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An Exploratory Sequential Mixed Methods Approach to Understanding Researchers’ Data Management Practices at UVM: Integrated Findings to Develop Research Data Services

Fri, 03/31/2017 - 9:02am

This is the third in a series of articles reporting on a study of researcher data management practices and data services at the University of Vermont.

This article reports on the integrated findings of an exploratory sequential mixed methods research design aimed to understand data management behaviors and challenges of faculty at the University of Vermont (UVM) in order to develop relevant research data services. The exploratory sequential mixed methods design is characterized by an initial qualitative phase of data collection and analysis, followed by a phase of quantitative data collection and analysis, with a final phase of integration or linking of data from the two separate strands of data. A joint display was used to integrate data focused on the three primary research questions: How do faculty at UVM manage their research data, in particular how do they share and preserve data in the long-term?; What challenges or barriers do UVM faculty face in effectively managing their research data?; and What institutional data management support or services are UVM faculty interested in? As a result of the analysis, this study suggests four major areas of research data services for UVM to address: infrastructure, metadata, data analysis and statistical support, and informational research data services. The implementation of these potential areas of research data services is underscored by the need for cross-campus collaboration and support.

An Exploratory Sequential Mixed Methods Approach to Understanding Researchers’ Data Management Practices at UVM: Findings from the Quantitative Phase

Fri, 03/31/2017 - 9:02am

This is the second in a series of articles reporting on a study of researcher data management practices and data services at the University of Vermont.

This article reports on the second quantitative phase of an exploratory sequential mixed methods research design focused on researcher data management practices and related institutional support and services. The study aims to understand data management activities and challenges of faculty at the University of Vermont (UVM), a higher research activity Research University, in order to develop appropriate research data services (RDS). Data was collected via a survey, built on themes from the initial qualitative data analysis from the first phase of this study. The survey was distributed to a nonrandom census sample of full-time UVM faculty and researchers (P=1,190); from this population, a total of 319 participants completed the survey for a 26.8% response rate. The survey collected information on five dimensions of data management: data management activities; data management plans; data management challenges; data management support; and attitudes and behaviors towards data management planning. Frequencies, cross tabulations, and chi-square tests of independence were calculated using demographic variables including gender, rank, college, and discipline. Results from the analysis provide a snapshot of research data management activities at UVM, including types of data collected, use of metadata, short- and long-term storage of data, and data sharing practices. The survey identified key challenges to data management, including data description (metadata) and sharing data with others; this latter challenge is particular impacted by confidentiality issues and lack of time, personnel, and infrastructure to make data available. Faculty also provided insight to RDS that they think UVM should support, as well as RDS they were personally interested in. Data from this study will be integrated with data from the first qualitative phase of the research project and analyzed for meta-inferences to help determine future research data services at UVM.

An Exploratory Sequential Mixed Methods Approach to Understanding Researchers’ Data Management Practices at UVM: Findings from the Qualitative Phase

Fri, 03/31/2017 - 9:01am

This is the first in a series of articles reporting on a study of researcher data management practices and data services at the University of Vermont.

The objective of this article is to report on the first qualitative phase of an exploratory sequential mixed methods research design focused on researcher data management practices and related institutional research data services. The aim of this study is to understand data management behaviors of faculty at the University of Vermont (UVM), a higher-research activity Research University, in order to guide the development of campus research data management services. The population of study was all faculty who received National Science Foundation (NSF) grants between 2011 and 2014 who were required to submit a data management plan (DMP); qualitative data was collected in two forms: (1) semi-structured interviews and (2) document analysis of data management plans. From a population of 47 researchers, six were included in the interview sample, representing a broad range of disciplines and NSF Directorates, and 35 data management plans were analyzed. Three major themes were identified through triangulation of qualitative data sources: data management activities, including data dissemination and data sharing; institutional research support and infrastructure barriers; and perceptions of data management plans and attitudes towards data management planning. The themes articulated in this article will be used to design a survey for the second quantitative phase of the study, which will aim to more broadly generalize data management activities at UVM across all disciplines.

