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Effects of Motivational Interviewing and Wearable Fitness Trackers on Motivation and Physical Activity in Inactive Adults

Effects of Motivational Interviewing and Wearable Fitness Trackers on Motivation and Physical Activity in Inactive Adults

Despite tremendous adoption of wearable fitness trackers by adults, it is unclear if they affect physical activity engagement or motivation. In a paper published in the Journal of Sports Sciences, Dr. Kayla Nuss, Klein Buendel Scientist, and her research collaborators reported on a study to examine the combined effects of motivational interviewing and wearable fitness trackers on motivation and physical activity in inactive adults.

The authors hypothesized that combining a wearable fitness tracker (such as a FitBit®) with an effective intervention (motivational interviewing), would positively influence both motivation and physical activity. To test the hypothesis, a 12-week randomized controlled trial was conducted with 40 adults who did not meet physical activity recommendations. The four comparison groups were: (1) physical activity education only (educational control) with 10 participants, (2) use of a wearable fitness tracker (WFT) with 10 participants, (3) bi-weekly motivational interviewing sessions with 10 participants, or (4) both motivational interviewing and WFT (WFT+) with 10 participants.

Motivation and physical activity were measured though an online survey and actigraphy (a method to objectively estimate physical activity) pre- and post-intervention. Both the WFT+ and motivational interviewing groups scored higher in autonomy, competence, and relatedness for physical activity compared to the control group, which is associated with higher quality, or more autonomous forms of motivation. Further, both groups did show improvements in autonomous forms of motivations (such as interest or enjoyment) and decreased controlled forms of motivation (such as pressure or reward). Detailed descriptions of the study’s methods, recruitment efforts, measures, data analysis, outcomes, and limitations can be found in the Journal of Sports Sciences publication.

The authors detected no changes in physical activity. High autonomous motivation at baseline predicted higher post-intervention physical activity in the WFT+ group, but predicted lower post-intervention physical activity in the WFT group. The results of the study suggest that motivational interviewing alone or with a wearable fitness tracker can improve basic psychological needs and autonomous forms of motivation for physical activity, but not physical activity participation. The authors conclude that individual differences in motivation at baseline may moderate the effect of a wearable fitness tracker on physical activity. The findings add to the growing body of evidence that wearable fitness trackers can have some positive effect on adult’s physical activity.

This research was supported by Colorado State University Department of Health and Exercise Science (Dr. Kayla Nuss, Project Director). Collaborating authors included Ms. Kristen Moore from the University of Southern California; Dr. Tasha Marchant from the University of Colorado Health Sciences Center; Dr. Jimikaye Beck Courtney from the University of North Carolina-Chapel Hill; and Ms. Kathryn Edwards, Dr. Julia Sharp, Dr. Tracy Nelson, and Dr. Kaigang Li from Colorado State University.

A Protocol for Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students

A Protocol for Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students

A research team led by Dr. Anne Ray from the University of Kentucky, and including Dr. David Buller from Klein Buendel, has published (online ahead of print) the protocol for  an active research project in JMIR Research Protocols. The study is designed to curb drinking and risky sexual behavior by first-year college students using an innovative, cross-tailored, dynamic feedback (CDF) component. The intervention purposefully integrates content on the relationship between alcohol use and risky sexual behavior and leverages technology to incorporate daily assessments of student behavior and deliver weekly dynamic feedback.

Two-thirds of college students are current drinkers of alcoholic beverages. One in three college students report past month binge drinking (five or more drinks in a row), and one in ten report high intensity drinking (ten or more drinks in a row). Greater student alcohol consumption and heavy drinking on a given day are linked to increased sexual activity and risky sexual behavior, such as unprotected sex and sex with casual partners. This puts students at risk for negative health outcomes, such as sexually-transmitted infections, and other harmful consequences, such as sexual victimization.

A hybrid effectiveness-implementation design will allow the investigators to evaluate the effectiveness of the integrated personalized feedback intervention (PFI) with 600 first-year college students at two college sites in a randomized controlled trial. In addition, formative evaluation with local and national stakeholders (such as students and student affairs staff) will help to better understand factors that influence implementation and ensure its success and sustained use.

