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Launching a resiliency group program to assist frontline clinicians in meeting the challenges of the COVID-19 pandemic: Results of a hospital-based systems trial

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... Significant improvements were reported in resiliency, stress coping, emotional distress, loneliness, mindfulness, and self-compassion. [18] 2.2 Sociodemographic information Demographic information collected included age, sex, race and ethnicity, and clinical role. ...
... As reported in Park et al., [18] program participants had a mean age of 45 years, were 92.1% female, 83.3% white, from 15 institutions, and had varied clinical roles (see Table 1). ...
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Objective: The COVID-19 pandemic has strained healthcare systems worldwide, placing a high psychological burden on frontline clinicians. There is an urgent need to better understand their stressors and determine if stressors differ by clinical role. The present study assessed the concerns among frontline clinicians across a large healthcare system during the COVID-19 pandemic to inform the development of tailored supportive services.Methods: From March – June 2020, frontline clinicians across the Mass General Brigham healthcare system were invited to register for an adapted mind-body resiliency group program. Clinicians completed pre- and post-program assessments asking them to report their COVID-19-related concerns. Qualitative data were analyzed in aggregate and by clinical role using content analysis to identify overarching domains.Results: Frontline clinicians’ concerns fall within seven domains: concerns for self, patients, family members, staff, existential concerns, systems-level concerns, and job-level concerns. Concerns for self and existential concerns were most commonly reported across clinical roles. Long-term care clinicians were highly concerned about patients’ wellbeing while rehabilitation therapists were highly concerned about their family members’ health. Across groups, nurse practitioners and physician assistants more often reported job-level concerns. Concerns for staff and systems level concerns were less frequently reported across clinical roles.Conclusions: Frontline clinicians share common pandemic-related concerns, but nuances exist among the concerns most frequently reported across clinical roles. Interventions that offer stress management and resiliency training may be helpful for addressing pandemic-related concerns overall. Future research should determine if tailored support services by clinical role may be warranted.
... Among the 2553 documents, 46 potentially relevant articles were selected after title and abstract screening. On the full-text screening, fifteen non-clinical studies [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39], four non-intervention studies [40][41][42][43], three generic studies [44][45][46], five studies not using MBMs [47][48][49][50][51], and one not presenting evaluation results [52] were excluded. Ultimately, this review included 18 studies [53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70] (Figure 1). ...
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Healthcare workers (HCWs) have suffered physical and psychological threats since the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Mind-body modalities (MBMs) can reduce the long-term adverse health effects associated with COVID-specific chronic stress. This systematic review aims to investigate the role of MBMs in managing the mental health of HCWs during the COVID-19 pandemic. A comprehensive search was conducted using 6 electronic databases, resulting in 18 clinical studies from 2019 to September 2021. Meta-analysis showed that MBMs significantly improved the perceived stress of HCWs (standardized mean difference, −0.37; 95% confidence intervals, −0.53 to −0.21). In addition, some MBMs had significant positive effects on psychological trauma, burnout, insomnia, anxiety, depression, self-compassion, mindfulness, quality of life, resilience, and well-being, but not psychological trauma and self-efficacy of HCWs. This review provides data supporting the potential of some MBMs to improve the mental health of HCWs during COVID-19. However, owing to poor methodological quality and heterogeneity of interventions and outcomes of the included studies, further high-quality clinical trials are needed on this topic in the future.
... To minimize participant burden, particularly in light of the substantial workload of healthcare workers during the pandemic, the survey was composed of a limited number of items selected from validated questionnaires, with the exception of the Patient Health Questionnaire-4 (PHQ-4; (Löwe et al., 2010), which was included in its entirety (four items, two assessing anxiety and two assessing depression) to capture emotional distress. Other questions assessed a range of outcomes including demographic characteristics, COVID-19 related anxiety, resilience (with two items from the Brief Resilience Scale (Smith et al., 2008)), one item assessing one's ability to utilize coping skills (Park et al., 2021); loneliness (with two items from the UCLA Loneliness Scale (Russell, 1996)); self-compassion (with one item from the Self-Compassion Scale (Neff et al., 2019)), and burn-out (with one item from the Maslach Burnout Inventory (Maslach et al., 1986). ...