The Sodium Channel beta4 Auxiliary Subunit Selectively Controls Long-Term Depression in Core Nucleus Accumbens Medium Spiny Neurons

Wed, 03/29/2017 - 1:04pm

Voltage-gated sodium channels are essential for generating the initial rapid depolarization of neuronal membrane potential during action potentials (APs) that enable cell-to-cell communication, the propagation of signals throughout the brain, and the induction of synaptic plasticity. Although all brain neurons express one or several variants coding for the core pore-forming sodium channel alpha subunit, the expression of the beta (beta1-4) auxiliary subunits varies greatly. Of particular interest is the beta4 subunit, encoded by the Scn4b gene, that is highly expressed in dorsal and ventral (i.e., nucleus accumbens - NAc) striata compared to other brain regions, and that endows sodium channels with unique gating properties. However, its role on neuronal activity, synaptic plasticity, and behaviors related to drugs of abuse remains poorly understood. Combining whole-cell patch-clamp recordings with two-photon calcium imaging in Scn4b knockout (KO) and knockdown mice, we found that Scn4b altered the properties of APs in core accumbens medium spiny neurons (MSNs). These alterations are associated with a reduction of the probability of MSNs to evoke spike-timing-dependent long-term depression (tLTD) and a reduced ability of backpropagating APs to evoke dendritic calcium transients. In contrast, long-term potentiation (tLTP) remained unaffected. Interestingly, we also showed that amphetamine-induced locomotor activity was significantly reduced in male Scn4b KO mice compared to wild-type controls. Taken together, these data indicate that the Scn4b subunit selectively controls tLTD by modulating dendritic calcium transients evoked by backpropagating APs.

Leukoaraiosis, intracerebral hemorrhage, and functional outcome after acute stroke thrombolysis

Wed, 03/29/2017 - 1:04pm

OBJECTIVE: To perform a systematic review and pooled meta-analysis of published studies to assess whether the presence of leukoaraiosis on neuroimaging before treatment with thrombolysis (IV or intra-arterial) is associated with an increased risk of symptomatic intracerebral hemorrhage (sICH) or poor functional outcome.

METHODS: We included studies of patients with acute ischemic stroke, treated with IV or intra-arterial thrombolysis, which assessed functional outcome (3-month modified Rankin Scale [mRS]) or sICH in relation to leukoaraiosis on pretreatment neuroimaging (CT or MRI). We used random-effects models to calculate pooled relative risks (RR) of sICH and poor functional outcome (mRS > /= 2) for any vs no leukoaraiosis (using any rating scale) and for no to mild vs moderate to severe leukoaraiosis (using the Van Swieten or Fazekas Schmidt scale).

RESULTS: We identified 15 studies (total n = 6,967). For sICH outcome, the RR was 1.65 (n = 5,551; 95% confidence interval [CI] 1.26-2.16, p = 0.001) with an absolute risk (AR) increase of 2.5% for any leukoaraiosis vs none. The RR was 2.4 (n = 4,192; 95% CI 1.83-3.14, p = 0.001) with an AR increase of 6.2% for moderate to severe vs no to mild leukoaraiosis. For poor functional outcome; the RR was 1.30 (n = 3,401; 95% CI 1.19-1.42, p = 0.001) with an AR increase of 15.4% for any leukoaraiosis vs none. The RR was 1.31 (n = 3,659; 95% CI 1.22-1.42, p = 0.001) with an AR increase of 17.5% for moderate to severe vs no to mild leukoaraiosis. No statistical heterogeneity was noted for any of the analyses.

CONCLUSIONS: Leukoaraiosis presence and severity are consistently associated with an increased risk of sICH and poor functional outcome after IV or intra-arterial thrombolysis for acute ischemic stroke.

