Eating disorders (ED) usually involve hospital admission and a high relapse rate, with the return home being a critical moment for patients and their families. After their return home, they often have trouble incorporating the guidelines they have learned into their daily context. ECHOMANTRA intervention program aims to facilitate this transition by offering psychological strategies that involve both patients and their families and carers. Specifically, the ECHO program is aimed at the relatives of these patients. The present study aimed to analyze the efficacy of adding the ECHO program to the usual treatment (TAU) of relatives through a novel format based on individual intervention and with an online format and to examine the acceptability and feasibility of this new format. The study design was multi-center, randomized, controlled, with a longitudinal design and comparing two parallel groups. A total of 108 family members participated. Results indicated that relatives from both groups, TAU and ECHO + TAU, showed improvements in expressed emotion, accommodation, impact of the ED, emotional well-being, and caregiver skills. However, effect sizes in the ECHO + TAU group were slightly larger than the TAU group. In addition, the changes were greater in depression and caregiver skills when the ECHO component was added. Most caregivers (81.48%) completed the ECHO and indicated a high level of satisfaction with the program. These results suggest the efficacy and the feasibility of adding the ECHO intervention program to the usual treatment in an individual online format.

OBJECTIVE: Environmental chemical exposures may disrupt child development, with long-lasting health impacts. To date, U.S. studies of early environmental exposures have been limited in size and diversity, hindering power and generalizability. With harmonized data from over 60,000 participants representing 69 pregnancy cohorts, the National Institutes of Health\'s Environmental influences on Child Health Outcomes (ECHO) Program is the largest study of U.S. children\'s health. Here, we: (1) review ECHO-wide studies of chemical exposures and maternal-child health; and (2) outline opportunities for future research using ECHO data.
RESULTS: As of early 2024, in addition to over 200 single-cohort (or award) papers on chemical exposures supported by ECHO, ten collaborative multi-cohort papers have been made possible by ECHO data harmonization and new data collection. Multi-cohort papers have examined prenatal exposure to per- and polyfluoroalkyl substances (PFAS), phthalates, phenols and parabens, organophosphate esters (OPEs), metals, melamine and aromatic amines, and emerging contaminants. They have primarily focused on describing patterns of maternal exposure or examining associations with maternal and infant outcomes; fewer studies have examined later child outcomes (e.g., autism) although follow up of enrolled ECHO children continues. The NICHD\'s Data and Specimen Hub (DASH) database houses extensive ECHO data including over 470,000 chemical assay results and complementary data on priority outcome areas (pre, peri-, and postnatal, airway, obesity, neurodevelopment, and positive health), making it a rich resource for future analyses. ECHO\'s extensive data repository, including biomarkers of chemical exposures, can be used to advance our understanding of environmental influences on children\'s health. Although few published studies have capitalized on these unique harmonized data to date, many analyses are underway with data now widely available.

In an era of political polarization, growing anti-science sentiment, and pervasive inequities in the social drivers of health, a rising tide of potentially harmful state policy proposals in the United States threaten to undermine the health of the public. In response, our health system\'s population health and government relations offices partnered with key health advocacy organizations in our state of New Hampshire to offer an interactive virtual learning series aimed at preparing diverse professionals and citizens to effectively advocate for sound health policies. Two hundred forty-seven individuals registered for the six-session series. Our findings indicate that participants experienced increased awareness of the political determinants of health, better understanding of specific legislative proposals in New Hampshire, and enhanced preparedness for advocacy, with many reporting greater active engagement in advocacy. Given its flexible and virtual nature, this innovative learning model could easily be adapted to promote dialogue and advocacy for sound health policy in diverse regional contexts.

Breast cancer is amongst the most common invasive cancers in adults. There are established relationships between anti-cancer treatments for breast cancer and cardiovascular side effects. In recent years, novel anti-cancer treatments have been established, as well as the availability of multi-modal cardiac imaging and the sophistication of treatment for cardiac disease. This review provides an in-depth overview regarding the interface of breast cancer and cancer therapy-related cardiovascular toxicity. Specifically, it reviews the pathophysiology of breast cancer, the method of action in therapy-related cardiovascular toxicity from anti-cancer treatment, the use of echocardiography, cardiac CT, MRI, or nuclear medicine as diagnostics, and the current evidence-based treatments available. It is intended to be an all-encompassing review for clinicians caring for patients in this situation.

UNASSIGNED: Overdoses and alcohol consumption rose during the pandemic. However, uptake of practices which reduce mortality (eg, medications for opioid use disorder, harm reduction practices) remains insufficient. Provider training and telementoring is needed to ensure sufficient capacity for treating substance use disorders (SUDs) with evidence-based practices. The Project ECHO (Extension for Community Healthcare Outcomes) model involves the use of web technologies to deliver didactic and case-based learning through a panel of experts to build such competency in a community of learners. Project ECHO was leveraged to implement a statewide telementoring center of addictions-focused ECHO programs, including programming in prescribing, harm reduction, recovery support services, collaborations with first responders, and systems-level challenges.
UNASSIGNED: Participants represented health and behavioral health disciplines practicing across the state of Texas in metropolitan and rural areas. Learners were administered: (1) an online registration form that inquired about basic demographics, (2) a post-session survey at the conclusion of each session capturing satisfaction and likelihood to implement, and (3) annual surveys measuring changes in knowledge and self-efficacy. Attendance and other learner data were stored and extracted from the partner relationship management database: iECHO.
UNASSIGNED: Training programs were attended by 968 learners, with an average of 48 learners per session. Geographic reach included 47 Texas cities. Post-training survey results indicated high rates of learner satisfaction, with an average rating of 4.68 on a 5-point Likert-like scale. Annual surveys indicated improvements in provider knowledge and self-confidence across all programs.
UNASSIGNED: Early results indicate robust uptake, wide geographic reach, high learner satisfaction, and provider knowledge and confidence gains. This preliminary evidence supports the use of the ECHO model as a potential tool for scaling comprehensive SUD telementoring centers to meet workforce development needs over large geographic areas.

