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BackgroundCommunication within the circle of care is central to coordinated, safe, and effective care; yet patients, caregivers, and health care providers often experience poor communication and fragmented care. Through a sequential program of research, the Loop Research Collaborative developed a web-based, asynchronous clinical communication system for team-based care. Loop assembles the circle of care centered on a patient, in private networking spaces called Patient Loops. The patient, their caregiver, or both are part of the Patient Loop. The communication is threaded, it can be filtered and sorted in multiple ways, it is securely stored, and can be exported for upload to a medical record. ObjectiveThe objective of this study was to implement and evaluate Loop. The study reporting adheres to the Standards for Reporting Implementation Research. MethodsThe study was a hybrid type II mixed methods design to simultaneously evaluate Loop’s clinical and implementation effectiveness, and implementation barriers and facilitators in 6 health care sites. Data included monthly user check-in interviews and bimonthly surveys to capture patient or caregiver experience of continuity of care, in-depth interviews to explore barriers and facilitators based on the Consolidated Framework for Implementation Research (CFIR), and Loop usage extracted directly from the Loop system. ResultsWe recruited 25 initiating health care providers across 6 sites who then identified patients or caregivers for recruitment. Of 147 patient or caregiver participants who were assessed and met screening criteria, 57 consented and 52 were enrolled on Loop, creating 52 Patient Loops. Across all Patient Loops, 96 additional health care providers consented to join the Loop teams. Loop usage was followed for up to 8 months. The median number of messages exchanged per team was 1 (range 0-28). The monthly check-in and CFIR interviews showed that although participants acknowledged that Loop could potentially fill a gap, existing modes of communication, workflows, incentives, and the lack of integration with the hospital electronic medical records and patient portals were barriers to its adoption. While participants acknowledged Loop’s potential value for engaging the patient and caregiver, and for improving communication within the patient’s circle of care, Loop’s relative advantage was not realized during the study and there was insufficient tension for change. Missing data limited the analysis of continuity of care. ConclusionsFundamental structural and implementation challenges persist toward realizing Loop’s potential as a shared system of asynchronous communication. Barriers include health information system integration; system, organizational, and individual tension for change; and a fee structure for health care provider compensation for asynchronous communication.

The academic achievement gap is a persistent and pernicious educational challenge confounded with race and socioeconomic status. The achievement gap persists despite over three decades of interventions and federal, state, and local policies and initiatives meant to close it. We examine the achievement gap in one of the most diverse states in the United States, New Jersey. Across the 480 school districts in New Jersey, the school district racial makeup varies from almost complete segregation to high diversity. Using data-mining techniques on the statewide standardized test, the 2010-2011 New Jersey Assessment of Skills and Knowledge (NJ ASK) standard language arts literacy and mathematics, we found that test scores increased with increasing diversity. In particular, the achievement gap between Black and White third grade students was lower by more than 60% in racially diverse districts when compared to racially homogeneous districts. This result is consistent with theories of peer spillover effects that implicate peer racial diversity in reducing the achievement gap. A cluster analysis of New Jersey school districts revealed eight common profiles, which could inform school policy and practice aimed at improving school performance and closing the achievement gap.

Currently college promise programs are proliferating in number at the local and state levels. Most promise programs provide financial resources beyond conventional state and federal student aid to students who live in designated places and meet local- or state-defined eligibility criteria.There is an immense variety of models and funding designs for these programs. In this study, we conducted a rigorous content analysis of the public web sites for a diverse subsample of 35 promise programs to explore how college promise programs promote student academic and financial readiness. Although our analysis made it clear that there is more to learn about promise programs, including understanding general administrative processes and program operations, we highlight several design and implementation considerations that may increase the capacity of these programs to promote equity in higher education access and success.

An evaluation of the Princeton University Preparatory Program (PUPP), a college access program for low-income and high-achieving public high school students, yielded favorable findings regarding the perceptions of program alumni. PUPP Alumni Survey respondents (N =126) reported that PUPP had positively impacted their development of academic and social-emotional skills and their knowledge of college admissions and financial aid application processes and that they attended and graduated from college, including selective colleges, after completing PUPP. Some PUPP alumni believe that the program made college attendance a reality for them, while others believe PUPP enabled them to attend a more selective college than they otherwise would have. Although alumni were not immune from continued challenges, both financial and academic, during college, they tended to attribute their college enrollment and graduation successes at least in part to the personalized supports and resources PUPP provided.

