confidence, maturity, and put forth a good effort. They did demonstrations and used constructive feedback provided by leaders. The GJWHF program was designed to end by providing the youth the opportunity to teach a PA-based life skill activity to their younger peers—BGC members between the ages of seven and nine that did not participate in the GJWHF program. This was perceived as being a great success by the youth, as expressed by these two quotations: “I felt like a leader for the kids to help them have fun…felt proud about the game I came up with and it was really good” (Y-4), and “we taught the other kids…that was fun. You learn different things from it…like to help others and to teach other people what I’ve learned” (Y-2). This activity was also reinforced as a success by the leaders, as they recognized that when provided such opportunities the youth step up, are able to teach and take a leadership role. One of the leaders discussed the impact of this activity: “some of the girls had some great teachable moments, like where they brainstormed a quality and then defined it to other younger youth” . Furthermore, it was outlined by this leader that the youth seemed to take great initiative when planning and implementing these activities for the younger club members. For the teaching part, I think it went really well; better than originally expected. They took on a great leadership role within their own groups when they were planning and developing the activities. It gave them their own purpose, like it was on them as to what they were going to choose—everything was left up to them, which was great. I think they really enjoyed having that flexibility…it was all independent and I think they really enjoyed that. (L-5)Another leader highlighted during a session debrief that the youth were “very creative and the young girls had a lot of fun participating. One group went as far as bringing treats for the kids and adding it in as part of the obstacle course. They really took great ownership” . Finally, one of the program leaders reflected on the overall process of the youth-led end-of-program activity: Open lines of communication. We always sent out an email once a week beforehand and just kind of talked about what we’re going to be doing, does anyone have any questions or suggestions on how we can make this session better…so I think that’s been really good. (L-5)Over the course of the program, a major success was having a strong supportive network of program leaders who were responsible for implementing the program. As one leader explained, consistent communication was critical to effective implementation: This helped the planning process over the course of the program to continually keep all leaders involved in what each session would entail. The consistent communication via email also provided opportunities for any of the leaders to deliver feedback or suggestions. Furthermore, in addition to communicating for logistical reasons, leaders communicated with each other for guidance and advice. One leader indicated: “One of the other leaders, she’s been working with the BGC for years and years and she has experience working with youth in camps and things like that, so she’s sort of the person that I turn to” (L-1).More of a structure in training would have been helpful and maybe…knowing how to handle certain situations better. I do find that when there are certain things that people will say, where I’m not really sure how to handle the situation. (L-1)Although the leaders discussed having a supportive network two of the leaders recommended that future years incorporate more training in helping with aspects that arise not directly related to the program curriculum such as dealing with social cliques and issues that the youth may be experiencing outside of the program. One leader shared “We had a debrief with (university supervisor) and at the end of the program, but I think more regular training or informal discussions of the behavioral understanding and how to act on certain behavioral issues that arise.” (L-5) while another leader stated: As mentioned, one of the main goals for this program was to provide opportunities for the youth to be physically active. Results found that each session provided sufficient opportunities for youth to engage in a variety of physical activities. From the leaders’ weekly reports of the session implementation, they outlined a number of program achievements with respect to providing an environment supportive of PA. During the program session debriefs, two leaders stated: “all of the activities were successful in getting the girls active while applying a life skill”  and “the girls had fun and they were successful in getting their heart rates up and getting them active” .A youth-led dance instructor tried a new method of dance with the girls called the GROOVE method. It allowed for a lot of independent movement, and I think the kids really enjoyed it. It gave them a sense of ownership and independence, while allowing for creativity. Not only was the program successful in facilitating PA, but also providing opportunities to youth that they might have otherwise not have had the opportunity to do. One leader stated: Yoga was another activity that many of the youth were able to try for the first time: “Yoga went very well! All the girls were sweating and working hard…they all gave 100% effort and tried very hard (no one gave up). Something new and exciting to do!” . Additionally, the youth played lacrosse, went swimming, and skating. The following quotations highlight the youth’s perceptions of the variety of activities: “I really liked the games and how sometimes we would go places—Oh I really liked the swimming activity which was really fun” (Y-1) and “I liked soccer, racquet hockey—oh and huckle buckle. I liked the walking that we did all the way to the river. And swimming–I got to do tricks in the water” (Y-7).Overall, the youth participants thoroughly enjoyed the PA opportunities they had during the program. This youth discussed how the experience helped her at school: “It got me more active and for some reason it just got me happy and I was just like ‘oh yeah I’m going to have something to do after school!’ and my mom is happy because I’m more active” (Y-3). As mentioned, it is critical to ensure the youth are enjoying themselves during the activities in order to ensure adherence to the program and participation in PA. “We had the girls run a lot, while not really realizing it, and having a lot of fun; you could tell they were all tired at the end but had enjoyed themselves” .As with any program, especially in the first year of implementation, there were challenges. Three main themes emerged which included difficulties with the facility and transportation, recognizing that, at times, some activities were too much like schoolwork, and issues related to and social distractions and cliques.The room for the life skills, once we were more than 12 girls, it was pretty crammed, so it got loud and sometimes it would be hard to talk over them, so if we could get a bigger room, more private, more isolated. Especially next year, I think we’re estimating to get more girls, so a bigger room would be the ideal. (L-3)One challenge that was encountered was the space allocated for the program—it was too small for the group. There was a small craft room for the relational time and awareness talk and GJWHF only had access to the larger gymnasium for the PA time. One leader emphasized this issue: Additionally, as the room in which the girls participated in the life skills activities was right beside the gymnasium, it was often quite loud and distracting having other BGC programming going on at the same time. “If there were people in the gym, the room was right next to the gym and you could hear all the balls thrown and all the kids playing and having fun so it was a bit distracting” (L-3).As mentioned, another challenge was transportation. A large majority of the participants travelled, with their leader, to the program from a different BGC clubhouse. As a result, over the course of the year, some issues occurred with transportation since the program relied on taxis to transport the youth from clubhouse to clubhouse. The issue of having non-reliable transportation caused serious disruptions in at least two of the program sessions. The leader stated: “Taxis didn't come therefore multiple waves of people caused constant interruptions. Only had 15 minutes to do life skill…a little bit frustrating” .If you’re someone who is struggling in school and you come to the club and you want to participate in the program, and you get a workbook that’s full of words you can’t read and you’re sitting at a desk again, I think it kind of re-creates an environment where a lot of our girls aren’t very successful and don’t feel very good about themselves…It’s very school-like. (L-2)I think having the in-class portion does have its benefits, but it’s just trying to limit the amount of regimented, school-like activities that there are…You have to be adaptable and it might not work out exactly how you planned in the workbook or manual. (L-5)One challenge was attempting to avoid having the program feel too much like schoolwork. For the life skills activities, the leaders tried to incorporate as many active or discussion-like activities as possible to avoid the feeling of doing schoolwork . However, for some of the life skills activities, a workbook was used to have the youth write down their ideas related to the skill . Therefore, at times, these workbook activities were a challenge as indicated by these two leaders. We tried to plan stuff that you wouldn’t necessarily do in gym class, or if you do soccer or basketball, try and go one step further than what they [the youth] would do in gym class. If they wanted to play a game of bump, play a game of bump, rather than do