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Introduction The psychological wellbeing of healthcare workers has been impacted by the high levels of stress many have experienced during the Coronavirus Disease 2019 (COVID-19) pandemic. This study aimed to examine the feasibility and acceptability of a brief online course focused on introducing evidence-based skills that could increase resilience and decreases emotional distress in healthcare workers during the pandemic. Materials and methods Employees of a large healthcare system completed a mental health survey at baseline, and then one month and two months after some employees participated in an online resilience-enhancement course consisting of three 12–19 min videos focused on mindfulness, mentalization, and self-compassion. Results A total of 554 participants completed the baseline survey, endorsing moderate to high levels of emotional distress. Of those who completed all three assessments and participated in the course (n = 38), significant improvements in resilience and reductions in emotional distress were found across two months, in comparison to those who did not participate in the course (n = 110). Discussion: These findings suggest that a brief, online intervention can improve the mental health of healthcare workers during a crisis such as the COVID-19 pandemic.
... To minimize participant burden, particularly in light of the substantial workload of healthcare workers during the pandemic, the survey was composed of a limited number of items selected from validated questionnaires, with the exception of the Patient Health Questionnaire-4 (PHQ-4; (Löwe et al., 2010), which was included in its entirety (four items, two assessing anxiety and two assessing depression) to capture emotional distress. Other questions assessed a range of outcomes including demographic characteristics, COVID-19 related anxiety, resilience (with two items from the Brief Resilience Scale (Smith et al., 2008)), coping (Park et al., 2021); loneliness (with two items from the UCLA Loneliness Scale (Russell, 1996)); self-compassion (with one item from the Self-Compassion Scale (Neff et al., 2019)), and burn-out (with one item from the Maslach Burnout Inventory (Maslach et al., 1986). ...
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Introduction The psychological wellbeing of healthcare workers has been impacted by the high levels of stress many have experienced during the COVID-19 pandemic. This study aimed to examine the feasibility and acceptability of a brief online course focused on introducing skills that could increase resilience and decreases emotional distress in healthcare workers during the pandemic. Materials and Methods Employees of a large healthcare system completed a survey at baseline, one month, and two months later. The online course, called Resilience Training for Healthcare Workers, consists of three 12-20 minute videos focused on evidence-based skills that support aspects of emotional resilience: mindfulness, mentalization, and self-compassion. Results A total of 554 participants completed the baseline survey, endorsing moderate to high levels of emotional distress. Of those who completed all three assessments and participated in the course (n = 38), significant improvements in resilience and reductions in emotional distress were found across two months, in comparison to those who did not participate in the course. Discussion These findings suggest that a brief, online intervention can improve the mental health of healthcare workers during a crisis such as the COVID-19 pandemic.
... [25,26] Recently, the SMART-3RP was delivered to frontline COVID-19 healthcare workers and resulted in improvements in stress coping, resiliency, emotionally balanced thoughts, emotional distress, and mindfulness. [27] Considering social distancing demands of the COVID-19 pandemic, one approach could be offering remotely-delivered (e.g., virtual) interventions with options for asynchronous content to accommodate variable shift schedules among healthcare workers occupying different clinical roles. [25] If health uncertainty is found to impact psychological outcomes, interventions like the SMART-3RP may provide benefit by promoting tolerance of uncertainty and thereby improved psychological functioning. ...