The Princeton University Preparatory Program (PUPP) is a high-touch, intensive college access program aimed at providing a multiyear college preparation experience to high-achieving, low-income students in the Princeton, New Jersey, area. This report presents the theory of change and logic model of PUPP, detailing the theoretical basis for the expectation that PUPP inputs, resources, and activities will lead to the expected program outcomes, which include that program participants gain admittance to and graduate from selective colleges and universities providing comprehensive financial aid in the form of grants and scholarships.

Background: There is growing recognition of the importance of sex and gender differences within falls literature, but the characterization of such literature is uncertain. The aim of this scoping review was to (1) map the nature and extent of falls literature examining sex or gender differences among older adults, and (2) identify gaps and opportunities for further research and practice. Methods: We used a scoping review methodology. Eligible studies included participants with a mean age of ≥60 years and study aims specifying falls and either sex or gender concepts. MEDLINE, Embase, CINAHL, Ageline, and Psychinfo databases were searched from inception to March 2, 2022. Records were screened and charted by six independent reviewers. Descriptive and narrative reports were generated. Results: A total of 15,266 records were screened and 74 studies were included. Most studies reported on sex and gender differences in fall risk factors (n = 52, 70%), incidence/prevalence (n = 26, 35%), fall consequences (n = 22, 30%), and fall characteristics (n = 15, 20%). The majority of studies (n = 70, 95%) found significant sex or gender differences in relation to falls, with 39 (53%) identifying significant sex differences and 31 (42%) identifying significant gender differences. However, only three (4%) studies defined sex or gender concepts and only nine (12%) studies used sex or gender terms appropriately. Fifty‐six (76%) studies had more female participants than males. Four (5%) were intervention studies. Studies did not report falls in line with guidelines nor use common fall definitions. Conclusion: Sex and gender differences are commonly reported in falls literature. It is critical for future research to use sex and gender terms appropriately and include similar sample sizes across all genders and sexes. In addition, there is a need to examine more gender‐diverse populations and to develop interventions to prevent falls that address sex and gender differences among older adults. [ABSTRACT FROM AUTHOR]

Introduction: Physical activity (PA) is critical for disease prevention and maintaining functional ability with aging. Despite this, as many as 50% of older adults in populations worldwide are considered insufficiently active. There is a recognized need to mobilize policies targeted toward modifiable determinants of healthy aging like PA. This umbrella review aimed to summarize the evidence for determinants of PA in community-dwelling older adults. Methods: A research librarian searched six databases. Systematic and scoping reviews were included if they investigated community-dwelling people with a mean age of 60 + years and examined a relationship between a determinant and any type of PA. Two independent reviewers screened and extracted data from all reviews. JBI methodology and Critical Appraisal Checklist for Systematic Reviews and Research Syntheses were followed and information on the quality of the evidence was extracted. Results: From 17,277 records screened,11 reviews representing > 300 unique primary papers were ultimately included. Only 6% of studies included in all reviews had longitudinal designs. Included studies used a large variety of PA measures, with 76% using only self-report, 15% using only direct measures (e.g., accelerometry), 3% using both types, and 6% with no outcome measure reported. Only four reviews provided a definition of PA and there was substantial inconsistency in the way PA was categorised. Community level influences, which only included the physical environment, were the most commonly assessed (6/11) with more than 70% of the summarized relationships demonstrating null associations. Three out of four reviews reported a positive relationship between walkability and PA in general community-dwelling older adults. There was also evidence supporting relationships between presence of social support for PA, younger age, and men having higher PA from a single systematic review. None of the included reviews assessed the quality of evidence but over 60% performed a risk of bias assessment. Conclusions: Walkability, age, gender, and social support for PA were the most supported PA determinants identified. Further research should focus on interpersonal and intrapersonal influences and incorporate direct measures of PA with clear operational definitions. There is a need for longitudinal study designs to further understand determinants of PA behaviour trajectories. [ABSTRACT FROM AUTHOR]