Clinical and laboratory parameters and morphological characteristics of the endometrium in women with impaired fat metabolism and failed IVF attempts.

Objective: To study clinical and laboratory parameters and morphological characteristics of the endometrium in women with impaired fat metabolism and failed IVF attempts. Materials and methods: Clinical examination, laboratory tests, morphological analysis, and immunohistochemistry of the endometrium were conducted in 76 patients with different BMI, followed up with infertility and failed IVF attempts. Patients were divided into four groups by body mass index (BMI): 1 group - 17 women with overweight, BMI = 25.0 - 29.9 kg/m2; 2 group - 15 women with class I obesity, BMI 30.0-34.9 kg/m2; 3 group - 14 women with class II obesity, BMI 35.0-39.9 kg/m2; and the control group of 30 women with normal weight, BMI 18.5-24.9 kg/m2. Results: Clinical and laboratory analysis revealed menstrual irregularities and hormonal imbalance such as hypoestrogenism. Immunohistochemistry of the endometrium found a significant decrease in the expression of ERα and PR receptors in the glands correlated to increasing BMI. Conclusion: Pregravid preparation of women with increased BMI and failed IVF attempts has to include life-style modification and weight reduction program to restore normal hormonal status and expression of estrogen and progesterone receptors, prevention of excessive proliferative processes in the endometrium, and improving endometrial receptivity.

Teachers' patterns of implementation of an evidence-based intervention and their impact on student outcomes: results from a nationwide dissemination over 24-months follow-up.

More information is needed about factors influencing real-life implementation and program impact of interventions effective in controlled study conditions. Ongoing national implementation of an evidence-based HIV prevention program targeting grade 6 students in The Bahamas offers the opportunity to examine patterns of implementation and relate them to student outcomes. Data were collected from 208 grade 6 teachers, 75 grade 7 teachers and 4411 grade 6 students followed over 2 years. Mixed-effects modeling analysis examined the association of teachers' patterns of implementation with student outcomes. High quality program implementation in grade 6 (high implementation dosage and fidelity) was significantly related to student outcomes six and 18 months post-intervention. Quality of implementation of the booster session in grade 7 was also significantly related to student outcomes in grade 7. Quality of delivery of the brief booster session a year after initial implementation is important in maintaining or resetting the student outcome trajectory.

Long-term prevalence and predictors of urinary incontinence among women in the Diabetes Prevention Program Outcomes Study.

OBJECTIVES: To examine the long-term prevalence and predictors of weekly urinary incontinence in the Diabetes Prevention Program Outcomes Study, a follow-up study of the Diabetes Prevention Program randomized clinical trial of overweight adults with impaired glucose tolerance. METHODS: This analysis included 1778 female participants of the Diabetes Prevention Program Outcomes Study who had been randomly assigned during the Diabetes Prevention Program to intensive lifestyle intervention (n = 582), metformin (n = 589) or placebo (n = 607). The study participants completed semi-annual assessments after the final Diabetes Prevention Program visit and for 6 years until October 2008. RESULTS: At the study entry, the prevalence of weekly urinary incontinence was lower in the intensive lifestyle intervention group compared with the metformin and placebo groups (44.2% vs 51.8%, 48.0% urinary incontinence/week, P = 0.04); during the 6-year follow-up period, these lower rates in intensive lifestyle intervention were maintained (46.7%, 53.1%, 49.9% urinary incontinence/week; P = 0.03). Statistically adjusting for urinary incontinence prevalence at the end of the Diabetes Prevention Program, the treatment arm no longer had a significant impact on urinary incontinence during the Diabetes Prevention Program Outcomes Study. Independent predictors of lower urinary incontinence during the Diabetes Prevention Program Outcomes Study included lower body mass index (odds ratio 0.988, 95% confidence interval 0.982-0.994) and greater physical activity (odds ratio 0.999, 95% confidence interval 0.998-1.000) at the Diabetes Prevention Program Outcomes Study entry, and greater reductions in body mass index (odds ratio 0.75, 95% confidence interval 0.60-0.94) and waist circumference (odds ratio 0.998, 95% confidence interval 0.996-1.0) during the Diabetes Prevention Program Outcomes Study. Diabetes was not significantly related to urinary incontinence. CONCLUSIONS: Intensive lifestyle intervention has a modest positive and enduring impact on urinary incontinence, and should be considered for the long-term prevention and treatment of urinary incontinence in overweight/obese women with glucose intolerance.

