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Assignment 3: Developing an Intervention and Determining the Impact SOLUTION

Assignment 3: Developing an Intervention and Determining the Impact SOLUTION

Walden University Assignment 3: Developing an Intervention and Determining the Impact SOLUTION-Step-By-Step Guide

 

This guide will demonstrate how to complete the Walden University Assignment 3: Developing an Intervention and Determining the Impact SOLUTION  assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

 

How to Research and Prepare for Assignment 3: Developing an Intervention and Determining the Impact SOLUTION  

 

Whether one passes or fails an academic assignment such as the Walden University Assignment 3: Developing an Intervention and Determining the Impact SOLUTION depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

 

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

 

How to Write the Introduction for Assignment 3: Developing an Intervention and Determining the Impact SOLUTION  

The introduction for the Walden University Assignment 3: Developing an Intervention and Determining the Impact SOLUTION  is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

 

How to Write the Body for Assignment 3: Developing an Intervention and Determining the Impact SOLUTION  

 

After the introduction, move into the main part of the Assignment 3: Developing an Intervention and Determining the Impact SOLUTION  assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

 

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

 

How to Write the Conclusion for Assignment 3: Developing an Intervention and Determining the Impact SOLUTION  

 

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

 

How to Format the References List for Assignment 3: Developing an Intervention and Determining the Impact SOLUTION  

 

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 8310 Assignment 3: Developing an Intervention and Determining the Impact

Section 3: The Intervention

  • An outline of an intervention you would implement to address the population health problem with your selected population based on the results of the study in Section 2 (Note: If you selected a descriptive study design, you are still required to outline an intervention that might be developed based on future research.)
  • A review of the literature that supports this intervention

Section 4: The Impact

  • An explanation of the health outcome you would be seeking and the social impact of solving this issue

The Effect of Self-Monitoring on the Reduction of Hypertension Amongst Health Workers

For years, patient quality care and safety have been the major focus of nursing, meaning that efforts are put explored for ensuring that high standards are maintained. Nurses and other stakeholders employ various strategies such as evidence-based practice and quality improvement initiatives to ensure that patients receive the best nature of care possible. The implication is that nurses usually engage in the research processes, which may entail identifying health care problems and coming up with potential solutions which are then fine-tuned before implementation to ensure that the interventions achieve the intended purpose (Aiken et al., 2021). In the previous weeks, various attempts have been made to use the epidemiological approach in a critical analysis of a population health problem. Therefore, the health problem identified in the previous weeks is hypertension among healthcare workers. The purpose of this assignment is to discuss an intervention that will be implemented to address the health problem a literature review that supports the intervention. Besides, this write-up explores the potential social impact of the solution.

The Intervention

As discussed in the previous sections, this project seeks to address hypertension among healthcare workers. Therefore, the following PICOT statement was chosen: Among Healthcare Personnel On a Medical Unit Aged 21 To 51 Years Having Psychological Stress, Does Blood Pressure Self-Monitoring with A Comprehensive Education in The Healthcare Facility as Compared to No Intervention Contribute to The Deterrence of Development of Hypertension Over 6 Months? From the above, the population encompasses the health workers of the medical unit aged 20 years to 50 years. Therefore, the chosen intervention to help address the problem of developing hypertension due to psychological stress is blood pressure self-monitoring with comprehensive education.

A Review of Literature

Hypertension has various adverse impacts, and therefore, over the years, there have been efforts to address the condition and come up with better ways of managing it. One of such interventions that have been used in Literature is the use of blood pressure self-monitoring and comprehensive education on how to keep the pressure normal. Therefore, this section presents some of the studies in the past that have addressed hypertension using this intervention.

