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The acceptance of the Scholarship of Teaching and Learning (SoTL) as a legitimate form of scholarly investigation and the shape that it takes in post-secondary education are inherently discipline-specific. This paper examines how the character and heritage of public administration influence the acceptance of SoTL, and the form that it takes. It argues that the applied nature of public administration and its interdisciplinary character have influenced SoTL in the discipline. This study concludes systematic self-reflection by disciplines may be needed to identify potential factors that limit the acceptance and/or direction of SoTL in a discipline.

In this issue's "Ethical Challenges" column, commentators share their views of how evaluators might respond to specific problematic situations, linking their analyses to the principles and standards they believe are most relevant to the case. Not surprisingly, the perspectives that commentators offer are not always in agreement. When this occurs, reflection on the nature and sources of these differences of opinion can enhance sensitivity to the ethical dimensions of evaluation work and awareness of the options available for addressing them. In this issue's scenario, "Should We Call the Whole Thing Off?" an evaluator realizes that the participants in the program being evaluated speak different languages. Although the evaluator was prepared to work with English-speaking and Spanish-speaking participants, he is unprepared to deal with the significant population of Russian immigrants who are also involved in the program. Moreover, he does not have the financial resources to expand his evaluation team to include a native speaker of Russian. In responding to the scenario, the commentators start from very different, but complementary perspectives. The first commentator is Dr. Dina Birman, from the Department of Psychology at the University of Illinois at Chicago, whose response to the scenario is rich in detail about the specific circumstances faced by Russian immigrants, including the subgroups one is likely to find within that population, the ways in which the welfare system interacts with refugees, and other contextual influences (see EJ753261). She points out that language is only one aspect of culture that is needed to address in working with diverse populations. The second commentator is Dr. Donna Mertens of Gallaudet University's Department of Educational Foundations and Research. She points out that language is a potential barrier to developing an evaluation that is not just inclusive but also works to increase the power of communities who are disadvantaged in the majority culture (see EJ753260). The two commentators both conclude that leaving the Russian immigrant population out of the evaluation would have negative implications for the ethical soundness of the evaluation, as well as for the quality and usefulness of the information obtained. (Contains 1 note.)

Purpose – Parenting programmes are seen as feasible and cost-effective in preventing early behavioural problems in children and adolescents. A number of studies have concluded that such programmes are effective in reducing child problem behaviours and improving the skills and well-being of parents. Nevertheless, less is known about long-term programme effects. The paper aims to discuss these issues. Design/methodology/approach – A non-meta-analytic discussion. Findings – Long-term evaluations of parenting programmes suffer from a number of methodological weaknesses resulting in an inability to make robust causal inferences about child and parent outcomes in the longer term. The current evidence is favourable but is likely to be biased by methodological weaknesses. There is a need for more studies of greater methodological strength to obtain conclusive evidence that would guide empirical research, practice and policy. Originality/value – The paper discusses weaknesses in long-term evaluations of parenting programmes and highlights concrete future directions towards improving the quality of study design, evaluation and data analysis. [ABSTRACT FROM AUTHOR]

Background: This paper explores the importance of electronic medical records (EMR) for predicting 30-day all-cause non-elective readmission risk of patients and presents a comparison of prediction performance of commonly used methods.Methods: The data are extracted from eight Advocate Health Care hospitals. Index admissions are excluded from the cohort if they are observation, inpatient admissions for psychiatry, skilled nursing, hospice, rehabilitation, maternal and newborn visits, or if the patient expires during the index admission. Data are randomly and repeatedly divided into fitting and validating sets for cross validations. Approaches including LACE, STEPWISE logistic, LASSO logistic, and AdaBoost, are compared with sample sizes varying from 2,500 to 80,000.Results: Our results confirm that LACE has moderate discrimination power with the area under receiver operating characteristic curve (AUC) around 0.65-0.66, which can be improved to 0.73-0.74 when additional variables from EMR are considered. These variables include Inpatient in the last six months, Number of emergency room visits or inpatients in the last year, Braden score, Polypharmacy, Employment status, Discharge disposition, Albumin level, and medical condition variables such as Leukemia, Malignancy, Renal failure with hemodialysis, History of alcohol substance abuse, Dementia and Trauma. When sample size is small (≤5000), LASSO is the best; when sample size is large (≥20,000), the predictive performance is similar. The STEPWISE method has a slightly lower AUC (0.734) comparing to LASSO (0.737) and AdaBoost (0.737). More than one half of the selected predictors can be false positives when using a single method and a single division of fitting/validating data.Conclusions: True predictors can be identified by repeatedly dividing data into fitting/validating subsets and referring the final model based on summarizing results. LASSO is a better alternative to the STEPWISE logistic regression, especially when sample size is not large. The evidence for adequate sample size can be explored by fitting models on gradually reduced samples. Our model comparison strategy is not only good for 30-day all-cause non-elective readmission risk predictions, but also applicable to other types of predictive models in clinical studies. [ABSTRACT FROM AUTHOR]