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Objective: Health uncertainty among healthcare workers has yet to be examined as a contributor to the psychological toll of the COVID-19 pandemic. We aimed to (1) characterize health uncertainty levels among healthcare workers in a large, U.S. hospital system during the COVID-19 pandemic and (2) examine associations between health uncertainty and psychological outcomes.Methods: From March to June 2020, healthcare workers in a large, urban U.S. healthcare system were invited to complete an online questionnaire. Self-report measures assessed sociodemographic characteristics and job roles, health uncertainty, and emotional wellbeing variables (anxiety, depression, loneliness, self-compassion, and coping confidence). Health uncertainty (categorical and continuous scores) was compared across each variable using correlations and ANOVAs.Results: Healthcare workers (N = 440) were on average 44.5 years of age, 88.9% female, and 84.5% non-Hispanic white. Over half (52%) endorsed experiencing health uncertainty “sometimes” to “all the time”. While unrelated to sociodemographic characteristics (ps > .05), health uncertainty was highest among pharmacists and technicians, with levels significantly higher than other roles including physicians (p < .05) and mental health and spiritual counselors (p < .05). Higher health uncertainty was associated with higher anxiety (p < .001), depression (p < .001), and loneliness (p < .001), higher self-compassion (p = .02), and lower coping confidence (p < .001).Conclusions: Health uncertainty during the COVID-19 pandemic is common among healthcare workers, with higher levels related to poorer emotional wellbeing and less confidence in their coping abilities. Further research is needed to understand the relationships between healthcare workers’ health uncertainties and associated factors (i.e., job roles) and to identify whether health uncertainty may be a modifiable target for future interventions.
Article
Background: The emotional health of adolescent and young adult (AYA) cancer survivors is compromised both during and after cancer treatment. Targeted programs designed to support AYAs' ability to cope with stress in the years following treatment completion are lacking. Mind-body programs may ameliorate the negative psychological and emotional effects of stress and assist AYAs with managing the psychosocial challenges of early survivorship. Objective: Our randomized waitlist-control trial aims to assess the feasibility, acceptability, and preliminary efficacy of a virtual group program (Bounce Back) to promote stress management and resiliency among posttreatment AYAs. Methods: Bounce Back is a stress management and resiliency program delivered via videoconference by a trained mental health clinician. Sessions were adapted from an evidence-based mind-body program (Stress Management and Resiliency Training - Relaxation Response Resiliency Program [SMART-3RP]) grounded in relaxation response elicitation, mindfulness, cognitive behavioral therapy, and positive psychology. Seventy-two AYAs (diagnosed with cancer between ages 14 years and 29 years and had completed cancer treatment within the last 5 years) were randomly assigned to the Bounce Back program or waitlist-control group and completed assessments at baseline, 3 months postbaseline, and 6 months postbaseline. The primary aim of the study is to determine the feasibility and acceptability of the Bounce Back program. Descriptive statistics, including means, frequencies, and ranges supplemented by qualitative exit interview feedback will be used to characterize the sample and to summarize feasibility and acceptability. The exploratory aims are to evaluate the preliminary effects of the program on stress coping and psychosocial outcome measures (ie, anxiety, depression) collected across the 3 time points. Results: This study was funded by the National Cancer Institute in July 2017. Study procedures were approved by the Dana-Farber Harvard Cancer Center Institutional Review Board in October 2018 (Protocol 18-428). The randomized trial was conducted from July 2019 to March 2021. Quantitative data collection is complete, and qualitative exit interview data collection is ongoing. Results are expected to be published in peer-reviewed journals and presented at local, national, or international meetings in the coming years. Conclusions: Few evidence-based programs exist that tackle the key transitional issues faced by AYA cancer survivors. Future analyses will help us determine the feasibility and acceptability of the Bounce Back program and its impact on AYA stress coping and psychological well-being. Trial registration: ClinicalTrials.gov NCT03768336; https://clinicaltrials.gov/ct2/show/NCT03768336. International registered report identifier (irrid): DERR1-10.2196/34033.