In one of such studies, Persell et al. (2020) conducted research to investigate the impact of using a coaching application among patients to enhance various aspects such as blood pressure monitoring. The applied design was a randomized controlled study design. Upon the use of the intervention, the researchers observed various results. The mean systolic blood pressure was found to be better in the intervention group as compared to the control group. Besides, the participants in the study group showed more self-confidence in controlling blood pressure. One notable result is also that the blood pressure was similar among patients using a smartphone coaching app integrated with home monitoring and those who performed home monitoring integrated with a blood pressure monitoring app (Persell et al., 2020). Therefore, this study shows that blood pressure monitoring leads to better outcomes in reference to hypertension.

Khorsandi et al.( 2017), also conducted a study to evaluate the impact of education built on the health belief model on the adoption of behaviors that help control hypertension among the elderly. This research used a quasi-experimental study design involving a total of one hundred elderly patients living with hypertension. While part of the study participants was placed in the intervention group, the other part was in the control group. The researchers analyzed the results through repeated measures analysis of variance. From the analysis, the study revealed a substantial difference in the scores of the intervention and the control group’s constructs (Khorsandi et al., 2017).

The data were collected at baseline, immediately after the intervention, and three months after the educational intervention. Therefore, the use of the education initiative led to better use of strategies for controlling hypertension among elderly patients. From the study, it was evident that there is a close connection between patients’ health beliefs and their health behaviors (Khorsandi et al., 2017). The implication is that deliberate efforts should be made to design education initiatives that can influence such beliefs and promote health for better patient outcomes. This was reflected in the increased mean score of the patient’s health beliefs when the education initiative was used.

In another study, Gamage et al. (2020) focused on evaluating the impact of using a community health worker-led group-based education coupled with monitoring in improving patients’ blood pressure control. The researchers undertook a baseline community-based survey that was then integrated with a randomized controlled trial of individuals with hypertension. As the intervention, the trained community health workers offered a group-based education to individuals with hypertension, with the intervention offered every two weeks for three months. The researchers integrated health lifestyle change support, education about hypertension, and monitoring of blood pressure (Gamage et al., 2020).

Upon analysis of the data using mixed-effects regression, the researchers unveiled some important results. For example, while blood pressure was similar at baseline between the groups, it was observed that the blood pressure control significantly improved between the baseline time and follow-up time more in the intervention group as compared to the control group (Gamage et al., 2020). In addition, the researchers also noted a more significant reduction in the systolic and diastolic blood pressure in the experimental group in comparison to the control group.

Khanal et al. (2021) recently conducted another study involving the use of education among patients with hypertension. The research focused on assessing the effectiveness of health education sessions integrated with support programs in lowering blood pressure among patients living with hypertension. Using a cluster randomized controlled trial, the researchers randomly assigned wards into control and intervention groups. They went ahead and offered four health education sessions, and home care was done frequently for six months in the intervention group. The control group was offered the usual care.

The analysis of the collected data revealed significant differences between the control and the intervention groups. For example, they noted that the participants in the intervention group had had a better controlled systolic blood pressure as compared to the individuals in the control group (Khanal et al., 2021). Besides, it was also evident that the improvement in the knowledge scores significantly improved among the participants in the intervention group in comparison to those recruited in the control group. Therefore, this study also addresses the importance of using education as an intervention for patients with hypertension.

Recently, Mini et al. (2022) explored research involving nurse-initiated/led education programs among teachers. The research focused on examining the impact of nurse-led educational intervention on hypertension rate control among teachers. Using a cluster randomized controlled trial, the researchers recruited a total of four hundred and two teachers living with hypertension. While both the control and the intervention groups were offered leaflets with hypertension education such as medication adherence and healthy lifestyle, the intervention group received a further nurse-led education initiative which was conducted for three months on hypertension control.

Using a mixed-effect logistic regression model, the researchers noted a significant difference in the outcomes regarding the two groups. After the third month, most of the individuals recruited in the intervention group achieved hypertension control in comparison to usual care. In addition, the individuals in the intervention groups were almost two times more likely to practice medication adherence in comparison to the control group. Another significant result is that the reduction in systolic blood pressure was substantially bigger in the intervention group than in the control group.