Background: Elder mistreatment (EM) prevalence varies greatly according to definitional criteria. However, little is known regarding the significance of different EM definitions with respect to health outcome. This paper explores the association between different definitions of EM and their subtypes and suicidal ideation (SI) in an U.S. Chinese aging population.Methods: The Population Study of ChINese Elderly in Chicago Study was conducted from 2011 to 2013 of 3157 community-dwelling Chinese older adults aged 60 years. Psychological, physical mistreatment (PM), caregiver neglect (CN), financial exploitation (FE), and overall EM were measured by different definitional approaches varying in the strictness. SI in the past 2 weeks and 12 months were assessed.Results: After adjusting for confounders, the least restrictive EM definition (odds ratio [OR], 2.10 [1.34-3.28]; OR, 2.43 [1.66-3.55]), moderately restrictive EM definition (OR, 2.87 [1.80-4.56]; OR, 2.71 [1.82-4.04]), and most restrictive EM definition (OR, 2.24 [1.36-3.66]; OR, 2.34 [1.54-3.56]) were associated with increased risk for 2-week and 12-month SI. For subtypes of EM, psychological mistreatment (the least and most restrictive definitions, 2-week SI: OR, 2.83 [1.71-4.68]; OR, 3.13 [1.10-8.91]; 12-month SI: OR, 2.43 [1.56-3.78]; OR, 2.88 [1.10-7.54]), PM (2-week SI: OR, 5.12 [1.83-14.29]; 12-month SI: OR, 3.45 [1.30-9.13]), and FE was not associated with 2-week SI, only the broadly defined FE (OR, 1.73 [1.01-2.96]) was associated with higher odds of reporting 12-month SI. CN was only associated with higher odds of reporting 12-month SI (OR, 2.17 [1.19-3.96]; OR, 1.94 [1.24-3.04]) but not 2-week SI.Conclusion: EM and its subtypes were significantly associated with SI; some associations varied by definitions and subtypes. [ABSTRACT FROM AUTHOR]

Objective: The objective of the current study was to evaluate the impact of the Market to MyPlate (M2MP) program on participants' reported farmers' market (FM) attitudes and shopping behaviours, frequency of serving vegetables to their families, food resource management behaviours and food security. A secondary objective was to identify facilitators and barriers to shopping at FM and food waste reduction techniques used by low-income families.Design: The current study used a mixed methods evaluation embedded within a cluster randomised trial of the M2MP intervention.Setting: The 7-week M2MP program was delivered at Extension offices and community centres in central Illinois.Participants: Participants included 120 adults and their families. Class cohorts were randomly assigned to one of three treatment groups: (1) nutrition education and cooking classes with produce allocations (PAE, n 39); (2) nutrition education and cooking classes only (EO, n 36) or (3) control group (n 45).Results: Compared with control participants, PAE participants were significantly more likely to report shopping at FM (P = 0·029) and reported serving more vegetables to their families (P = 0·010) (EO participants did not differ from the control group on any outcomes). There were no differences between conditions in survey-based measures of food security or food resource management behaviours. Interview results describe facilitators and barriers to shopping at FM and a variety of food waste reduction techniques (including food placement and food resource management).Conclusions: These findings suggest that fresh produce provision coupled with nutrition and culinary education can positively impact shopping and dietary behaviours. [ABSTRACT FROM AUTHOR]

Objective: The main objective of this study was to evaluate the impact of the Market to MyPlate (M2MP) program on fruit and vegetable consumption and cooking behaviours. Secondary objectives were to examine factors that affected participant retention and program completion, and analyse program feedback provided by participants.Design: This study conducted a mixed methods evaluation embedded within a cluster randomised controlled trial of the M2MP intervention. Adult participants completed a pre- and post-program survey reporting on their fruit and vegetable consumption and cooking behaviours. A subsample participated in structured interviews, providing feedback about M2MP and the impact of the program.Setting: Seven weekly classes took place in community centres and extension offices in central Illinois.Participants: 120 adults and their families participated. Class cohorts were randomly assigned to one of three treatment groups: (1) nutrition education and cooking classes with produce allocations (PAE, n 39); (2) nutrition education and cooking classes only (EO, n 36) or (3) control group (n 45).Results: Compared to control, PAE participants reported larger increases from pre- to post-intervention in fruit (P = 0·001) and vegetable consumption (P = 0·002), with no differences in cooking frequency. Interview analyses identified key themes in behaviour changes due to M2MP, including reported increases in dietary variety, cooking self-efficacy and children's participation in cooking.Conclusions: PAE participants who received an intervention that directly increased their access to fresh produce (via produce allocations) increased their reported fruit and vegetable consumption. Though participants' cooking frequency did not change, interviewees reported increased variety, cooking confidence and family participation in cooking. [ABSTRACT FROM AUTHOR]

Background/objectives: The recent upsurge in online food delivery options has reshaped the food market. The aim of this study was to examine between-city differences and within-city socioeconomic differences in the number of online meal delivery options, meal types, and meal prices.Subjects/methods: A cross-sectional study was conducted in three international cities within high-income countries. Across 10 sampled addresses in Chicago (USA), Amsterdam (The Netherlands), and Melbourne (Australia), meal delivery options provided by a major international meal delivery company were sampled. Bonferroni adjusted Chi2-tests were conducted to assess between-city differences as well as within-city socioeconomic differences in price levels.Results: Across the 10 sampled addresses in each city, there were n = 1668 delivery options in Chicago, n = 1496 in Amsterdam and n = 1159 in Melbourne. In total, 10,220 keywords (representing 148 different meal types) were recorded across all 4323 delivery options. In all three cities, burgers, pizza and Italian were in the top 10 of most advertised meals. Compared with Amsterdam, healthy and meat-free meals were less commonly advertised in Chicago and Melbourne. In Chicago, the number of delivery options for addresses in the most disadvantaged and least disadvantaged neighborhoods were similar. In Amsterdam and Melbourne, a greater number of options was available for the addresses in the least disadvantaged neighborhoods.Conclusions: This study highlights the vast number of meal delivery options individuals can source when at home via a meal delivery service, noting the number differs across and within cities. In each city, most food types available for delivery were not considered healthy. [ABSTRACT FROM AUTHOR]

