Food is Medicine for HIV: Improved health and hospitalizations in the Changing Health through Food Support (CHEFS-HIV) pragmatic randomized trial.

BACKGROUND: Policy support for "Food is Medicine"-medically tailored meals or groceries to improve health-is rapidly growing. No randomized trials have heretofore investigated the benefits of medically tailored food programs for people living with HIV (PLHIV). METHODS: The CHEFS-HIV pragmatic randomized trial included PLHIV who were clients of Project Open Hand (POH), a San Francisco-based nonprofit food organization. The intervention arm (n = 93) received comprehensive medically tailored meals, groceries, and nutritional education. Control participants (n = 98) received less intensive (POH "standard of care") food services. Health, nutrition, and behavioral outcomes were assessed at baseline and 6 months later. Primary outcomes measured were viral non-suppression and health related quality of life. Mixed models estimated treatment effects as differences-in-differences between arms. RESULTS: The intervention arm had lower odds of hospitalization (odds ratio [OR] = 0.11), food insecurity (OR = 0.23), depressive symptoms (OR = 0.32), antiretroviral therapy adherence <90% (OR = 0.18), and unprotected sex (OR = 0.18), and less fatty food consumption (ß= -0.170 servings/day) over 6 months, compared to the control arm. There was no difference between study arms in viral non-suppression and health-related quality of life over 6 months. CONCLUSIONS: A "Food-is-Medicine" intervention reduced hospitalizations and improved mental and physical health among PLHIV, despite no impact on viral suppression. CLINICAL TRIALS REGISTRATION: NCT03191253.

Collaborative drug therapy modification (CDTM): Facilitators, barriers, and perceptions of individual pharmacist participation in Georgia.

BACKGROUND: Georgia Board of Pharmacy (BOP) regulations permit pharmacists to engage in collaborative drug therapy modification (CDTM) with physicians, allowing them to perform patient assessments, adjust pharmacotherapy, and order laboratory tests. Pharmacist-led CDTM can positively affect health outcomes leading to reduced healthcare expenditures. CDTM is underutilized, with < 1% of Georgia pharmacists holding an active license to practice CDTM. OBJECTIVE(S): The objective of this study was to examine CDTM licensed pharmacists' perceptions of facilitators and barriers in providing CDTM. METHODS: Georgia-licensed CDTM pharmacists were invited to participate in a 60-minute qualitative interview. Interview questions were developed from electronic survey responses. The interview was designed to elicit information regarding perceived benefits and barriers to CDTM implementation. Guided by the Consolidated Framework for Implementation Research, thematic analysis was applied to identify themes using ATLAS.ti software to code. Themes were described qualitatively and prevalence of each was reported. RESULTS: Nine interviews were conducted, and data saturation was achieved at interview 6. After resolution of discrepancies, 100% coding agreement was reached among 2 independent researchers. Nine themes were identified, and each was categorized as a facilitator or barrier to establishing pharmacist-led CDTM in Georgia. Themes associated with facilitating were (prevalence %) (1) practice autonomy (100), (2) personal attributes (100), (3) having support (100), and (4) institutional logistics (88). Barrier themes included issues concerning (5) the Georgia BOP (100), (6) pharmacist autonomy (88), (7) lack of provider status (88), (8) institutional restrictions (75), and (9) personal development (e.g., confidence) (22). CONCLUSION: Facilitators to the establishment of pharmacist-led CDTM exist and pharmacists can capitalize on these to create successful CDTM programs. Barriers are varied, and it may be difficult to systematically address individual barriers such as pharmacist autonomy and personal development. Barriers associated with institutional restrictions, the Georgia BOP, and lack of provider status can likely be removed or addressed by policy.

It Is Up to Faculty: An Exploration of Registered Nurse-to-Bachelor of Science in Nursing Student Intent for Faculty Role.

AIM: The aim of this study was to explore registered nurse (RN)-to-bachelor of science in nursing (BSN) students' intent to pursue a faculty role. BACKGROUND: The nursing faculty shortage is predicted to worsen as faculty reach retirement age. The shortage affects enrollment into nursing programs because of lack of qualified faculty. Increasing the number of faculty available is critical to maintain nurses needed to care for citizens. METHOD: Using a qualitative descriptive approach, RN-to-BSN students were asked about their intent to become faculty later in their career. RESULTS: Eight RNs pursuing their BSN were interviewed. Five themes emerged from interviews: modeling the role, positive and negative; planting the seed; perceiving rather than knowing; seeing the light bulb go on; and weighing the pros and cons. CONCLUSION: Nursing faculty can influence RN-to-BSN students' intent to become faculty and can attract students to the role by conveying enthusiasm, being collegial, and maintaining clinical relevance.