drills. You could tell they didn’t love it [doing drills] so we kind of left it to be a little bit more unstructured and up to the youth to decide. (L-5)In addition, many of the activities that the girls chose were similar to what the girls would participate in during a physical education class so the leaders made an extra effort to go beyond what would be done in within the school curriculum. As long as they’re moving and getting PA, that’s the most important part of it. I guess be on the basketball team if you want to learn the more structured stuff, so that was something that we had to re-adjust—we were like ‘okay, this isn’t working as well as we hoped. We’ll move on and try it a different way’. (L-5)One of the most important elements the leaders recognized early in the program was that the youth were not as engaged when the PA was regimented like a sport practice so leaders worked to ensure that the activities were not rigid and more enjoyable for the youth. In some ways, I think it’s easier for them [girls at home clubhouse] because they have other options, so if they’re feeling shy, they can just go hide in the computer room where the girls [from other clubhouse] don’t have those options. They bus here and this is the program and they’re going to participate in the program. (L-4)In line with the above challenge, the leaders struggled with behavioral management of the youth a few times over the course of the program. The youth were from two different clubhouses and the youth who were from the clubhouse in which the program was run were often very distracted by other people and other programs at the club. Therefore, there was an ongoing issue of these youth milling in and out of the sessions at their own leisure. Towards the end of the program this became frustrating not only to the leaders, but also the other youth. While one leader expressed that there was “bickering between certain girls” , another leader stated: Separate them [the youth] into smaller groups…something that we want to work on for next year. Maybe get one or two more leaders…if we do get a big group of 20 girls, split up 10 and 10 and then break those groups smaller. (L-5)Although not discussed during the interviews, some of the youth who attended the program on a regular basis openly discussed their frustration with the lack of commitment of some of the participants displayed during the program sessions. Related to this, the leaders also occasionally struggled with behavioral challenges due to having all of the girls in one group and so a leader suggested changing this in the future: For our girls, the ones at (name of clubhouse), I think they actually were a little bit uncomfortable with the idea that there were new girls coming to the centre that they didn’t know and that was kind of like—you know, girls that age, they kind of have their friends and it’s a little bit uncomfortable to meet new people. (L-4)In addition to informal discussions that took place throughout the program, some of the youth took the opportunity to express their concern on their confidential paper indicating elements of the program they did not like: “what I don't like about the GJWHF is that there are no communications between the (name of clubhouse) girls or with the (name of clubhouse) girls and that would be the only reason why I don't really like the program” (AYF-9) and “I think I didn't really talk to the (name of clubhouse) girls that much and I wanted to” (AYF-8). When asked what she did not like about the program, one youth stated: “the (name of clubhouse) girls. It’s not like we’re trying not to talk to them, but I don’t know, we just didn’t bother talking to them as much” (P-10). Lastly, a leader that works at the clubhouse where the program was held had built a strong relationship with the youth from this clubhouse over many years and tried to explain why this issue might have occurred: This evaluation represents an important step in responding to calls for increased evaluation in community-based programs (Salmon et al. An important outcome that emerged from the GJWHF program was the facilitation of positive relationships between the youth and leaders, as results from this study indicated that the program was successful in providing an environment in which the girls felt comfortable and trusted by their leaders. More specifically, the interview data indicated that these relationships and trust appear to have been facilitated with the use of the ‘Rose and Thorn’ activity at the beginning of each session. It is possible that by providing an intentional time at the beginning of each session for the youth to share both positive and negative moments of the past week with each other allowed them to learn more about each other, listen to each other, and support each other helped which facilitated a sense of trust. This finding is consistent with previous research in which Markowitz  identifiWithin the current literature on the TPSR model, suggestions for how to facilitate relational time are quite vague in that it is suggested to check in with the youth (Hellison, The results of this study also suggest that when youth are provided the opportunity to lead, in particular by teaching younger peers, they may be empowered by being able to take ownership of different activities. Recent research conducted on youth involvement and PA contexts found that creating opportunities for female youth to share their experiences with others and build relationships with peers may help female youth develop their confidence as leaders (Yoshida et al. Researcher flexibility is essential when conducting program evaluations, yet program leader flexibility is also critical when facilitating youth-driven programs (Ozer et al. While this study was successful in understanding the processes of implementing the GJWHF program, there were some limitations within the study. First, there is always the potential of self-monitoring when participants know a program is being evaluated. Second, the majority of the data analyzed was based on self-report data; however, using the Leader Logbook helped to align what was discussed by the participants. Additionally, having the program leader conduct the youth interviews could have had the potential for youth social desirability; however, as stated earlier, this is not something the authors felt was an issue and some researchers believe that having leaders interview youth may be an effective as the youth are apt to open up and discuss their experiences with someone with whom they are familiar (Heath et al. Hirsch  indicateWith regards to transportation, instead of relying on taxis and clubhouse vans, for the second year of the program the BGC provided a bus that allowed for all of the youth to be transported to and from the program together. Having reliable and secure transportation helped avoid program interruptions and brought the youth together prior to beginning of the program session. It should be noted that while it is recognized that there are no youth quotations related to this theme, it was because the researcher did not ask the youth about this issue specifically; however, this theme was very apparent to the leaders.Lastly, within this study, it was requested by the leaders to have more in-depth training prior to and during program implementation. Although the requested training was for issues that were not directly related to the program curriculum it is important that leaders feel competent to be able to deal effectively with all aspects of the program and not just the skills and activities planned for the program sessions. This is consistent with previous TPSR process evaluations that struggled with adequate training for their leaders as “it is not realistic to expect that the Youth Leaders can learn to become effective TPSR leaders through mere observation or through a 10 minute discussion before or after the first session” (Wright et al. This paper provided a detailed description of the first year of implementation of the GJWHF program. Such detailed descriptions and process evaluations have been absent in much of the PYD literature (Hodge et al.


Aleurocanthus spiniferus (Quaintance), a well-known pest from the superfamily Aleyrodidae. The A. spiniferus mitogenome contains 36 genes, including 13 protein-coding genes (PCGs), 21 transfer RNAs (tRNA), two ribosomal RNAs (rRNA) and a large non-coding region . Like most whiteflies, the A. spiniferus mitogenome had a large degree of rearrangement due to translocation of the nad3-trnG-cox3 gene cluster. The 13 PCGs initiated with ATN and generally terminated with TAA, although some used TAG or T as stop codons; atp6 showed the highest evolutionary rate, whereas cox2 appeared to have the lowest rate. The A. spiniferus mitogenome had 21 tRNAs with a typical cloverleaf secondary structure composed of four arms. Modeling of the two rRNA genes indicated that their secondary structure was similar to that of other insects. The CR of A. spiniferus was 920 bp and mapped between the nad3-trnG-cox3 and trnI-trnM gene clusters. One potential stem-loop structure and five tandem repeats were identified in the CR. Phylogenetic relationships of 11 species from the Aleyrodidae were analyzed based on the deduced amino acid sequences of the 13 PCGs and evolutionary characteristics were explored. Species with more genetic rearrangements were generally more evolved within the Aleyrodidae.In this study, we sequenced the complete mitochondrial genome  of the citrus spiny whitefly,  Aleurocanthus spiniferus (Quaintance), the citrus (orange) spiny whitefly (Hemiptera: Aleyrodidae), is an important pest of citrus  and tea (Camelia sinensis (L.) Kuntze; Ericales: Theaceae). A. spiniferus is indigenous to tropical Asia and was first reported in Japan [A. spiniferus; the first type is the direct damage caused when immature and adult whiteflies ingest phloem