Objective: There are concerns that some non-profit organisations, financed by the food industry, promote industry positions in research and policy materials. Using Freedom of Information (FOI) requests, we test the proposition that the International Life Sciences Institute (ILSI), one prominent non-for profit in international health and nutrition research, promotes industry positions.Design: U.S. Right to Know filed five FOI from 2015 to 2018 covering communications with researchers at four US institutions: Texas A&M, University of Illinois, University of Colorado and North Carolina State University. It received 15 078 pages, which were uploaded to the University of California San Francisco's Industry Documents Library. We searched the Library exploring it thematically for instances of: (1) funding research activity that supports industry interests; (2) publishing and promoting industry-sponsored positions or literature; (3) disseminating favourable material to decision makers and the public and (4) suppressing views that do not support industry.Results: Available emails confirmed that ILSI's funding by corporate entities leads to industry influence over some of ILSI activities. Emails reveal a pattern of activity in which ILSI sought to exploit the credibility of scientists and academics to bolster industry positions and promote industry-devised content in its meetings, journal and other activities. ILSI also actively seeks to marginalise unfavourable positions.Conclusions: We conclude that undue influence of industry through third-party entities like ILSI requires enhanced management of conflicts of interest by researchers. We call for ILSI to be recognised as a private sector entity rather than an independent scientific non-profit, to allow for more appropriate appraisal of its outputs and those it funds. [ABSTRACT FROM AUTHOR]

In 2018, Heartland disease virus infected 2 persons in Illinois, USA. In 2019, ticks were collected at potential tick bite exposure locations and tested for Heartland and Bourbon viruses. A Heartland virus-positive pool of adult male Amblyomma americanum ticks was found at 2 locations, 439 km apart, suggesting widespread distribution in Illinois. [ABSTRACT FROM AUTHOR]

Background: Identification and treatment of malnutrition across the care continuum can help prevent illness onset or relapse and maximize the effectiveness of other medical treatments. This study aimed to evaluate the effect of a nutrition-focused quality improvement program (QIP) conducted in a home health agency (HHA) on hospitalization rates and healthcare costs incurred over 90 days.Methods: This was a multisite, pre-post QIP implemented at 2 branches of an Illinois-based HHA. The QIP included 1546 patients who were (1) at-risk or malnourished hospitalized patients discharged to the HHA, (2) referred by a physician during an outpatient visit, or (3) enrolled in the HHA through a skilled nursing facility. A historic (n = 7413 patients) and concurrent group (n = 5235) of patients were used for comparisons. Propensity score matching was used to account for imbalances in patient characteristics.Results: The QIP led to reduced relative risk of hospitalization post-enrollment to the QIP by 24.3%, 22.8%, and 18.3% at 30, 60, and 90 days, respectively, when compared with the historic group, and by 18.2%, 16.2%, and 12.1% when compared with the concurrent group. Total cost savings from reduced 90-day healthcare resource utilization was $2,318,894, or $1500 per patient treated.Conclusions: Rates of hospitalization and healthcare resources can be significantly reduced through the implementation of a nutrition-focused QIP delivering oral nutritional supplements in home health settings for adults at-risk/malnourished. These results highlight the importance of nutrition as a strategy for HHAs and other post-acute care institutions to improve patients' health outcomes and generate cost savings. [ABSTRACT FROM AUTHOR]

Women of color do not have the same level of access to mammography services as their White counterparts, and this inequity may be one of the contributing factors to the documented racial disparity in breast cancer mortality in the US. The present study sought to assess the effectiveness of the mammogram party, a promising, but under-studied approach to increasing mammography uptake, particularly among under-served populations. The program targeted mammogram-eligible women in community settings on the west and southwest sides of Chicago, gathering basic demographic information, mammography history, and interest in assistance obtaining a mammogram. Women were navigated either through traditional one-on-one navigation or to a mammogram party. Seven outcome metrics were calculated for each type of navigation. We compared navigation outcomes for those who attended to those who did not attend a mammogram party using two-tailed t tests and chi-square tests. We found that the mammography completion rate for mammogram parties was comparable to that for standard one-on-one navigation (65.8 vs. 63.7%), which is more labor-intensive as evidenced by the number of contacts needed to successfully navigate a woman to mammography (10.9 vs. 15.0). Mammogram parties offer a unique opportunity for fellowship and support for clients who are particularly fearful of mammograms or identifying breast cancer. Programmatically, mammogram parties are an efficient way to complete several mammograms in 1 day. Having the option to both navigate women to mammogram parties or one-on-one navigation allows for more flexibility for scheduling and may ensure a completed a mammogram. [ABSTRACT FROM AUTHOR]

Some law enforcement officials and other observers have asserted that theft is the primary source of guns to crime. In fact, the role of theft in supplying the guns used in robbery, assault, and murder is unknown, and current evidence provides little guidance about whether an effective program to reduce gun theft would reduce gun violence. The current article analyzes publicly available national data on gun theft together with a unique data set for Chicago. The results tend to support a conclusion that stolen guns play only a minor role in crime. First, publicly available data are used to calculate that thefts are only about 1% of all gun transactions nationwide. Second, an analysis of original data from Chicago demonstrates that less than 3% of crime guns recovered by the police have been reported stolen to the Chicago Police Department (CPD). If a gun is reported stolen, there is a 20% chance that it will be recovered, usually in conjunction with an arrest for illegal carrying. Less than half of those picked up with a stolen gun have a criminal record that includes violent offenses. Third, results from surveys of convicted criminals, both nationally and in Chicago, suggest that it is rare for respondents to have stolen the gun used in their most recent crime. The data on which these results are based have various shortcomings. A research agenda is proposed that would provide more certainty about the role of theft. [ABSTRACT FROM AUTHOR]