Yatim et al. (2018) also conducted research that focused on evaluating the effect of group-based education on psychosocial and clinical outcomes among patients living with hypertension. The researchers employed a pretest-posttest quasi-experimental study design involving a total of forty-five study subjects. The group-based education was offered for a period of two months where, at the end of the sessions, the participants were found to have a substantial improvement in various aspects related to hypertension such as physical activity, cholesterol, and high-density lipoprotein. In addition, the researchers also note a substantial improvement in the patient’s self-care behavior.

The Impact

As earlier indicated, hypertension is a condition impacting patients negatively, and so there is always a need to seek better solutions or improved interventions. Indeed, hypertension has been shown to be a major risk factor for chronic kidney disease, stroke, and heart disease (Lee et al., 2018). Therefore, addressing hypertension using the already described intervention is expected to have various impacts. Since part of the intervention is the use of an educational initiative to teach the patients on the importance of blood pressure self-monitoring and leading a healthy lifestyle, among the expected impacts are improved acceptance of the use of blood pressure self-monitoring and health activities or lifestyles that support high blood pressure care and control. Since the study also focuses on patients experiencing psychological stress, it is also expected that the educational sessions will lead to reduced levels of psychological stress hence lower chances of patients getting hypertension.

The patients are also expected to have improved knowledge on the relationship between psychological stress and the development of hypertension among patients. Such knowledge will be key in ensuring that the patients follow appropriate steps and stick to treatment and management plans to ensure that they have better outcomes. The intervention can only be impactful if the educational sessions are designed to optimize content delivery and ensure that the patients understand the intervention’s aspects.

Conclusion

Hypertension is a global health concern whose prevalence can be reduced by lifestyle modifications. While various factors can cause it, it is possible for individuals to adopt lifestyle modifications to either prevent it or have better health outcomes while living with it. The importance of exploring interventions emanates from the fact that hypertension has been shown to be a major risk factor for chronic kidney disease, stroke, and heart disease. Therefore, this project has proposed a possible invention to help patients experiencing psychological stress from developing hypertension. The use of blood pressure self-monitoring coupled with educational initiatives has been shown to lead to better health outcomes. As such, a literature review has also been conducted to explore various publications in Literature that support the intervention.

References

Aiken, L. H., Sloane, D. M., Ball, J., Bruyneel, L., Rafferty, A. M., & Griffiths, P. (2021). Patient satisfaction with hospital care and nurses in England: an observational study. BMJ open8(1), e019189. http://dx.doi.org/10.1136/bmjopen-2017-019189

Gamage, D. G., Riddell, M. A., Joshi, R., Thankappan, K. R., Chow, C. K., Oldenburg, B., … & Thrift, A. G. (2020). Effectiveness of a scalable group-based education and monitoring program, delivered by health workers, to improve control of hypertension in rural India: A cluster randomized controlled trial. PLoS medicine17(1), e1002997. https://doi.org/10.1371/journal.pmed.1002997

Khanal, M. K., Bhandari, P., Dhungana, R. R., Bhandari, P., Rawal, L. B., Gurung, Y., … & Courten, B. D. (2021). Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial. PloS one16(10), e0258406. https://doi.org/10.1371/journal.pone.0258406

Khorsandi, M., Fekrizadeh, Z., & Roozbahani, N. (2017). Investigation of the effect of education based on the health belief model on the adoption of hypertension-controlling behaviors in the elderly. Clinical interventions in aging12, 233. https://dx.doi.org/10.2147%2FCIA.S117142.