sap, which leads to a weakened host plant and premature senescence. The second type of damage is caused when the whiteflies excrete honeydew on leaf surfaces; this promotes the growth of sooty mold, interferes with photosynthesis, and reduces plant quality [A. spiniferus may reside on the abaxial surface of infested leaves, which provides a safe overwintering site for a variety of mite pests [A. spiniferus infests many other economically important plants including rose, grape, peach, pear, and guava [A. spiniferus is on the list of quarantined species published by EPPO and was recently moved from the A1 to the A2 list [cox3-nad3 region as compared to the hypothesized model insect mitogenome. Based on these rearrangements, they speculated that this region underwent a transposition and at least four types of gene rearrangement had occurred in the evolution of whiteflies. Although the genes contained in the insect mitogenome are highly conserved, rearrangements or even disappearance of these 37 genes often occur, and the position of tRNA genes rearrange more frequently than the PCGs and rRNA genes in some species [in Japan ; thereafin Japan –3 and bein Japan . There a quality . In addite pests . In addind guava . It is i A2 list . In rece A2 list –13. Gene A2 list –15. Thao species .A. spiniferus, including the biology, behavior, ecology, and management have been thoroughly investigated [A. spiniferus have been lacking; consequently, the phylogenetic position of this species is unclear [A. spiniferus and provided a thorough description of its genome features. Finally, we discussed phylogenetic relationships and evolutionary traits among species of the Aleyrodidae based on the sequenced mitogenomes.Currently, many aspects of stigated –22. Howe unclear –24. FurtA. spiniferus were collected at West Lake  in September, 2012, Zhejiang Province, China. All studies were conducted on public lands; our research activities were not banned by any organization or individual and did not involve endangered or protected species. Samples were identified, preserved in 100% ethanol, and stored at −20°C until DNA was extracted. Whole genomic DNA was extracted from individual samples using DNAVzol  and stored at −20°C until used for PCR.Adult specimens of A. spiniferus was amplified with 15–20 overlapping PCR fragments. PCR primers were designed using Primer Premier 5.0 software and were based on universal primers of insect mitogenome [The mitogenome of togenome  and 11 Stogenome  , annealing for 1 min at 45–60°C, elongation for 1–3 min (depending on putative length of the fragments) at 72°C, and a final extension step of 10 min at 72°C. LA Taq polymerase  was used for PCR amplification, except for fragments less than 1.2 kb, which were amplified with Taq polymerase (TaKaRa). All PCR reactions were performed in an ABI thermal cycler . PCR products were separated by 1.0% agarose gel electrophoresis. Purified PCR products were ligated into pGEM-T Easy Vector (Promega). Recombinant clones were sequenced in both directions using the BigDye Terminator Sequencing Kit (Applied BioSystems) and the ABI 3730XL Genetic Analyzer  with vector-specific and internal primers. All PCR fragments were sequenced after separation and purification.http://www.codoncode.com/aligner/) was used for sequence assembly and annotation. Protein-coding (PCGs) and rRNA genes were identified by sequence alignment [Codencode Aligner (lignment  with publignment .http://lowelab.ucsc.edu/tRNAscan-SE/) [http://tandem.bu.edu/trf/trf.advanced.submit.html) [Most tRNA genes were identified by tRNAscan-SE Search Server v. 1.21 (can-SE/)  using thcan-SE/) –31. Stracan-SE/) . The sofcan-SE/)  was usedit.html) .Sitobion avenae and Diuraphis noxia, two Aphididae species, as outgroups. Thirteen PCGs were initially aligned with Clustal X, translated into amino acid sequences using default settings, and then analyzed with MEGA v. 5.0 [Ten complete Aleyrodidae mitogenomes were downloaded from GenBank to investigate phylogenetic relationships  . Substantial rearrangements and altered transcriptional directions were observed in the tRNAs, rRNAs and PCGs relative to other insect mitogenomes. Seventeen A. spiniferus genes were transcribed on the J-strand and the remaining 19 were transcribed on the N-strand.The complete mitogenome of J437166) , Table 1A. spiniferus mitogenome contained 51 bp of overlapping nucleotides; these spanned ten pairs of neighboring genes and ranged in length from 1 to 20 bp. The longest overlap (20 bp) existed between trnE and trnF. Overall, the complete mitogenome of A. spiniferus was very compact; the mitogenome contained only 91 bp of intergenic nucleotides (IGN). The IGNs were located between 14 pairs of neighboring genes and ranged from 1 to 25 bp; the longest IGN was a 25-bp region located between trnT and trnP.The A. spiniferus mitogenome was as follows: A = 31.0%, T = 39.8%, C = 12.4%, G = 16.8%. The A. spiniferus mitogenome was significantly biased towards the A and T nucleotides (70.8%), and this percentage was lower than the A+T content of other whitefly mitogenomes. The overall A+T content of the PCGs was 69.2%; genes with the highest and lowest A+T content were trnC (92.1%), and atp8 (63.3%). Furthermore, the AT-skew and GC-skew were calculated for the A. spiniferus mitogenome (Table B in A. spiniferus mitogenome was not consistent with the strand bias of metazoan mitogenome (positive AT-skew and negative GC-skew for the J-strand). The results showed that the AT-skew of the A. spiniferus mitogenome was -0.125 and was biased to use T rather than A; conversely, the GC-skew was 0.151 and was biased to use G rather than C.The nucleotide base composition of the cox1) to 75.8% (nad4l)  initiated with ATA, five with ATG , and two with ATT (cox2 and nad3) ; exceptions included nad3, cox2, and nad5, which contained the incomplete termination codon T. It is important to note that the truncated termination codon T could be potentially completed through post-transcriptional polyadenylation [The combined length of the 13 PCGs was 10,841 bp; the mean A+T content was 69.2% and ranged from 65% (nd nad3) . Althougnylation .A. spiniferus and the other ten whiteflies were TTT (Phe), ATT (Ile), TTA (Leu), ATA (Met) and AAT (Asn), which is consistent with the strong bias for A and T.The base composition at each codon position of the concatenated PCGs was analyzed. The results showed that the A+T content of the first, second, and third codon positions was 68.8, 69.2, and 69.6%, respectively, and there was no obvious nucleotide bias. We summarized and compared the relative synonymous codon usage (RSCU) values of all eleven whiteflies in atp6 had the highest evolutionary rate, followed by cytb, while cox2 appeared to be the lowest . With the exception of trnS2 (UCN), the tRNAs were identified using tRNAscan-SE [trnS2 was inferred by comparison with other Hemipteran mitogenomes. There were 15 mismatched nucleotides in the 21 tRNA genes of A. spiniferus, and these were all G-U pairs  gene of A. spiniferus was 1,278 bp in length with an A+T content of 77.7%, and the small ribosomal RNA (rrnS) gene was 771 bp with an A+T content of 77.1%. rrnL and rrnS were located between trnL2 (CUN) and trnN  with 47 helices  contained 920 bp nucleotides, and the A+T content was 65.9%. The CR was located between the nad3-trnG-cox3 and trnI-trnM gene clusters, and this unusual location for CR is presumably due to genetic rearrangement. The CR of A. spiniferus could be subdivided into five parts (In ve parts : (1) a 2Bemisia tabaci, and each biotype had two putative CRs. Thus the CRs of whiteflies obviously vary in length, nucleotide content, and structure when compared with other insects. CR length is generally dictated by the number and length of tandem repeats. The CR of A. spiniferus contained a single stem-loop structure, which was probably associated with the initiation of mitogenome replication or transcription [nT motif at the 3′ end of the stem-loop structure(s), are conserved in some insect species [n-like stretch in A. spiniferus was different from the 4-bp motif (TATA) observed in other whiteflies.There are very few reports that compare the CRs of different whitefly species. Wang et al.  comparedcription . Two mot species . HoweverDrosophila yakuba; this was regarded as the model mitogenome because of its conserved gene order when compared with non-insect hexapods [Aleurodicus dugesii mitogenome is similar to D. yakuba and is recognized as the model mitogenome of whiteflies [Genetic rearrangements in insect mitogenomes occur randomly between orders but are very informative with respect to insect evolution . The firhexapods  and crushexapods . The Aleiteflies , 52.A. spiniferus mitogenome when compared to the D. yakuba mitogenome. In this respect, our findings are similar with those reported previously [A. spiniferus mitogenome were similar to the A type observed in B. tabaci [cox3-trnG-nad3 ancestral gene cluster was rearranged in A. spiniferus and occurred in the reverse order (nad3-trnG-cox3) between trnA and CR. The ancestral cluster consisting of trnA-trnR-trnN was translocated in A. spiniferus and mapped between rrnS and the nad3-trnG-cox3 gene cluster. In addition, trnS1 (AGN) was absent from the A. spiniferus mitogenome, and trnV and trnQ were placed between trnN and trnR  and Bemisia afer (Africa). The sequences of additional whitefly mitogenomes are needed to confirm whether the translocation of the nad3-trnG-cox3 gene cluster is a common feature in the Aleyrodidae. It is also noteworthy that the phylogenetic tree recovered by MGR is very similar to the trees constructed by BI and ML, which shows that a total of 28 rearrangements occurred in the published mitogenomes of Aleyrodidae  with high evolutionary rates, an additional phylogenetic tree was constructed by BI analysis Click here for additional data file.