Criminal offenders often turn to social networks to gain access to firearms, yet we know little about how networks facilitate access to firearms. This study conducts a network analysis of a co-offending network for the City of Chicago to determine how close any offender may be to a firearm. We use arrest data to recreate the co-offending network of all individuals who were arrested with at least one other person over an eight-year period. We then use data on guns recovered by the police to measure potential network pathways of any individual to known firearms. We test the hypothesis that gangs facilitate access to firearms and the extent to which such access relates to gunshot injury among gang members. Findings reveal that gang membership reduces the potential network distance (how close someone is) to known firearms by 20% or more, and regression results indicate that the closer gang members are to guns, the greater their risk of gunshot victimization. [ABSTRACT FROM AUTHOR]

Young people in the USA who inject drugs, particularly those at a risk of residence instability, experience the highest incidence of hepatitis C (HCV) infections. This study examined associations between geographic mobility patterns and sociodemographic, behavioral, and social network characteristics of 164 young (ages 18-30) persons who inject drugs (PWID). We identified a potential bridge sub-population who reported residence in both urban and suburban areas in the past year (crossover transients) and higher-risk behaviors (receptive syringe sharing, multiple sex partners) compared to their residentially localized counterparts. Because they link suburban and urban networks, crossover transients may facilitate transmission of HIV and HCV between higher and lower prevalence areas. Interventions should address risk associated with residential instability, particularly among PWID who travel between urban and suburban areas. [ABSTRACT FROM AUTHOR]

Rationale: Low-Vt ventilation lowers mortality in patients with acute respiratory distress syndrome (ARDS) but is underused. Little is known about clinician attitudes toward and perceived barriers to low-Vt ventilation use and their association with actual low-Vt ventilation use.Objectives: The objectives of this study were to assess clinicians' attitudes toward and perceived barriers to low-Vt ventilation (Vt <6.5 ml/kg predicted body weight) in patients with ARDS, to identify differences in attitudes and perceived barriers among clinician types, and to compare attitudes toward and perceived barriers to actual low-Vt ventilation use in patients with ARDS.Methods: We conducted a survey of critical care physicians, nurses, and respiratory therapists at four non-ARDS Network hospitals in the Chicago region. We compared survey responses with performance in a cohort of 362 patients with ARDS.Results: Survey responses included clinician attitudes toward and perceived barriers to low-Vt ventilation use. We also measured low-Vt ventilation initiation by these clinicians in 347 patients with ARDS initiated after ARDS onset as well as correlation with clinician attitudes and perceived barriers. Of 674 clinicians surveyed, 467 (69.3%) responded. Clinicians had positive attitudes toward and perceived few process barriers to ARDS diagnosis or initiation of low-Vt ventilation. Physicians had more positive attitudes and perceived fewer barriers than nurses or respiratory therapists. However, use of low-Vt ventilation by all three clinician groups was low. For example, whereas physicians believed that 92.5% of their patients with ARDS warranted treatment with low-Vt ventilation, they initiated low-Vt ventilation for a median (interquartile range) of 7.4% (0 to 14.3%) of their eligible patients with ARDS. Clinician attitudes and perceived barriers were not correlated with low-Vt ventilation initiation.Conclusions: Clinicians had positive attitudes toward low-Vt ventilation and perceived few barriers to using it, but attitudes and perceived process barriers were not correlated with actual low-Vt ventilation use, which was low. Implementation strategies should be focused on examining other issues, such as ARDS recognition and process solutions, to improve low-Vt ventilation use. [ABSTRACT FROM AUTHOR]

Background: Alcohol abuse, other substance use disorders, and risk behaviors associated with the human immunodeficiency virus (HIV) represent three of the top 10 modifiable causes of mortality in the US. Despite evidence that continuing care is effective in sustaining recovery from substance use disorders and associated behaviors, patients rarely receive it. Smartphone applications (apps) have been effective in delivering continuing care to patients almost anywhere and anytime. This study tests the effectiveness of two components of such apps: ongoing self-monitoring through Ecological Momentary Assessments (EMAs) and immediate recovery support through Ecological Momentary Interventions (EMIs).Methods/design: The target population, adults enrolled in substance use disorder treatment (n = 400), are being recruited from treatment centers in Chicago and randomly assigned to one of four conditions upon discharge in a 2 × 2 factorial design. Participants receive (1) EMAs only, (2) EMIs only, (3) combined EMAs + EMIs, or (4) a control condition without EMA or EMI for 6 months. People in the experimental conditions receive smartphones with the apps (EMA and/or EMI) specific to their condition. Phones alert participants in the EMA and EMA + EMI conditions at five random times per day and present participants with questions about people, places, activities, and feelings that they experienced in the past 30 min and whether these factors make them want to use substances, support their recovery, or have no impact. Those in the EMI and EMA + EMI conditions have continual access to a suite of support services. In the EMA + EMI condition, participants are prompted to use the EMI(s) when responses to the EMA(s) indicate risk. All groups have access to recovery support as usual. The primary outcome is days of abstinence from alcohol and other drugs. Secondary outcomes are number of HIV risk behaviors and whether abstinence mediates the effects of EMA, EMI, or EMA + EMI on HIV risk behaviors.Discussion: This project will enable the field to learn more about the effects of EMAs and EMIs on substance use disorders and HIV risk behaviors, an understanding that could potentially make treatment and recovery more effective and more widely accessible.Trial Registration: ClinicalTrials.gov, ID: NCT02132481 . Registered on 5 May 2014. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular risk factors are increasing in most developing countries. To date, however, very little standardized data has been collected on the primary risk factors across the spectrum of economic development. Data are particularly sparse from Africa.Methods: In the Modeling the Epidemiologic Transition Study (METS) we examined population-based samples of men and women, ages 25-45 of African ancestry in metropolitan Chicago, Kingston, Jamaica, rural Ghana, Cape Town, South Africa, and the Seychelles. Key measures of cardiovascular disease risk are described.Results: The risk factor profile varied widely in both total summary estimates of cardiovascular risk and in the magnitude of component factors. Hypertension ranged from 7% in women from Ghana to 35% in US men. Total cholesterol was well under 200 mg/dl for all groups, with a mean of 155 mg/dl among men in Ghana, South Africa and Jamaica. Among women total cholesterol values varied relatively little by country, following between 160 and 178 mg/dl for all 5 groups. Levels of HDL-C were virtually identical in men and women from all study sites. Obesity ranged from 64% among women in the US to 2% among Ghanaian men, with a roughly corresponding trend in diabetes. Based on the Framingham risk score a clear trend toward higher total risk in association with socioeconomic development was observed among men, while among women there was considerable overlap, with the US participants having only a modestly higher risk score.Conclusions: These data provide a comprehensive estimate of cardiovascular risk across a range of countries at differing stages of social and economic development and demonstrate the heterogeneity in the character and degree of emerging cardiovascular risk. Severe hypercholesterolemia, as characteristic in the US and much of Western Europe at the onset of the coronary epidemic, is unlikely to be a feature of the cardiovascular risk profile in these countries in the foreseeable future, suggesting that stroke may remain the dominant cardiovascular event. [ABSTRACT FROM AUTHOR]

