How does mentoring occupational therapists improve intervention fidelity in a randomised controlled trial? A realist evaluation.

BACKGROUND: Integrating complex interventions within healthcare settings can be challenging. Mentoring can be embedded within a randomised controlled trial (RCT) to upskill and support those delivering the intervention. This study aimed to understand, from a realist perspective, how mentoring worked to support implementation fidelity for occupational therapists (OTs) delivering a vocational rehabilitation (VR) intervention within the context of an RCT. METHODS: A realist evaluation using secondary data (emails, mentoring record forms, interviews) collected as part of an RCT. Three researchers coded the data following content analysis, focused on refining or refuting an initial programme theory by exploring the interactions between context, mechanisms, and outcomes. The research team met to further refine the programme theories. RESULTS: Data from 584 emails, 184 mentoring record forms, and 25 interviews were analysed following a realist approach. We developed a programme theory consisting of two contexts (trial set-up, ongoing mentoring), nine mechanisms (collective understanding, monitoring, timely support, positive reinforcement, reflective practice, support data completeness, facilitation strategy, shared learning experience, management of research and clinical duties), and three outcomes (improved confidence, improved fidelity, reduced contamination). CONCLUSIONS: Offering mentoring support to OTs delivering a VR intervention as part of an RCT improves intervention fidelity and reduces the risk of contamination. It improves OTs' understanding of the differences between their clinical and research roles and increases their confidence and competence in trial paperwork completion and identification of potential contamination issues.

A tool for assessing interprofessional collaborative practice: evolution of the Jefferson Teamwork Observation Guide (JTOG)®.

The Jefferson Teamwork Observation Guide® (JTOG®), a multi-source tool to formatively assess interprofessional collaborative practice competencies, evolved from a need to teach learners the characteristics of high functioning teams. Over time, researchers developed and refined four versions of the tool - Team, Individual, Patient and Support Person - eliciting feedback from learners, providers, patients and family members to create 360-degree evaluations of team performance. Development of all four versions of the JTOG into a native mobile application facilitated workplace based assessment, enhancing the ability to collect real-time data, gather responses from a variety of stakeholders and provide timely feedback to practice teams and individuals. Several studies have found the JTOG to be feasible to administer in both educational and practice settings across all user groups. Data also suggest the tool is a valid measure of team performance and individual performance on teams. However, scores that trended high indicate the need for continued psychometric work and high demand for the tool highlights the importance of a more robust database and dynamic analytic support. Three main conclusions have emerged from our experience with the JTOG: there is a clear need for a competency-based assessment tool to assist educators and clinicians in improving team functioning; incorporating technology into assessment may help bridge the persistent gap between educational innovation in IPE and organizational change in practice; and an assessment strategy incorporating the voices of the patient and family is highly valued by key stakeholders and has the potential to influence patient experience.

Structural and Genetic Determinants of Convergence in the Drosophila tRNA Structure-Function Map.

The evolution of tRNA multigene families remains poorly understood, exhibiting unusual phenomena such as functional conversions of tRNA genes through anticodon shift substitutions. We improved FlyBase tRNA gene annotations from twelve Drosophila species, incorporating previously identified ortholog sets to compare substitution rates across tRNA bodies at single-site and base-pair resolution. All rapidly evolving sites fell within the same metal ion-binding pocket that lies at the interface of the two major stacked helical domains. We applied our tRNA Structure-Function Mapper (tSFM) method independently to each Drosophila species and one outgroup species Musca domestica and found that, although predicted tRNA structure-function maps are generally highly conserved in flies, one tRNA Class-Informative Feature (CIF) within the rapidly evolving ion-binding pocket-Cytosine 17 (C17), ancestrally informative for lysylation identity-independently gained asparaginylation identity and substituted in parallel across tRNAAsn paralogs at least once, possibly multiple times, during evolution of the genus. In D. melanogaster, most tRNALys and tRNAAsn genes are co-arrayed in one large heterologous gene cluster, suggesting that heterologous gene conversion as well as structural similarities of tRNA-binding interfaces in the closely related asparaginyl-tRNA synthetase (AsnRS) and lysyl-tRNA synthetase (LysRS) proteins may have played a role in these changes. A previously identified Asn-to-Lys anticodon shift substitution in D. ananassae may have arisen to compensate for the convergent and parallel gains of C17 in tRNAAsn paralogs in that lineage. Our results underscore the functional and evolutionary relevance of our tRNA structure-function map predictions and illuminate multiple genomic and structural factors contributing to rapid, parallel and compensatory evolution of tRNA multigene families.