According the paper’s abstract: “This study utilizes a hybrid type 1 effectiveness-implementation design and will be conducted in three phases. Phase 1 is a stakeholder-engaged PFI+CDF adaptation guided by focus groups and usability testing. In Phase 2, 600 first-year college students who drink and are sexually active will be recruited from two sites (n=300 per site) to participate in a 4-group randomized controlled trial to examine the effectiveness of PFI+CDF in reducing alcohol-related RSB. Eligible participants will complete a baseline survey during the first week of the semester and follow-up surveys at 1, 2, 3, 6, and 13 months postbaseline. Phase 3 is a qualitative evaluation with stakeholders to better understand relevant implementation factors.” Intervention, recruitment, and implementation plans are described in JMIR Research Protocols.

This research is supported by a grant from the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health (AA028246; Dr. Anne Ray, Principal Investigator). Collaborators include Dr. David Buller (Co-Investigator) from Klein Buendel. Klein Buendel’s Creative Team is developing the technology-delivered program for college students.

A Protocol for a Facebook Intervention for Young Melanoma Survivors and Their Families

A Protocol for a Facebook Intervention for Young Melanoma Survivors and Their Families

Individuals diagnosed with melanoma before the age of 40 (young-onset melanoma survivors) and their first-degree relatives (FDRs) are a growing population at risk for developing recurrent melanoma or new melanomas. Regular surveillance using clinical skin examination (CSE) and skin self-examination (SSE), and engagement in preventive behaviors including sun protection are recommended. Given the growing population of young melanoma survivors and their families who are at increased risk, it is surprising that no behavioral interventions have been developed and evaluated to improve risk-reduction behaviors.

In response, 16 researchers from ten institutions and organizations have developed an intervention and published its protocol in JMIR Research Protocols. Ultimately, the intervention is designed to improve skin cancer prevention and screening for young-onset melanoma survivors and their families. The authors believe the intervention’s delivery via Facebook will increase its impact because of the dissemination potential.

The randomized controlled trial will evaluate the efficacy of a Facebook intervention providing information, goal setting, and peer support to increase CSE, SSE, and sun protection for young-onset melanoma survivors and their FDRs. A sample of over 500 melanoma survivors and their FDRs will be randomly assigned to either the Young Melanoma Family Facebook Group or another Facebook group control condition. Before and after the intervention, study participants will complete measures of CSE, SSE, sun protection, attitudes, and beliefs. An additional objective is to evaluate the efficacy of the Facebook interventions on perceived stress, physical activity, and healthy eating behaviors.

The authors plan to complete study enrollment by late 2023. Data analysis will employ multilevel modeling with family as the upper-level sampling unit and individual as the lower-level sampling unit. According to the authors, “Fixed effect predictors in these models will include condition, role, sex, all 2- and 3-way interactions, and covariates.” If effective, the Young Melanoma Family Facebook program could be disseminated by dermatology practices, public health and nonprofit melanoma organizations, and existing melanoma and skin cancer Facebook groups, expanding its reach.

Paper Authors and Affiliations

Dr. Sharon Manne, Dr. Carolyn Heckman, Sara Frederick, Mara Domider, and Marissa Grosso:  Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey

Dr. Sherry Pagoto:  Department of Allied Health Sciences, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, Connecticutt

Dr. Susan Peterson:  Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, MD Anderson Cancer Center, The University of Texas, San Antonio, Texas

Dr. Deborah Kashy:  College of Social Science, Department of Psychology, Michigan State University, East Lansing, Michigan

Dr. Adam Berger:  Division of Surgical Oncology, Department of Surgery, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey

Dr. Christina Studts: Pediatrics – General Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado

Dr. Rosalyn Negron: College of Liberal Arts, University of Massachusetts Boston, Boston, Massachusetts

Dr. David Buller: Klein Buendel, Inc, Golden, Colorado

Dr. Lisa Paddock and Alexandria Kulik: Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey

Joseph Gallo: Hackensack Meridian Jersey Shore Medical Center, Hackensack Meridian Health, Neptune City, New Jersey

Morgan Pesanelli: School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, New Jersey

This project was supported by a grant from the National Cancer Institute to Rutgers University (CA221854; Dr. Sharon Manne, Principal Investigator). Dr. David Buller, Klein Buendel Director of Research, is a Co-Investigator on the project.

