Effects of Adverse Childhood Experiences in Black Older Adults.

Adverse childhood experiences (ACEs) are socially complex events that affect children early in their lives. Research indicates that experiencing multiple ACEs increases an individual's risk for chronic physical and mental illness and premature death. Multigenerational traumas, including slavery, segregation, and institutional racism, have created an environment that perpetuates social and economic inequalities, ultimately leading to an increased risk of ACEs in Black individuals. ACEs' effects can manifest in Black older adults as physical health problems and mental health and social issues. Addressing the disparities in ACEs among Black older adults requires a multifaceted approach. Culturally sensitive and trauma-informed approaches are vital in supporting the mental and physical health of Black older adults who experienced ACEs. Clinicians, researchers, and policymakers need to advocate for supportive policies and interventions that address systemic racism, promote economic opportunities, and ensure equitable access to resources. [Journal of Psychosocial Nursing and Mental Health Services, 62(2), 9-12.].

Public awareness of legal decision-making capacity and planning instruments in dementia: implications for health care practitioners.

The protection of a person facing difficulties with legal decision-making can be challenging; however, estate planning documents (EPDs) can offer safeguards. Little is known about the community awareness of EPDs and their perceived importance, including for people with dementia. Two-hundred and thirty adults read a mild dementia vignette, proposed a diagnosis for the vignette character (VC), and rated the VC's legal decision-making capacity (DMC). The effect on ratings about DMC under different conditions was explored (e.g., variation of VC characteristics and the decision). Awareness, and the personal importance, of EPDs were assessed. DMC was affected by the variations in the VC's age, diagnosis, and the decision, as high- or low-stakes, but not VC sex. Awareness of EPDs was low; however, planning importance was increased for dementia. Although the public understand that dementia affects DMC, they require further information about EPDs to validly enact them, thereby reducing potential vulnerability.

The perceptions and experience of developing patient (version of) guidelines: a descriptive qualitative study with Chinese guideline developers.

OBJECTIVE: To understand developers' perception of patient (versions of) guidelines (PVGs), and identify challenges during the PVG development, with the aim to inform methodological guidance for future PVG development. METHODS: We used a descriptive qualitative design. Semi-structured interviews were conducted virtually from December 2021 to April 2022, with a purposive sampling of 12 PVG developers from nine teams in China. Conventional and directed content analysis was used for data analysis. RESULTS: The interviews identified PVG developers' understanding of PVGs, their current practice experience, and the challenges of developing PVGs. Participants believed PVGs were a type of health education material for patients; therefore, it should be based on patient needs and be understandable and accessible. Participants suggested that PVGs could be translated/adapted from one or several clinical practice guidelines (CPG), or developed de novo (i.e., the creation of an entirely new PVG with its own set of research questions that are independent of existing CPGs). Participants perceived those existing methodological guidelines for PVG development might not provide clear instructions for PVGs developed from multiple CPGs and from de novo development. Challenges to PVG development include (1) a lack of standardized and native guidance on developing PVGs; (2) a lack of standardized guidance on patient engagement; (3) other challenges: no publicly known and trusted platform that could disseminate PVGs; concerns about the conflicting interests with health professionals. CONCLUSIONS AND PRACTICE IMPLICATIONS: Our study suggests clarifying the concept of PVG is the primary task to develop PVGs and carry out related research. There is a need to make PVG developers realize the roles of PVGs, especially in helping decision-making, to maximize the effect of PVG. It is necessary to develop native consensus-based guidance considering developers' perspectives regarding PVGs.

Ratings of the reasons for and against the disclosure of an Alzheimer's disease diagnosis: has anything changed in the past 20 years?

OBJECTIVES: The disclosure of an Alzheimer's disease diagnosis poses challenges for health care professionals, patients, and their families. Past research has shown that people favour disclosure, but it is uncertain if this situation has changed. METHOD: We used a cross-sectional online survey to explore disclosure preferences in a sample of young adults (n = 229; 66.7% aged 18 - 25 years, 79.5% Australian born). Factors contributing to preferences were also examined (knowledge, experience, close experience, age, relationship to diagnosis recipient). Established measures were used to assess knowledge (the Alzheimer's Disease Knowledge Test) and preferences (the Reasons for Wanting to Know Questionnaire). RESULTS: Most (95%) but not all participants favoured disclosure, whilst recognising as important at least one reason against it. Only age was a significant determinant of preferences (older people were more likely to prefer disclosure). Those against disclosure cited the fear of suicide as a key reason. CONCLUSION: The right to know remains a primary reason for preferring disclosure. Health care professionals should use pre-diagnostic interviewing to discuss overall preference and the underpinning reasons both for and against disclosure. Focus should be on developing a person-centred approach that responds to concerns, with further research to evaluate this approach.