Lee, M. R., Lim, Y. H., & Hong, Y. C. (2018). Causal association of body mass index with hypertension using a Mendelian randomization design. Medicine97(30). https://dx.doi.org/10.1097%2FMD.0000000000011252

Mini, G. K., Sathish, T., Sarma, P. S., & Thankappan, K. R. (2022). Effectiveness of a School‐Based Educational Intervention to Improve Hypertension Control Among Schoolteachers: A Cluster‐Randomized Controlled Trial. Journal of the American Heart Association, e023145. https://doi.org/10.1161/JAHA.121.023145

Persell, S. D., Peprah, Y. A., Lipiszko, D., Lee, J. Y., Li, J. J., Ciolino, J. D., … & Sato, H. (2020). Effect of home blood pressure monitoring via a smartphone hypertension coaching application or tracking application on adults with uncontrolled hypertension: a randomized clinical trial. JAMA network open3(3), e200255-e200255. Doi: 10.1001/jamanetworkopen.2020.0255.

Yatim, H. M., Wong, Y. Y., Lim, S. H., Hassali, M. A., Hong, Y. H., Dali, A. F., & Neoh, C. F. (2018). Evaluation of a group-based hypertension self-management education programme among hypertensive community dwellers. European Journal of Integrative Medicine24, 79-84. https://doi.org/10.1016/j.eujim.2018.10.016

Sample Answer 2 for NURS 8310 Assignment 3: Developing an Intervention and Determining the Impact

The opioid use disorder (OUD) or the opioid use epidemic is a serious public health issue that continues to increase costs on the healthcare system, lead to morbidity and mortality, and exert pressure on limited healthcare resources, especially personnel. While initially aimed at helping patients with chronic and terminal illnesses relieve pain, these drugs have become a public health concern because of their addictive nature that has led to their abuse by nonelderly and those without terminal conditions. Effective interventions are essential to helping the health care system deal with this problem. Such interventions must be supported by research evidence based on the kind of studies conducted from existing literature (Fischer et al., 2021). The purpose of this assignment is to outline an intervention to address the opioid crisis as a population health issue. The paper offers a literature review to support the proposed intervention and discusses its impact on the opioid crisis.

Section 3: The Intervention

The National Institute on Drug Abuse (2021) asserts that the opioid overdose crisis claimed over 50,000 individuals in the U.S. in 2019. The institute observes that this crisis impacts public health and the social and economic welfare of the individuals, families, communities, and the nation because of the increased cost burden estimated to be over $78 billion each year. Every day, at least 90 Americans die prematurely from an overdose that involves an opioid, leaving families and friends bereft. The implication is that using a proven intervention program will help avail resources to state and local governments to develop strategies aimed at easing access to medication and other measures to reduce addiction and associated problems. The proposed intervention is the Centers for Disease Control and Prevent (CDC) program called “Prevention for States” that seeks to provide sufficient resources and support to states to address the issue. The approach is a critical component of reducing prevalence through a raft of measures by selected states to roll out to the rest to enhance surveillance and management of the opioid crisis.

The intervention allows CDC to offer annual grants of up to $1 million to cater for prevention of the problem in four key areas. States getting the awards collaborate with key partners to maximize efforts and tackle issues that influence and impact prescription and drug overdoses. These areas include the maximization of prescription drug monitoring programs (PDMPs), community and insurer health systems interventions, policy evaluations, and rapid response projects (CDC, 2021). The intervention by CDC is essential as it allows different partners and stakeholders to participate through various strategies to prevent the problem. Maximizing PDMPs ensures that they move to universal registration and use, ease use and access to the programs, having timely data on trends and research interventions to tackle the problem, expansion, and improvement of the reporting mechanism to recognize and address inappropriate prescription patterns and trends and using the data to have a better understanding about the nature of OUD.

The intervention also entails having insurers and community health care providers get technical assistance in most affected areas, enhancing opioid prescribing aspects for insurers and health systems, and improving the utilization of evidence-based guidelines on prescribing opioids. The use of policy interventions entails having a better understanding of working strategies to prevent prescription drug overdose problems. The CDC intervention’s fourth area is to execute a project that advances an innovative prevention approach in responding to emerging crises and opportunities.