Addressing COVID-19 Misinformation

Addressing COVID-19 Misinformation

Misinformation online can confuse consumers and influence people to dismiss vital public health advice. Health Chat team members from Klein Buendel, the University of Connecticut, and Colorado State University have published analyses of misinformation from a social media study in the Journal of Public Health Management and Practice. The purpose of the study was to examine how an epidemiological procedure for monitoring, diagnosing, and responding quickly to misinformation among members of a Facebook group may have affected debate and dropout among group members.

Facebook group participants were 303 mothers of adolescent daughters. The Facebook group was administered by a community manager. The social media feed varied the source of information in posts on four topics: social distancing, COVID-19 vaccines, digital and media literacy, and family communication about COVID-19. Mothers received one social media post each weekday in three randomly assigned Facebook private groups, covering all four topics plus one additional post on a positive non-pandemic topic to promote broad engagement. Posts in the three groups had the same messages but differed by links to information from government agencies, near-peer parents, or news media sources in the post.

The community manager identified misinformation in mothers’ comments. Misinformation was defined as COVID-19 information in opposition to recommendations from the Centers for Disease Control and Prevention, National Institutes of Health, and/or World Health Organization. Misinformation took several forms. In some comments, mothers directly presented false information or expressed their own negative opinions or opposition toward COVID-19 prevention. In other comments, mothers presented misinformation indirectly.

Research methods and analyses are detailed in the Journal of Public Health Management and Practice paper. Most misinformation comments were in response to posts about vaccination, followed by non-pharmaceutical interventions, digital and media literacy, and family communication. The responsive epidemiological protocol exposed the mothers to credible information and appeared to prevent debate and dropout of Facebook group members.

This research was funded by a grant and supplement from the National Cancer Institute (CA192652). Dr. David Buller from Klein Buendel and Dr. Sherry Pagoto from the University of Connecticut were the project’s Multiple Principal Investigators. Additional authors on this publication include Joseph Divito from the University of Connecticut; Dr. Kim Henry from Colorado State University; and Dr. Barbara Walkosz, Dr. Gill Woodall, Julia Berteletti, and Alishia Kinsey from Klein Buendel.

iTRAC Pilot Study

iTRAC Pilot Study

A research team led by Dr. Christopher Houck from Lifespan and the Rhode Island Hospital has published a paper in the Journal of Developmental & Behavioral Pediatrics on the feasibility and acceptability of an initial digital iTRAC (Talking About Risk and Adolescent Choices) intervention. Collaborators included colleagues from the Rhode Island Hospital, the University of Oregon, Brown University, Penn State University, and Klein Buendel. iTRAC is a tablet-based intervention to promote emotion regulation skills among middle schoolers as a strategy for reducing risky behavior.

For the pilot study, adolescents aged 12–14 years were recruited from three urban schools for advisory groups (n=15), acceptability testing (n=11), and pilot testing (n=85). Youth advisory boards and expert panels tailored content, resulting in an animated intervention of instructional videos, games, and activities designed to teach emotion regulation strategies to young adolescents. Eighty-five adolescents were randomized to the 4-module digital iTRAC intervention or a wait-list control group. Adolescents and one parent completed baseline and 3-month follow-up questionnaires examining emotion regulation attitudes and behaviors. The adolescent participants also completed behavioral tasks related to distress tolerance.

Eighty-eight percent of those randomized to iTRAC completed all modules. Moderate effect sizes were found from baseline to follow-up on adolescents’ beliefs in the controllability of emotions, awareness of emotions, self-efficacy for managing emotions, perceived access to emotion regulation strategies, and use of emotion regulation strategies. Parent measures of adolescent regulation showed mixed results.