Outcomes of an intensive couple relationship education program with fragile families.

Couple relationship education (CRE) has been proposed as one means to help fragile families stabilize their relationships. The current research is one of the first studies to look at the outcomes of a CRE program with fragile families in the areas of couple stability and marriage formation. Data were from the Family Formation Project, a federal and state funded program working with fragile family couples (n = 96) in a metropolitan area. A historical cohort control group quasi-experimental research design was used with a matched control group from the Fragile Family and Child Well-being Study. The intervention consisted of in-home education and support, group educational events, and social service referrals. Findings showed that couples had the same rate of couple stability as the control group but an increased rate of marriage. These findings suggest that CRE can help fragile families achieve marriage when that is their goal, but that some fragile families may need more than CRE to help them stabilize their relationship, or they may be better off separating.

A Novel Palliative Care Peer Support Program for Adolescents and Young Adults: Survey and Factor Analytic Study.

Background: Palliative care literature indicates a dearth of programs addressing the psychosocial needs of adolescents and young adults (AYAs). Objectives: This study assessed patient-reported experiences of a palliative care peer support program, analyzed psychometric qualities of the program evaluation, and examined associations with quality-of-life scores to assess validity and potential impact on aspects of AYA quality of life. Design: This retrospective, cross-sectional study described self-reported Streetlight program evaluation and quality of life of AYA patients, exploratory factor analysis of survey responses, and analysis of associations with quality of life. Setting/Subjects: AYA participants (13-30) enrolled in the Streetlight program for at least six months were recruited during hospital admissions and clinic visits at UF Health Shands Hospital. Results: Participants' (n = 69) scores were high for Youth Quality of Life Instrument-Short Form (YQOL-SF) (82.6 of 100), and Streetlight evaluations (4.47 of 5). Patients endorsed themes of: high-quality friendships with volunteers, transformative impacts to wellbeing, and benefits to mental health and coping in open-ended responses. Analyses identified three factors explaining 61% of variance in Streetlight program evaluation responses: "Friendships and Support" (26%); "Coping, Family, and Providers" (20%); and "Diversion and Respect" (15%). Significant positive associations were found between Streetlight evaluation scores and YQOL-SF Belief in Self and Family factor scores, as well as between Streetlight evaluation Friendships and Support factor scores, and YQOL-SF total and factor-specific scores. Conclusions: Results suggest that the Streetlight program is a viable model to facilitate positive experiences, opportunities for socialization, and meaningful peer support for AYA patients.

Aligning the Post Master's DNP with the 2021 AACN Essentials.

BACKGROUND: The Essentials: Core Competencies for Professional Nursing Education was published in 2021 to establish competency-based education on two levels; entry and advanced. Advanced level competencies are intended for doctorally prepared professionals. PURPOSE: The purpose of this initiative was to align a Post Master's Doctor of Nursing Practice (DNP) Program with the new 2021 American Association of Colleges of Nursing (AACN) Competency-Based Essentials. METHODS: Three DNP faculty met weekly, outlined a timeframe and approached the revision as a quality improvement plan to revise the curriculum based on our comprehensive review of the domains and concepts of the revised (2021) AACN Essentials. DNP Course Leads were interviewed to evaluate the course objectives, student learning objectives, assignments, and course content. RESULTS: Six new program outcomes (POs) were written. For each (PO), measurable student learning outcomes (SLOs) were articulated for each course. Several courses were combined or retired, and several new courses were added including an elective. The DNP project was reframed based on a 'systems' approach to implement quality improvement (QI) within the health care system in consideration of the concepts of diversity, equity, and inclusion (DEI) and the impact on patient outcomes. CONCLUSIONS: In keeping with the Mission, Vision and Values of the College and with the collaboration and support from the Dean, the graduate Chair, and faculty of the College, the post-master's DNP program was approved with an anticipated start date in Summer, 2023.