Paternal nicotine exposure alters hepatic xenobiotic metabolism in offspring

Wed, 03/29/2017 - 1:04pm

Paternal environmental conditions can influence phenotypes in future generations, but it is unclear whether offspring phenotypes represent specific responses to particular aspects of the paternal exposure history, or a generic response to paternal 'quality of life'. Here, we establish a paternal effect model based on nicotine exposure in mice, enabling pharmacological interrogation of the specificity of the offspring response. Paternal exposure to nicotine prior to reproduction induced a broad protective response to multiple xenobiotics in male offspring. This effect manifested as increased survival following injection of toxic levels of either nicotine or cocaine, accompanied by hepatic upregulation of xenobiotic processing genes, and enhanced drug clearance. Surprisingly, this protective effect could also be induced by a nicotinic receptor antagonist, suggesting that xenobiotic exposure, rather than nicotinic receptor signaling, is responsible for programming offspring drug resistance. Thus, paternal drug exposure induces a protective phenotype in offspring by enhancing metabolic tolerance to xenobiotics.

Data quality assurance and control in cognitive research: Lessons learned from the PREDICT-HD study

Wed, 03/29/2017 - 1:04pm

We discuss the strategies employed in data quality control and quality assurance for the cognitive core of Neurobiological Predictors of Huntington's Disease (PREDICT-HD), a long-term observational study of over 1,000 participants with prodromal Huntington disease. In particular, we provide details regarding the training and continual evaluation of cognitive examiners, methods for error corrections, and strategies to minimize errors in the data. We present five important lessons learned to help other researchers avoid certain assumptions that could potentially lead to inaccuracies in their cognitive data.

Prolonged cannabis withdrawal in young adults with lifetime psychiatric illness

Wed, 03/29/2017 - 1:04pm

Young adults with psychiatric illnesses are more likely to use cannabis and experience problems from use. It is not known whether those with a lifetime psychiatric illness experience a prolonged cannabis withdrawal syndrome with abstinence. Participants were fifty young adults, aged 18-25, recruited from the Boston-area in 2015-2016, who used cannabis at least weekly, completed the Structured Clinical Interview for DSM-IV to identify Axis I psychiatric diagnoses (PD+ vs PD-), and attained cannabis abstinence with a four-week contingency management protocol. Withdrawal symptom severity was assessed at baseline and at four weekly abstinent visits using the Cannabis Withdrawal Scale. Cannabis dependence, age of initiation, and rate of abstinence were similar in PD+ and PD- groups. There was a diagnostic group by abstinent week interaction, suggesting a difference in time course for resolution of withdrawal symptoms by group, F(4,46)=3.8, p=0.009, controlling for sex, baseline depressive and anxiety symptoms, and frequency of cannabis use in the prior 90days. In post hoc analyses, there was a difference in time-course of cannabis withdrawal. PD- had significantly reduced withdrawal symptom severity in abstinent week one [t(46)=-2.2, p=0.03], while PD+ did not report improved withdrawal symptoms until the second abstinent week [t(46)=-4.1, p=0.0002]. Cannabis withdrawal symptoms improved over four weeks in young people with and without a lifetime psychiatric diagnosis. However, those with a psychiatric illness reported one week delayed improvement in withdrawal symptom severity. Longer duration of cannabis withdrawal may be a risk factor for cannabis dependence and difficulty quitting.

Weight loss support seeking on twitter: the impact of weight on follow back rates and interactions

Wed, 03/29/2017 - 1:04pm

People seek weight loss support on online social networks, but little is known about how to build a supportive community. We created four Twitter accounts portraying women interested in weight loss (two obese, two normal weight/overweight) and followed health care professional and peer accounts for 2-5 weeks. We examined follow back rates, interactions, and organic follows from professionals and peers by weight status. Follow back rates did not differ by weight status when following professionals (6.8 % normal weight/overweight vs 11.0 % for obese; p = 0.4167) or peers (6.7 % for normal weight/overweight vs 10.8 % for obese; p = 0.1548). Number of interactions and organic followers also did not differ by weight status. Peers interacted with study accounts significantly more than professionals (p = 0.0138), but interactions were infrequent. Women seeking weight loss support on Twitter may need to be present for more than 5 weeks to build an interactive weight loss community.

Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety

Wed, 03/29/2017 - 1:04pm

Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary workgroup to develop an evidence-based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow-up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation.