A tablet-based intervention to enhance emotion skills for youth in early adolescence was deemed feasible and demonstrated promising indicators of impact on emotional competence. Increasing adolescents’ awareness of and access to emotion regulation strategies may reduce decisions driven by transient emotions, which in turn may reduce engagement in risky behavior and resultant negative health outcomes. The authors conclude that the brief iTRAC intervention may be used to increase emotional competency among middle schoolers.

Dr. Valerie Myers and Ms. Tiffany Jerrod, both formerly from Klein Buendel, were co-authors on this publication. Research on the full production and evaluation of iTRAC is continuing with an STTR Fast Track grant to Klein Buendel from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Dr. Christopher Houck, Principal Investigator from Lifespan; HD110333). Collaborators on the current study include Dr. Wendy Hadley from the University of Oregon; Dr. David Barker from Rhode Island Hospital; and Ms. Julia Berteletti from Klein Buendel. The iTRAC modules will be programmed by Klein Buendel’s Creative Team.  

UV Measured under Built Shade in Public Parks

UV Measured under Built Shade in Public Parks

Reducing exposure to ultraviolet radiation (UV) is crucial for preventing UV-induced diseases of the skin and eyes. Shade may offer significant protection from UV.

A research team from Klein Buendel and Cancer Council Victoria and LaTrobe University in Australia have published a paper on UV measurements under shade structure built in public parks in International Journal of Environmental Research and Public Health. The paper expands empirical research to quantify the UV protection offered from built shade to guide disease prevention practices and confidence in investment in shade.

Specifically, the research team quantified UV levels under built shade relative to unshaded passive recreation areas (PRAs) over summer months in parks in two cities (Denver, Colorado, USA and Melbourne, Victoria, Australia). In a randomized controlled trial, 1,144 UV measurements were recorded at the center and periphery of PRAs in a total sample of 144 public parks as part of pretest and posttest measures of use of the PRAs by park visitors. UV measurements were recorded for three recruitment waves per city during 2010 to 2014. Following pretest, 36 of the PRAs received built shade structures.

Regression analyses modelled pre-post change in UV (Standard Erythemal Dose (SED) per 30 min) at PRAs; and environmental predictors. Mean UV at the center of built shade PRAs decreased from pretest to posttest, adjusting for the covariates of ambient SED, solar elevation, and cloud cover. Clouds decreased and solar elevation increased UV levels under shade. No significant differences in UV by design of the shade structure occurred. A substantial reduction in UV exposure can be achieved using built shade with shade cloth designs, offering considerable protection for shade users. Supplementary sun protection  is recommended for extended periods of shade use during clear sky days. This could include things like brimmed hats, long sleeves, sunglasses, and sunscreen.

This research was supported by a grant from the National Cancer Institute (CA140367; Dr. David Buller, PI). Collaborators on this publication also include Dr. Suzanne Dobbinson and Dr. James Chamberlain from Cancer Council Victoria; Jody Simmons from LaTrobe University; and Mary Buller from Klein Buendel.

Promoting Social Distancing and COVID-19 Vaccination in a Social Media Feed for Mothers

Promoting Social Distancing and COVID-19 Vaccination in a Social Media Feed for Mothers

The Health Chat team from Klein Buendel, the University of Connecticut, Colorado State University, and East Tennessee State University has published findings from a health communication study in the journal JMIR Infodemiology. The purpose of the study was to examine how the source of health information shared via a Facebook social media feed might impact behavioral intentions related to practicing social distancing or accepting COVID-19 vaccination. The Facebook group participants were mothers of adolescent daughters. The social media feed varied the source of information in posts on four topics: social distancing, COVID-19 vaccines, digital and media literacy, and family communication about COVID-19. The information sources were government agencies, near-peer parents, and news media.

In summary, 303 mothers with adolescent daughters from a previous study testing a social media campaign on indoor tanning were recruited in January 2021 and enrolled in a randomized single-factor design (government agencies vs. near-peer parents vs. news media) evaluating the 9-week Facebook feed with four assessments at baseline and 3-week, 6-week, and 9-week follow-ups. Mothers received one social media post each day (Monday-Friday) in three randomly assigned Facebook private groups, covering all four topics plus one additional post on a positive non-pandemic topic to promote engagement. Posts in the three groups had the same messages but differed by links to information from government agencies, near-peer parents, or news media in the post. Views, reactions, and comments related to each post were counted to measure engagement with the messages. Mothers reported on social distancing and vaccine intentions for themselves and their daughters at the four assessment points.