Health At Every Size intervention® under real-world conditions: the rights and wrongs of program implementation.

Implementation integrity is known to be critical to the success of interventions. The Health At Every Size® (HAES®) approach is deemed to be a sustainable intervention on weight-related issues. However, no study in the field has yet investigated the effects of implementation on outcomes in a real-world setting. Objective: This study aims to explore to what extent does implementation integrity moderate program outcomes across multiple sites. Methods: One hundred sixty-two women nested in 21 health facilities across the province of Québec (Canada) were part of a HAES® intervention and completed questionnaires at baseline and after the intervention. Participant responsiveness (e.g. home practice completion) along with other implementation dimensions (dosage, adherence, adaptations) and providers' characteristics (n = 45) were assessed using a mix of qualitative and quantitative data analysis. Adaptations to the program curriculum were categorized as either acceptable or unacceptable. Multilevel linear modeling was performed with participant responsiveness and other implementation dimensions predictors. Intervention outcomes were intuitive eating and body esteem. Results: Unacceptable adaptations were significantly associated with providers' self-efficacy (rs (23) = .59, p = .003) and past experience with facilitating the intervention (r(23) = .47, p = .03). Participant responsiveness showed a significant interaction between time and home practice completion (B = .07, p < .05) on intuitive eating scores. Conclusion: Except for participant responsiveness, other implementation dimensions did not moderate outcomes. Implications for future research and practice are discussed.

Responding to emerging oral healthcare needs with CARE: Design of the CARE curriculum model.

The release of the National Institutes of Health report, Oral Health in America: Advances and Challenges, in 2022 identified a pressing concern about oral healthcare and that "the job is far from finished." The High Point University Workman School of Dental Medicine utilized this report as inspiration to facilitate the design of the Clinician-Advocate-Researcher-Entrepreneur Curriculum. The aspiration was to create a novel curriculum and experiential model to prepare learners for the future of dental medicine, including addressing these public oral healthcare needs. This article describes how we conducted this process in three steps: defining the curriculum philosophy, outcomes, and structure. We present this example for those interested in curriculum design and modifications. Our goal is to encourage educators to explore opportunities to enhance dental education as a critical component of the complex system that impacts oral healthcare broadly.

Building Program Efficiencies Utilizing JRCNMT Compliance Forms.

In the past, program assessment had been considered a supplemental activity that was designed to analyze program performance once instruction had concluded. This process was sometimes very much a summative activity that ignored the possibility of being able to change instruction throughout the implementation of the curriculum. However, the assessment process has evolved in such a way that it can now be considered an integral part of curriculum development. Forms J and L of the JRCNMT requirements for the annual report have recently been updated to support Nuclear Medicine Technology programs in their effort to meet and exceed industry standards. At Bronx Community College, the NMT program has taken advantage of the newly developed forms J and L to streamline program assessment. These modifications not only changed how assessment is implemented at the end of the program, but also how students are evaluated throughout their coursework.

Satisfying Program-Level Outcomes by Integrating Primary Literature into the Online Classroom.

Because of the coronavirus pandemic, there has been a paradigm shift from traditional classroom instruction to remote online modalities. To provide the most current and relevant information on nuclear medicine technology to students without access to traditional resources on a college campus, it has become imperative that primary literature within the field be made readily accessible. Nuclear medicine technology students at Bronx Community College are being taught to use the Journal of Nuclear Medicine Technology as the basis for their required presentations, which span the curriculum. Guided by instructors who are armed with a rubric ultimately used as a formative assessment tool, the students are required to explore current articles from the Journal of Nuclear Medicine Technology and ultimately present their findings to their cohort. By design, this article-share project has successfully been implemented as a principal metric in satisfying the program accreditation requirements of the Joint Review Committee on Nuclear Medicine Technology while also being conducive to increasing oral presentation skills and cohort socialization.

