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Research has established that “cognitive rehearsal,” (CR) or the visualization of application of a behavioral response to a situation, can increase self-efficacy through vicarious experience, but is challenging to induce online. Online higher education curricula can include collaborative game-based learning (GBL) in the form or roleplaying, which can facilitate CR. The purpose of this study was to develop an online GBL module to facilitate CR in online business graduate students learning management theory case studies, and to evaluate its ability to induce CR. A convenience sample of students voluntarily participated in a proof-of-conduct study using a mixed-methods design to gauge whether use of the module facilitated CR, a descriptive and thematic analysis was conducted. Data were collected from 106 students within two course sections in an online Master of Business Administration (MBA) program. The module was used as an optional supplement to a management case study assignment and approximately 50% of students used it. Scores on the assignment were compared between students who used the module and students who did not, and those who did scored statistically significantly higher (p = 0.0003). Students reported in a survey that the module induced CR about applying management theory. Students also expressed satisfaction with the module and provided feedback for its improvement in the areas of format and content. Our findings suggest that collaborative roleplaying GBL and other methods to induce CR in online higher education should be explored and formally studied.

Objective:The objective of this narrative review is to summarize the current knowledge on the prevalence of periodontitis in the Kingdom of Saudi Arabia (KSA) and to make recommendations for monitoring and improving oral health in the KSA population.Background:Periodontitis is a significant health issue in the general population, so conducting routine public health surveillance for this condition is important in every country. KSA is currently implementing a strategic plan called Vision 2030 which aims to improve many of the country’s infrastructures, including healthcare.Methods:To conduct this narrative review, Google Scholar (GS) was used to search for peer-reviewed articles on the prevalence of periodontitis in KSA. No limits were placed on the year of publication, but only articles translated into English were considered. Search terms used included “Saudi Arabia”, “periodontitis”, “surveillance”, “prevalence”, “rates”, “oral health” and “dental”.Results:The earliest estimate identified was from 1992, in which the rate of lack of periodontal health was estimated to be 90% in KSA residents aged 25 and over. A more recent estimate reported rates around 50%, but used a different case definition. Studies on tobacco use, periodontal health and KSA established that how tobacco is used strongly influences periodontal status. Other dental studies in KSA focus on other topics. The Saudi Health Information Survey (SHIS) conducted in 2013 asked oral health questions, but did not seek to estimate the rates of periodontitis in KSA.Conclusion:The World Health Organization’s (WHO) recommendations suggest that KSA should conduct research to develop surveillance case definitions of periodontitis that will have specific utility in KSA, and can be standardized to compare KSA rates with the rates worldwide. The existing surveillance definitions and efforts in other countries have been considered less than optimal, so research is needed to inform KSA’s effort. Recommendations are made for a national oral health research agenda in KSA under Vision 2030.

Lipedema (LI) is a common yet misdiagnosed condition, often misconstrued with obesity. LI affects women almost exclusively, and its painful and life-changing symptoms have long been thought to be resistant to the lifestyle interventions such as diet and exercise. In this paper, we discuss possible mechanisms by which patients adopting a ketogenic diet (KD) can alleviate many of the unwanted clinical features of LI. This paper is also an effort to provide evidence for the hypothesis of the potency of this dietary intervention for addressing the symptoms of LI. Specifically, we examine the scientific evidence of effectiveness of adopting a KD by patients to alleviate clinical features associated with LI, including excessive and disproportionate lower body adipose tissue (AT) deposition, pain, and reduction in quality of life (QoL). We also explore several clinical features of LI currently under debate, including the potential existence and nature of edema, metabolic and hormonal dysfunction, inflammation, and fibrosis. The effectiveness of a KD on addressing clinical features of LI has been demonstrated in human studies, and shows promise as an intervention for LI. We hope this paper leads to an improved understanding of optimal nutritional management for patients with LI and stimulates future research in this area of study.

This chapter proposes a global agenda to eliminate racism in nursing by targeting reform at nursing education administration internationally. First, the history of racism in nursing is reviewed, along with two models – the diversity model and the cultural competence model – that were applied unsuccessfully to counteract racism in nursing. Second, a description of how racism is entrenched in nursing leadership globally is presented. Third, the recalcitrant structures that serve to maintain institutionalized racism (IR) in the international nursing education system are carefully examined. Specifically, the components and constructs involved in IR in nursing education are delineated, and the way in which these negatively impact both ethnic minority (EM) students and faculty are explained. Based on this, a global agenda to eliminate racism in nursing education internationally is proposed. Eliminating racism in higher education in nursing is a mandatory social responsibility if global healthcare is ever to be equitable. Five actionable recommendations are made to eliminate racism in higher education are summarized as follows: (1) components of nursing programs which are designed to eliminate racism in nursing education should be governed at the country level, (2) to design and implement a system of surveillance of the global nursing community to enable standardized measurement to ensure nursing education programs in all countries are meeting anti-racism benchmark targets, (3) nursing education programs should be established worldwide to provide individual pipeline and mentorship programs to ensure the career success of EM nursing students and faculty, (4) nursing education programs should be conducted to reduce barriers to EM participation in these individual support programs, and (5) nursing education programs are required to teach their nursing faculty skills in developing anti-racist curricula that seeks to eliminate implicit bias.