Research methods and analyses are detailed in the JMIR Infodemiology paper. Nearly all mothers (98%) remained in the Facebook private groups throughout the 9-week trial period, and assessment completion rates were high. Analysis showed that social distancing behavior by mothers and daughters decreased over time but vaccine intentions increased. Decrease in social distancing by daughters was greater in the near-peer source group and lesser in the government agency group. The higher perceived credibility of the assigned information source increased social distancing and vaccine intentions. Mothers’ intentions to vaccinate themselves may have increased when they considered the near-peer source to be not credible. According to the authors, decreasing case counts, relaxation of government restrictions, and vaccine distribution during the study may explain the decreased social distancing and increased vaccine intentions.

This research was funded by a grant and supplement from the National Cancer Institute (CA192652). Dr. David Buller from Klein Buendel and Dr. Sherry Pagoto from the University of Connecticut were the project’s Multiple Principal Investigators. Additional authors on this publication include Joseph Divito from the University of Connecticut; Dr. Kim Henry from Colorado State University; Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; and Dr. Barbara Walkosz, Dr. Gill Woodall, Julia Berteletti, and Alishia Kinsey from Klein Buendel.

Effects of Engagement with a Social Media Campaign to Reduce Indoor Tanning

Effects of Engagement with a Social Media Campaign to Reduce Indoor Tanning

A paper by Klein Buendel scientists, staff, and collaborators published in the Journal of Health Communication reports on a secondary analysis of engagement effects from a social media campaign. The campaign, called Health Chat, was aimed at reducing mothers’ permissiveness for indoor tanning (IT) by their teenage daughters.

In the study, over 800 mothers with daughters aged 14-17 were recruited in 34 states that did not ban IT by minors under age 18 for a randomized trial. Follow-up assessments were completed at the end of the intervention (12 months) and six months after that (18 months). Daughters’ baseline and follow-up responses were analyzed also. Mothers received a Facebook feed on adolescent health topics that included posts about preventing IT (intervention) or prescription drug misuse (control).

Engagement was measured by extracting reactions (such as like or sad) and comments posted by mothers to the campaign posts. Overall, 76.4% of posts received a reaction and/or comment. Mothers who engaged with IT posts were less permissive of daughters’ IT immediately at the end of the campaign and six months after the intervention than mothers who did not engage with the posts.

Social media is a large part of the media diets of many parents and show some promise for health behavior change interventions. Social media posts need to both reach and engage parents, especially in social media like Facebook whose algorithm prioritizes posts from feeds that receive more views, reactions, and comments. This is to ensure that the posts appear in participants’ news feeds so well-crafted health communication can influence them. The authors conclude, however, that more work is needed on strategies to engage individuals with social media posts in the context of improving public policies that restrict minors’ access to IT facilities.

This research was funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). Collaborating authors include Dr. Kimberly Henry from Colorado State University; Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; Jessica Bibeau from the University of Connecticut; and Dr. Barbara Walkosz and Julia Berteletti from Klein Buendel.

Evaluation of the STAC
Teacher Module

Evaluation of the STAC
Teacher Module

Bullying is a significant problem for youth and is associated with a wide range of negative consequences. Educating teachers about bullying and training them to support students to intervene as “defenders” may increase the efficacy of bullying bystander programs. This is particularly important in middle school when bullying peaks and rates of reporting bullying to teachers begin to decline.

This study, published in JMIR Formative Research, used a mixed-methods design to inform the development of a Teacher Module as a companion training to a brief bullying prevention program for middle schools, called STAC. The STAC bystander intervention is a 75-minute training that includes didactic and experiential components. It teaches middle school students to act as “defenders” on behalf of targets of bullying through utilizing four intervention strategies:

STAC Bullying Bystander Strategies

(1) “Stealing the Show” – using humor or distraction to interrupt a bullying situation and remove the attention away from the target;

(2) “Turning it Over” – identifying a trusted adult at school, reporting, and asking for help during a bullying incident;

(3) “Accompanying Others” – befriending and/or providing support to a peer who was a target of bullying; and

(4) “Coaching Compassion” – gently confronting the perpetrator and increasing empathy for the target.