The intervention is critical as it allows states to develop programs that align with the level of severity of the opioid use disorder within their jurisdictions. Effective management of health problems impacting a population requires scientific and proven ways (Strain et al., 2018). This is evident through using policies and protocols that align every effort to achieve a common goal and offer long-term impact for the affected population. Population health management requires the development of policy interventions that mandate wide acceptance and reforms to enhance access to critical resources by affected individuals and families.

In their response to the opioid crisis, the Health and Human Services Department and the National Institute on Drug Abuse (2021) focus on an array of interventions in different areas. These include enhancing access to treatment and recovery services as core components of managing the epidemic, promotion of overdose-reverse drugs, and increasing the level of awareness and understanding of the epidemic through public health surveillance (Orgera & Tolbert, 2019.) The need to support cutting-edge research on pain and addiction management and advancing better practices among providers on pain relieve interventions are also key areas for these federal agencies in tackling the opioid use disorder.

Further, evidence suggests that using safe, effective, and non-addictive approaches in pain management and novel and innovative medications and technologies in the treatment of opioid use disorders are critical in addressing this population health issue(Orgera& Tolbert, 2019). Studies also demonstrate the increased importance of having and systems approach to the problem where strategies are implemented at the jurisdictional levels in systems that are not doing well to tackle the problem (Liang & Shi, 2019). The implication is that using the model by CDC ensures that states with programs that lag in prescription drug overdose surveillance have sufficient resources to capture data that provide a prescriber or pharmacist information concerning a patient’s prescription history. The intervention ensures that prescribers can identify patients that are deliberately or unknowingly misusing medications. PDMP programs as an intervention are necessary to help mitigate the adverse effects of opioid overdose disorder.

Improved overdose prevention and reversal strategies are essential as they save lives and support recovery among the most affected patients (Strain et al., 2018). These programs require scientific and evidence-based interventions that focus on recovery and long-term efforts to reverse addiction while helping individuals to overcome the negative effects of elongated use (Friis & Sellers, 2021). The Trans-agency approach or a systems approach remains a core aspect of tackling opioid use disorder. The integration of different agencies and healthcare providers through an inter-agency approach is an intervention that will lead to more data, understanding of the underlying trends and emerging issues in addressing opioid use disorder.

Section 4: The Impact

An epidemiological approach to the prevalence of opioid use disorder would offer substantial positive effects for the healthy population and systems at both federal and state levels of government (Friis & Sellers, 2021). The use of “Prevention of States” challenges all states to develop a raft of programs to address the opioid crisis as a public health emergency despite the effects of the Coronavirus disease of 2019 (COVID-19) pandemic on the healthcare system. In their study, Lee et al. (2021) evaluate the effects of state policy interventions focused on the Opioid crisis for over 10 years, from 2007 to 2018. The study’s findings indicate that existing state policies have led to a reduction in the known indicators of prescription opioid misuse. These policies have also been effective in reducing opioid overdose-associated mortalities. The authors are also categorical these policies have enhanced the diagnose of OUD, overdose, and drug overdose mortality from illicit substances. The implication is that states can leverage the CDC’s program as a systems approach to tackling the opioid crisis within their jurisdictions (Strain et al., 2018). The intervention will use a systems approach that entails having different strategies and partners who collaborate at institutional and organizational levels to address the opioid use disorder (OUD).

The Health Resources and Services Administration (HRSA) (2021) asserts that a wide approach that entails using many interventions through one program is essential as it ensures that the affected individuals with different resultant conditions and effects can benefit from available resources. The HRSA asserts that access to resources, technical assistance, and training ensure that providers can integrate behavioral health care services into their practice settings to enhance interventions to address the effects of prescription drug overdose and misuse among the different health populations, especially those targeted (Haley & Saitz, 2020). The “Prevention for States” through its funding component demonstrates the role that inter-agency and inter-governmental collaboration and partnerships play in addressing opioid use disorder by increasing interventions like screening and data collection to inform new and effective policies.