On becoming a dementia-friendly community: An empirical study of the individual factors that predict openness towards dementia-friendly communities.

BACKGROUND AND OBJECTIVES: Evidence suggests that limited public awareness and dementia-related stigma can create barriers to community inclusiveness. This study explored the relation between public knowledge of dementia, attitudes towards people with dementia, experience with dementia and openness towards dementia-friendly communities. RESEARCH DESIGN AND METHODS: Two-hundred and twenty-nine members of the public completed a cross-sectional online survey with three established measures [Alzheimer's Disease Knowledge Test, Attitudes Towards People with Dementia scale and Understanding of Health Problems survey] and one exploratory scale [Openness Towards Dementia-Friendly Communities]. An existing 'mild' dementia vignette was used to evaluate dementia recognition. Factors contributing to correct dementia recognition (knowledge, exposure to dementia, education and gender), worry about developing dementia (knowledge, exposure and respondent age), and openness towards dementia-friendly communities (knowledge, exposure and attitudes) were examined through group comparisons and a multiple linear regression. RESULTS: Consistent with the literature, the respondents had poor knowledge, reasonably good dementia recognition, and mostly positive attitudes towards people with dementia. None of the proposed factors were significantly associated with correct dementia recognition, and only gender was significantly associated with dementia worry. Knowledge and attitudes towards people with dementia (not exposure) were significant independent predictors of openness towards dementia-friendly communities. DISCUSSION AND IMPLICATIONS: The expansion of dementia-friendly communities will require further investment in awareness-raising initiatives to improve dementia knowledge and attitudes in the community. This study shows the importance of these factors in the broader community's openness towards dementia-friendly communities.

User testing of a Scottish Intercollegiate Guideline Network public guideline for the parents of children with autism.

BACKGROUND: The Scottish Intercollegiate Guidelines Network (SIGN) is the leading national clinical guideline producer in Scotland. Improved design and dissemination of guidelines produced for the public can empower people to take an active role in self-management and shared decision-making. The public version of the guideline examined covered getting assessed and diagnosed with autism, and approaches that can help. The aim of this study was to test a public version of a guideline for the parents of children and young people with autism, implement improvements, and identify what works in making it usable and accessible. METHODS: We recruited mothers from across Scotland. User testing involved formal 'think aloud' semi-structured interviews that guided users through the booklet. Interviews took place individually and were recorded and transcribed. Key findings were identified and themed using the honeycomb user experience model. RESULTS: Fourteen user-testing interviews were conducted. Facilitators for usability and desirability of the guideline included the chunking of text, consistent use of colour and boxes to highlight important information. Simple language, written in a tone of partnership, helped to engage mothers. Value arose from the guidelines ability to explain the process of diagnosis and make mothers feel empowered in their relationships with healthcare professionals. There was a lack of consensus on the usefulness of rating the strength of evidence and recommendations. CONCLUSION: There was a marked similarity between what was important to the mothers and what has been found to be important to other groups. The involvement of service users and carers in the guidelines development was key to its credibility. One size does not fit all in presenting evidence-based recommendations to the public and it is a challenge to provide sufficient information while avoiding information overload. Recommendations and evidence levels are suitable for use in public versions, but these should be kept as simple as possible.

The Impact of Adverse Childhood Experiences on Cognition in African American Older Adults: An Integrated Literature Review.

The current integrative literature review examined the existing evidence on the connection between adverse childhood experiences (ACEs) and cognitive changes in African American older adults. Using the Covidence platform, several databases were searched, resulting in 266 publications dated 2008-2020. Ten articles met inclusion criteria and were reviewed. Findings indicate that four ACEs (physical, sexual, and verbal abuse, and low socioeconomic status) are associated with impaired cognition in African American older adults. Four gaps were identified: lack of (a) older adult participants in research investigating original and expanded ACEs; (b) exclusively African American samples of participants in studies examining the relationship between ACEs and cognition; (c) consensus about what specific ACEs contribute to changes in cognition in older adults; and (d) information about successful interventions created to prevent and mitigate the effects of ACEs in older adults. This review provides a synthesis of the limited evidence on the effects of ACEs on cognition among other outcomes. Findings on the effects of ACEs on African American older adults' cognition are limited, thus making a compelling case for further investigating the role of childhood adversity in the disparity of cognitive changes in African American communities. [Research in Gerontological Nursing, 14(5), 265-272.].