Compared to ARID1A+, ARID1A− significantly increased cancer-specific mortality  = 1.19–2.00, I2 = 31%). Using HRs adjusted for potential confounders, ARID1A− was associated with a greater risk of cancer-specific mortality  and cancer recurrence . On the basis of these results, we have demonstrated that loss of ARID1A shortened time to cancer-specific mortality, and to recurrence of cancer when adjusting for potential confounders. For its role, this gene should be considered as an important potential target for personalized medicine in cancer treatment.Loss of the tumor suppressor gene AT-rich interactive domain-containing protein 1A (ARID1A) has been demonstrated in several cancers, but its prognostic role is unknown. We aimed to investigate the risk associated with loss of ARID1A (ARID1A−) for all-cause mortality, cancer-specific mortality and recurrence of disease in subjects with cancer. PubMed and SCOPUS search from database inception until 01/31/2015 without language restriction was conducted, contacting authors for unpublished data. Eligible were prospective studies reporting data on prognostic parameters in subjects with cancer, comparing participants with presence of ARID1A (ARID1A+) vs. ARID1A−, assessed either via immunohistochemistry (loss of expression) or with genetic testing (presence of mutation). Data were summarized using risk ratios (RR) for number of deaths/recurrences and hazard ratios (HR) for time-dependent risk related to ARID1A− adjusted for potential confounders. Of 136 hits, 25 studies with 5,651 participants (28 cohorts; ARID1A−:  Recent studies established that cancer development depends on both epigenetic and genomic alterations , 3. Part0-G1 and lowest in S and G2-M phases .–38.14–38N = 25, 89.3%) assessed the presence of ARID1A with immunohistochemistry (tissue microarray or whole-section immunohistochemistry), while 3 (10.7%) assessed the genetic status directly  , 35–38 fdirectly .p = 0.40), and 54.9% and 52.7% were females (p = 0.41) (p = 0.26), with the corresponding figures being 53.1% and 63.6% (p = 0.002) using the TNM classification. Finally, 47.0% and 51.3% of participants with ARID1A− and ARID1A+ had a low grade cancer (p = 0.14) (Participants with ARID1A− and ARID1A+ averaged 62.1 ± 12.6 years and 58.8 ± 11.2 years ( = 0.41) . Partici = 0.14) .p = 0.69, I2 = 87%)   as shown in Table Pooling data from 26 studies , 30–38, %) Table . Similar%) Table . ConversIn secondary analyses, we investigated whether using hazard ratios (adjusted for the maximum number of the covariates available in each study) instead of risk ratios influenced the results. Altogether, the number of adjustments ranged from 0 to 10, with a mean of 3 ± 3 covariates used in the survival analyses .p = 0.36, I2 = 67%). Conversely, in adjusted survival analyses, compared to ARID1A+, ARID1A− was associated with a significantly greater risk of dying from cancer (2 studies) ). All final inferential statistics used alpha = 0.05.Lastly, we assessed the presence of publication bias by visual inspection of Funnel plots.


Classic, a state-endorsed but previously untested lifestyle health promotion program. It will: (1) discuss Texercise Classic’s participant reach and adoption over time; (2) describe the rationale and processes employed to formalize Texercise Classic into a more structured program known as Texercise Select; (3) outline the essential elements and activities included in Texercise Select and contrast them with those included in Texercise Classic; and (4) highlight key components for uniform facilitator training. The discussion will reflect upon the evolution of Texercise, compare and contrast the benefits and challenges of each program, and review the “next steps” for Texercise Select. In contrasting Texercise Classic and Select, it is important to understand the benefits and challenges of both programs. Preliminary results indicate that Texercise Select is effective, yet its ability to sustain the same reach as Texercise Classic remains unknown and an area for future study.Little is known about the structure, content, and benefits of practice-based or grass roots health programs that have been widely delivered by a variety of community organizations and stakeholders. This perspective will document the natural history of Texercise  With greater recognition of the value of health promotion for adults across the life-course , a multiIncluded in the first programmatic stream, health promotion/disease prevention programs have traditionally been delivered by non-academic community-based practitioners with the generic goals of maintaining or improving health –8. BecauA second programmatic stream involves the recent nationwide movement toward the widespread dissemination of evidence-based programs (EBPs) for older adults that were developed and tested by academics in controlled settings. This movement reflects the assumption that EBPs are preferable because they are “assumedly” more efficient and cost-effective than programs that are not theoretically based and rigorously evaluated . With thLess is known, however, about the structure, content, and benefits of grass roots health programs that have been delivered by a variety of community organizations across vast geographic distances . Further, little attention has been given to understand how these programs might contribute to practice-based evidence. Given the recent emphasis on administrative policies within the Administration on Community Living (ACL), which give funding preference to EBPs , it is eClassic) so that it could be formally evaluated. Specifically, this article will: (1) document the natural history of Texercise Classic, including its programmatic reach and adoption across Texas over the past decade and a half; (2) describe the rationale and processes employed to formalize Texercise Classic into a more structured program known as Texercise Select; (3) outline the essential elements and activities included in Texercise Select and contrast them with those included in Texercise Classic; and (4) highlight key components for uniform facilitator training. The discussion will reflect upon the evolution of Texercise, the comparisons across the two program types, and the “Select.This perspective article presents a case study of Texercise, a community-based health promotion movement established in 1999 to help Texans ages 45 and older live healthier lives. Based on a historical review of existing Texercise materials, supplemented by information provided by key Texercise staff, this article will examine the processes employed to structure the original Texercise program  about how to initiate an exercise program have been distributed to individuals wanting to exercise on their own  and collect more detailed information from participants with the hopes of establishing a rigorous, scientific evidence base for this program. This evaluation has generated a new phase of activity.Classic program would make program evaluation difficult. Initially, Texercise Classic was designed as a participant-driven grass roots program in which participants, in collaboration with group leaders, decide upon the nature and amount of group exercises. While this strategy offered substantial choice, the lack of uniformity between workshops offered made it difficult to examine effectiveness and generalize to all Texercise programs. The Texas A&M research team and DADS staff jointly decided to utilize existing program materials and activities to create a more formally designed program. As indicated in Table Select. Texercise Select is implemented in 12 weeks, which includes 2 weeks for participant recruitment and 10 weeks of 1.5-hour sessions conducted twice a week. Utilizing evidence-based skills and tools, each session incorporates interactive educational discussions, interactive activities related to physical activity and/or nutrition topics, and 30–45 minutes of actual exercise.We identified in the beginning stages of the evaluation project that the loosely structured nature of the existing Texercise Select program, manual, and training that operationalized essential intervention elements and processes. To accomplish this task, the research team reviewed the literature as well as comparable EBPs. This review enabled the team to identify key exercise and behavior change elements that would work best in the Texercise context . Drawing on social cognitive learning principles  with information about how to safely introduce exercises. These training sessions were supplemented with course material that included screening questions and safety tips for participants , it was designed to be highly participatory and interactive with participants learning to actively engage in behavior change principles such as goal setting, problem solving, tracking behaviors, and providing support to fellow class participants. In addition to a peer-to-peer learning approach, Texercise r adults , 28–30. r adults , 26, 31.icipants .Given the high probability of behavioral relapse in achieving one’s desired lifestyle behavioral goals , the curClassic with those of Texercise Select. When compared to Texercise Classic, Texercise Select has some similarities and many substantial differences. We draw upon Schulz and colleague’s . In contrast, Texercise Select was designed by individuals with formal training in exercise science and behavioral science as related to older adults. As such, this version of the program has benefited from an emerging science and practice base in both of these disciplines , the structure varies across the two programs, which makes the actual program duration and class time likely to vary as well. Texercise Select, the research team decided to utilize the term “facilitator” for program “lay” or “peer” leaders who are typically community volunteers versus health professionals. This decision was intended to emphasize that facilitators are not experts; rather, their role was to “facilitate” participants’ ability to influence their health and functioning by presenting them with the concepts and exercises included within the program. The facilitator training was seen as essential for maintaining treatment fidelity  identifying the session topic; (2) identifying session materials needed; (3) identifying session activities; and (4) choosing one exercise from each exercise category  and demonstrating it. Facilitators were then critiqued by trainers and any issues discussed and clarified.Twenty-nine facilitators were trained during this pilot study. The curriculum was originally developed with two Texas A&M trained facilitators per class in mind. Once the research team began working with organizations to identify implementation sites and facilitators, it became apparent the class would most likely be led by one trained facilitator with assistance from another person who had not gone through the formal A&M training session. Given the pilot nature of this demonstration study, the Texas A&M class trainers were available by telephone and email to provide additional assistance to newly trained facilitators.Texercise Select into a testable and replicable EBP. These involved: (1) inventorying the current literature to identify foundational concepts in evidence-based health and wellness programs, with special emphasis on strategies for promoting participant’s self-efficacy for engaging in physical activity and peer-to-peer learning; (2) evaluating the match between existing programmatic elements and anticipated delivery capacity and structure to ensure program adoptability and maximal population coverage; (3) organizing the sessions around a “ready, set, go, stay” framework for ease of