Embedding mentoring to support trial processes and implementation fidelity in a randomised controlled trial of vocational rehabilitation for stroke survivors.

BACKGROUND: Little guidance exists regarding how best to upskill and support those delivering complex healthcare interventions to ensure robust trial outcomes and implementation fidelity. Mentoring was provided to occupational therapists (OTs) delivering a complex vocational rehabilitation (VR) intervention to stroke survivors. This study aimed to explore mentors' roles in supporting OTs with intervention delivery and fidelity, and to describe factors affecting the mentoring process and intervention delivery. METHODS: Quantitative data (duration, mode and total time of mentoring support) was extracted from mentoring records and emails between mentors and OTs, alongside qualitative data on barriers and facilitators to intervention delivery. Semi-structured interviews with mentors (n = 6) and OTs (n = 19) explored experiences and perceptions of intervention training, delivery and the mentoring process. Mean total and monthly time spent mentoring were calculated per trial site. Qualitative data were analysed thematically. RESULTS: Forty-one OTs across 16 sites were mentored between March 2018 and April 2020. Most mentoring was provided by phone or Microsoft Teams (range: 88.6-100%), with the remainder via email and SMS (Short Message Service) text messages. Mentors suggested strategies to enhance trial recruitment, improved OTs' understanding of- and adherence to trial processes, intervention delivery and fidelity, and facilitated independent problem-solving. Barriers to mentoring included OT non-attendance at mentoring sessions and mentors struggling to balance mentoring with clinical roles. Facilitators included support from the trial team and mentors having protected time for mentoring. CONCLUSIONS: Mentoring supported mentee OTs in various ways, but it remains unclear to what extent the OTS would have been able to deliver the intervention without mentoring support, or how this might have impacted fidelity. Successful implementation of mentoring alongside new complex interventions may increase the likelihood of intervention effectiveness being observed and sustained in real-life contexts. Further research is needed to investigate how mentors could be selected, upskilled, funded and mentoring provided to maximise impact. The clinical- and cost-effectiveness of mentoring as an implementation strategy and its impact on fidelity also requires testing in a future trial. TRIAL REGISTRATION: ISRCTN, ISRCTN12464275 . Registered on 13th March 2018.

What is a 'return to work' following traumatic brain injury? Analysis of work outcomes 12 months post TBI.

Background: Literature lacks a clear description of return to work following traumatic brain injury (TBI). Aim: to describe work metrics for people with mild and moderate/severe TBI at 3, 6, and 12 months post-injury.Methods: A retrospective cross-sectional analysis of 172 TBI participants measuring work outcomes up to 12-months post-injury. Metrics described vocational status, accommodations, satisfaction, hours, time taken to return, financial status, and responsibilities. Logistic regression identified factors indicative of complete (80% of pre-injury hours) return to work.Results: 59/86 moderate/severely injured (68.6%) and 68/81 mildly injured (84%) people returned to work following TBI. Twenty-eight (16.3%) achieved a complete return by 12 months. The regression model was statistically significant X2 (4) =  51.980, p = <.0005, suggesting that those with high health-related quality of life, anxiety and functional ability were more likely to achieve complete return to work. At 12 months, 41 participants (23.8%) had workplace accommodations. One hundredfifteen (66.9%) were less content with their job and many reported reduced working hours.Discussion: This study highlights the heterogeneity of work post-TBI. Even people with 'mild' TBI fail to make a complete return to work by 12 months.Conclusions: Further longitudinal research is needed to explore the personal and economic legacy of TBI.

The role of rural communities in the recruitment and retention of women physicians.