Article
Introduction Adults with congenital heart disease (ACHD) often experience elevated health anxiety. The SMART-3RP is an eight-week, mind-body group resiliency intervention with evidence to reduce health anxiety in other medical populations. The aims of this waitlist-controlled, randomized pilot feasibility trial were to explore (1) feasibility and acceptability of videoconference-delivered SMART-3RP, (2) feasibility and acceptability of remote blood pressure monitoring, and (3) changes in health anxiety, mindfulness, and resiliency. Methods Participants (N = 12 adults with CHD; Mean age = 41.2 years, SD = 13.8, 100% white, and 75% female) were 1:1 randomized into a pilot from July 2020 to September 2020. Participants completed surveys at baseline, three-month, and six-month follow-up; recorded their blood pressure via a digital health platform four times per week for eight weeks post-randomization (n = 32 total recordings); and completed individual exit interviews. Results 91% (29/32) of patients screened were eligible; of those, 41% (12/29) enrolled. 83% were retained at three-month follow-up (10/12) and 90% of those (9/10) were retained at six months. Average adherence to blood pressure monitoring was 70% (22/32 recordings completed; SD = 31.9). Effect sizes from baseline to three months suggested greater improvement in the immediate group compared to the waitlist group for health anxiety (Cohen's r = −.59), mindfulness (r = −0.44), and resiliency (r = −0.49). Exit interviews revealed positive experiences with the intervention, benefits of mindfulness skills for coping with anxiety, and suggestions for improvement including further targeting ACHD-specific needs. Conclusions These findings support the feasibility of conducting a randomized controlled efficacy trial of SMART-3RP for ACHD, and the acceptability and potential utility of SMART-3RP for emotional health in ACHD.
Article
Background To mitigate the psychological burdens of COVID-19 for frontline clinicians (FCs), we adapted an existing evidence-based resiliency program, Stress Management and Resilience Training Relaxation Response Program (SMART-3RP), for FCs. This analysis explores moderators of stress coping to determine which subgroups of FCs benefited most from SMART-3RP. Methods 102 FCs from Mass General Brigham hospitals engaged in the adapted SMART-3RP. Assessments were completed at group entry (Week 0) and completion (Week 4). The primary outcome was stress coping, and we examined 15 possible baseline moderators. We fit linear mixed effects regression models and assessed potential baseline moderators using a likelihood ratio test. We report model-based estimates and confidence intervals for each moderator-by-time interaction (i.e., differential effect), where positive/negative values indicate more/less improvement in average perceived stress coping. Results Stress coping improved from Week 0 to Week 4 (mean improvement [95% CI] = 0.9 [0.6 to 1.2]). FCs with higher anxiety (differential effect [95% CI] = 0.3 [0.1 to 0.4]), depression (0.4 [0.2 to 0.6]), and loneliness (0.4 [0.1 to 0.6]), but lower levels of mindfulness (CAMS-Rfocus: 1.0 [0.4 to 1.6]; CAMS-Raccept: 1.3 [0.7 to 2.0]) and self-compassion (0.4, [0.1 to 0.8]) at baseline experienced greater benefits in perceived stress coping from the SMART-3RP. Baseline health uncertainty along with sociodemographic and work characteristics did not moderate stress coping. Discussion Results highlight particular sub-populations of FCs that may benefit more from a stress management intervention, especially during emergency responses (e.g., COVID-19 pandemic).
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Objectives One in five children have a learning and attentional disability (LAD). Parents of children with LAD are vulnerable to distress, but an evidence-based treatment has not been developed. Methods From June 2016 to November 2017, we conducted a mixed methods study to adapt and assess the virtual delivery of a mind-body group resiliency program, the Stress Management and Resiliency Training-Relaxation Response Resiliency Program (SMART-3RP), to meet the needs of parents of children with LAD; this is an 8-session weekly group intervention. In the first phase, we conducted 4 parent focus group interviews, 2 professional focus group interviews, and 5 professional individual interviews, and 1 pilot group to adapt the SMART-3RP to target the needs of parents of children with LAD. In the second phase, we conducted a pilot wait-list controlled study to assess the feasibility, acceptability, and preliminary efficacy of a videoconferencing delivery of the adapted program. Parents were randomized to an immediate intervention group (IG) or wait-list control group (WC). Surveys were administered at baseline (time 1), end of intervention for the IG or 3 months post-baseline for the WC (time 2), and 3 months post treatment for the IG or end of intervention for the WC (time 3). Results Qualitative findings illustrated high levels of parental stress, with primary stressors including navigating the educational system, interactions with other parents, familial concerns, and financial and professional sacrifices. We adapted the manual to target these stressors and modified session logistics and delivery. Fifty-three parents (mean age = 46.8; 90.6% female) participated nationally in the pilot trial. 62.5% of participants completed ≥ 6/8 sessions; 81.8% reported continued daily/weekly relaxation response exercise practice. T1–T2 comparisons found that IG versus WC participants showed significant improvements in distress [VAS], ∆M = − 1.95; d = .83 and resilience [CES], ∆M = 6.38; d = .83, as well as stress coping [MOCS-A] ∆M = 8.69; d = 1.39; depression and anxiety [PHQ-4], ∆M = − 1.79; d = .71; social support [MOS-SSS], ∆M = 5.47; d = .71; and empathy [IRI], ∆M = 3.17; d = .77; improvements were sustained at the 3 month post intervention follow-up. Conclusion Pilot wait-list randomized trial findings showed promising feasibility, acceptability, and preliminary efficacy for the SMART-3RP intervention adapted for parents of children with LAD. This virtually-delivered resiliency intervention improved parents’ distress, resiliency, and stress coping, which were sustained. Clinical Trials ID NCT02772432.