Aims and objectives To assess the acceptability and usability of a standardised communication tool for nurses. Background and significance Communication is key in health care. On a daily, if not hourly, basis, nursing staff is inundated with new information regarding tools and resources, practice changes and the work environment. However, there is currently no standardised messaging or delivery method to effectively communicate new information. Even with a plethora of communication tools such as flyers, posters, emails, unit huddles and unit meetings, there is no means to guarantee attendance to crucial information. Design Descriptive, cross-sectional online survey, implemented at a nonacademic, suburban hospital with 280 nurses. Methods The Clinical Chatter, an online tool developed by nursing leadership to standardise messages regarding the organisation, new tools and resources, professional development, recognition and unit updates, was delivered to each nurse on a weekly basis followed by administration of Acceptability and Usability scales. Results The Clinical Chatter tool has adequate acceptability and usability as a method of communication among nurses in a hospital organisation. Sociodemographic variables of age and years of experience had no statistically significant association with perceived acceptance and usefulness of the tool. Conclusion The findings indicate that the Clinical Chatter tool can be used as a standardised communication tool to deliver key information among nurses working in a hospital organisation. Nursing leadership must establish and support a clear communication system to enhance patient care and outcomes and improve nursing job satisfaction. Relevance to clinical practice Communication is vital to advancing health care. Lack of communication among nursing has been linked to unsafe patient care: medication errors, unhealthy work environments and decreased nurse retention rates. Clinical Chatter is an effective communication tool for presentation of institutional information to nursing personnel. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is classically defined as a dual clinicopathological entity. The recent advances in use of reliable biomarkers of AD that provide in-vivo evidence of the disease has stimulated the development of new research criteria that reconceptualise the diagnosis around both a specific pattern of cognitive changes and structural/biological evidence of Alzheimer's pathology. This new diagnostic framework has stimulated debate about the definition of AD and related conditions. The potential for drugs to intercede in the pathogenic cascade of the disease adds some urgency to this debate. This paper by the International Working Group for New Research Criteria for the Diagnosis of AD aims to advance the scientific discussion by providing broader diagnostic coverage of the AD clinical spectrum and by proposing a common lexicon as a point of reference for the clinical and research communities. The cornerstone of this lexicon is to consider AD solely as a clinical and symptomatic entity that encompasses both predementia and dementia phases. [ABSTRACT FROM AUTHOR]

Background: Peroral endoscopic myotomy (POEM) is a novel surgical option for the treatment of achalasia. Most centers perform a routine esophagram on postoperative day (POD) #1 to rule esophageal perforation and leaks. In this study, we sought to determine the clinical utility of routine contrast studies post-POEM.Methods: POEM was performed using an anterior submucosal tunnel and selective myotomy of the circular muscle layer. A routine contrast esophagram was obtained on POD #1. We conducted a retrospective review of the radiologists' interpretations of these studies and compared them to patient's clinical course.Results: Seventy-eight patients were included. Among these, two complications occurred. One patient was non-compliant with postoperative nil per os orders and developed epigastric pain suspicious for a leak that was demonstrated on esophagram. Another patient had subcutaneous emphysema on POD #1 esophagram, a finding that was also present on physical examination, without esophageal leakage. Another esophagram in an asymptomatic patient was suspicious for submucosal tunnel hematoma which prompted a return to the operating room with negative results. Overall, 56 patients had abnormal studies. POD #1 esophagram demonstrated a sensitivity of 100 % and specificity of 45 % in identifying clinically significant complications.Conclusions: In this series, we found routine esophagram to have a high sensitivity but a very low specificity in detecting clinically significant complications. Routine esophagram after POEM may not be necessary. [ABSTRACT FROM AUTHOR]