implementation; (4) developing a standardized manual and training protocol; (5) incorporating fidelity checks and quality assurance into the implementation and evaluation processes; and (6) identifying a practical measurement battery to assess pre–post intervention outcomes.We employed several steps in transforming Classic widely available and disseminated through existing community partners and delivery systems even before it was formally evaluated. Further, participation in Texercise Classic has grown state-wide for over 15 years, confirming the importance of high level endorsements and community buy-in for achieving long-term program sustainability  the reconfigured program with fidelity. For example, some park and recreation programs might easily adapt the exercise training part but not be as comfortable with facilitating the behavioral lifestyle educational aspects.Conversely, Texercise Select is likely to be more effective than Texercise Classic in changing lifestyle behaviors because of its standardized incorporation of evidence-based behavioral change principles. Yet, it is also unknown whether Texercise Select will be as appealing to community organizations and able to sustain the same reach and adoption as Texercise Classic. This issue illustrates a potential trade-off often seen when attempting to simultaneously achieve public health reach and effectiveness  seen in positive health behaviors  with large effect sizes for physical activity and smaller ones for nutrition behaviors. Additionally, enhanced dissemination of Texercise Select requires infrastructure resources such as the widespread availability of standardized training. Toward this end, DADS is updating the training and implementation manual so it will be web-based and easily accessible by community partners and potential facilitators. Although initial outcome results are promising, further study is needed to understand factors associated with the ability of Texercise Select to be widely disseminated and sustained over time. Once the results of initial pilot testing from 2013 are fully published, we recommend a state-wide campaign with DADS’s current Texercise partners to help spread the word about the benefits of implementing evidence-based programing for seniors and how Texercise Select might be broadly disseminated through existing community channels.The purpose of this article was to illustrate the evolution of a grass roots program to become a theoretically derived and research-tested program. The further expansion of Texercise romising , 50, witThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.This paper is included in the Research Topic, “Evidence-Based Programming for Older Adults.” This Research Topic received partial funding from multiple government and private organizations/agencies; however, the views, findings, and conclusions in these articles are those of the authors and do not necessarily represent the official position of these organizations/agencies. All papers published in the Research Topic received peer review from members of the Frontiers in Public Health  panel of Review Editors. Because this Research Topic represents work closely associated with a nationwide evidence-based movement in the US, many of the authors and/or Review Editors may have worked together previously in some fashion. Review Editors were purposively selected based on their expertise with evaluation and/or evidence-based programming for older adults. Review Editors were independent of named authors on any given article published in this volume.


Numerous digital health interventions have been developed for mental health promotion and intervention, including eating disorders. Efficacy of many interventions has been evaluated, yet knowledge about reasons for dropout and poor adherence is scarce. Most digital health intervention studies lack appropriate research design and methods to investigate individual engagement issues. User engagement and program usability are inextricably linked, making usability studies vital in understanding and improving engagement.The aim of this study was to explore engagement and corresponding usability issues of the Healthy Body Image Program—a guided online intervention for individuals with body image concerns or eating disorders. The secondary aim was to demonstrate the value of usability research in order to investigate engagement.We conducted an iterative usability study based on a mixed-methods approach, combining cognitive and semistructured interviews as well as questionnaires, prior to program launch. Two separate rounds of usability studies were completed, testing a total of 9 potential users. Thematic analysis and descriptive statistics were used to analyze the think-aloud tasks, interviews, and questionnaires.Participants were satisfied with the overall usability of the program. The average usability score was 77.5/100 for the first test round and improved to 83.1/100 after applying modifications for the second iteration. The analysis of the qualitative data revealed five central themes: layout, navigation, content, support, and engagement conditions. The first three themes highlight usability aspects of the program, while the latter two highlight engagement issues. An easy-to-use format, clear wording, the nature of guidance, and opportunity for interactivity were important issues related to usability. The coach support, time investment, and severity of users’ symptoms, the program’s features and effectiveness, trust, anonymity, and affordability were relevant to engagement.This study identified salient usability and engagement features associated with participant motivation to use the Healthy Body Image Program and ultimately helped improve the program prior to its implementation. This research demonstrates that improvements in usability and engagement can be achieved by testing and adjusting intervention design and content prior to program launch. The results are consistent with related research and reinforce the need for further research to identify usage patterns and effective means for reducing dropout. Digital health research should include usability studies prior to efficacy trials to help create more user-friendly programs that have a higher likelihood of “real-world” adoption. Digital health technologies are increasingly common and are used in the prevention, diagnosis, and treatment of mental health problems. In the eating disorders field, several online programs have been developed and demonstrate promising results -3. AvailTo date, there is scant research examining the specific reasons for dropout and poor user engagement in online programs. The multidimensional nature of user engagement complicates research design because engagement includes individual users’ thoughts and feelings, degree of activity, and attitudes towards technical aspects of the program including aspects of usability and appeal . User enThis study aimed to explore and reveal different usability and engagement issues in the course of the redesign of the Healthy Body Image Program (HBI) -17, whicParticipants were recruited through Web-based and print advertisements  in the San Francisco Bay Area and on the campus of a large private university. Participants were offered free access to the online program and gift cards of US $10-30 depending on how much time they spent in the usability testing. The HBI program was originally designed for college-aged females, so this study also included women aged 18-25 years with an interest in improving body image and reducing disordered eating behaviors. Interested individuals were first contacted via phone in order to explain the study procedure and to conduct a short telephone screening, for which we used the SCOFF questionnaire . SCOFF  chosen by the participants. The privacy of the participants and a possible impact regarding their answers was taken into consideration by making sure that there were no people in close vicinity. We obtained human subjects approval from the Institutional Review Board at Stanford University.HBI begins with a Web-based assessment to determine the severity of disordered eating symptoms and risk for developing an eating disorder. Based on assessment results, participants are directed to one of several tracks of a tailored online evidence-based intervention, referred to by variations of “Student Bodies,” which is for individuals across the eating disorder risk and diagnostic spectrum . TailoriDiagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), excluding full-syndrome anorexia nervosa. As part of a dissemination partnership and technology transfer, the Healthy Body Image Program and variations of “Student Bodies” were licensed to a private company, Lantern, which now provides the programs under its name. SB-ED aims to reduce disordered eating behaviors , improve body image, and support the development of effective coping skills. It includes daily sessions based on motivational principles of Cognitive Behavioral Therapy (CBT), Motivational Interviewing, and the Fogg Behavior Model for Persuasive Design (FBM)  to track in a healthy way.” Additionally, the use of a CBT approach was seen as positive and participants described it as “fancy” and “fascinating.”Two major issues resulted from the first test round and were changed before the second test round. Some participants raised doubts regarding the text passage showing the results of the assessment tool. They felt “shocked,” “concerned,” or “scared,” and they expressed “moments of unease.” They suggested avoiding strong or serious language and instead giving the user more personal and tentative feedback. As a consequence, we used more sensitive language for the assessment results. After the wording had been changed and information had been added that the survey was not meant as a diagnostic tool, most participants in the second round agreed with their results and stated that they found it “useful” and “helpful to hear that you need help.” However, some participants noted that there was “too much” text on the assessment results. Second, unfavorable wording seemed to be the issue with the exercise “Dear Thighs,” which prompted participants to write a letter to a particular body part. Some participants were turned off by the exercise, saying that it felt “weird,” “awkward,” “crazy,” and “cheesy”, “like they were in middle school” and that they just wanted it to be over. However, when the exercise was renamed to “Dear Body,” there seemed to be a dramatic change in participant reaction and most participants found the exercise “extremely helpful,” “powerful,” and “clever.” Other minor wording issues occurred throughout the test: participants mentioned that some information was missing or that some words would benefit from an additional definition .During the test, support in general, and more specifically, the support of the coach turned out to be major issues. All participants liked the idea of having a coach and perceived that the coach would be there to advise, help, and motivate them. This impression was made without participants’ engaging in an active conversation with the coach (as this was not possible in the prototype they tested). There was confusion about the method of user-coach communication. With this knowledge, after the first test round, the concept and role of the coach was further clarified (see the details on navigation below).Although participants liked the idea of the coach in general, they expressed mixed feelings about having the support of an online coach. One person mentioned that “some people prefer interaction with the computer” because they might feel embarrassed when talking to a