Quantitative EEG during normal aging: association with the Alzheimer's disease genetic risk variant in PICALM gene

Wed, 03/29/2017 - 1:04pm

Genome-wide association studies have identified novel risk variants for Alzheimer's disease (AD). Among these, a gene carrying one of the highest risks for AD is PICALM. The PICALM rs3851179 A allele is thought to have a protective effect, whereas the G allele appears to confer risk for AD. The influence of the PICALM genotype on brain function in nondemented subjects remains largely unknown. We examined the possible effect of the PICALM rs3851179 genotype on quantitative electroencephalography recording at rest in 137 nondemented volunteers (age range: 20-79 years) subdivided into cohorts of those younger than and those older than 50 years of age. The homozygous presence of the AD risk variant PICALM GG was associated with an increase in beta relative power, with the effect being more pronounced in the older cohort. Beta power elevation in resting-state electroencephalography has previously been linked to cortical disinhibition and hyperexcitability. The increase in beta relative power in the carriers of the AD risk PICALM GG genotype suggests changes in the cortical excitatory-inhibitory balance, which are heightened during normal aging.

Supervisor and Organizational Factors Associated with Supervisor Support of Job Accommodations for Low Back Injured Workers

Wed, 03/29/2017 - 1:03pm

Purpose Temporary job accommodations contribute to the prevention of chronic work disability due to low back pain (LBP) through the facilitation of early return to work; yet, workplace dimensions of job accommodation are poorly understood. The objective of this study was to determine supervisor and organizational factors associated with supervisors' support for temporary job accommodations for LBP injured workers. Methods Supervisors were recruited from 19 workplaces in the USA and Canada and completed an online survey regarding job accommodation practices and potential associated factors with respect to a case vignette of a worker with LBP. Multivariable linear regression was used to identify the most parsimonious set of factors associated with supervisors' support for accommodations. Results A total of 804 supervisors participated with 796 eligible for inclusion in the analysis. The final set of factors explained 21 % of the variance in supervisors' support for temporary job accommodations. Considerate leadership style (beta = 0.261; 95 % CI 0.212, 0.310), workplace disability management policies and practices (beta = 0.243; 95 % CI 0.188, 0.298), and supervisor autonomy for designing and providing workplace accommodations (beta = 0.156; 95 % CI 0.071, 0.241) had the largest effect on supervisor support for accommodations. Conclusion Factors predicting supervisors' likelihood to accommodate LBP injured workers include use of considerate leadership style, workplace disability management policies and practices, and supervisor autonomy. Workplace interventions targeting these factors should be developed and evaluated for their ability to improve work disability prevention outcomes.

Affective Responses in Different Stages of Anorexia Nervosa: Results from a Startle-reflex Paradigm

Wed, 03/29/2017 - 1:03pm

OBJECTIVE: There is an evolving debate about pathological affective responses in patients with anorexia nervosa (AN). We examined startle responses in different stages of AN.

METHODS: We applied a startle reflex paradigm with standardized visual stimuli (International Affective Pictures System; food and body pictures) in 64 female participants (17 acute AN, 16 chronically ill AN, 15 long-term recovered AN, 16 healthy controls). We measured subjective ratings of valence and anxiety, and electromyographic startle responses.

RESULTS: Participants with acute and chronic AN displayed the same subjective valence ratings to affective stimuli but showed less startle reactivity to affective pictures (F(6, 116) = 2.75, p = .02) compared with healthy control. Food pictures were rated as more unpleasant and higher anxiety provoking by currently ill AN (F(3, 59) = 3.32, p=.03).

DISCUSSION: We observed diverging subjective and psychophysiological reactions in different stages of AN. Psychophysiological methods can help to attain a more comprehensive understanding of biological alterations in the long-term course of AN.

Are some of the stigmas of addictions culturally sanctioned

Wed, 03/29/2017 - 11:32am

We provide three examples of how addiction stigma is sanctioned: (a) discrimination against people with addictions is often legal; (b) public health communications frequently use stigma to promote prevention; (c) some programmes, such as '12 steps' promote self-stigma. The implications of sanctioned stigma for stigma-change programmes are then discussed.