Perceived Patient Safety Competence of Baccalaureate Nursing Students: A Descriptive Comparative Study.

INTRODUCTION: Patient safety is an issue of utmost concern within health care. An interrelated approach between nursing education and practice is needed. For more than a decade, nursing education programs have responded to calls for curricular reform, integrating strategies to prepare graduates for safe nursing practice. OBJECTIVES: The purpose of the descriptive study was to examine self-perceived safety competencies among baccalaureate (BSN) nursing students at end of program (n = 72) using the Health Professional Education in Patient Safety Survey. In addition to the objective of describing self-perceived safety competencies of BSN students, another objective was to investigate any significant differences in self-perceived competencies between traditional 4-year and accelerated 12-month program students. METHODS: A descriptive comparative design was used with a purposive sample of baccalaureate nursing students from both traditional and accelerated second-degree programs at a comprehensive university in the Northeast. RESULTS: Students rated self-confidence with patient safety learned in the clinical environment higher than within the classroom setting. Overall, students reported a high level of self-confidence within each of the seven patient safety dimensions with knowledge gained from the clinical setting higher than knowledge gained from the classroom setting. Paired t-test analyses revealed statistically significant differences (p < .05) between self-confidence gained in classroom and clinical environments with communicating effectively and managing safety risks. Independent t-test analyses revealed accelerated students reported lower self-confidence than traditional students, with statistically significant differences (p < .05) in dimensions of culture of safety, working in teams, managing safety risks, and disclosing adverse events/close calls. CONCLUSION: In most patient safety dimensions, students felt confident with their competencies within each of the dimensions of patient safety. Results also revealed that accelerated second-degree students report lower confidence with their knowledge of patient safety gained from classroom and clinical settings. Nursing programs must continue to emphasize a culture of safety within the nursing curriculum.

"I don't think the problem's the student I think it's us": Engaging faculty in curriculum innovation.

PURPOSE: The need to innovate predoctoral dental education is well established; however, there are few recent reports to guide substantial curriculum transformation. The purpose of this study was to describe faculty perspectives on their vision of future graduates, curriculum needs, and potential barriers to a successful redesign. This information would be used to inform strategic planning for the predoctoral curriculum transformation. METHODS: Eighty full-time faculty from the University of North Carolina Adams School of Dentistry participated in 60-minute focus groups in March 2018. Focus group questions were developed to elicit perceptions about the current curriculum, what the dental graduate should know in 2040, and what is needed to engage faculty in curriculum change. Transcripts of the focus group sessions were analyzed by a third-party research group using qualitative thematic analysis to identify pertinent themes shared by participants. RESULTS: Faculty identified that developing clinical skill that engages multiple specialties, student time to engage in advocacy activities, and opportunities to integrate biomedical, clinical, and behavioral sciences as critical features of the curriculum. They believed the 2040 graduate should be able to critically evaluate literature, exhibit strong leadership skills, and adapt to the changing healthcare environment. To better engage faculty in curriculum change, there needs to be dedicated time, sufficient resources, a clear plan, and greater collaboration across the school. CONCLUSION: When embarking on curriculum transformation, engagement with faculty is a critical component of the change process. Focus groups can be used as a technique to better understand faculty perspectives about curricular needs and the overall vision.

Developing a curriculum blueprint and taxonomy: Process, progress, and pivots.

Curriculum transformations represent opportunities to innovate; however, there are few examples to inform this process. In 2018, the University of North Carolina at Chapel Hill (UNC) Adams School of Dentistry began to transform the predoctoral curriculum to improve content integration, enhance team-based experiences, and develop leaders. Part of this experience has been crafting a conceptual curriculum guide or "blueprint" that outlines a vision for the design process and ensures the transformation achieves its goals. We describe how we created the UNC Blueprint for our revised curriculum, which defines who our graduates are, what they know, and what they can do. This approach has led us to develop a mapping taxonomy to ensure the student outcomes are appropriately aligned with content, instruction, and assessment throughout the curriculum. Last, we encourage others to be agile in their approach, create a common language among their teams, and frequently engage faculty to facilitate the process.