A Scoping Review Evaluating the Effect of SGLT-2 Inhibitors on Insulin Dose Requirements in Insulin-Dependent Patients With Type 2 Diabetes.

OBJECTIVE: Assess evidence describing the effect of Sodium-Glucose Cotransporter-2 (SGLT2) inhibitors on total daily insulin (TDI) requirements in insulin-dependent patients with type 2 diabetes. DATA SOURCES: A scoping review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Protocols and Scoping Reviews (PRISMA-ScR) guidelines. The search was conducted in PubMed; citation mapping was completed in Web of Science. Filters for human studies, English language, and a publication date, from January 1, 2005 to April 12, 2021, were applied. STUDY SELECTION AND DATA EXTRACTION: Studies assessing insulin dose requirements with concurrent use of an SGLT2 inhibitor for patients with type 2 diabetes were included. DATA SYNTHESIS: Sixteen studies were included and demonstrated that addition of an SGLT2 inhibitor typically reduced TDI requirements. Insulin reductions were often statistically significant, occurring in studies evaluating (1) within subjects who received SGLT2 inhibitors, and (2) between subjects receiving SGLT2 inhibitors versus placebo. Compared with placebo, insulin dose reduction ranged from -0.72 to -19.2 units. However, studies were relatively small, not designed to assess TDI change, and some utilized fixed dose insulin protocols or empiric insulin dose reductions. CONCLUSIONS: Lowering insulin requirements may have benefits, such as decreased hypoglycemia risk, insulin resistance, and cost. Addition of an SGLT2 inhibitor may modestly reduce TDI requirements for patients with type 2 diabetes. Evidence indicating SGLT2 inhibitor use reduces TDI may lead to additional implementation in practice and inform future research. Further research is needed to clarify insulin type (i.e., basal or prandial) and degree of TDI reduction expected with addition of an SGLT2 inhibitor.

Does preschool children's self-regulation moderate the impacts of instructional activities? Evidence from a randomized intervention study.

There is strong evidence linking children's self-regulation with their academic and behavioral outcomes. These relations have led to the development of interventions aimed at improving academic outcomes by promoting self-regulation, based in part on the idea that self-regulation promotes the development of academic skills. Although a considerable number of studies have examined the degree to which interventions designed to improve aspects of self-regulation have a positive impact on academic outcomes, only a few studies have examined the degree to which children's self-regulation moderates the effects of academic interventions. The goal of this study was to examine whether self-regulation, indexed by a direct assessment of executive function and teacher-rated attention, moderated the uptake of early literacy interventions for 184 children (average age = 58 months, SD = 3.38; 66% Black/African American, 28% White; 59% male) at risk for reading difficulties who participated in a randomized controlled trial examining the efficacy of Tier 2 interventions in preschool. Multilevel models were used to examine the degree to which children's self-regulation moderated the impacts of the interventions. The results of this study provided little evidence that self-regulation moderated the impacts of the interventions and call into question the likelihood of a causal relation between self-regulation and academic achievement.

Person-centred care for abortion services in private facilities to improve women's experiences in Kenya.

Globally, access to good quality abortion services and post-abortion care is a critical determinant for women's survival after unsafe abortion. Unsafe abortions account for high levels of maternal death in Kenya. We explored women's experiences and perceptions of their abortion and post-abortion care experiences in Kenya through person-centred care. This qualitative study included focus group discussions and in-depth interviews with women aged 18-35 who received safe abortion services at private clinics. Through thematic analyses of women's testimonies, we identified gaps in the abortion care and person-centred domains which seemed to be important throughout the abortion process. When women received clear communication and personalised comprehensive information on abortion and post-abortion care from their healthcare providers, they reported more positive experiences overall and higher reproductive autonomy. Communication and supportive care were particularly valued during the post-abortion period, as was social support more generally. Further research is needed to design, implement and test the feasibility and acceptability of person-centred abortion care interventions in community and clinical settings with the goal of improving women's abortion experiences and overall reproductive health outcomes.

Differential Patterns of Growth in Reading and Math Skills during Elementary School.

This study investigated developmental trajectories of reading and math using latent-growth-curve analyses across multiple academic skills, measures, and multiple time periods within a single sample. Reading-related growth was marked by significant individual differences during the early elementary-school period and non-significant individual differences during the late elementary-school period. For math-related skills, non-significant individual differences were present for early math growth and significant individual differences were present in late elementary-school. No clear pattern of cumulative, compensatory, or stable development emerged for either reading-related or math skills. These differing growth patterns highlight developmental complexities and suggest domain-specific differences in achievement growth that are potentially associated with contextual factors.