Rural communities in the United States have a shortage of primary care physicians. Women physicians are more likely than male physicians to choose primary care specialties but less likely to locate in rural areas. With an increasing proportion of women physicians, it is important to understand community characteristics that encourage their recruitment and retention. This qualitative study explored community characteristics that influenced successful rural practice. We conducted telephone interviews with 25 women family physicians in rural practice in the United States in 2012. Interviews continued until saturation of themes was reached. Data were analyzed using immersion and crystallization. Community themes associated with successful rural practice included: fit with the community; spouse/partner fit with the community; relationships with individuals; and relationships with the community. Family ties, training experience within the community, social networks, and investment in the community were positive factors, while political/cultural differences were negative. Community integration arose from compatibility between the physicians' goals and community characteristics, opportunities for a spouse/partner, friendships, and a feeling of community purpose. This information can be used by rural communities to recruit and retain physicians, and by physicians, medical students, and those who advise them to promote successful rural practice.

Magnetic resonance imaging of the time course of hyperpolarized 129Xe gas exchange in the human lungs and heart.

PURPOSE: To perform magnetic resonance imaging (MRI), human lung imaging, and quantification of the gas-transfer dynamics of hyperpolarized xenon-129 (HPX) from the alveoli into the blood plasma. MATERIALS AND METHODS: HPX MRI with iterative decomposition of water and fat with echo asymmetry and least-square estimation (IDEAL) approach were used with multi-interleaved spiral k-space sampling to obtain HPX gas and dissolved phase images. IDEAL time-series images were then obtained from ten subjects including six normal subjects and four patients with pulmonary emphysema to test the feasibility of the proposed technique for capturing xenon-129 gas-transfer dynamics (XGTD). The dynamics of xenon gas diffusion over the entire lung was also investigated by measuring the signal intensity variations between three regions of interest, including the left and right lungs and the heart using Welch's t test. RESULTS: The technique enabled the acquisition of HPX gas and dissolved phase compartment images in a single breath-hold interval of 8 s. The y-intersect of the XGTD curves were also found to be statistically lower in the patients with lung emphysema than in the healthy group (p < 0.05). CONCLUSION: This time-series IDEAL technique enables the visualization and quantification of inhaled xenon from the alveoli to the left ventricle with a clinical gradient strength magnet during a single breath-hold, in healthy and diseased lungs. KEY POINTS: • The proposed hyperpolarized xenon-129 gas and dissolved magnetic resonance imaging technique can provide regional and temporal measurements of xenon-129 gas-transfer dynamics. • Quantitative measurement of xenon-129 gas-transfer dynamics from the alveolar to the heart was demonstrated in normal subjects and pulmonary emphysema. • Comparison of gas-transfer dynamics in normal subjects and pulmonary emphysema showed that the proposed technique appears sensitive to changes affecting the alveoli, pulmonary interstitium, and capillaries.

Specialty income and career decision making: a qualitative study of medical student perceptions.

CONTEXT: Medical educators in the USA are interested in the ways medical students make career choices because shortages in key specialties, particularly primary care specialties, limit access to care. Although anticipated specialty income is a strong predictor of student interest, no studies have qualitatively explored the reasons why income is important to students. By better understanding students' perspectives on income and specialty choice, educators can help students make choices that fit their goals and better educate students about the specialties in which the need for expansion is greatest. METHODS: In 2012, Year-2 students at one USA medical school were invited to write an essay about how debt and anticipated income levels influence their career choices. A total of 132 essays (response rate: 67%) were qualitatively analysed using a hermeneutic phenomenology approach to conventional content analysis, in which themes emerge inductively from the data. Researchers employed peer debriefing, modified member checking, thick description, code-recode strategies, audit trails and reflexivity to ensure quality and rigour. Although this analysis initially focused on student perceptions of specialty income, prestige also emerged as an important related theme. RESULTS: Three major findings emerged. Income is of varying importance to different students. Students value income because it provides freedom and flexibility, and power and security. Students recognise that high income confers social prestige. Students also define specialty prestige in other ways, including match competitiveness, perceived expertise, opportunities for advancement through fellowships, and power and autonomy. CONCLUSIONS: Medical students' perspectives of specialty income, specialty choice and prestige are more complex than previously reported. Medical educators should frame conversations about specialty choices in ways that incorporate varied perspectives on income and prestige. Health policymakers should recognise that income and prestige influence medical students' decisions in complex ways. These insights may inform strategies to counteract shortages in key specialties, including primary care specialties.