Preliminary Outcomes From a Community-Based Elder Abuse Risk and Evaluation Tool.

This research addresses the need to develop an assessment tool for case workers working in the aging services field outside of APS. As such, the research discusses the development, implementation, and preliminary outcomes of the Elder Abuse Risk Assessment and Evaluation© tool (EARAE). This instrument was developed and pilot tested by the Elder Abuse Prevention Program (EAPP), a program within Lifespan of Greater Rochester Inc. in Rochester, New York. A total of 189 suspected elder mistreatment cases were investigated using the EARAE instrument to track elements at the start and close of each case. Results indicate the tool represents an effective way to capture abuse indicators, track contributing risk factors, measure multiple case outcomes, and track types of interventions utilized. Opportunities and limitations of the tool are also discussed.

Does Competency-Based Education Have a Role in Academic Pharmacy in the United States?

Competency-based Education (CBE) is an educational model that allows students to learn and demonstrate their abilities at their own pace. CBE is growing in popularity in undergraduate educational programs and its role in pharmacy education in the United States (US) is under review. In comparison, medical education is utilizing competency-based approaches (such as competencies and Entrustable Professional Activities) to ensure that students possess the required knowledge, skills, and attitudes prior to graduation or program completion. The concept of competency-based approaches is growing in use in pharmacy education in the US, but the future related to aspects of this concept (e.g., mandatory Entrustable Professional Activities) is not certain. A review of pharmacy education's evolution in the US and a comparison of competency-related terms offers insight into the future use of competency-based approaches and CBE in pharmacy education in the US through the lens of benefits and challenges.

The Role of Participant Responsiveness on a Socio-Emotional Learning Program.

The present study set out to evaluate participant responsiveness, one of the main dimensions of implementation quality, in a Socio-Emotional Learning after-school program using Educational Dance activities, Experiencing Emotions, and also to understand its influence on program outcomes. The sample involved 98 middle-school Portuguese pupils, 53 of whom participated in the program and 45 in after-school control sessions. Outcome measures included pre-test and post-test questionnaires of pupils' socio-emotional skills, well-being and school engagement. A self-report item measured pupils' satisfaction at the end of the program, and a checklist measuring attendance and homework completion was filled in by the facilitator at each session of the program and control condition. Results revealed (1) high levels of pupils' satisfaction and attendance, and a medium-high level of homework completion towards the program; (2) that pupils' higher attendance rate in the program predicted higher results in the self-management (p = .04, d = .57; p = .003, d = .87) and social awareness (p = .04, d = .59) SEL domains, emotional (p = .02, d = .67) and psychological (p = .009, d = .76) well-being and school engagement (p = .04, d = .56); (3) that pupils' higher rate of homework completion in the program predicted higher results in the relationship skills SEL area (p = .04, d = .59) and in school engagement (p = .005, d = 1.50); (4) that pupils' from the control condition higher rates of homework completion also predicted better school engagement (p = .006, d = .88). Implications for research and practice are discussed.

Do Program Implementation Factors or Fidelity Affect Chronic Disease Self-Management Education Programs' Outcomes?

PURPOSE: To evaluate whether implementation factors or fidelity moderate chronic disease self-management education program outcomes. DESIGN: Meta-analysis of 34 Arthritis Self-Management Program and Chronic Disease Self-Management Program studies. SETTING: Community. PARTICIPANTS: N = 10 792. MEASURES: Twelve implementation factors: program delivery fidelity and setting and leader and participant characteristics. Eighteen program outcomes: self-reported health behaviors, physical health status, psychological health status, and health-care utilization. ANALYSIS: Meta-analysis using pooled effect sizes. RESULTS: Modest to moderate statistically significant differences for 4 of 6 implementation factors; these findings were counterintuitive with better outcomes when leaders and participants were unpaid, leaders had less than minimum training, and implementation did not meet fidelity requirements. CONCLUSION: Exploratory study findings suggest that these interventions tolerate some variability in implementation factors. Further work is needed to identify key elements where fidelity is essential for intervention effectiveness.