Influences of the Home Language and Literacy Environment on Spanish and English Vocabulary Growth among Dual Language Learners.

Little is known regarding the extent to which aspects of the home language and literacy environment (HLE) promote growth in language skills among dual language learners (DLLs). Therefore, the purpose of this study was to evaluate which aspects of the HLE significantly predict growth in English and Spanish vocabulary among Spanish-speaking DLLs. 944 Spanish-speaking DLLs (51.6% female; mean age = 53.77 months) completed assessments of English and Spanish vocabulary at four time points across two academic years. Parents completed a survey of the HLE that included information on language exposure, reading exposure, and family reading habits. Results indicated that specific literacy-related practices, including availability of books in the home, language read to the child, and parental reading skills were significant predictors of growth in children's Spanish and English vocabulary knowledge, even after controlling children's initial level of language skills and family socioeconomic status.

Development and validation of a person-centered abortion scale: the experiences of care in private facilities in Kenya.

BACKGROUND: There is a need for a standardized way to measure person-centered care for abortion. This study developed and validated a measure of person-centered abortion care. METHODS: Items for person-centered abortion care were developed from literature reviews, expert review, and cognitive interviews, and administered with 371 women who received a safe abortion service from private health clinics in Nairobi, Kenya. Exploratory factor analyses were performed and stratified by surgical abortion procedures and medication abortion. Bivariate linear regressions assessed for criterion validity. RESULTS: We developed a 24-item unifying scale for person-centered abortion care including two sub-scales. The two sub-scales identified were: 1) Respectful and Supportive Care (14 items for medication abortion, 15 items for surgical abortion); and 2) Communication and Autonomy (9 items for both medication and surgical abortion). The person-centered abortion care scale had high content, construct, criterion validity, and reliability. CONCLUSIONS: This validated scale will facilitate measurement and further research to better understand women's experiences during abortion care and to improve the quality of women's overall reproductive health experiences to improve health outcomes.

Preschool teachers' language and vocabulary knowledge: Development and predictive associations for a new measure.

The present study reports on the development, structure, and associations with practice for a new measure of preschool teachers' knowledge about language and vocabulary development and how to support this development in the classroom. Results from item response theory models with responses from a sample of 248 preschool teachers indicated that four scales measuring pedagogical content knowledge and content knowledge for vocabulary and language, respectively, had adequate psychometric characteristics. Confirmatory factor analyses further supported a four-factor structure, although all scales were correlated. In an overlapping sample of 94 preschool teachers, preliminary investigation of associations between knowledge and teachers' self-reported practices, observed instructional time allocation, and the quality of classroom language environments were mixed. Results indicate promise for the measure yet add to prior research suggesting that connections between knowledge and practice are highly complex and likely interwoven with many other influences on instructional decision-making in early childhood classrooms.

Perspectives on implementing a quality improvement collaborative to improve person-centered care for maternal and reproductive health in Kenya.

OBJECTIVE: To understand perspectives and experiences related to participation in a quality improvement collaborative (QIC) to improve person-centered care (PCC) for maternal health and family planning (FP) in Kenya. DESIGN AND SETTING: Semi-structured qualitative interviews were conducted with members of the QIC in four public health facilities in Kenya. PARTICIPANTS: Clinical and nonclinical public health facility staff who had participated in the QIC were purposively sampled to participate in the semi-structured interviews. INTERVENTION: A QIC was implemented across four public health facilities in Nairobi and Kiambu Counties in Kenya to improve PCC experiences for women seeking maternity or FP services. MAIN OUTCOME MEASURE: Semi-structured interviews with participants of the QIC to understand perspectives and experiences associated with sensitization to and implementation of PCC behaviors in maternity and FP services. RESULTS: Respondents reported that sensitization to PCC principles resulted in multiple perceived benefits for staff and patients alike, including improved interactions with patients and clients, deeper awareness of patient and client preferences, and improved interpersonal skills and greater job satisfaction. Respondents also highlighted system-level challenges that impeded their ability to consistently provide high-quality PCC to women, namely staff shortages and frequent turnover, high patient volumes and lack of space in their respective health facilities. CONCLUSION: Respondents were easily able to articulate perceived benefits derived from participation in this QIC, although they were equally able to identify challenges that hindered their ability to consistently provide high-quality PCC to women seeking maternity or FP services.

How the Science of Reading Informs 21st-Century Education.