Risk indicators of length of acute hospital stay after traumatic spinal cord injury in South Africa: a prospective, population-based study.

STUDY DESIGN: Population-based cohort study. OBJECTIVES: To determine non-modifiable and modifiable risk indicators of acute length of hospital stay (LOHS) after traumatic spinal cord injury (TSCI). SETTING: Government-funded hospitals within the City of Cape Town, South Africa. METHODS: Newly injured survivors of TSCI during a 1 year period were prospectively included. Non-modifiable (e.g., demographic factors and clinical characteristics) and modifiable risk indicators (e.g., clinical processes, timing of surgery, secondary complications) of prolonged LOHS (31 days) were determined using univariate and multivariable logistic regression analyses. RESULTS: Of the total population-based cohort of 145 individuals, 139 (96%) had valid LOHS data and were included in the analyses. Significant univariate non-modifiable risk indicators of LOHS were age, complete injury and vertebral injury, whereas modifiable risk indicators were delayed spinal surgery (>72 h) and the occurrence of any secondary complications, as well as specifically pressure ulcers, pneumonia and urinary tract infection. In the final multivariable model showing good fit and acceptable discrimination (AUC = 0.86), older age (OR: 1.04, 95% CI: 1.00-1.07), vertebral injury (OR: 3.18, 95% CI: 1.07-9.44), pneumonia (OR: 8.40, 95% CI: 2.76-25.55) and pressure ulcers (OR: 7.16, 95% CI: 2.54-20.22) remained significant independent factors. Only injury completeness was insignificant in the final model. CONCLUSIONS: Our findings shed light on the need of developing prevention programs for secondary complications to improve the quality and efficiency of acute SCI care in South Africa. SPONSORSHIP: The National Research Foundation of South Africa.

Examining the relationship between pregnancy and quitting use of tobacco products in a U.S. national sample of women of reproductive age.

This study examined quit rates longitudinally for cigarettes, e-cigarettes, hookah, cigars, and all tobacco products in a U.S. national sample of women aged 18-44 who completed both Wave 1 (W1) and Wave 2 (W2) of the Population Assessment of Tobacco and Health (PATH, 2013-2014, 2014-2015) study (N = 7814). Quit rates were examined among women who transitioned into pregnancy across survey waves, and among a comparable sample of non-pregnant women to provide contextual information about quitting among the broader population of reproductive-aged women. Multiple logistic regression modeling was used to estimate the associations of pregnancy and quitting adjusting for other demographic and psychosocial characteristics. Quit rates among women who were pregnant in W2 were highest for hookah (98.3%), followed by cigars (88.0%), e-cigarettes (81.3%), and lowest for tobacco cigarettes (53.4%). Slightly more than half (58.7%) of women reported quitting use all tobacco products while pregnant. Pregnancy was independently associated with increased odds of quitting hookah (AOR = 52.9, 95%CI = 3.4, 830.2), e-cigarettes (AOR = 21.0, 95%CI = 2.6, 170.3), all tobacco products (AOR = 9.6, 95%CI = 6.4, 14.5), and cigarettes (AOR = 6.5, 95%CI = 4.2, 10.1), although not cigars. Relative to other demographic and psychosocial characteristics, pregnancy was the strongest predictor of quitting use of each tobacco product. While these data indicate that pregnancy has strong, independent associations with quitting a variety of commercially available tobacco products, the comparatively lower quit rates for cigarettes versus other tobacco products underscores the long-standing need for more intensive, multipronged clinical and regulatory interventions to reduce cigarette use among reproductive-aged women.

Patterns of Single and Multiple Tobacco Product Use Among US Women of Reproductive Age.