The use of innovative prevention approaches and response to new and emerging crises and opportunities is a component of the intervention by CDC and states. Through this approach, states and their partnering organizations can leverage innovative technology like telehealth to enhance access to substance use disorder treatment in rural, frontier, and underserved urban communities. Using virtual sessions, providers can interact with individuals at risk of relapsing from treatment and explore different approaches to enhance adherence to treatment protocols (HRSA et al., 2021). The essence is that state-level interventional programs can reach more patients and health communities compared to federal strategies and policy frameworks. These interventions will help tackle the crisis by collecting sufficient and appropriate data for stakeholders to make better decisions and choices regarding the OUD.

Stakeholders need opioid-related resources and access to best practices to help tackle the problem. Provision of resources on emerging public health issues like opioids is essential for providers and stakeholders to train, disseminate and inform patients, their families, and communities about the crisis and how to navigate it for a better quality of life (Fischer et al., 2021). Rural populations are at an increased risk of suffering from the opioid crisis because they may have limited access to essential resources, especially information. Therefore, the intervention to empower states ensures that they will have sufficient resources to distribute to different areas and communities within their jurisdictions to encounter the opioid crisis.

Conclusion

Opioid use disorder (OUD) is a public health issue with significant negative effects on individuals, families, and communities. Interventional efforts and activities should focus on enhancing capacity at different levels, from federal to state and local and organizational levels, to deal with the issue and reduce its effects. State programs are essential for stakeholders to encounter the issue because they embrace a systems approach. Existing studies and evidence suggests that these interventions are a critical part of enhancing access to information and treatment while also helping organizations to collect data to make better decisions. The paper illustrates the need for interventions to tackle the opioid use problem which continues to be a public health concern.

References

Centers for Disease Control and Prevention (CDC) (2021). Prevention for States.

https://www.cdc.gov/drugoverdose/states/state_prevention.html

Fischer, B., Pang, M., & Jones, W. (2020). The opioid mortality epidemic in North America: do

we understand the supply side dynamics of this unprecedented crisis? Substance abuse treatment, prevention, and policy, 15(1), 1-8. https://doi.org/10.1186/s13011-020-0256-8

Friis, R. H., & Sellers, T. A. (2021). Epidemiology for public health practice (6th ed.). Jones &

Bartlett. Chapter 8, “Experimental Study Designs”

Haley, D. F., & Saitz, R. (2020). The opioid epidemic during the COVID-19 pandemic. JAMA,

324(16), 1615-1617. https://doi.org/10.1001/jama.2020.18543

Health Resources and Services Administration (HRSA) (2021). Opioid Crisis.

https://www.hrsa.gov/opioids

Lee, B., Zhao, W., Yang, K. C., Ahn, Y. Y., & Perry, B. L. (2021). Systematic evaluation of state

policy interventions targeting the US opioid epidemic, 2007-2018. JAMA network open, 4(2), e2036687-e2036687. https://doi.org/10.1001/jamanetworkopen.2020.36687

Liang, D., & Shi, Y. (2019). Prescription drug monitoring programs and drug overdose deaths

involving benzodiazepines and prescription opioids. Drug and alcohol review, 38(5), 494-502. https://doi.org/10.1111/dar.12959.

National Institute on Drug Abuse (2021 March 11). Opioid Overdose Crisis.

https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis

Orgera, K. & Tolbert, J. (2019 May 24). The Opioid Epidemic and Medicaid’s Role in

Facilitating Access to Treatment. https://www.kff.org/medicaid/issue-brief/the-opioid-epidemic-and-medicaids-role-in-facilitating-access-to-treatment/

Strain, E., Saxon, A. J., & Hermann, R. (2018). Opioid use disorder: Epidemiology,

pharmacology, clinical manifestations, course, screening, assessment, and diagnosis. Up-to-date, Post, TW, editor. Up-to-date. Waltham, MA