The science of reading should be informed by an evolving evidence base built upon the scientific method. Decades of basic research and randomized controlled trials of interventions and instructional routines have formed a substantial evidence base to guide best practices in reading instruction, reading intervention, and the early identification of at-risk readers. The recent resurfacing of questions about what constitutes the science of reading is leading to misinformation in the public space that may be viewed by educational stakeholders as merely differences of opinion among scientists. Our goals in this paper are to revisit the science of reading through an epistemological lens to clarify what constitutes evidence in the science of reading and to offer a critical evaluation of the evidence provided by the science of reading. To this end, we summarize those things that we believe have compelling evidence, promising evidence, or a lack of compelling evidence. We conclude with a discussion of areas of focus that we believe will advance the science of reading to meet the needs of all children in the 21st century.

Profiles of Foundational Learning Components among First Graders.

School readiness includes a constellation of skills and behaviors, such as social and emotional development, language and literacy, and self-regulation that provide a basis critical for classroom participation and learning. Whereas it has been well-established that students who enter kindergarten with weaknesses in language and literacy are more likely to struggle academically, less research has focused on the variability and educational impact of other foundational learning components, including internalizing and externalizing behaviors, particularly in first grade. This study used latent profile analysis to identify the following four subgroups (profiles) of students, using foundational learning components, in a sample of first graders (n = 324): Emergent Hyperactive, Externalizing, Generally Good Students, and Internalizing. Latent class growth analysis illustrated significant differences in the average rate of growth in literacy skills from the beginning to the end of first grade across the four profiles, after controlling for gender and socioeconomic status. Findings indicated the greatest growth in literacy skills for students in the Externalizing profile and the least amount of vocabulary growth for students in the Emergent Hyperactive profile followed by the Internalizing profile. Educational implications of how researchers and educators might consider students' individual differences across profiles of foundational learning components to inform ways to support development and learning in the classroom are discussed.

Validation of the person-centered maternity care scale in India.

BACKGROUND: Person-centered care during childbirth is recognized as a critical component of quality of maternity care. But there are few validated tools to measure person-centered maternity care (PCMC). This paper aims to fill this measurement gap. We present the results of the psychometric analysis of the PCMC tool that was previously validated in Kenya using data from India. We aim to assess the validity and reliability of the PCMC scale in India, and to compare the results to those found in the Kenya validation. METHODS: We use data from a cross-sectional survey conducted from August to October 2017 with recently delivered women at 40 government facilities in Uttar Pradesh, India (N = 2018). The PCMC measure used is a previously validated scale with subscales for dignity and respect, communication and autonomy, and supportive care. We performed psychometric analyses, including iterative exploratory and confirmatory factor analysis, to assess construct and criterion validity and reliability. RESULTS: The results provide support for a 27-item PCMC scale in India with a possible score range from 0 to 81, compared to the 30-item PCMC scale in Kenya with a 0 to 90 possible score range. The overall PCMC scale has good reliability (Cronbach alpha = 0.85). Similar to Kenya, we are able to group the items in to three conceptual domains representing subscales for "Dignity and Respect," "Communication and Autonomy," and "Supportive Care." The sub-scales also have relatively good reliability (Cronbach alphas range from 0.67 to 0.73). In addition, increasing scores on the scale is associated with future intentions to deliver in the same facility, suggesting good criterion validity. CONCLUSIONS: This research extends the PCMC literature by presenting results of validating the PCMC scale in a new context. The psychometric analysis using data from Uttar Pradesh, India corroborates the Kenya analysis showing the scale had good content, construct, and criterion validity, as well as high reliability. The overlap in items suggests that this scale can be used across different contexts to compare women's experiences of care, and to inform and evaluate quality improvement efforts to promote comprehensive PCMC.

Examining the Efficacy of Targeted Component Interventions on Language and Literacy for Third and Fourth Graders Who are at Risk of Comprehension Difficulties.

Testing a component model of reading comprehension in a randomized controlled trial, we evaluated the efficacy of four different interventions that were designed to target components of language and metacognition that predict children's reading comprehension: vocabulary, listening comprehension, comprehension of literate language, academic knowledge, and comprehension monitoring. Third- and fourth-graders with language skills falling below age expectations participated (N = 645). Overall, the component interventions were only somewhat effective in improving the targeted skills, compared to a business-as-usual control (g ranged from -.14 to .33), and no main effects were significant after correcting for multiple comparisons. Effects did not generalize to other language skills or to students' reading comprehension. Moreover, there were child-characteristic-by-treatment interaction effects. For example, the intervention designed to build sensorimotor mental representations was more effective for children with weaker vocabulary skills. Implications for component models of reading and interventions for children at risk of reading comprehension difficulties are discussed.