Background: Physician recommendation of colorectal cancer (CRC) screening is a critical facilitator of screening completion. Providing patients a choice of screening options may increase CRC screening completion, particularly among racial and ethnic minorities.Objective: Our purpose was to assess the effectiveness of physician-only and physician-patient interventions on increasing rates of CRC screening discussions as compared to usual care.Design: This study was quasi-experimental. Clinics were allocated to intervention or usual care; patients in intervention clinics were randomized to receipt of patient intervention.Participants: Patients aged 50 to 75 years, due for CRC screening, receiving care at either a federally qualified health care center or an academic health center participated in the study.Intervention: Intervention physicians received continuous quality improvement and communication skills training. Intervention patients watched an educational video immediately before their appointment.Main Measures: Rates of patient-reported 1) CRC screening discussions, and 2) discussions of more than one screening test.Key Results: The physician-patient intervention (n = 167) resulted in higher rates of CRC screening discussions compared to both physician-only intervention (n = 183; 61.1 % vs.50.3 %, p = 0.008) and usual care (n = 153; 61.1 % vs. 34.0 % p = 0.03). More discussions of specific CRC screening tests and discussions of more than one test occurred in the intervention arms than in usual care (44.6 % vs. 22.9 %,p = 0.03) and (5.1 % vs. 2.0 %, p = 0.036), respectively, but discussion of more than one test was uncommon. Across all arms, 143 patients (28.4 %) reported discussion of colonoscopy only; 21 (4.2 %) reported discussion of both colonoscopy and stool tests.Conclusions: Compared to usual care and a physician-only intervention, a physician-patient intervention increased rates of CRC screening discussions, yet discussions overwhelmingly focused solely on colonoscopy. In underserved patient populations where access to colonoscopy may be limited, interventions encouraging discussions of both stool tests and colonoscopy may be needed. [ABSTRACT FROM AUTHOR]

The National Postbaccalaureate Collaborative (NPBC) is a partnership of Postbaccalaureate Programs (PBPs) dedicated to helping promising college graduates from disadvantaged and underrepresented backgrounds get into and succeed in medical school. This study aims to determine long-term program outcomes by looking at PBP graduates, who are now practicing physicians, in terms of health care service to the poor and underserved and contribution to health care workforce diversity. Methods. We surveyed the PBP graduates and a randomly drawn sample of non-PBP graduates from the affiliated 10 medical schools stratified by the year of medical school graduation (1996-2002). Results. The PBP graduates were more likely to be providing care in federally designated underserved areas and practicing in institutional settings that enable access to care for vulnerable populations. Conclusion. The NPBC graduates serve a critical role in providing access to care for underserved populations and serve as a source for health care workforce diversity. [ABSTRACT FROM AUTHOR]

Problem Low enrollment and participation are common in face-to-face parenting interventions. Developing innovative delivery methods is one way to address participation barriers. The purpose of this study was to test the feasibility of a Web-based delivery model for an evidence-based behavioral parent training program. Methods Parents ( n = 9) completed two Web-based prototype sessions of the Chicago Parent Program delivered on an Android tablet over 2 weeks, and then participated in a post-intervention focus group. Quantitative and qualitative data were collected. Findings The Web-based delivery adaptation was feasible and useful for low-income urban parents. Conclusions Our preliminary findings suggest that Web-based delivery is a feasible approach to integrating mental health prevention into systems of care. Translating interventions to alternative delivery platforms is promising for nursing to increase access to evidence-based interventions. [ABSTRACT FROM AUTHOR]

Youth are increasingly seen as competent in participating in research and program evaluation, two activities previously reserved for adults. This article is a report of the findings from an evaluation audit of Stand Up! Help Out!, a participatory action after-school youth leadership development program for disadvantaged urban youth that utilized youth evaluations to develop a best practices service model. The youths' feedback assisted providers in improving services so that youth engagement in the program was 99% (by comparison with national highs of 79%). Here, the authors describe an important aspect of the process of youth-led program evaluation leading to such high youth engagement: how youth interviewed each other so as to optimize the authenticity of their program evaluations and contributions to program design. Drawing from over 5 years of program evaluation data collected by youth, the authors report on the youths' experiences as informants and coresearchers, consider strategies used to help youth best describe their experiences in the program, and describe implications for other settings looking to incorporate youth-led program evaluation. Youth-led program evaluation has considerable promise for helping service providers make programs more meaningful for disadvantaged youth. [ABSTRACT FROM AUTHOR]

The article mentions the Southern Seven Women's Initiative for Cardiovascular Health (SSWICH), a customized prevention model built on existing resources aimed for effective outreach to rural females in southern Illinois. Both behavioral and environmental factors pose high risk of cardiovascular disease to rural women. The article examines the success strategies such as collaborating with community partners, flexibility and responsiveness to challenges and opportunities and usage of mass media.

Background: Little is known about how often patients desire and experience discussions with hospital personnel regarding R/S (religion and spirituality) or what effects such discussions have on patient satisfaction. OBJECTIVE, DESIGN AND PARTICIPANTS: We examined data from the University of Chicago Hospitalist Study, which gathers sociodemographic and clinical information from all consenting general internal medicine patients at the University of Chicago Medical Center.Main Measures: Primary outcomes were whether or not patients desired to have their religious or spiritual concerns addressed while hospitalized, whether or not anyone talked to them about religious and spiritual issues, and which member of the health care team spoke with them about these issues. Primary predictors were patients' ratings of their religious attendance, their efforts to carry their religious beliefs over into other dealings in life, and their spirituality.Key Results: Forty-one percent of inpatients desired a discussion of R/S concerns while hospitalized, but only half of those reported having such a discussion. Overall, 32% of inpatients reported having a discussion of their R/S concerns. Religious patients and those experiencing more severe pain were more likely both to desire and to have discussions of spiritual concerns. Patients who had discussions of R/S concerns were more likely to rate their care at the highest level on four different measures of patient satisfaction, regardless of whether or not they said they had desired such a discussion (odds ratios 1.4-2.2, 95% confidence intervals 1.1-3.0).Conclusions: These data suggest that many more inpatients desire conversations about R/S than have them. Health care professionals might improve patients' overall experience with being hospitalized and patient satisfaction by addressing this unmet patient need. [ABSTRACT FROM AUTHOR]