SSI/SSDI Outreach, Access, and Recovery (SOAR): Disability Application Outcomes Among Homeless Adults.

OBJECTIVE: The SSI/SSDI Outreach, Access, and Recovery (SOAR) program has been shown to increase access to Supplemental Security Income and Social Security Disability Insurance benefits among homeless adults. However, little empirical data exist on how or for whom SOAR achieves successful application outcomes. This study investigated applicant and application characteristics associated with disability application outcomes among homeless adults. METHODS: Secondary data on 6,361 SOAR-assisted applications were obtained. Multilevel models investigated between-applicant differences in application processing time and decision as a function of applicant and application characteristics. RESULTS: Older age and living in an institution were associated with greater odds of application approval. Female gender and receipt of public assistance were associated with longer processing time and lower odds of approval. Except for quality review, SOAR critical components were associated with greater odds of approval. CONCLUSIONS: Women and adults receiving public assistance appear disadvantaged in the SOAR application process. SOAR critical components promote successful disability application outcomes.

High rates of retention and viral suppression in the scale-up of antiretroviral therapy adherence clubs in Cape Town, South Africa.

INTRODUCTION: Increasingly, there is a need for health authority scale up of successfully piloted differentiated models of antiretroviral therapy (ART) delivery. However, there is a paucity of evidence on system-wide outcomes after scale-up. In the Cape Town health district, stable adult patients were referred to adherence clubs (ACs) - a group model of ART delivery with five visits per year. By the end of March 2015, over 32,000 ART patients were in an AC. We describe patient outcomes of a representative sample of AC patients during this scale-up. METHODS: Patients enrolled in an AC at non-research supported sites between 2011 and 2014 were eligible for analysis. We sampled 10% of ACs (n = 100) in quintets proportional to the number of ACs at each facility, linking each patient to city-wide laboratory and service access data to validate retention and virologic outcomes. We digitized registers and used competing risks regression and cross-sectional methods to estimate outcomes: mortality, transfers, loss to follow-up (LTFU) and viral load suppression (≤400 copies/mL). Predictors of LTFU and viral rebound were assessed using Cox proportional hazards models. RESULTS: Of the 3216 adults contributing 4019 person years of follow-up (89% in an AC, median 1.1 years), 70% were women. Retention was 95.2% (95% CI, 94.0-96.4) at 12 months and 89.3% (95% CI, 87.1-91.4) at 24 months after AC enrolment. In the 13 months prior to analysis closure, 88.1% of patients had viral load assessments and of those, viral loads ≤400 copies/mL were found in 97.2% (95% CI, 96.5-97.8) of patients. Risk of LTFU was higher in younger patients and in patients accessing ART from facilities with larger ART cohorts. Risk of viral rebound was higher in younger patients, those that had been on ART for longer and patients that had never sent a buddy to collect their medication. CONCLUSIONS: This is the first analysis reporting patient outcomes after health authorities scaled-up a differentiated care model across a high burden district. The findings provide substantial reassurance that stable patients on long-term ART can safely be offered care options, which are more convenient to patients and less burdensome to services.

Proxies for Success: How the Application Process Correlates to PhD Pursuit for a Small Diversity Research Program.

Science, technology, engineering, and mathematics (STEM) diversity research programs seek to make progress in increasing the number of underrepresented students that pursue STEM at the highest degree levels. Yet few programs have outlined their path to help students achieve the STEM PhD. Our program, Opportunities in Genomics Research (OGR), showed significant increases in PhD matriculation over 8 years of National Institutes of Health (NIH) funding. We explored typical measures, which include grade point average (GPA), institution classification, and graduate school ranking, and found that these measures alone do not explain the improved outcomes. We examined changes in the application materials as proxies for commitment to a PhD degree. These data show a significant correlation of desired degree pursuit to increased proxies and proxy type (open- or close-ended questions answered by applicant or referee). We demonstrate that changes in application procedures for diversity research programs correlate to improved program outcomes with statistical significance.