Impaired cue identification and intention retrieval underlie prospective memory deficits in patients with first-episode schizophrenia

Wed, 03/29/2017 - 11:32am

OBJECTIVE: Schizophrenia is associated with impairment in prospective memory, the ability to remember to carry out an intended action in the future. It has been established that cue identification (detection of the cue event signaling that an intended action should be performed) and intention retrieval (retrieval of an intention from long-term memory following the recognition of a prospective cue) are two important processes underlying prospective memory. The purpose of this study was to examine prospective memory deficit and underlying cognitive processes in patients with first-episode schizophrenia.

METHODS: This study examined cue identification and intention retrieval components of event-based prospective memory using a dual-task paradigm in 30 patients with first-episode schizophrenia and 30 healthy controls. All participants were also administered a set of tests assessing working memory and retrospective memory.

RESULTS: Both cue identification and intention retrieval were impaired in patients with first-episode schizophrenia compared with healthy controls ( ps < 0.05), with a large effect size for cue identification (Cohen's d = 0.98) and a medium effect size for intention retrieval (Cohen's d = 0.62). After controlling for working memory and retrospective memory, the difference in cue identification between patients and healthy controls remained significant. However, the difference in intention retrieval between the two groups was no longer significant. In addition, there was a significant inverse relationship between cue identification and negative symptoms ( r = -0.446, p = 0.013) in the patient group.

CONCLUSION: These findings suggest that both cue identification and intention retrieval in event-based prospective memory are impaired in patients with first-episode schizophrenia. Cue identification and intention retrieval could be potentially used as biomarkers for early detection and treatment prognosis of schizophrenia. In addition, addressing cue identification deficit through cognitive enhancement training may potentially improve negative symptoms as well.

Using Factor Mixture Models to Evaluate the Type A/B Classification of Alcohol Use Disorders in a Heterogeneous Treatment Sample

Wed, 03/29/2017 - 11:31am

BACKGROUND: The type A/B classification model for alcohol use disorders (AUDs) has received considerable empirical support. However, few studies examine the underlying latent structure of this subtyping model, which has been challenged as a dichotomization of a single drinking severity dimension. Type B, relative to type A, alcoholics represent those with early age of onset, greater familial risk, and worse outcomes from alcohol use.

METHOD: We examined the latent structure of the type A/B model using categorical, dimensional, and factor mixture models in a mixed gender community treatment-seeking sample of adults with an AUD.

RESULTS: Factor analytic models identified 2-factors (drinking severity/externalizing psychopathology and internalizing psychopathology) underlying the type A/B indicators. A factor mixture model with 2-dimensions and 3-classes emerged as the best overall fitting model. The classes reflected a type A class and two type B classes (B1 and B2) that differed on the respective level of drinking severity/externalizing pathology and internalizing pathology. Type B1 had a greater prevalence of women and more internalizing pathology and B2 had a greater prevalence of men and more drinking severity/externalizing pathology. The 2-factor, 3-class model also exhibited predictive validity by explaining significant variance in 12-month drinking and drug use outcomes.

CONCLUSIONS: The model identified in the current study may provide a basis for examining different sources of heterogeneity in the course and outcome of AUDs.

Use of Veterans Health Administration Mental Health and Substance Use Disorder Treatment After Exiting Prison: The Health Care for Reentry Veterans Program

Wed, 03/29/2017 - 11:31am

The Veterans Health Administration (VA) Health Care for Reentry Veterans (HCRV) program links veterans exiting prison with treatment. Among veterans served by HCRV, national VA clinical data were used to describe contact with VA health care, and mental health and substance use disorder diagnoses and treatment use. Of veterans seen for an HCRV outreach visit, 56 % had contact with VA health care. Prevalence of mental health disorders was 57 %; of whom 77 % entered mental health treatment within a month of diagnosis. Prevalence of substance use disorders was 49 %; of whom 37 % entered substance use disorder treatment within a month of diagnosis. For veterans exiting prison, increasing access to VA health care, especially for rural veterans, and for substance use disorder treatment, are important quality improvement targets.

Using Getting To Outcomes to facilitate the use of an evidence-based practice in VA homeless programs: a cluster-randomized trial of an implementation support strategy

Wed, 03/29/2017 - 11:31am

BACKGROUND: Incorporating evidence-based integrated treatment for dual disorders into typical care settings has been challenging, especially among those serving Veterans who are homeless. This paper presents an evaluation of an effort to incorporate an evidence-based, dual disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) into case management teams serving Veterans who are homeless, using an implementation strategy called Getting To Outcomes (GTO).