Stressful Life Events and Racial Disparities in Cognition Among Middle-Aged and Older Adults.

BACKGROUND: It is well-documented that African Americans have elevated risk for cognitive impairment and dementia in late life, but reasons for the racial disparities remain unknown. Stress processes have been linked to premature age-related morbidity, including Alzheimer's and related dementias (ADRD), and plausibly contribute to social disparities in cognitive aging. OBJECTIVE: We examined the relationship between stressful life events and cognitive decline among African American and White participants enrolled in the Wisconsin Registry for Alzheimer's Prevention (WRAP). METHODS: Linear mixed models including demographic, literacy, and health-related covariates were used to estimate (1) relationships between a life event index score and decline in cognitive test performance in two domains of executive function (Speed & Flexibility, Working Memory) and one domain of episodic memory (Verbal Learning & Memory) among 1,241 WRAP enrollees, stratified by race, and (2) contributions of stressful life events to racial differences in cognition within the full sample. RESULTS: African Americans (N = 50) reported more stressful life events than Whites (N = 1,191). Higher stress scores associated with poorer Speed & Flexibility performance in both groups, though not with declines across time, and partially explained racial differentials in this domain. Among African Americans only, stressor exposure also associated with age-related decline in Verbal Learning & Memory. Stressor-cognition relationships were independent of literacy and health-related variables. CONCLUSIONS: Greater lifetime stress predicted poorer later-life cognition, and, in a small sample of African Americans, faster declines in a key domain of episodic memory. These preliminary findings suggest that future work in large minority aging cohorts should explore stress as an important source of modifiable, socially-rooted risk for impairment and ADRD in African Americans, who are disproportionately exposed to adverse experiences across the life course.

Perspectives of ambulatory patients visiting the emergency department during the Christmas and New Year holiday period: Descriptive survey.

OBJECTIVE: To assess the perceptions of ambulatory patients presenting to the emergency department (ED) of symptom acuity and access to care; the proportion of ambulatory patients who contacted their GPs before attending the ED; and patients' knowledge about whether their GPs provide after-hours or walk-in services. DESIGN: Descriptive survey and proportion test comparisons for data analysis. SETTING: Kingston, Ont. PARTICIPANTS: All ambulatory patients presenting to the ED from December 22, 2016, to January 2, 2017 ("holiday surge" period), and from September 25, 2017, to October 1, 2017 (nonholiday period). MAIN OUTCOME MEASURES: Patients' perceptions of symptom acuity and access to primary care; proportion of patients who contacted their GPs before attending the ED; and patients' knowledge about their GPs' after-hours or walk-in services. RESULTS: Overall, 1638 patients during the holiday surge period and 642 patients during the nonholiday period completed the survey (response rate of 54.8% and 38.3%, respectively). Out of all 2280 participants, 530 (23.2%) contacted their GP before going to the ED; 1514 (66.4%) participants decided to go to the ED on their own, and about half of them (795 of 1514 [52.5%]) believed their problem was urgent and could not wait for a GP. A third of all participants (825 of 2280 [36.2%]) believed their GP could have managed their medical problem if they could have gotten an appointment that day. Among a subgroup of participants with a GP, 1095 (52.5%) were aware of off-hour services provided by their GP. There were no statistically significant differences in responses between the holiday and nonholiday periods. CONCLUSION: A large proportion of ambulatory patients would have seen their GP for their medical issue if they thought that they had same-day or next-day access. There is a need for general and emergency physicians to work together on improving access to acute care services.

Translation of the Canadian Cardiovascular Society/Canadian Heart Rhythm Society Cardiovascular Screening and Care of Athletes Program Into Practice.

