Effective Utilization of Computerized Curricular Assistive Tools in Improving NCLEX-RN Pass Rates for a Baccalaureate Nursing Program.

Achieving satisfactory first-time pass rates on the national nursing licensure examination represents a challenge for nursing programs across the United States. The consequences of examination failure for first-time test takers can be devastating, both emotionally and financially. Nursing programs are evaluated by national higher-education credentialing bodies and state boards of nursing based on the first-time pass rate of their students. One Midwestern nursing program faced unsatisfactory first-time pass rates and developed strategies for improving first-time pass rates over a 3-year period. The nursing program utilized several strategies documented in the literature but found implementing computerized curricular assistive tools that complemented the nursing program's curriculum to be most effective. In addition, changing faculty and student culture on preparation for the national licensure examination was beneficial to all involved in the process.

CHILE: Outcomes of a group randomized controlled trial of an intervention to prevent obesity in preschool Hispanic and American Indian children.

OBJECTIVE: We examined the outcomes of the Child Health Initiative for Lifelong Eating and Exercise (CHILE) study, a group randomized controlled trial to design, implement, and test the efficacy of a trans-community intervention to prevent obesity in children enrolled in Head Start centers in rural American Indian and Hispanic communities in New Mexico. METHODS: CHILE was a 5-year evidence-based intervention that used a socioecological approach to improving dietary intake and increasing physical activity of 1898 children. The intervention included a classroom curriculum, teacher and food service training, family engagement, grocery store participation, and healthcare provider support. Height and weight measurements were obtained four times (fall of 2008, spring and fall of 2009, and spring of 2010), and body mass index (BMI) z-scores in the intervention and comparison groups were compared. RESULTS: At baseline, demographic characteristics in the comparison and intervention groups were similar, and 33% of all the children assessed were obese or overweight. At the end of the intervention, there was no significant difference between the two groups in BMI z-scores. CONCLUSIONS: Obesity prevention research among Hispanic and AI preschool children in rural communities is challenging and complex. Although the CHILE intervention was implemented successfully, changes in overweight and obesity may take longer than 2years to achieve.

Healthy Kids, Healthy Cuba: findings from a group model building process in the rural Southwest.

BACKGROUND: Healthy Kids, Healthy Cuba (HKHCuba) is 1 of 49 community partnerships that participated in the national Healthy Kids, Healthy Communities program of the Robert Wood Johnson Foundation. One method of evaluation was to introduce systems thinking at the community level by identifying the essential parts of the HKHCuba system and how it influences policy and environmental changes to promote healthy eating and active living as well as to prevent childhood obesity in this unique, triethnic, rural community in New Mexico. METHODS: In this cross-sectional design, 12 HKHCuba partners participated in a group model building (GMB) session to develop behavior over time graphs and a causal loop diagram. RESULTS: Twenty-seven influences identified in the behavior over time graphs emerged as feedback loops and 5 subsystems emerged within the causal loop diagram. In addition to specific strategy-related influences (eg, access to healthy food, participation in community gardens), sense of cultural pride, sense of community, and social engagement, particularly among youth, were highly salient topics. CONCLUSIONS: The GMB process provided participants with the opportunity to explore the connections across their specific areas of work and make connections between policy and environmental influences on healthy eating and active living behaviors. The GMB processes and systems thinking approaches were new to the majority of participants, received positively, and perhaps should have been introduced earlier in the project period.

Engagement, recruitment, and retention in a trans-community, randomized controlled trial for the prevention of obesity in rural American Indian and Hispanic children.

Engagement, recruitment and retention of participants are critical to the success of research studies but specific strategies are rarely elucidated in the literature. The purpose of this paper is to describe the engagement, recruitment and retention process and outcomes in the Child Health Initiative for Lifelong Eating and Exercise (CHILE) study, and to describe lessons learned in the process. CHILE is a multi-level, group randomized controlled trial of a childhood obesity prevention intervention in rural American Indian and predominantly Hispanic Head Start (HS) centers in New Mexico. Barriers to engagement, recruitment and retention included distrust of researchers, long travel distances, and different HS and community structures. CHILE employed multiple strategies from the onset including the use of formative assessment, building on previous relationships, developing Memoranda of Agreement, using a community engagement specialist, and gaining support of a community champion. As a result of lessons learned, additional strategies were employed, including more frequent feedback to intervention sites, revised permission forms, telephone reminders, increased site visits and over-scheduling of interviews. These strategies resulted in the recruitment of 16 HS centers, 1,879 children, 655 parents, 7 grocery stores and 14 healthcare providers, meeting or exceeding recruitment goals. By combining principles of community engagement, a variety of recruitment strategies, and lessons learned, this study obtained a high level of recruitment and retention.

Role of PUG1 in inducible porphyrin and heme transport in Saccharomyces cerevisiae.