METHODS: This Hybrid Type III, cluster-randomized controlled trial assessed the impact of GTO over and above MISSION-Vet Implementation as Usual (IU). Both conditions received standard MISSION-Vet training and manuals. The GTO group received an implementation manual, training, technical assistance, and data feedback. The study occurred in teams at three large VA Medical Centers over 2 years. Within each team, existing sub-teams (case managers and Veterans they serve) were the clusters randomly assigned. The trial assessed MISSION-Vet services delivered and collected via administrative data and implementation barriers and facilitators, via semi-structured interview.

RESULTS: No case managers in the IU group initiated MISSION-Vet while 68% in the GTO group did. Seven percent of Veterans with case managers in the GTO group received at least one MISSION-Vet session. Most case managers appreciated the MISSION-Vet materials and felt the GTO planning meetings supported using MISSION-Vet. Case manager interviews also showed that MISSION-Vet could be confusing; there was little involvement from leadership after their initial agreement to participate; the data feedback system had a number of difficulties; and case managers did not have the resources to implement all aspects of MISSION-Vet.

CONCLUSIONS: This project shows that GTO-like support can help launch new practices but that multiple implementation facilitators are needed for successful execution of a complex evidence-based program like MISSION-Vet.


Anomalous gray matter structural networks in recent onset post-traumatic stress disorder

Wed, 03/29/2017 - 11:31am

Alterations of the topological organization of abnormal regions or network-level structural aberrations are still poorly understood for post-traumatic stress disorder (PTSD). Herein, we investigated brain structural networks in recent-onset PTSD patients, all affected by the coalmine-flood disaster. Cortical networks were studied in recent onset PTSD patients (n = 15) and matched healthy controls (n = 25). Cortical networks were constructed by thresholding correlation matrices of 150 regions and quantified using graph theoretical approaches. Contributions of high-degree nodes, and regional and global network measures, including degree and betweenness, were studied. Compared with healthy controls, PTSD patients showed altered quantitative values in global network properties, characterized by shorter path length and higher clustering. Moreover, PTSD patients exhibited decreased connectivity in the right lingual gyrus, parahippocampal gyrus, left supramarginal gyrus, parahippocampal gyrus, bilateral superior and inferior frontal gyrus, superior frontal gyrus, and posterior cingulate gyrus. Nodal centrality decreased predominantly in the occipital regions (lingual gyrus) and default-mode regions, while increased correlations and centralities were observed in the medial temporal lobe and posterior cingulate cortex. PTSD-related networks exhibited a less efficient organization and regional connectivity. According to these findings, we conclude that regional connections involving fear-processing and re-experiential-processing cortex may play a role in maintaining or adapting to PTSD pathology.

What defines mindfulness-based programs? The warp and the weft

Wed, 03/29/2017 - 11:31am

There has been an explosion of interest in mindfulness-based programs (MBPs) such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy. This is demonstrated in increased research, implementation of MBPs in healthcare, educational, criminal justice and workplace settings, and in mainstream interest. For the sustainable development of the field there is a need to articulate a definition of what an MBP is and what it is not. This paper provides a framework to define the essential characteristics of the family of MBPs originating from the parent program MBSR, and the processes which inform adaptations of MBPs for different populations or contexts. The framework addresses the essential characteristics of the program and of teacher. MBPs: are informed by theories and practices that draw from a confluence of contemplative traditions, science, and the major disciplines of medicine, psychology and education; underpinned by a model of human experience which addresses the causes of human distress and the pathways to relieving it; develop a new relationship with experience characterized by present moment focus, decentering and an approach orientation; catalyze the development of qualities such as joy, compassion, wisdom, equanimity and greater attentional, emotional and behavioral self-regulation, and engage participants in a sustained intensive training in mindfulness meditation practice, in an experiential inquiry-based learning process and in exercises to develop understanding. The paper's aim is to support clarity, which will in turn support the systematic development of MBP research, and the integrity of the field during the process of implementation in the mainstream.