In the absence of systematic cardiovascular preparticipation screening (PPS) practices in Canada, the Canadian Cardiovascular Society and Canadian Heart Rhythm Society published a joint position statement outlining PPS recommendations for competitive athletes in an effort to standardize screening. The Queen's University Cardiovascular Screening and Care of Athletes Program aimed to translate these recommendations into practice. Screening packages were administered to athletes in 2017 and 2018. Each package required completion of a medical/history questionnaire, a physician's examination, and 12-lead electrocardiogram performed by the athlete's primary care physician. A tiered approach to screening, as recommended by the position statement, was implemented. A multidisciplinary team flagged at-risk athletes and determined the need for follow-up testing and participation eligibility. Over a 2-year period, 517 varsity athletes were screened, with 438 (84.7%) completing all recommended screening components. Analysis of completed packages resulted in 114 (26.0%) athletes flagged for initial review. After subsequent review by an emergency care physician, only 12 (2.7%) athletes required further referral to cardiology for assessment or further testing. All athletes referred for cardiology assessment were cleared for participation, except for one, who was eventually cleared after a shared decision-making process and cardiovascular intervention. The Queen's University Cardiovascular Screening and Care of Athletes Program shows the successful implementation of a cardiovascular PPS program that used shared decision-making and a multidisciplinary approach to screening, allowing for efficiency and effective resource utilization.

Combining stem cell-derived hepatocytes with impedance sensing to better predict human drug toxicity.

Background: The liver plays a central role in human drug metabolism. To model drug metabolism, the major cell type of the liver, the hepatocyte, is commonly used. Hepatocytes can be derived from human and animal sources, including pluripotent stem cells. Cell-based models have shown promise in modeling human drug exposure. The assays used in those studies are normally 'snap-shot' in nature, and do not provide the complete picture of human drug exposure. Research design and methods: In this study, we employ stem cell-derived hepatocytes and impedance sensing to model human drug toxicity. This impedance-based stem cell assay reports hepatotoxicity in real time after treatment with compounds provided by industry. Results: Using electric cell-substrate impedance Sensing (ECIS), we were able to accurately measure drug toxicity post-drug exposure in real time and more quickly than gold standard biochemical assays. Conclusions: ECIS is robust and non-destructive methodology capable of monitoring human drug exposure with superior performance to current gold standard 'snapshot' assays. We believe that the methodology presented within this article could prove valuable in the quest to better predict off-target effects of drugs in humans.

Initiatives aimed at retaining ethnically diverse student nurses in undergraduate programmes: An integrative review.

AIMS AND OBJECTIVES: To identify initiatives aimed at retaining ethnically diverse students in Bachelor/Baccalaureate undergraduate nursing programmes. The review focused on identifying strategies attempting to address this issue. BACKGROUND: There is a recognised shortage of ethnically diverse registered nurses (RN) worldwide. Multiple strategies have been implemented internationally to create a more linguistically and culturally diverse RN workforce. Governments have invested significant resources into these strategies, but the outcomes have been variable. If a future RN workforce is to be representative of their populations, then effective evidence-based interventions are required. DESIGN: An integrative review of the literature published from January 2006-December 2015. METHOD: CINAHL, PubMed, ProQuest, ERIC and Cochrane databases were searched using the key terms student nurse, attrition and retention to identify papers. The CASP tools were used to evaluate relevant studies for rigour (Critical Appraisal Skills Programme [CASP], 2017). Seventeen papers were identified for inclusion. The findings from these studies were analysed using thematic analysis. RESULTS: Four themes emerged from the analysis: prediction, recruitment and retention, single approach and multiple approaches. CONCLUSIONS: Many factors affect the processes of retaining ethnically diverse student nurses in a Bachelor/Baccalaureate undergraduate programme. Programme single approaches appear to be limiting; however, implementation of a broad range of strategies across the continuum from recruitment to graduation is likely to be a more appropriate solution to achieving higher graduation rates amongst ethnically diverse students. RELEVANCE TO CLINICAL PRACTICE: Supporting the recruitment and retention of ethnically diverse students assists in greater numbers of RNs graduating and provides a more linguistically and culturally diverse workforce representative of their population.

Facilitators of research registry enrollment and potential variation by race and gender.

INTRODUCTION: Little is known about what motivates people to enroll in research registries. The purpose of this study is to identify facilitators of registry enrollment among diverse older adults. METHODS: Participants completed an 18-item Research Interest Assessment Tool. We used logistic regression analyses to examine responses across participants and by race and gender. RESULTS: Participants (N=374) were 58% black, 76% women, with a mean age of 68.2 years. All participants were motivated to maintain their memory while aging. Facilitators of registry enrolled varied by both race and gender. Notably, blacks (estimate=0.71, p<0.0001) and women (estimate=0.32, p=0.03) were more willing to enroll in the registry due to home visits compared with whites and men, respectively. CONCLUSIONS: Researchers must consider participant desire for maintaining memory while aging and home visits when designing culturally tailored registries.