Introduction: Understanding patterns of single and multiple tobacco product use among reproductive-aged women is critical given the potential for adverse health effects on mother and infant should a woman become pregnant. Methods: Patterns of tobacco use over a 2-year period were examined among all women (18-44 years) who completed wave 1 (W1) and wave 2 (W2) of the US Population Assessment of Tobacco and Health (PATH, 2013-2014, 2014-2015) Study. We examined the most common patterns of single and multiple tobacco product use in W1, and longitudinal trajectories of women engaged in each of these patterns of use from W1 to W2, among women not pregnant in either wave (n = 7480), not pregnant in W1 and pregnant in W2 (n = 332), and pregnant in W1 and not pregnant in W2 (n = 325). Results: The most prevalent patterns of tobacco use in W1 among all three subgroups were using cigarettes alone followed by using cigarettes plus e-cigarettes. In all three subgroups, women using multiple products in W1 were more likely to adopt new use patterns in W2 relative to single-product users, with the new patterns generally involving dropping rather than adding products. The majority of multiple product use included cigarettes, and transitions to single product use typically involved dropping the noncigarette product. The most common trajectory among tobacco users transitioning to or from pregnancy was to use cigarettes alone in W2. Discussion: This study contributes new knowledge characterizing tobacco use patterns across time and reproductive events among reproductive-aged women.

GEneSTATION 1.0: a synthetic resource of diverse evolutionary and functional genomic data for studying the evolution of pregnancy-associated tissues and phenotypes.

Mammalian gestation and pregnancy are fast evolving processes that involve the interaction of the fetal, maternal and paternal genomes. Version 1.0 of the GEneSTATION database (http://genestation.org) integrates diverse types of omics data across mammals to advance understanding of the genetic basis of gestation and pregnancy-associated phenotypes and to accelerate the translation of discoveries from model organisms to humans. GEneSTATION is built using tools from the Generic Model Organism Database project, including the biology-aware database CHADO, new tools for rapid data integration, and algorithms that streamline synthesis and user access. GEneSTATION contains curated life history information on pregnancy and reproduction from 23 high-quality mammalian genomes. For every human gene, GEneSTATION contains diverse evolutionary (e.g. gene age, population genetic and molecular evolutionary statistics), organismal (e.g. tissue-specific gene and protein expression, differential gene expression, disease phenotype), and molecular data types (e.g. Gene Ontology Annotation, protein interactions), as well as links to many general (e.g. Entrez, PubMed) and pregnancy disease-specific (e.g. PTBgene, dbPTB) databases. By facilitating the synthesis of diverse functional and evolutionary data in pregnancy-associated tissues and phenotypes and enabling their quick, intuitive, accurate and customized meta-analysis, GEneSTATION provides a novel platform for comprehensive investigation of the function and evolution of mammalian pregnancy.

Food and non-food reinforcement among pregnant women.

Excessive gestational weight gain (GWG) in pregnancy may be driven in part by greater motivation to eat, and studying the relative reinforcing value of food versus non-food commodities may provide insight into factors important for excessive GWG. This study was a cross-sectional examination of the relationship between women meeting the Institute of Medicine (IOM) guidelines for GWG and the relative reinforcing value of food vs. non-food commodities during pregnancy. Two-hundred and thirty-three pregnant women (1st trimester, n = 44; 2nd trimester, n = 105; 3rd trimester, n = 84), aged 18-40, were recruited via a crowdsourcing platform and completed an online survey. Relative food reinforcement (RRVfood), relative non-food activity reinforcement (RRVactive) and relative non-food cognitively enriching activity reinforcement (RRVcognitive) were measured by a questionnaire at the point of contact. Self-reports of gestational age and weight gain during pregnancy were collected. The relationship between food and non-food reinforcement was assessed based on IOM classifications for weight gain during pregnancy. After adjustment for women's education level and parity, higher RRVfood (p = 0.036) and lower RRVcognitive (p = 0.040) responses were associated with greater GWG. Food reinforcing ratio (FRR) analysis was then conducted to systematically examine the effect of non-food behaviors on GWG when food reinforcement was accounted for. Women who gained below the IOM weight gain guidelines had significantly higher FRRcognitive than those gaining above (p = 0.013), indicating cognitively enriching activities may better compete with food among pregnant women. Interventions that help to increase the reinforcing value of cognitively enriching activities may be a new avenue to regulate eating to minimize GWG.