Three-Level Longitudinal Mediation with Nested Units: How does an Upper-Level Predictor Influence a Lower-Level Outcome via an Upper-Level Mediator Over Time?

In the study, extending from the cross-lagged panel model (CLPM) and the 2-2-1 cross-sectional multilevel mediation model, we proposed a three-level longitudinal mediation model to evaluate the causal process among variables at different levels over time. Given the complexity of the proposed model, Bayesian estimation was used. A simulation study was conducted to examine the estimation accuracy of Bayesian estimation for the proposed model. Factors considered in the simulation study included average sample sizes of the lower-level units within each upper-level unit (or cluster size; I‾ ), numbers of upper-level units (or clusters; J), numbers of time points (T), fixed direct and indirect effect sizes, and variances and covariances of upper-level random effects. Results indicated that the fixed effect estimates for the indirect effect components (a and b), fixed direct effect (c), and the average mediation effect estimate were reasonably accurate when I‾≥8 , J > 20, and T ⩾ 4. Comparing the proposed model against the CLPMs coupled with aggregation or disaggregation techniques, we found that the CLPMs yielded misleading fixed-effects estimates and low coverage rates when variation existed between upper-level units. The proposed model was illustrated using a study on early childhood education. We compared estimates and inferences from the proposed three-level longitudinal mediation model, the CLPMs with aggregation and disaggregation, and the traditional 2-2-1 mediation model. Limitations and extensions of the current study were discussed.

Teacher language in the preschool classroom: Initial validation of a classroom environment observation tool.

RESEARCH FINDINGS: This study reports initial descriptive and validity results of a new early childhood classroom observation measure, the Classroom Language Environment Observation Scales (CLEOS), designed to capture teachers' use of both implicit language supports (e.g., incidental scaffolding and shared reading) and more explicit language instruction (e.g., direct vocabulary instruction). Classrooms (n = 122) serving at-risk three-to-five year-old children, and representing child care, Head Start and public prekindergarten were observed; a subgroup was also observed with the Teacher Behavior Rating Scale (TBRS), a well-validated tool. Results indicated limited use of most language-support strategies, particularly those that were more explicit. Concurrent validity for the CLEOS was supported via significant correlations with TBRS subscales. Greater use of higher quality linguistic input was significantly associated with teachers' years of experience but not with their educational level. Findings supported the differential inclusion of linguistic input across settings, with large group circle timebeing the most frequent setting for explicit instructional input and centers being the most frequent setting for incidental supports. PRACTICE OR POLICY: Study results suggest a need to improve the professional development and preservice training for preschool teachers related to supporting rich language interactions and explicit language and vocabulary instruction within classrooms.

Agreement Among Traditional and RTI-based Definitions of Reading-Related Learning Disability with Preschool Children.

To investigate approaches for identifying young children who may be at risk for later reading-related learning disabilities, this study compared the use of four contemporary methods of indexing learning disability (LD) with older children (i.e., IQ-achievement discrepancy, low achievement, low growth, and dual-discrepancy) to determine risk status with a large sample of 1,011 preschoolers. These children were classified as at risk or not using each method across three early-literacy skills (i.e., language, phonological awareness, print knowledge) and at three levels of severity (i.e., 5th, 10th, 25th percentiles). Chance-corrected affected-status agreement (CCASA) indicated poor agreement among methods with rates of agreement generally decreasing with greater levels of severity for both single- and two-measure classification, and agreement rates were lower for two-measure classification than for single-measure classification. These low rates of agreement between conventional methods of identifying children at risk for LD represent a significant impediment for identification and intervention for young children considered at-risk.

Reciprocal Effects of Self-Regulation, Semantic Knowledge, and Reading Comprehension in Early Elementary School.

Many assume that cognitive and linguistic processes, such as semantic knowledge (SK) and self-regulation (SR), subserve learned skills like reading. However, complex models of interacting and bootstrapping effects of SK, SR, instruction, and reading hypothesize reciprocal effects. Testing this "lattice" model with children (n = 852) followed from first to second grade (5.9-10.4 years of age) revealed reciprocal effects for reading and SR, and reading and SK, but not SR and SK. More effective literacy instruction reduced reading stability over time. Findings elucidate the synergistic and reciprocal effects of learning to read on other important linguistic, self-regulatory, and cognitive processes; the value of using complex models of development to inform intervention design; and how learned skills may influence development during middle childhood.