Background: Couples who are at risk for having an infant with a serious genetic disorder can benefit from pre-implantation genetic diagnosis (PGD), but many couples still opt for the riskier pre-natal diagnosis (PND). Although couples make this decision together, the male and the female in the couple may have different attitudes toward choosing PGD vs. PND. The objective of this study was to determine if men and women in the same couple with at least one child with a genetic disorder will have significantly different attitudes toward choosing PGD vs. PND. Methodology: In this cross-sectional clinical study, couples with at least one child with a genetic disease attending the King Faisal Specialist Hospital Research Center, Genetic Counseling Clinic (KFSH-RC, GCC), Riyadh, Saudi Arabia were asked to complete an anonymous survey about their attitudes towards PGD vs. PND. The responses were compared between men and women in couples. The study was conducted during May 2017. Results: A total of 38 couples provided complete surveys. In terms of preference for PGD vs. PND, there were no significant differences in aggregate between men and women (p > 0.05). Over half the couples agreed (were concordant) on all statements about PGD vs. PND. An almost equal number of couples with members who disagreed (were discordant) had women preferring PND vs. men preferring PND compared to PGD. Conclusion: This study showed that members of couples sampled were generally in agreement about their preference for PGD vs. PND. Among discordant couples, there was no preference among women for PGD vs. PND. Studies like this are important to help clinicians understand intra-couple dynamics in genetic counseling.

Background Health care-associated infections, specifically catheter-associated urinary tract infections (CAUTIs), can cause significant mortality and morbidity. However, the process of collecting CAUTI surveillance data, storing it, and visualizing the data to inform health policy has been fraught with challenges. Objectives No standard has been developed, so the objective of this article is to present a prototype solution for dashboarding public health surveillance data based on a real-life use-case for the purposes of enhancing clinical and policy-level decision-making. Methods The solution was developed in open source software R, which allows for the creation of dashboard applications using the integrated development environment developed for R called RStudio, and a package for R called Rshiny. How the surveillance system was designed, why R was chosen, how the dashboard was developed, and how the dashboard features were programmed and function will be described. Results The prototype dashboard includes multiple tabs for visualizing data, and allows the user to interact with the data by setting dynamic filters. Controls were used to facilitate the interaction between the user and application. Rshiny is reactive, in that when the user (e.g., clinician or policymaker) changes the parameters on the data, the application automatically updates the visualization as well as parameters available based on current filters. Conclusion The prototype dashboard has the potential to enhance clinical and policy-level decision-making because it facilitates interaction with the data that provides useful visualizations to provide such guidance.

BackgroundUnfortunately, racism and discrimination against Ethnic minority (EM) has been globalized, universally infecting industries worldwide, and the field of nursing has not been spared. In the United States (US), overt and institutionalized racism (IR) still permeates the fields of nursing, nursing leadership, and nursing education. Programs to address these disparities, and efforts by nursing professional societies and nursing education policymaking bodies to address racism in the nursing field, specifically with nursing leadership and education, have met with little success.ObjectiveThe purpose of this paper is to illustrate the existence and magnitude of racism and its impact on the fields of nursing, nursing leadership, and nursing education, and to make evidence-based recommendations for an agenda for reforming nursing education in the US.MethodsA narrative literature review was conducted with a focus on pulling together the strongest evidence on which to base policy recommendations.ResultsBased on the available literature, we put forth five recommendations aimed at modifying nursing education in the US as a strategy to counter IR in the US in the nursing field.ConclusionsRecommendations to address IR in nursing focus on nursing education, and involve implementing programs to address the lack of opportunity for both EM students and faculty in nursing, developing an anti-discriminatory pedagogy, and incorporating diversity initiatives as key performance indicators (KPIs) in the process of approval and accreditation of nursing programs.

Background: The rate of periodontitis in the US population has been estimated to be close to 50%. Patients with periodontitis, especially those who smoke, suffer from a high rate of tooth loss. The purpose of this analysis is to evaluate predictors of poor oral health and oral health habits among smokers and determine if trying to quit smoking is associated with better oral health or oral health habits in smokers in the United States.Methods: Data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) were used in the analysis. After limiting the dataset to smokers, the designated exposure was respondent’s report of trying to quit smoking (yes/no). Two logistic regression models were developed. One model identified factors associated with having a most recent dental visit longer than 1 year before the survey. The second model identified factors associated with loss of six or more teeth. Both models were controlled for confounding factors.Results: After controlling for confounding, among smokers ...