Background: Cardiac auscultation is a core clinical skill. However, prior studies show that trainee skills are often deficient and that clinical experience is not a proxy for competence.Objective: To describe a mastery model of cardiac auscultation education and evaluate its effectiveness in improving bedside cardiac auscultation skills.Design: Untreated control group design with pretest and posttest.Participants: Third-year students who received a cardiac auscultation curriculum and fourth year students who did not.Intervention: A cardiac auscultation curriculum consisting of a computer tutorial and a cardiac patient simulator. All third-year students were required to meet or exceed a minimum passing score (MPS) set by an expert panel at posttest.Measurements: Diagnostic accuracy with simulated heart sounds and actual patients.Results: Trained third-year students (n = 77) demonstrated significantly higher cardiac auscultation accuracy compared to untrained fourth year students (n = 31) in assessment of simulated heart sounds (93.8% vs. 73.9%, p < 0.001) and with real patients (81.8% vs. 75.1%, p = 0.003). USMLE scores correlated modestly with a computer-based multiple choice assessment using simulated heart sounds but not with bedside skills on real patients.Conclusions: A cardiac auscultation curriculum consisting of deliberate practice with a computer-based tutorial and a cardiac patient simulator resulted in improved assessment of simulated heart sounds and more accurate examination of actual patients. [ABSTRACT FROM AUTHOR]

Objective: Performance consequences related to integrating an imperfect alert within a complex task domain were examined in two experiments.Background: Cockpit displays of traffic information (CDTIs) are being designed for use in airplane cockpits as responsibility for safe separation becomes shared between pilots and controllers. Of interest in this work is how characteristics of the alarm system such as threshold, modality, and number of alert levels impact concurrent task (flight control) performance and response to potential conflicts.Methods: Student pilots performed a tracking task analogous to flight control while simultaneously monitoring for air traffic conflicts with the aid of a CDTI alert as the threshold, modality, and level of alert was varied.Results: As the alerting system became more prone to false alerts, pilot compliance decreased and concurrent performance improved. There was some evidence of auditory preemption with auditory alerts as the false alarm rate increased. Finally, there was no benefit to a three-level system over a two-level system.Conclusion: There is justification for increased false alarm rates, as miss-prone systems appear to be costly. The 4:1 false alarm to miss ratio employed here improved accuracy and concurrent task performance. More research needs to address the potential benefits of likelihood alerting.Application: The issues addressed in this research can be applied to any imperfect alerting system such as in aviation, driving, or air traffic control. It is crucial to understand the performance consequences of new technology and the efficacy of potential mitigating design features within the specific context desired. [ABSTRACT FROM AUTHOR]

Background: Many scholars have written about the historical underpinnings and likely consequences of African Americans distrust in health care, yet little research has been done to understand if and how this distrust affects African Americans' current views of the trustworthiness of physicians.Objective: To better understand what trust and distrust in physicians means to African Americans.Design: Focus-group study, using an open-ended discussion guide.Setting: Large public hospital and community organization in Chicago, IL.Patients: Convenience sample of African-American adult men and women.Measurements: Each focus group was systematically coded using grounded theory analysis. The research team then identified themes that commonly arose across the 9 focus groups.Results: Participants indicated that trust is determined by the interpersonal and technical competence of physicians. Contributing factors to distrust in physicians include a lack of interpersonal and technical competence, perceived quest for profit and expectations of racism and experimentation during routine provision of health care. Trust appears to facilitate care-seeking behavior and promotes patient honesty and adherence. Distrust inhibits care-seeking, can result in a change in physician and may lead to nonadherence.Conclusions: Unique factors contribute to trust and distrust in physicians among African-American patients. These factors should be considered in clinical practice to facilitate trust building and improve health care provided to African Americans. [ABSTRACT FROM AUTHOR]

Outcome expectancies have been related to smoking behavior among adults, but less attention has been given to expectancies about smoking among adolescents at differing levels of smoking experience. The present study reports the psychometric properties and predictive validity of a brief expectancy scale across two samples of adolescents. Sample 1 (N = 349) consisted of high school students (54% female) who were regular smokers enrolled in a cessation program. Sample 2 (N = 273) consisted of 8th- and 10th-grade early experimenters (54% female) involved in a natural history study of smoking trajectories. In both samples, a principal component analysis of a 13-item expectancy scale yielded four factors (taste, weight control, boredom relief, and negative affect management), each with high internal consistency (coefficient alphas >.77) and accounting for 73% and 80% of the total variance for each sample, respectively. Expectancies were significantly higher among current smokers than among early initiators. In Sample 1, boredom relief and weight management expectancies predicted smoking status 6 months later. In Sample 2, students whose smoking increased over 18 months had higher overall expectancies at baseline compared with those who tried smoking and did not escalate. These findings support the predictive validity of expectancies in predicting escalation and cessation. Implications for the importance of expectancies in understanding adolescent smoking behavior are considered. [ABSTRACT FROM AUTHOR]

This study investigated the contributions of 5 mechanisms to the effects of preschool participation in the Child-Parent Centers for 1,404 low-income children in the Chicago Longitudinal Study. Based on a matched-group design, preschool participation was associated with significantly higher rates of educational attainment and lower rates of juvenile arrest. LISREL analysis revealed that the primary mediators of effects for both outcomes were attendance in high-quality elementary schools and lower mobility (school support hypothesis), literacy skills in kindergarten and avoidance of grade retention (cognitive advantage hypothesis), and parent involvement in school and avoidance of child maltreatment (family support hypothesis). The model accounted for 58% and 79% of the preschool links with school completion and juvenile arrest, respectively. The maintenance early intervention effects are influenced by many alterable factors. [ABSTRACT FROM AUTHOR]