Unlike pathogenic fungi, the budding yeast Saccharomyces cerevisiae is not efficient at using heme as a nutritional source of iron. Here we report that for this yeast, heme uptake is induced under conditions of heme starvation. Heme synthesis requires oxygen, and yeast grown anaerobically exhibited an increased uptake of hemin. Similarly, a strain lacking aminolevulinate synthase exhibited a sixfold increase in hemin uptake when grown without 2-aminolevulinic acid. We used microarray analysis of cells grown under reduced oxygen tension or reduced intracellular heme conditions to identify candidate genes involved in heme uptake. Surprisingly, overexpression of PUG1 (protoporphyrin uptake gene 1) resulted in reduced utilization of exogenous heme by a heme-deficient strain and, conversely, increased the utilization of protoporphyrin IX. Pug1p was localized to the plasma membrane by indirect immunofluorescence and subcellular fractionation. Strains overexpressing PUG1 exhibited decreased accumulation of [(55)Fe]hemin but increased accumulation of protoporphyrin IX compared to the wild-type strain. To measure the effect of PUG1 overexpression on intracellular heme pools, we used a CYC1-lacZ reporter, which is activated in the presence of heme, and we monitored the activity of a heme-containing metalloreductase, Fre1p, expressed from a constitutive promoter. The data from these experiments were consistent with a role for Pug1p in inducible protoporphyrin IX influx and heme efflux.

The Impact of the CHILE Intervention on the Food Served in Head Start Centers in Rural New Mexico.

BACKGROUND: The Child Health Initiative for Lifelong Eating and Exercise is a multicomponent obesity-prevention intervention, which was evaluated among Head Start (HS) centers in American Indian and predominantly Hispanic communities in rural New Mexico. This study examines the intervention's foodservice outcomes: fruits, vegetables, whole grains, discretionary fats, added sugars, and fat from milk served in meals and snacks. METHODS: Sixteen HS centers were randomized to intervention/comparison groups, following stratification by ethnicity and preintervention median body mass index of enrolled children. The foodservice component included quarterly trainings for foodservice staff about food purchasing and preparation. Foods served were evaluated before and after the 2-year intervention, in the fall 2008 and spring 2010. RESULTS: The intervention significantly decreased fat provided through milk and had no significant effect on fruit, vegetables and whole-grain servings, discretionary fats, and added sugar served in HS meals and snacks. When effect modification by site ethnicity was examined, the effect on fat provided through milk was only found in American Indian sites. CONCLUSIONS: Foodservice interventions can reduce the amount of fat provided through milk served in HS. More research is needed regarding the implementation of foodservice interventions to improve the composition of foods served in early education settings.

Cross-Sectional Relationships Between Household Food Insecurity and Child BMI, Feeding Behaviors, and Public Assistance Utilization Among Head Start Children From Predominantly Hispanic and American Indian Communities in the CHILE Study.

Associations between food insecurity and overweight/obesity, feeding behaviors, and public food assistance utilization have been explored to a greater extent among adults and adolescents than among young children. This cross-sectional study examines a subset of pre-intervention implementation data (n = 347) among families participating in the Child Health Initiative for Lifelong Eating and Exercise (CHILE) study conducted in rural New Mexico among predominantly Hispanic and American Indian Head Start centers. No significant relationships emerged between food insecurity and child overweight/obesity, certain feeding behaviors, or public food assistance utilization. Additional research is necessary to understand relationships between food insecurity and child overweight/obesity status, use of public assistance benefits, and certain feeding behaviors among rural preschool-aged children in predominantly Hispanic and American Indian communities.

CHILE: an evidence-based preschool intervention for obesity prevention in Head Start.

BACKGROUND: Obesity is a major concern among American Indians and Hispanics. The Child Health Initiative for Lifelong Eating and Exercise (CHILE) is an evidence-based intervention to prevent obesity in children enrolled in 16 Head Start (HS) Centers in rural communities. The design and implementation of CHILE are described. METHODS: CHILE uses a socioecological approach to improve dietary intake and increase physical activity. The intervention includes: a classroom curriculum; teacher and food service training; family engagement; grocery store participation; and health care provider support. RESULTS: Lessons learned from CHILE include the need to consider availability of recommended foods; the necessity of multiple training sessions for teachers and food service; the need to tailor the family events to local needs; consideration of the profit needs of grocery stores; and sensitivity to the time constraints of health care providers. CONCLUSIONS: HS can play an important role in preventing obesity in children. CHILE is an example of a feasible intervention that addresses nutrition and physical activity for preschool children that can be incorporated into HS curricula and aligns with HS national performance standards.

Chronic cough: Stepwise application in primary care practice of the ACCP guidelines for diagnosis and management of cough.

PURPOSE: To illustrate decision points encountered when using evidence-based guidelines for diagnosis and management of chronic cough by means of a composite case study based on primary care practice. DATA SOURCE: The American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines for Diagnosis and Management of Cough, and review of the scientific literature on cough and related topics. CONCLUSIONS: The ACCP guidelines offer a systematic approach that uses trials of empirical therapies to diagnose and resolve the very common, often perplexing complaint of chronic cough. The major diagnoses reached are upper airway cough syndrome, cough-variant asthma, gastroesophageal reflux disease, and nonasthmatic eosinophilic bronchitis. IMPLICATIONS FOR PRACTICE: Cough is the most common reason that patients seek an office visit. Many coughs resolve spontaneously, but coughs that persist significantly impair the quality of life. Use of the ACCP guidelines allows a stepwise empirical approach to the problem of unexplained chronic cough. This approach greatly increases the percentage of chronic coughs that are accurately diagnosed and effectively treated, and avoids unnecessary diagnostic testing.