Predictors of Physician Assistant Faculty Intent to Leave Academia: A Rasch Regression Analysis.

PURPOSE: The purpose of this research was to investigate whether a previously developed and validated measure of intention to stay in academia for physician assistant (PA) faculty could also be used to inform PA faculty intent to leave academia and return to full-time clinical practice. METHODS: A secondary analysis of the national survey data of PA faculty (n = 427) was conducted using a Rasch regression model. The 19 items from the previously validated Supportive Environment Scale were examined as potential predictors of the dichotomous outcome of intent to leave academia. In this analysis, PA faculty who were somewhat or very likely to leave academia were compared with those who were not at all likely to leave academia. RESULTS: Five items from the Supportive Environment Scale emerged as a linear meaningful measure that predicted intent to leave. These predictors included the following: recognition by administration, support for scholarly work, a fair promotion process, a sense of institutional community, and support of the PA program by administration. Rasch prediction maps were produced that allowed for powerful visualization of prediction and identification of areas for intervention. CONCLUSIONS: The intent of PA faculty to leave academia and return to clinical practice can be meaningfully predicted by 5 items. Importantly, these items are in the purview of institutional administrators and can be used to target PA faculty retention efforts.

The Fetal Care Team: Care for Pregnant Women Carrying a Fetus with a Serious Diagnosis.

BACKGROUND: Women carrying a fetus with a suspected or known fetal anomaly have complex needs such as emotional and informational support and help with the logistical aspects of arranging care and treatment from numerous specialists. IMPROVEMENT IN QUALITY OF CARE FOR WOMEN CARRYING A FETUS WITH A SUSPECTED OR KNOWN FETAL ANOMALY:: Our fetal care team was initiated in 2012 to meet the needs of this high-risk pregnant population. The fetal care team nurse coordinator supports the woman and her family through all aspects of care during the pregnancy and neonatal period including scheduling appointments with multiple specialists, being there with her as a support person, keeping her updated, making sure she has accurate information about the fetal diagnosis, and helping her to navigate the complex healthcare system. RESULTS: Since the program was started, the number of women enrolled has nearly doubled. Women overwhelmingly are satisfied with the various services and care provided by the nurse coordinators and believe the fetal care team has value for them. CLINICAL IMPLICATIONS: We present the development and operations of our fetal care team with a focus on the role of the fetal care team nurse coordinator.

What do patients and the public know about clinical practice guidelines and what do they want from them? A qualitative study.

BACKGROUND: Guideline producers are increasingly producing versions of guidelines for the public. The aim of this study was to explore what patients and the public understand about the purpose and production of clinical guidelines, and what they want from clinical guidelines to support their healthcare decisions. METHODS: Participants were purposively selected to represent a range of the likely users of patient versions of guidelines, including individuals with health conditions (diabetes and depression), general members of the public, health communication professionals and a group of young people. Participants were asked about their awareness and understanding of clinical guidelines and presented with scenario recommendations, or draft materials from patient guidelines to prompt discussion. Each discussion was facilitated by one or two researchers. All focus groups were recorded and transcribed prior to analysis. Data were analysed using framework analysis. RESULTS: We ran nine focus groups involving 62 individuals, supplemented by four interviews with people experiencing homelessness. Eight groups were held in Scotland, one in England. The four interviews were held in Scotland. The framework analysis yielded five themes: access and awareness; what patients want to know; properties of guidelines; presenting evidence; and format. Awareness of guidelines was low. Participants emphasised the need for information that enables them to choose between treatment options, including harms. They would like help with this from healthcare professionals, especially general practitioners. Participants differed in their support for the inclusion of numerical information and graphs. CONCLUSIONS: Members of the public want information to help them choose between treatments, including information on harms, particularly to support shared decisions with health professionals. Presenting numerical information is a challenge and layered approaches that present information in stages may be helpful. Ignoring the themes identified in this study is likely to lead to materials that fail to support public and patient healthcare decision making.

Improving the user experience of patient versions of clinical guidelines: user testing of a Scottish Intercollegiate Guideline Network (SIGN) patient version.