BACKGROUND: Organizations implement innovations to disrupt the status quo and create value. Within sectors such as healthcare, innovations need to navigate large scale system and organizational factors to succeed. This research explores the implementation of a global innovation- Project ECHO®. Project ECHO® is a validated virtual communities of practice model organizational teams implement to build workforce capacity and capability. Project ECHO® has experienced broad global adoption, particularly within the healthcare sector, and is experiencing growth across other sectors. This study sought to examine the state of implementation success for Project ECHO® globally, to understand how these implementations compare across geographic and sectoral contexts, and understand what enablers/barriers exist for organizational teams implementing the innovation.
METHODS: An empirical study was conducted to collect data on 54 Project ECHO® implementation success indicators across an international sample. An online survey questionnaire was developed and distributed to all Project ECHO® hub organizations globally to collect data. Data was analyzed using descriptive statistics.
RESULTS: The 54 implementation success indicators measured in this survey revealed that the adoption of Project ECHO® across 13 organizations varied on a case-by-case basis, with a strong rate of adoption within the healthcare sector. Implementation teams from these organizations successfully implemented Project ECHO® within 12-18 months after completing Immersion partner launch training and operated 51 ECHO® Networks at the time of data collection. Implementation teams which liaised more regularly with ECHO® Superhub mentors often went on to launch a higher number of ECHO® Networks that were sustained over the longer term. This suggests that these implementation teams better aligned and consolidated their Project ECHO® pilots as new innovations within the local context and strategic organizational priorities. Access to research and evaluation capability, and a more automated digital client relationship management system were key limitations to showcasing implementation success outcomes experienced by the majority of implementation teams.
CONCLUSIONS: These findings make a valuable contribution to address a knowledge gap regarding how a global sample of organizations adopting Project ECHO® measured and reported their implementation successes. Key successes included pre-launch experimentation and expansion, Superhub mentorship, stakeholder engagement, and alignment to strategic priorities.

Advancing the concept of multimodal voicing as a tool for describing user-generated online humour, this paper reports a study on humorous COVID-19 mask memes. The corpus is drawn from four popular social media platforms and examined through a multimodal discourse analytic lens. The dominant memetic trends are elucidated and shown to rely programmatically on nested (multimodal) voices, whether compatible or divergent, as is the case with the dissociative echoing of individuals wearing peculiar masks or the dissociative parodic echoing of their collective voice. The theoretical thrust of this analysis is that, as some memes are (re)posted across social media (sometimes going viral), the previous voice(s) - of the meme subject/author/poster - can be re-purposed (e.g. ridiculed) or unwittingly distorted. Overall, this investigation offers new theoretical and methodological implications for the study of memes: it indicates the usefulness of the notions of multimodal voicing, intertextuality and echoing as research apparatus; and it brings to light the epistemological ambiguity in lay and academic understandings of memes, the voices behind which cannot always be categorically known.

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UNASSIGNED: Cardiac dysfunction is often seen following neurological injury. Data regarding cardiac involvement after ischemic stroke is sparse. We investigated the association of electrocardiographic (ECG) and echocardiographic variables with neurological outcomes after an acute ischemic stroke.
UNASSIGNED: We retrospectively collected baseline characteristics, stroke location, National Institute of Health Stroke Scale (NIHSS) at the time of admission, acute reperfusion treatment, ECG parameters, and echocardiographic data on 174 patients admitted with acute ischemic stroke. Outcomes of the stroke were based on cerebral performance category (CPC) with a CPC score of 1-2 indicating a good outcome and a CPC score of 3-5 indicating a poor outcome.
UNASSIGNED: Older age (75.31 ± 11.89 vs. 65.16 ± 15.87, p < 0.001, OR = 1.04, 95 % CI 1.01-1.07), higher heart rate (80.63 ± 18.69 vs. 74.45 ± 17.17 bpm, p = 0.024, OR = 1.02, 95 % CI 1.00-1.05) longer QTc interval (461.69 ± 39.94 vs. 450.75 ± 35.24, p = 0.024, OR = 1.01, 95 % CI 0.99-1.02), NIHSS score (60.9 % vs. 17.8 %, p < 0.001, OR = 14.90, 95 % CI 3.83-69.5), and thrombolysis (15 % vs. 5 %, p = 0.049, OR = 0.55, 95 % CI 0.10-2.55) were associated with poor neurological outcomes. However, when adjusted for age and NIHSS, heart rate and QTc were no longer statistically significant. None of the other ECG and echocardiographic variables were associated neurological outcomes.
UNASSIGNED: Elevated heart rate and longer QTc intervals may potentially predict poor neurological outcomes. Further studies are needed for validation and possible integration of these variables in outcome predicting models.

Bone Health ECHO (Extension for Community Healthcare Outcomes) is a virtual community of practice with the aim of enhancing global capacity to deliver best practice skeletal healthcare. The prototype program, established at the University of New Mexico, has been meeting online weekly since 2015, focusing on presentation and discussion of patient cases. These discussions commonly cover issues that are relevant to a broad range of patients, thereby serving as a force multiplier to improve the care of many patients. This is a case report from Bone Health ECHO about a patient with stage 5 chronic kidney disease, hypercalcemia, and low bone density, and the discussion that followed.