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As interest grows in mindfulness training as a psychosocial intervention, it is increasingly important to quantify this construct to facilitate empirical investigation. The goal of the present studies was to develop a brief self-report measure of mindfulness with items that cover the breadth of the construct and that are written in everyday language. The resulting 12-item measure demonstrated acceptable internal consistency and evidence of convergent and discriminant validity with concurrent measures of mindfulness, distress, well-being, emotion-regulation, and problem-solving approaches in three samples of university students. To address potential construct contamination in two items, data are also presented on an alternate 10-item version of the measure.
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Research on stress-related growth typically relies on individuals' retrospective perceptions of growth, not indications of change in personal attributes over time (i.e., measured growth). This longitudinal study sought to: (1) examine the correspondence of perceived and measured growth, (2) elucidate the relations of these forms of growth, coping strategies, and change in adjustment in undergraduates (N = 162), and (3) examine whether current measurement approaches for selfperceived growth adequately capture the theoretical construct of psychological growth. Participants were undergraduates assessed at study entry and at 6 weeks. Perceptions of stress-related growth were not correlated with measured growth. In a path model, measured growth predicted increased positive mood and decreased distress. Perceived growth predicted increased positive mood, mediated by approach-oriented coping, as well as increased distress, partially mediated by coping through denial. These findings have implications for the measurement of stress-related growth and highlight the distinction between perceived and measured growth.
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The most common mental disorders in both outpatient settings and the general population are depression and anxiety, which frequently coexist. Both of these disorders are associated with considerable disability. When the disorders co-occur, the disability is even greater. Authors sought to test an ultra-brief screening tool for both. Validated two-item ultra-brief screeners for depression and anxiety were combined to constitute the Patient Health Questionnaire for Depression and Anxiety (the PHQ-4). Data were analyzed from 2,149 patients drawn from 15 primary-care clinics in the United States. Factor analysis confirmed two discrete factors (Depression and Anxiety) that explained 84% of the total variance. Increasing PHQ-4 scores were strongly associated with functional impairment, disability days, and healthcare use. Anxiety had a substantial effect on functional status that was independent of depression. The PHQ-4 is a valid ultra-brief tool for detecting both anxiety and depressive disorders.
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Research on loneliness has been hindered by the lack of a simple and reliable assessment technique. The development of the UCLA Loneliness Scale, a short, 20-item general measure of loneliness is reported. The measure has high internal consistency (coefficient alpha = .96) and a test-retest correlation over a two-month period of .73. Concurrent and preliminary construct validity are indicated by correlations with self-reports of current loneliness and related emotional states, and by volunteering for a "loneliness clinic."