Attending to a single voice when multiple voices are present is a challenging but common occurrence. An experiment was conducted to determine (a) whether presenting a video display of the target speaker aided speech comprehension in an environment with competing voices, and (b) whether the "ventriloquism effect" could be used to enhance comprehension, as found by Driver (1996), using ecologically valid stimuli. Participants listened for target words from videos of an actress reading while simultaneously ignoring the voices of 2 to 4 different actresses. Target-word detection declined as participants had to ignore more distracting voices; however, this decline was reduced when a video display of the target speaker was provided. Neither a signal-detection analysis of performance data nor a gaze-contingent analysis revealed a ventriloquism effect. Providing a video display of a speaker when competing voices are present improves comprehension, but obtaining the ventriloquism effect appears elusive in naturalistic circumstances. Actual or potential applications of this research include those circumstances in which a listener must filter a relevant stream of speech from among multiple, competing voices, such as air traffic control and military environments. [ABSTRACT FROM AUTHOR]

In the housing unit method, population is calculated as the number of households times the average number of persons per household (PPH), plus the population residing in group quarters facilities. Estimates of households and the group quarters population can be derived directly from concurrent data series, but estimates of PPH have traditionally been based on previous values or estimates for larger areas. In our study, we developed several regression models in which PPH estimates were based on symptomatic indicators of PPH change. We tested these estimates using county-level data in four states and found them to be more precise and less biased than estimates based on more commonly used methods. [ABSTRACT FROM AUTHOR]

The relation of patterns of family problems and patterns of delinquent behavior over time was evaluated among a sample of inner-city minority adolescent males. Empirically derived groups were identified and included: nonoffenders, chronic minor offenders, escalators, and serious chronic offenders. Patterns of family problems were also identified and differentially related to delinquency groups. Members of the group involved in serious chronic offending were more likely to have families characterized by multiple problems including disruption, conflict, and lack of parental involvement, sometimes so extreme as to meet the legal requirement of neglect. They were also more likely to have families characterized by deviant behavior and attitudes. The finding of specific relations between types of family problems and patterns of delinquent behavior has important implications for intervention and prevention. Rather than assuming a general relation between family functioning and delinquent involvement, specific aspects of family functioning may need to be targeted to affect different patterns of delinquent involvement. [ABSTRACT FROM AUTHOR]

We examine the effects of education, unemployment, and racial segregation on age-, sex-, and race-specific mortality rates in racially defined Chicago community areas from 1989 to 1991. Community socioeconomic factors account for large observed areal variations in infant and working-age mortality, but especially working-age mortality for the black population. For black men, the mortality consequences of living in economically distressed communities are quite severe. Segregation effects on mortality are more modest and largely operate through neighborhood socioeconomic conditions, although some direct effects of segregation on mortality for blacks are apparent. [ABSTRACT FROM AUTHOR]

We compared the actual diagnosis and treatmnent costs for nine colon cancer and 19 polyp patients detected by occult blood rsceening with excess hospitalization costs incurred by a comparable group of traditionally deteced patients. Program benefits were calculatedfrom data on group differentials in surgical length of stay, readmissions in the year following surgery, and preventive polvpectomnies. A sensitivity analysis was performed to evaluate varying estimates of ite per ientatge of polyps that may have become cancers, the urgency of presentation of clinically apparent cancer, and the inclusion or exclusion of the observed differences for hospitalization in the year after surgery. Two year program benefits varied from 59% to 185% of program costs. Adjusting estimates with DRG weightings for resource intensity produced considerably higher beneffis. All estimates ofprogram benefits are con ser ative because screened patients were compared with the 15-20% least severely ill, Most favorably staged of all traditionally detected colon cancer patients admitted. Results indicate that occult blood screening progranms may produce significant benefits derived from outpatient diagnosis, preventive polypectonmies, coordination of care between medical and surgical services, and enhanced patient education. [ABSTRACT FROM PUBLISHER]

Background: Breast cancer survival rates are significantly lower among African-American women compared to white women. In addition, African-American women with breast cancer are more likely than white women to die from co-morbid conditions. Obesity is common among African-American women, and it contributes to breast cancer progression and the development and exacerbation of many weight-related conditions. Intervening upon obesity may decrease breast cancer and all-cause mortality among African-American breast cancer survivors.Methods/design: Moving Forward is a weight loss intervention being evaluated in a randomized trial with a projected sample of 240 African American breast cancer survivors. Outcomes include body mass index, body composition, waist:hip ratio, and behavioral, psychosocial and physiological measures. Survivors are randomized to either a 6-month guided weight loss intervention that involves twice weekly classes and text messaging or a self-guided weight loss intervention based on the same materials offered in the guided program. The guided intervention is being conducted in partnership with the Chicago Park District at park facilities in predominantly African-American neighborhoods in Chicago. Recruitment strategies include direct contact to women identified in hospital cancer registries, as well as community-based efforts. Data collection occurs at baseline, post-intervention (6 months) and at a 12-month follow-up.Discussion: This study evaluates a community-based, guided lifestyle intervention designed to improve the health of African-American breast cancer survivors. Few studies have addressed behavioral interventions in this high-risk population. If successful, the intervention may help reduce the risk for breast cancer recurrence, secondary cancers, and co-morbid conditions, as well as improve quality of life.Trial Registration: U.S. Clinicaltrials.gov number: NCT02482506, April 2015. [ABSTRACT FROM AUTHOR]