Informing evaluation of a smartphone application for people with acquired brain injury: a stakeholder engagement study.

BACKGROUND: Brain in Hand is a smartphone application (app) that allows users to create structured diaries with problems and solutions, attach reminders, record task completion and has a symptom monitoring system. Brain in Hand was designed to support people with psychological problems, and encourage behaviour monitoring and change. The aim of this paper is to describe the process of exploring the barriers and enablers for the uptake and use of Brain in Hand in clinical practice, identify potential adaptations of the app for use with people with acquired brain injury (ABI), and determine whether the behaviour change wheel can be used as a model for engagement. METHODS: We identified stakeholders: ABI survivors and carers, National Health Service and private healthcare professionals, and engaged with them via focus groups, conference presentations, small group discussions, and through questionnaires. The results were evaluated using the behaviour change wheel and descriptive statistics of questionnaire responses. RESULTS: We engaged with 20 ABI survivors, 5 carers, 25 professionals, 41 questionnaires were completed by stakeholders. Comments made during group discussions were supported by questionnaire results. Enablers included smartphone competency (capability), personalisation of app (opportunity), and identifying perceived need (motivation). Barriers included a physical and cognitive inability to use smartphone (capability), potential cost and reliability of technology (opportunity), and no desire to use technology or change from existing strategies (motivation). The stakeholders identified potential uses and changes to the app, which were not easily mapped onto the behaviour change wheel, e.g. monitoring fatigue levels, method of logging task completion, and editing the diary on their smartphone. CONCLUSIONS: The study identified that both ABI survivors and therapists could see a use for Brain in Hand, but wanted users to be able to personalise it themselves to address individual user needs, e.g. monitoring activity levels. The behaviour change wheel is a useful tool when designing and evaluating engagement activities as it addresses most aspects of implementation, however additional categories may be needed to explore the specific features of assistive technology interventions, e.g. technical functions.

Women in rural family medicine: a qualitative exploration of practice attributes that promote physician satisfaction.

INTRODUCTION: The USA needs more rural physicians. Although women represent half of all US trained medical students, the rural physician workforce has remained predominantly male. Insight is needed into what makes rural practice attractive for women and which practice characteristics allow women physicians to practice successfully in rural areas. This study's purpose was to examine aspects of the practice environment that impact women physicians' professional satisfaction and commitment to rural medicine. METHODS: Twenty-five women family physicians practicing in rural areas of the USA were interviewed by phone using a semi-structured format. Transcribed interviews were analyzed using an immersion and crystallization approach. Emergent themes were identified, coded, and discussed until team consensus was attained. Interviews continued until saturation of themes was reached. RESULTS: Three themes emerged from the data, in relationship to practice and employment attributes that contribute to US women physicians' professional satisfaction and willingness to remain in a rural setting: professional relationships, practice characteristics, and support during times of transition. Participants placed high importance on professional relationships, both within and outside of their rural practice. Rural women physicians enjoyed practicing an expanded scope of care, valued loan repayment opportunities, and appreciated supportive practice partners. Importantly, women physicians who found themselves struggling to maintain rural careers often had experienced difficulty during times of practice transition, including maternity leaves. CONCLUSIONS: Understanding practice attributes valued by successful rural women family physicians in the USA will help rural health systems, practices, and physicians-in-training to develop and evaluate opportunities that will best contribute to successful rural practice. Supporting women physicians during periods of practice transition may improve retention.

Applying behavior change techniques to weight management during pregnancy: Impact on perinatal outcomes.