real person about their problems. Other participants mentioned that it is more “convenient,” “accessible for everyone because technology is omnipresent,” and also “important, because other resources on campus are scarce.” On the other hand, the majority of the participants mentioned that they would prefer to work with a coach in person rather than online or on the phone and that “online coaching can just be a support for personal counseling” indicating a belief that online coaching would not be sufficient on its own.Besides the importance of the coach, some participants also highlighted the value of community support. Some participants mentioned interaction with other users who had already finished the program as being a great motivator, which may be integrated in the future.For engagement, intrinsic motivation and external motivators  were highly relevant. In terms of intrinsic motivators, the severity of disease seemed important. Some participants raised doubts that the “program is not for people with serious eating disorder issues,” the “matter needs to be treated more seriously,” and that the program would need “to be more interactive to tackle the complex issue of eating disorders.” On the other hand, the program was seen “as a good start for people without an official diagnosis.” Other intrinsic motivators were curiosity, fun, or doing it for their family.Time was identified as another major factor influencing likelihood of use. Generally, most participants were skeptical about the time they had to invest, stating that a daily commitment of 10 minutes was too long. They felt that it would be “too intensive for students” because they perceived that students really just “want a quick fix for their problem.” Moreover, some participants mentioned that they felt like stopping during the assessment or the exercise “Dear Thighs” since it felt too long or it made them feel uncomfortable. One person who was undergoing therapy for an eating disorder stated that 10 minutes would not be enough to tackle her problem. Conversely, some participants found the procedure and the exercises engaging and the overall time commitment was fine.Another important factor in terms of finishing the program was the question of trust, which was challenging in an online format where there was initial confusion about the nature and role of the remote coach. However, credibility in terms of having already heard about the program or its developers had a positive impact. Additionally, information about the program developers was added in the recruiting email before the second test round.. Hence, no issues were raised regarding the confidentiality of the data. In addition to the program’s affordability, additional incentives were discussed, such as “a gift card together with personal commitment would seal the deal” and suggestions that program use should be compensated with class credits.Effectiveness or success was seen as a central motivator because participants mentioned that they would finish the program if they were to see “improvements,” “results,” or a “gain in health.” For instance, it was expected that the program or the coach would provide external motivation by integrating daily reminders, motivational pop-ups, affirmations, tips and advice, and detailed and customized feedback. Some participants also seemed to be impressed by the number of students enrolled in the program, the rate of symptom reduction (50%) in disordered eating behavior after completing the program, and the research background, which was outlined on the registration page. Anonymity and privacy were other factors that were highlighted positively and mentioned as relevant for program completionIn some cases, it was also misread as a fitness or weight management tool. More information was needed about how the assessment questions relate to the program personalization and other program abilities, such as customization of questions or if the program “learns” from the users’ answers and “how the program gets to know the people.” Some participants also indicated that they had not read or paid attention to the introduction text.Participants reported mixed feelings about using the program on their mobile phone or via the computer, yet the majority of the participants said that they would rather use it on their mobile phone as a mobile app or a widget. However, participants also mentioned some possible pitfalls to this, such as “it is tiring to read long texts on the phone,” that “texts are rather skimmed than read,” and that “less scrolling would be better.” Whereas the majority of participants described the mobile app as convenient, some participants also said that they would probably forget to use the app and others mentioned that they would prefer to use it on both the computer and mobile phone.This study aimed to assess and improve usability and engagement aspects of a guided online self-help program for improving body image and reducing disordered eating symptoms. The difference between the first and the second round of testing shown in the SUS as well as in the think-aloud and interview section clearly highlights the value and reliability of performing an iterative usability study using a mixed-methods approach. This study’s findings also further support the importance of incorporating usability and feasibility studies as part of the digital health intervention design process -30. UsabThis study found a need for intervention improvement in five major areas: layout, navigation, content, and support and engagement conditions. Regarding content, wording and language used was an important issue as it was found to trigger negative emotions in the first iteration . Choosing the right design, wording, and developing language in a user-centered and participatory design process is critical and may have a significant impact on engagement .In terms of assessment, a number of participants had concerns about the assessment logic and assessment items. Because the items were derived from standardized instruments, it was not possible to change question text. However, other simple changes in design resulted in immediate improvement. Assessment results were presented to highlight “strengths” and “challenges” (and not diagnoses) and were intended to help participants gain perspective about their need for help and the apparent urgency and severity of their needs. The feedback provided to participants aimed to help them make an informed and empowered decision about whether the online intervention was appropriate or if they would be better served by seeking in-person evaluation and therapy . The participant feedback on the standardized questions reveals a difficult challenge of using evidence-based and psychometric sound instruments for online assessments. Few research assessments are constructed on the basis of being user friendly, and many are developed using highly educated populations . In the future, assessments should be developed with consideration of how they might be used with digital programs, and text should be written at an average reading level to improve accessibility.Concerning navigation, a major issue was that it was not obvious to participants how to contact the coach. This finding was important due to the central role of the coach and prompted addition of information and design change to help participants understand the coach’s role and how to contact their coach.For engagement, the identified main themes center on motivation, ability (simplicity), and triggers as outlined in the FBM . The antIn terms of motivators, the users’ symptom severity or specific diagnosis seemed important, as it refers to the core motivator “pleasure/pain” in the FBM , indicatSome participants also seemed to be impressed by the success of other users, for example, the number of students enrolled in previous versions of the program so far and the rate of symptom reduction (50%), which was outlined on the registration page. “Seeing results” such as a reduction of disordered eating symptoms in their own lives was seen as another core motivator, which relates to the dimensions “hope/fear” in the FBM , which iTime, which is described as an important element of simplicity in the FBM , also emOverall, the results of this study are consistent with general characteristics of digital health interventions for behavior change and self-management suggested by Murray . These iAlthough the concepts of usability and engagement are inextricably linked, adequate and standardized methods to investigate issues of engagement are scarce. Thus, the strength of this study is that it demonstrates that engagement issues can be investigated within the scope of a usability study. This research design proved to be effective in identifying a range of issues for improvement and facilitating measurable program improvement prior to implementation. Ultimately, the conduction of usability studies fits with the general demand for alternative methods to evaluate behavioral intervention technologies. Traditional evaluation methodologies such as randomized controlled trials are not compatible with fast-changing customer expectations and rapid technology advancement, which demand less time-intensive methods .One major limitation of this study is the possibility that participants were influenced by the study situation itself, since the task of thinking aloud and simultaneously being observed might have provoked unintended reactions or statements. However, we tried to reduce this possible bias by practicing the think-aloud method with each participant prior to beginning the actual study. In three cases, the study situation might have been influenced because the tests were held in public places chosen by the participants. We tried to reduce possible influences by ensuring that there were no people in close vicinity, so that participants felt comfortable speaking openly. Another limitation was that the participants did not get individualized results based on their answers to the assessment questions since this was not possible at this stage of the development process of the program but instead a standardized results page according to their initial SCOFF results. This might have caused discrepancies regarding their expected results and thus led to negative statements about the wording of the results page. Another limitation is that participants tested a prototype rather than the actual program, so they could not use or test many of the program functionalities.Despite the limitations, this usability study allowed us to improve and refine our guided online SB-ED program prior to its launch by making changes based on our target group’s concerns and preferences. Our main findings regarding usability and engagement issues of online health programs are fairly consistent with prior research findings of similar studies, suggesting that this was a reliable and effective research method. The true advantage of conducting small-scale usability studies is evident in their ability to reveal specific program issues from the perspective of the target population in the implementation phase and at the same time contribute to larger research-based insights. Usability studies of programs incorporating online assessments or questionnaires need to pay attention to standardized question items, which cannot easily be adapted to user needs and thus can highly interfere with usability and engagement aspects. Accordingly, future usability and engagement research for different stages of digital health program use is needed in order to identify general usage and adherence patterns, which can ultimately help improve program adherence and reduce dropout.