Article
Background COVID-19 pandemic has the potential to significantly affect the mental health of healthcare workers (HCWs), who stand in the frontline of this crisis. It is, therefore, an immediate priority to monitor rates of mood, sleep and other mental health issues in order to understand mediating factors and inform tailored interventions. The aim of this review is to synthesize and analyze existing evidence on the prevalence of depression, anxiety and insomnia among HCWs during the Covid-19 outbreak. Methods A systematic search of literature databases was conducted up to April 17th, 2020. Two reviewers independently assessed full-text articles according to predefined criteria. Risk of bias for each individual study was assessed and data pooled using random-effects meta-analyses to estimate the prevalence of specific mental health problems. The review protocol is registered in PROSPERO and is available online. Findings Thirteen studies were included in the analysis with a combined total of 33,062 participants. Anxiety was assessed in 12 studies, with a pooled prevalence of 23·2% and depression in 10 studies, with a prevalence rate of 22·8%. A subgroup analysis revealed gender and occupational differences with female HCPs and nurses exhibiting higher rates of affective symptoms compared to male and medical staff respectively. Finally, insomnia prevalence was estimated at 38·9% across 5 studies. Interpretation Early evidence suggests that a considerable proportion of HCWs experience mood and sleep disturbances during this outbreak, stressing the need to establish ways to mitigate mental health risks and adjust interventions under pandemic conditions.
Article
Context: Palliative care clinicians (PCCs) are vulnerable to burnout as a result of chronic stress related to working with seriously ill patients. Burnout can lead to absenteeism, ineffective communication, medical errors, and job turnover. Interventions that promote better coping with stress are needed in this population. Objectives: This pilot study tested the feasibility of the Relaxation Response Resiliency Program for Palliative Care Clinicians (3RP-PCC), a program targeted to decrease stress and increase resiliency, in a multidisciplinary cohort of PCCs (N= 16) at a major academic medical center. Methods: A physician delivered the intervention over two months in five sessions (12 hours total). Data were collected the week before the program start and two months after completion. The main outcome was feasibility of the program. Changes in perceived stress, positive and negative affect, perspective taking, optimism, satisfaction with life, and self-efficacy were examined using non-parametric statistical tests. Effect size was quantified using Cohen's d. Results: The intervention was feasible; all participants attended at least four of the five sessions and there was no attrition. Following the intervention, participants showed reductions in perceived stress and improvements in perspective taking. Conclusion: Our findings suggest that a novel team-based resiliency intervention based upon elicitation of the relaxation response was feasible and may help promote resiliency and protect against the negative consequences of stress for PCCs.
Article
This article defines the construct of self-compassion and describes the development of the Self-Compassion Scale. Self-compassion entails being kind and understanding toward oneself in instances of pain or failure rather than being harshly self-critical; perceiving one's experiences as part of the larger human experience rather than seeing them as isolating; and holding painful thoughts and feelings in mindful awareness rather than over-identifying with them. Evidence for the validity and reliability of the scale is presented in a series of studies. Results indicate that self-compassion is significantly correlated with positive mental health outcomes such as less depression and anxiety and greater life satisfaction. Evidence is also provided for the discriminant validity of the scale, including with regard to self-esteem measures.
Measure of current status
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Carver CS. Measure of current status. http://local.psy.miami.edu/faculty/ccarver/ sclMOCS.phtml; 2006.
Contents lists available at ScienceDirect General Hospital Psychiatry journal homepage
Contents lists available at ScienceDirect General Hospital Psychiatry journal homepage: www.elsevier.com/locate/genhospsych https://doi.org/10.1016/j.genhosppsych.2020.10.005
Bliss a , Mary Susan Convery f , Sydney Crute a , John W. Denninger b,c,d , Karen Donelan a,b , Michelle L Dossett g , Maurizio Fava b,c , Stacie Fredriksson e
  • Elyse R Park
  • Louisa G Sylvia
  • Joanna M Streck
  • Christina M Luberto
  • Amelia M Stanton
  • Giselle K Perez
  • Margaret Baim D
  • C Cayley
Elyse R. Park a,b,c,d,*, Louisa G. Sylvia b,c, Joanna M. Streck a,b,c, Christina M. Luberto a,b,c,d, Amelia M. Stanton b,c, Giselle K. Perez a,b,c, Margaret Baim d, Cayley C. Bliss a, Mary Susan Convery f, Sydney Crute a, John W. Denninger b,c,d, Karen Donelan a,b, Michelle L Dossett g, Maurizio Fava b,c, Stacie Fredriksson e, Gregory Fricchione b,c,d, Nevita George c, Daniel L. Hall a,b,c, Betsy Remington Hart e,