Unhealthy behaviors and lifestyle choices are contributing to the obesity epidemic and associated morbidities. Among reproductive aged women, obesity adversely affects perinatal outcomes and longer term maternal and child health. Interventions utilizing strategies of behavior change have the potential to improve outcomes, especially during pregnancy. Antenatal interventions to improve adherence to gestational weight gain guidelines are one such example. Although behaviorally-based intervention trials have been associated with modest decreases in gestational weight gain, the effect on short term perinatal outcomes has thus far been minimal. This commentary aims to discuss possible reasons behind the failure to improve perinatal outcomes as well as to encourage future areas of study.

Tobacco and nicotine delivery product use in a national sample of pregnant women.

Monitoring use of tobacco products among pregnant women is a public health priority, yet few studies in U.S. national samples have been reported on this topic. We examined prevalence and correlates of using cigarettes, e-cigarettes, and other tobacco/nicotine delivery products in a U.S. national sample of pregnant women. Data were obtained from all pregnant women (≥18 years) in the first wave of the Population Assessment of Tobacco and Health (PATH, 2013-2014) Study (N=388). Prevalence of current and prior use of tobacco/nicotine products was examined overall and among current cigarette smokers. Multiple logistic regression was used to examine correlates of use of cigarettes, e-cigarettes, hookah and cigars. Overall prevalence was highest for cigarettes (13.8%), followed by e-cigarettes (4.9%), hookah (2.5%) and cigars (2.3%), and below 1% for all other products. Prevalence of using other tobacco products is much higher among current smokers than the general population, with e-cigarettes (28.5%) most prevalent followed by cigars (14.0%), hookah (12.4%), smokeless (4.7%), snus (4.6%), and pipes (2.1%). Sociodemographic characteristics (poverty, low educational attainment, White race) and past-year externalizing psychiatric symptoms were correlated with current cigarette smoking. In turn, current cigarette smoking and past year illicit drug use were correlated with using e-cigarettes, hookah, and cigars. These results underscore that tobacco/nicotine use during pregnancy extends beyond cigarettes. The results also suggest that use of these other products should be included in routine clinical screening on tobacco use, and the need for more intensive tobacco control and regulatory strategies targeting pregnant women.

Analysing the cognitive rigor of interprofessional curriculum using the Depth of Knowledge framework.

Interprofessional collaborative practice is widely documented as a strategy to improve quality of healthcare. To develop collaborative practitioners, educators need interprofessional curricula with proper cognitive demand and methods of delivery and assessment. The University of the Western Cape in South Africa incorporated an Interprofessional Core Courses Curriculum for all undergraduate students enrolled in the health sciences faculty. The objective of this study was to analyse the curriculum content to determine its cognitive rigor. Cognitive rigor can be measured by the quantitative content analysis method using the Depth of Knowledge (DOK) framework. This approach tests whether the rigor of instructional activities and assessments is aligned with learning outcomes. The curriculum content evaluated in this study found that assessment activities were less demanding than instructional activities and infrequently aligned with learning outcomes. This approach may be useful to other educators seeking to evaluate and plan interprofessional curriculum.

Rural Women Family Physicians: Strategies for Successful Work-Life Balance.

PURPOSE: Women family physicians experience challenges in maintaining work-life balance while practicing in rural communities. We sought to better understand the personal and professional strategies that enable women in rural family medicine to balance work and personal demands and achieve long-term career satisfaction. METHODS: Women family physicians practicing in rural communities in the United States were interviewed using a semistructured format. Interviews were recorded, professionally transcribed, and analyzed using an immersion and crystallization approach, followed by detailed coding of emergent themes. RESULTS: The 25 participants described a set of strategies that facilitated successful work-life balance. First, they used reduced or flexible work hours to help achieve balance with personal roles. Second, many had supportive relationships with spouses and partners, parents, or other members of the community, which facilitated their ability to be readily available to their patients. Third, participants maintained clear boundaries around their work lives, which helped them to have adequate time for parenting, recreation, and rest. CONCLUSIONS: Women family physicians can build successful careers in rural communities, but supportive employers, relationships, and patient approaches provide a foundation for this success. Educators, employers, communities, and policymakers can adapt their practices to help women family physicians thrive in rural communities.