The value and need for consumer involvement in the delivery of mental health services is becoming increasingly recognised and acknowledged both throughout government and non-government organisations. The aim of consumer and carer involvement and engagement is, ultimately, to improve the quality of health care provided.The Child and Adolescent Mental Health Service (CAMHS) Eating Disorders Program (EDP), is a specialised service located at Princess Margaret Hospital. CAMHS has always had a strong investment in consumer focus and participation and have consistently included consumer input in to the current clinical services. In 2013, funding was obtained from a Capacity Building Grant which allowed for collaboration between CAMHS EDP and Women’s Healthworks (WHW), Body Esteem Program (BEP). From this collaboration a peer support program called “Reaching out for Hope,” was piloted. The “Reaching out for Hope” program was designed to allow young people attending the PMH EDP service to hear the experiences of others who once had an eating disorder, but now manage life without one. Delivery of the group program is based on peer support workers having a reciprocal and equal, non-clinical, non-expert relationship with participants.Developing this program has involved several steps including ethics and funding approval, integration of research, clinical services and consumer input. This presentation will detail the program from inception to delivery, including details from the final report focusing on identified strengths and limitations. The presentation will be delivered collaboratively by CAMHS EDP and WHW BEP staff.Peer Support stream of the 2014 ANZAED Conference.This abstract was presented in the


For early detection of cancer, education and screening are important, but the most critical factor is the development of early diagnostic tools. Methods that recognize the warning signs of cancer and take prompt action lead to an early diagnosis; simple tests can identify individuals in a healthy population who have the disease but have not developed symptoms. Early detection of cancer is significant and is one of the most promising approaches by which to reduce the growing cancer burden and guide curative treatment. The early diagnosis of patients with breast cancer is challenging, since it is the most common cancer in women worldwide. Despite the advent of mammography in screening for breast cancer, low-resource, low-cost alternative tools must be implemented to complement mammography findings. IgM is part of the first line of defense of an organism and is responsible for recognizing and eliminating infectious particles and removing transformed cells. Most studies on breast cancer have focused on the development of IgG-like molecules as biomarkers or as a treatment for the advanced stages of cancer, but autoantibodies (IgM) and tumor-associated antigens (proteins or carbohydrates with aberrant structures) have not been examined as early diagnostic tools for breast cancer. The present review summarizes the function of natural and adaptive IgM in eliminating cancer cells in the early stages of pathology and their value as early diagnostic tools. IgM, as a component of the immune system, is being used to identify tumor-associated antigens and tumor-associated carbohydrate antigens. The detection of tumors at early stages allows curative treatment to be administered before tumor progression occurs ; consequAn early diagnosis is paramount in breast cancer (BC), since it is the most frequent tumor occurring in women in industrialized and developing nations ,6. Thus,The only effective screening method for BC is mammography. Mammography is expensive and is only cost-effective and feasible in developed countries with good health infrastructure. Many low- and middle-income nations must implement low-cost screening, such as clinical breast examination and early diagnostic tools ,9. OngoiTwo types of IgM exist: natural, which is present in an organism without prior antigenic contact and is part of the first-line defense; and adaptive, which develops after antigenic challenge . NaturalIn the present review, we discuss the function of natural IgM and adaptive IgM in eliminating cancer cells in the early stages of BC and their potential as early diagnostic tools and how, as components of an organism's defense, they can be used to identify TAAs and TACAs.μ heavy chains, is the first class of antibody that is synthesized by and appears on the surface of a developing B cell, although many B cells eventually switch to other classes  and allowing it to bind Ags with high avidity . Each peThe binding of an Ag to a single secreted pentameric IgM molecule initiates the complement system. When the Ag resides on the surface of an invading pathogen, senescent cells, cell debris, or precancerous or cancer cells, this activation marks pathogens and transformed cells for phagocytosis or kills them directly .Natural Abs are predominantly IgM and to a lesser extent IgA and IgG –28 and aNatural IgM has a significant function in primary defense mechanisms ,33,34. TNatural IgM is associated with the recognition and removal of precancerous and cancerous cells –18. Natu+) and B cells in the marginal zone (Mz) and do not require affinity maturation to provide early protection   . The str7 mol−1) . Natural7 mol−1) .Adaptive IgM is the first antibody to appear after an immunological challenge, but its production normally falls during the development of the IgG response. Consequently, IgM is generally not considered to have a significant function in long-term immunity, although it is effective in host defense ,47.−7 to 10−11 mol−1), and their variable regions contain point mutations. The half-life of monoreactive IgM is 35 h  and effect the development of memory cells and highaffinity plasma cells . Mature henotype .Natural and adaptive IgM molecules participate in the recruitment of Ags into secondary lymphoid organs, priming subsequent adaptive immune response ,57. ThisIn 1909, Paul Ehrlich postulated that the immune system not only eliminates pathogenic bacteria but also suppresses the growth of carcinomas with great frequency by generating Abs against malignant cells . Fifty yInnate immunity is the first line of defense and stimulates secondary adaptive immune responses , relyingBC is a heterogeneous disease with tumors that express a variety of aberrant proteins . NaturalAberrant proteins have been used since the 1970's in serological studies in BC patients that have suggested that some portion of positive sera contains Abs that are directed toward TAAs, but they did not specify the type of Ab. The serum of 28 patients with BC showed positive fluorescence against breast carcinoma cells that were grown by tissue culture, while that of donors was negative . In anotin vivo and detect the disease earlier than current methods; furthermore, natural IgM is detected in the asymptomatic stages of cancer, up to 5 years before disease onset ; specifically, the carbohydrate moiety of certain glycoproteins mediates the 3 to 105 M−1, FC-2.15 has an affinity constant of 6.9×107 M−1, which might explain its potent effects in vivo. The presence of Lex epitopes on BC cells and peripheral PMNs explains the antitumor responses and neutropenia that were observed in a trial of FC-2.15. Neutropenia was inconsequential to the patients, although >90% of PMNs disappeared from the peripheral blood, and the neutropenia resolved rapidly after mAb infusion was halted, with the appearance of juvenile myeloid forms after repeated courses of mAb, as myeloid precursors are not lysed by FC-2.15 . The post-transcriptionally modified CFr-1/PAM-1 receptor is expressed in nearly all epithelial cancers of every type and origin and in the precursor stages but not in healthy tissue. The binding of PAM-1 induces apoptotic events  in vivo ,80.CFR-1/PAM-1 receptor expression in the precancerous stages of BC was analyzed by immunohistochemistry and compared with normal breast tissue and adenocarcinomas. The CFR-1/PAM-1 receptor was expressed in nearly all precancerous stages and carcinomas, whereas normal breast tissue was negative. The unique expression of this CFR-1/PAM-1 receptor renders PAM-1 Ab an ideal diagnostic tool and therapeutic agent for precancerous and cancerous epithelial lesions in BC .The levels of cell surface-associated chaperone GRP78 are high in BC cells. GRP78 is a ubiquitously expressed member of the heat-shock protein 70 (HSP70) family and governs cellular homeostasis by preventing stress-induced apoptosis. In malignant cells, which are permanently exposed to environmental stress, GRP78 is overexpressed, and its levels increase in the cytoplasm and on the cell membrane . Thus, GThe fully human monoclonal IgM Ab SAM-6 binds to a new variant of GRP78, which has a molecular weight of 82 kDa. The epitope is an O-linked carbohydrate moiety that is specific to malignant cells . SAM-6 ic is released by mitochondria and subsequently, the initiators caspase-8 and caspase-9 and effectors caspase-3 and caspase-6 are activated. Thus, SAM-6 induces a near-intrinsic form of apoptosis by overfeeding malignant cells with lipoproteins  belongs to the molecular family of breast mucins (MUCs) and is a macromolecular glycolic protein with a molecular