Study protocol for Attachment & Child Health (ATTACHTM) program: promoting vulnerable Children's health at scale.

BACKGROUND: Children's exposure to toxic stress (e.g., parental depression, violence, poverty) predicts developmental and physical health problems resulting in health care system burden. Supporting parents to develop parenting skills can buffer the effects of toxic stress, leading to healthier outcomes for those children. Parenting interventions that focus on promoting parental reflective function (RF), i.e., parents' capacity for insight into their child's and their own thoughts, feelings, and mental states, may understand help reduce societal health inequities stemming from childhood stress exposures. The Attachment and Child Health (ATTACHTM) program has been implemented and tested in seven rapid-cycling pilot studies (n = 64) and found to significantly improve parents' RF in the domains of attachment, parenting quality, immune function, and children's cognitive and motor development. The purpose of the study is to conduct an effectiveness-implementation hybrid (EIH) Type II study of ATTACHTM to assess its impacts in naturalistic, real-world settings delivered by community agencies rather than researchers under more controlled conditions. METHODS: The study is comprised of a quantitative pre/post-test quasi-experimental evaluation of the ATTACHTM program, and a qualitative examination of implementation feasibility using thematic analysis via Normalization Process Theory (NPT). We will work with 100 families and their children (birth to 36-months-old). Study outcomes include: the Parent Child Interaction Teaching Scale to assess parent-child interaction; the Parental Reflective Function and Reflective Function Questionnaires to assess RF; and the Ages and Stages Questionnaire - 3rd edition to examine child development, all administered pre-, post-, and 3-month-delayed post-assessment. Blood samples will be collected pre- and post- assessment to assess immune biomarkers. Further, we will conduct one-on-one interviews with study participants, health and social service providers, and administrators (total n = 60) from each collaborating agency, using NPT to explore perceptions and experiences of intervention uptake, the fidelity assessment tool and e-learning training as well as the benefits, barriers, and challenges to ATTACHTM implementation. DISCUSSION: The proposed study will assess effectiveness and implementation to help understand the delivery of ATTACHTM in community agencies. TRIAL REGISTRATION: Name of registry: https://clinicaltrials.gov/. REGISTRATION NUMBER: NCT04853888 . Date of registration: April 22, 2021.

Using innovative models in transition to practice and Master's Entry programs to teach ambulatory and primary care nursing.

With advancements in health care and changes in reimbursement that contribute to shorter hospitalizations, health care delivery is increasingly shifting to other settings to include skilled nursing, home care, and outpatient areas. There is a well-documented shortage of hospital-based capacity for clinical placements in California. The need for clinical placements is creating an opportunity to utilize ambulatory care settings as innovative alternative learning experiences for prelicensure nursing students. Care coordination, health coaching, and population health management are examples of skills useful for all RNs that ambulatory care settings offer as learning experiences for nursing students. The skills and knowledge students gain in ambulatory care are valuable for a wide range of employment settings. Additionally, these alternative settings provide faculty other clinical placement options since acute care placements are difficult to secure and sustain. The University of San Francisco (USF), School of Nursing and Health Professions (SONHP) developed two educational models to prepare nurses for complex disease management. One was a post-graduate new RN program that focused on outpatient/ambulatory care, the Transition to Practice Program (TTP). The other was a prelicensure Master's-Entry Master's of Science in Nursing (ME-MSN) program that has an ambulatory and acute care pathway.

Breeding genetically modified rodents: tips for tracking and troubleshooting reproductive performance.

Infertility or reduced fertility in genetically modified mouse strains represents a serious bottleneck for planned research projects. The authors describe simple methods for troubleshooting poor reproductive performance in breeding colonies and introduce various means of assisted reproduction that might be used to 'rescue' infertile lines.