Introduction: Successful transition to practice of internationally educated nurses (IENs) can critically affect quality of care. The aim of this study was to characterize the facilitators and barriers to transition of Nigerian IENs (NIENs) to the United States health care setting. Method: Using a descriptive phenomenology approach, 6 NIENs were interviewed about their transitional experiences in the United States. Thematic methods were used for data analysis. Results: The three major themes identified from the participants’ stories were “fear/anger and disappointment” (FAD), “road/journey to success/overcoming challenges” (RJO), and “moving forward” (MF). The FAD theme predominated, including experiences of racism, bullying, and inequality. The RJO theme included resilience, and the MF theme encompassed personal growth. Discussion: NIENs face personal and organizational barriers to adaptation, especially fear, anger and disappointment. Future research should seek to develop a model for optimal adaptation that focuses on improving both personal and organizational facilitators and decreasing barriers.

Many aspects of medical school are stressful for students. To empirically assess student reactions to clerkship programs, or to assess efforts to improve such programs, educators must measure the overall well-being of the students reliably and validly. The purpose of the study was to develop and validate a measure designed to achieve these goals. The authors developed a measure of quality of life for medical students by sampling (public domain) items tapping general happiness, fatigue, and anxiety. A quality-of-life scale was developed by factor analyzing responses to the items from students in two different clerkships from 2005 to 2008. Reliability was assessed using Cronbach's alpha. Validity was assessed by factor analysis, convergence with additional theoretically relevant scales, and sensitivity to change over time. The refined nine-item measure is a Likert scaled survey of quality-of-life items comprised of two domains: exhaustion and general happiness. The resulting scale demonstrated good reliability and factorial validity at two time points for each of the two samples. The quality-of-life measure also correlated with measures of depression and the amount of sleep reported during the clerkships. The quality-of-life measure appeared more sensitive to changes over time than did the depression measure. The measure is short and can be easily administered in a survey. The scale appears useful for program evaluation and more generally as an outcome variable in medical educational research.

Although course management systems (CMSs) provide technology platforms that help faculty members adopt better techniques for teaching and learning, and training contributes to faculty information technology (IT) use, many higher education faculty members do not complete CMS training programs, resulting in underuse of CMSs. Therefore, the overall purpose of this research was to address how instructor perceptions influence willingness to complete IT training on CMSs, and to discern techniques university administrators can implement to improve training completion rates and, ultimately, CMS adoption rates. The basic design of the study was a cross-sectional survey. Data were obtained from 102 public university faculty members who responded to an anonymous, web-based survey about their perceptions of the relative advantage, compatibility, complexity, trialability, and observability of their institution’s CMS. The data were analyzed using multiple linear regression models. Compatibility, defined as the degree to which instructors perceive the CMS as being consistent with their existing values, past experiences, and current or future teaching needs, was statistically significantly associated with willingness to complete online and in-person CMS training after controlling for other factors. Major findings suggest that faculty training on the CMS is not “one size fits all.” If greater use of CMSs by faculty is to be achieved, university administrators should consider compatibility of teaching style with CMS adoption when developing and promoting CMS training.

Recombinant factor VIIa (rFVIIa, NovoSeven RT, Novo Nordisk) was approved by the Food and Drug Administration (FDA) in 1999 for the prevention and treatment of bleeding episodes in hemophilia patients with inhibitors against clotting factors.[1][1] After its approval, rFVIIa was regarded as a “

Many aspects of medical school are stressful for students. To empirically assess student reactions to clerkship programs, or to assess efforts to improve such programs, educators must measure the overall well-being of the students reliably and validly. The purpose of the study was to develop and validate a measure designed to achieve these goals. The authors developed a measure of quality of life for medical students by sampling (public domain) items tapping general happiness, fatigue, and anxiety. A quality-of-life scale was developed by factor analyzing responses to the items from students in two different clerkships from 2005 to 2008. Reliability was assessed using Cronbach's alpha. Validity was assessed by factor analysis, convergence with additional theoretically relevant scales, and sensitivity to change over time. The refined nine-item measure is a Likert scaled survey of quality-of-life items comprised of two domains: exhaustion and general happiness. The resulting scale demonstrated good reliability and factorial validity at two time points for each of the two samples. The quality-of-life measure also correlated with measures of depression and the amount of sleep reported during the clerkships. The quality-of-life measure appeared more sensitive to changes over time than did the depression measure. The measure is short and can be easily administered in a survey. The scale appears useful for program evaluation and more generally as an outcome variable in medical educational research.