weight of >300,000 kDa. MSA is targeted by the murine monoclonal IgM Ab 3EL.2. The diagnostic value of MSA in identifying BC has been studied in 56 healthy patients and 43 subjects with benign BC, in whom this Ag was abnormally elevated. Thus, 3EL.2 is useful in the clinic, is a good indicator of the extent of disease, and might have significant prognostic value .Y (LeY) mediate complement-dependent cytotoxicity and have been suggested to be more cytotoxic to tumor cells than Abs that recognize proteins Ag or TACAs (Abs that recognize such glycosphingolipids (GSLs) as GD2, GM2 and Lewisor TACAs , which kPreexisting ganglioside-reactive IgM has been detected in normal healthy individuals. Circulating gangliosides from tumors might be perceived as danger signals by the host's immune system, as evidenced by the endogenous antiganglioside immune response to gangliosides. Then, endogenous IgM against gangliosides might facilitate the elimination of these signals in BC in order to restore the immune competence of the host .P10s-WRYTAPVHLGDG, a CMP that induces primarily weak anti-GD2 IgM responses that are crossreactive with several gangliosides, including GD3, GM2 and GD1a, has been developed. P10s was derived from a sequence (P10-GVVWRY-TAPVHLGDG) that was selected by panning a peptide library against the GD2-binding mAb ME36.1. The P10 peptide mediates antitumor responses . This seMUCs are highly glycosylated proteins that are expressed in cancers of epithelial origin in an underglycosylated form and have been used to develop several tests for cancer detection. MUCs are components of mammary cell-cell junctions and mediate ICAM-1-initiated signal transduction. Polymorphic epithelial mucin  and MUC16 (CA 125) are the most extensively studied MUCs, although the latter is more frequently used for ovarian cancer than for BC.Recent evidence indicates that MUC-1 Ag induces apoptosis in T-lymphocytes, providing insight into the mechanisms of escape from immune surveillance by tumors .MUC1 was examined to determine the incidence of naturally occurring MUC1 Ab in patients with early BC and correlate these Abs in pretreatment serum to disease outcome. IgG and IgM against MUC1 were measured by ELISA in pretreatment serum samples from 154 patients with BC and 302 controls. A positive test result for both anti-MUC1 IgG and IgM in pretreatment serum was associated with a significant benefit for disease-specific survival in BC patients. Patients with early BC with a natural humoral response to MUC1 are less likely to develop metastases and have better disease-specific survival. MUC1 Abs may control hematogenic tumor dissemination and outgrowth by aiding in the destruction of circulating or established MUC1-expressing tumor cells ,89.MUC1 is a high-molecular-weight molecule with multiple tandem repeats (VTSAPDTRPAPGSTAP-PAHG). The most immunogenic motif is APDTRPA, which harbors the epitope that is recognized by various monoclonal Abs, normal sera and cytotoxic T-cells. Mice that are vaccinated with MUC1 peptide that contains 1.5 tandem repeats and is conjugated to keyhole limpet hemocyanin (KLH) and mixed with QS-21 induce high-titer Ab (but no evidence of T-cell immunity) against MUC1 and MUC1-expressing tumor cells. Furthermore, these vaccinations conferred protection to these mice when they were challenged with MUC1-expressing tumor cells .Carcinoembryonic Ag (CEA) was described in 1965 and was the first tumor Ag to be identified. CEA is a glycoprotein that belongs to the Ig family of genes and is detected in the serum of cancer patients by radioimmunoassay or ELISA. However, its clinical value is limited due to a high false-positive rate in normal populations and its low diagnostic sensitivity and specificity. Elevated CEA levels are not specific for BC (50% of cases), CEA is expressed in many types of neoplasia and is detected by anti-CEA IgM. Nevertheless, in breast tumors, CEA is more prevalent in ductal versus lobular carcinomas. CEA is found in patients with ductal carcinoma in situ, suggesting that it is an early marker of tumorigenesis ,92.The ABH blood group Ags, which are expressed in normal epithelial cells, are downregulated in various carcinomas. BC cells produce I Ag or I Ag-like substances that influence serum anti-I. I Ags are precursors to ABH and accumulate in cancer cells. The levels of I Ag rise in the serum of individuals with breast carcinoma, based on their anti-I scores and IgM concentrations. These alterations in cold hemagglutinins could be a host response to the production of I Ag by BC cells and is thus important in understanding immune modulation of breast carcinoma. However, the concentration of IgM in patients with BC was similar to that of controls .Malignin is a 10-kDa polypeptide in the cytoplasmic and outer membranes of all malignant cells. Anti-malignin Ab (AMA) is an IgM that is spontaneously produced by the host against the oncoprotein malignin when neoplastic transformation occurs; because AMAs are IgM molecules, they are an indicator of 'early' transformation that is useful for the early detection of cancer.Elevated AMA serum concentrations have been measured using a commercial reagent. The AMA test has a sensitivity and specificity of 95% on first determination and >99% on repeat measurements and is a promising diagnostic tool for the early detection of cancer, the monitoring of treatment responses, and the screening of asymptomatic populations .In tumor marker assays with AMAs, CEA  and biopsies were examined following a suspicious mammogram to determine whether tumor markers aided in the diagnosis and could be used to monitor residual disease. In the present study, by AMA test, 3 of 154 healthy volunteers were AMA-positive. After further examination, 2 were positive for cancer and 1 had a history of ulcerative colitis. Tumor biopsies of 43 suspicious patients by mammography revealed that 32 were cancerous and 11 were benign by pathology. Furthermore, 31 of 32 cancer patients were positive for AMA versus 4 of 11 pathological benign cases .Several structurally similar blood group-related carbohydrate Ags, including Thomsen-Freidenreich (TF), Tn, and sialyl Tn (sTn), that are attached to the protein backbones of glycoproteins are promising targets, based on their widespread distribution on the cell surface of human tumors. The disaccharide sTn [NeuAca (2→6) GalNAca-0-ser/Thr] is O-linked with serine and threonine residues on mucins. Greater sTn expression in tumors might be linked to a poorer prognosis in BC. Abnormal glycosylation of tumor cell MUCs results in shorter and fewer carbohydrate chains, increasing the exposure of Ags, such as sTn, which might upregulate sTn in tumors compared with normal cells.The induction of IgM and IgG against synthetic sTn(c) was measured before and after immunization with clustered sTn-KLH [sTn(c)-KLH] conjugate plus QS-21 in 27 patients with BC, all of whom developed significant IgM and IgG titers against sTn(c). Furthermore, IgM reactivity against LSC tumor cells was observed in patients, indicating the production of IgM and IgG. Thus, immunization with sTn(c)-KLH conjugate plus QS-21 is well tolerated and immunogenic in high-risk patients with BC .The occurrence of circulating immune complexes (CICs) is considered a marker of tumor burden. CICs are formed by Abs or Ags with and without complement. CICs that comprise two classes of Ig (Ig-Ig) or an Ig class of and C3 (Ig-C) are collectively referred to as two-component-determined CICs (TCICs). Ig/Ig TCICs may reveal alterations in immune regulation in patients. IgM and IgG TCICs were measured in the sera of patients with BC, in whom IgM/IgG TCICs and IgG/IgM TCICs were detected. Downregulation of IgM/IgG TCICs was a common feature in patients, whereas IgG/IgM TCIC levels were significantly higher, lower, or unchanged with respect to the control. Total serum IgM differed significantly in BC patients (1.20±0.94 mg/ml) vs. healthy controls (0.99±0.53 mg/ml). These results suggested that IgM and IgG TCICs have a significant function in immune regulation during the course of malignancies and are hallmarks of cancer pathogenesis. Decreased IgM/IgG TCIC levels, accompanied by IgG/IgM-TCICs, constitute a peculiar trait in malignancies .Certain IgMs, natural and adaptive, have been isolated from the tumors of patients with cancer; they eliminate BC tumors through various mechanisms, such as apoptosis and complement. Natural IgM has a direct cytotoxic effect on tumor cells, it recognizes tumor-modified cell surfaces that develop during tumorigenesis, and it activates complement to destroy nascent transformed cells. The first Ig that is produced after an immune challenge is adaptive IgM, which must be considered as an early diagnostic tool. Auto-Abs that target TAAs could serve as molecular signatures for the early diagnosis and prognosis of patients with BC by serology to increase the sensitivity and specificity of diagnostic markers for BC patients. Most studies have focused on the development of IgG-like biomarkers for BC treatment; however, IgG is subject to immunoregulation, which can manifest as immunosuppression, whereas natural IgM is not. IgM as a diagnostic tool can be coupled with early mammography, magnetic resonance imaging, or Doppler ultrasound to detect cancer.