Providing students who witness bullying with intervention strategies to act as “defenders” can reduce both bullying and negative associated outcomes for both targets and bystanders.

For the development of the companion STAC Teacher Module, 18 teachers were recruited from one middle school in a rural, low-income community. Before and after the training, teachers completed surveys assessing immediate outcomes (such as knowledge, confidence, comfort, and self-efficacy), intention to use the program strategies, and program acceptability and relevance. After the final survey, a subset of six teachers participated in a qualitative focus group to obtain feedback regarding program appropriateness, feasibility, content, perception of need, and potential desire for an online version of the teacher training.

Study measures, procedures, analyses, and results are detailed in the JMIR Formative Research paper. Descriptive statistics, independent sample t-tests, and thematic analysis were used to analyze the data. In summary, the researchers found an increase in teacher knowledge and confidence to support “defenders,” confidence and comfort in managing bullying, and bullying self-efficacy. Most teachers reported they were likely or very likely to use the STAC strategies to support students who intervene in bullying in the future. Both quantitative and qualitative data showed the teacher training was easy to use, useful, relevant, and appropriate. Qualitative data provided feedback on program improvement. Teachers shared positive feedback on program feasibility and implementation, and described strengths of an online version of the module. This study demonstrates the effectiveness of the STAC Teacher Module in increasing teacher knowledge and bullying self-efficacy and provides support for the development of an online version of the module for teachers.

This research was supported by a grant to Boise State University from the Mental Research Institute (Dr. Aida Midgett, Principal Investigator). Co-authors include Dr. Diana Doumas from Boise State University and Ms. Mary Buller from Klein Buendel.

EZPreemie Study Protocol

EZPreemie Study Protocol

A research team from The Ohio State University, Rush University, Nationwide Children’s Hospital, and Klein Buendel has published a paper describing a 5-year research project to develop and evaluate a technology-based, widely accessible, and effective form of behavioral parent training (BPT) delivery to address the unmet and unique needs of parents of very preterm children.

As presented in the paper published in BMJ Open, children born very preterm (gestational age <32 weeks) are twice as likely to demonstrate behavior problems such as aggression, non-compliance, temper tantrums and irritability compared with their term-born peers. While BPT is a gold standard for prevention and treatment of childhood problem behaviors, there are limited accessible and effective BPT interventions for families with children born very preterm. The paper describes a multi-center, randomized controlled protocol for a factorial design trial evaluating the independent and combined effects of the ezParent BPT intervention plus brief, weekly coaching calls on parent and child outcomes for families with toddlers born very preterm.

The BMJ Open paper details the study design, aims, intervention, measures, analysis plans, and procedures of the study which will employ a 2×2 factorial randomized design. Parents (n=220) of children aged 20–30 months corrected age who were born very preterm (<32 weeks) will be recruited from two large metropolitan Neonatal Intensive Care Unit follow-up clinics and randomized to one of four conditions: (1) ezParent (2) ezParent + coach, (3) active control or (4) active control + coach. A web-based app will provide behavioral training through brief videos, interactivity, reflection questions, and assessments. Data on parenting and child behavior outcomes will be obtained from all participants at baseline and 3, 6 and 12 months for program evaluation.

This research is being led by Dr. Susan Breitenstein from The Ohio State University (OSU) and Dr. Michelle Greene of Rush University (Multiple Principal Investigators). It is funded by a grant from The Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institute of Health (HD104072). Additional co-authors on this publication include Dr. Michael Schoeny and Dr. Kousiki Patra from Rush University; Dr. Sarah Keim from Nationwide Children’s Hospital and OSU; Dr. Mary Lauren Neel from Nationwide Children’s Hospital; Ms. Shea Smoske from OSU; and Ms. Julia Berteletti from Klein Buendel.