BACKGROUND: Guideline producers are increasingly producing versions of guidelines for the public, and knowledge of what the public want from them is also increasing. The aim of this study was to user test a patient version of a SIGN clinical guideline that was designed based on preliminary work for the DECIDE project. SIGN is the leading national guideline producer in Scotland. METHODS: People with a diagnosis of glaucoma and non-professional carers were recruited from across Scotland. User testing was conducted using a think-aloud protocol method. Each session was conducted by one interviewer and one observer. All sessions were recorded and transcribed. The data was analysed, problems with the guideline were identified and resolved and key findings were themed using a user experience model. RESULTS: Thirteen user testing sessions with people with glaucoma and one with a carer were conducted. Key facilitators of desirability and usability identified include clear branding as a patient version and a clearly described purpose, audience and contents page. Other facilitators include a "friendly" tone which is achieved by the use of colour, quotes, icons, simple language and charts, and brief chunked text. The value and usefulness of the patient guideline was influenced by its ability to: inform the public, link information to actions, and empower people in their interaction with healthcare professionals. Participants were disappointed by the lack of information on treatment in the patient version, which was outside its scope. Information on the evidence based guideline production process and the involvement of appropriately skilled professionals was key to the credibility of the guideline. Lack of awareness of guidelines and guideline producing bodies, is a potentially serious threat to findability/accessibility. CONCLUSIONS: It is important for guideline producers to maximise the user experience of the public when they access patient versions of guidelines, particularly given the current low level of access and awareness. One size does not fit all and guideline producers need to strike a balance between keeping the patient version simple and providing sufficient information to facilitate shared decision making and empower the public. Guideline producers may find the results of this study useful in designing their own patient versions.

Crisis management of fire in the OR.

Fire in the OR is a life-threatening emergency that demands prompt, coordinated, and effective interventions. Specific applications of fire protocols and guidelines for perioperative nurses and their interprofessional colleagues may take several approaches. The perioperative nurse's role is one that can frequently prevent or ameliorate the damaging thermal effects of a fire. For example, to some degree, the nurse can control all three components of the fire triangle: the ignition sources used during surgery (eg, fiberoptic lights, ESU devices), the oxidizers (eg, room air, supplemental oxygen administered during procedures under straight local anesthesia), and the fuel sources (eg, alcohol-based prep solutions). Although all members of the surgical team play an important role, the ability of and the opportunity for the nurse to minimize the risks of fire are important patient safety attributes of the nurse. Team training, rehearsing appropriate actions, and reacting effectively are essential to preparing health care providers to respond in emergent situations and be able to deliver optimal care. In most jurisdictions, any fired--regardless of size--must be reported to the local fire department. Personnel, managers, and administrators should be prepared also for the possibility of participating in postcrisis evaluations by the fire marshal, The Joint Commission, the Occupational Safety and Health Administration, Centers for Medicare & Medicaid Services, and possibly other fire safety-related organizations. Additionally, supplemental information related to investigating a fire is available through the ECRI Institute.28 The ECRI Institute serves as a third-party investigator and can facilitate root-cause analyses, identify whether the crisis ought to be reported and to whom, and assist in restoring clinical operations.

Development and initial validation of a measure of intention to stay in academia for physician assistant faculty.

PURPOSE: The purpose of this research was to construct and validate a measure of "intention to stay in academia" for physician assistant faculty members. METHODS: The 70-item instrument was developed through a literature review, a qualitative investigation of how experienced physician assistant faculty members conceptualized "intention to stay in academia," and an expert review of survey items. The items were pilot tested on a convenience sample of 53 faculty members from 9 physician assistant programs; the revised survey was then administered to all 1002 physician assistant program faculty members in the United States with physician assistant credentials. Rasch analyses were conducted to examine psychometric properties of the measure and collect evidence of validity. RESULTS: The national survey had a 48% response rate, and participants were representative of all physician assistant faculty members. Although the overall instrument demonstrated acceptable construct coverage, good reliability estimates, and adequate fit statistics for the majority of the items, only 36.5% of the variance in the data could be explained by the measure. A subset of 19 items relating to a supportive academic environment ("Supportive Environment" scale) was extracted and met the expectations of the Rasch model. CONCLUSIONS: The Supportive Environment scale produced a meaningful progression of indicators of "intention to stay in academia" for physician assistant faculty members and demonstrated characteristics of a linear measure. Administrators can make valid inferences regarding physician assistant faculty intention to stay from the subscale analysis.