Falls among older adults (OAs) living in retirement homes (RHs) in Canada are a major public health concern due to high morbidity and mortality as well as significant healthcare expenditures. This ...quality improvement (QI) initiative, conducted for the author's Doctor of Nursing Practice (DNP) project, aimed to decrease fall rates and ED transfers related to falls among OAs in six RHs across the Greater Toronto Area in Ontario, Canada through a multipart intervention with two primary goals. First, the project aimed to facilitate RH NPs' implementation of a comprehensive fall risk assessment and fall prevention strategy in their practice by incorporating the Stopping Elderly Accidents, Deaths & Injuries (STEADI) toolkit into their armamentarium. Second, it sought to enhance the knowledge of the RHs' registered practical nurses (RPNs), personal support workers (PSWs), and unregulated care providers (UCPs) in assessing fall risk and incorporating fall prevention strategies in their daily practice. By improving NP, RPN, PSW, and UCP knowledge and increasing (by 20%) RPN, PSW, and UCP use of fall prevention strategies, this QI initiative successfully reduced fall rates in the RHs by 40.4%, with no falls requiring transfer to the ED, in the postintervention period. The results of this project highlight the need for an interdisciplinary approach to fall risk reduction in RHs that includes implementation of multifactorial intervention strategies as well as effective organizational policies and procedures for maximum impact.
The purpose of this study is to examine first through fifth-grade teachers’ beliefs regarding whether technology integration relates to increased student academic performance. This study was created ...to analyze what the most influential factors are when it comes to using technology in the classroom that could increase student academic performance. This study revealed what encouraged teachers most when integrating technology into their instruction. Things that encouraged teachers gave them the knowledge and understanding to implement technology into a lesson with the proper professional development, infrastructure, and training. In this descriptive study, the researcher used a phenomenological qualitative research methodology. The researcher gained knowledge as the participants shared their feelings and described their perceptions from their own experiences. Approximately 40 current elementary school teacher participants in Texas addressed questions on the survey about these factors. The participants were purposefully selected and placed in categories based on their participation using technology and being a part of a district program called Innovate Academy/Level Up program. The instrumentation of the survey showed the variety of participants who gave their perceptions of how integrating technology affected them in the classroom, how it impacted student academic performance, and what programs, if any, were the cause of students excelling. The data collected came from two different means: (a) survey containing demographic questions and likert-type questions and (b) responses obtained in focus group interviews using the open-ended questions from the survey, as well as allowing participants to orally expand their thoughts through written responses. Information collected from the participants showed how teachers at this school taught evenly between students learning from the teacher directly and using technology as a tool with the curriculum. The participants showed how technology integration impacted student academic performance. Integrating technology has shown how it can be beneficial in so many ways for educators, administrators, students, parents, and society. As we continue to live in a world of constant change, it is shown that people will always need to be lifelong learners for the betterment of themselves and society.
Bladder cancer is the fifth most prevalent cancer in the U.S., yet is understudied, and few laboratory models exist that reflect the biology of the human disease. Here, we describe a biobank of ...patient-derived organoid lines that recapitulates the histopathological and molecular diversity of human bladder cancer. Organoid lines can be established efficiently from patient biopsies acquired before and after disease recurrence and are interconvertible with orthotopic xenografts. Notably, organoid lines often retain parental tumor heterogeneity and exhibit a spectrum of genomic changes that are consistent with tumor evolution in culture. Analyses of drug response using bladder tumor organoids show partial correlations with mutational profiles, as well as changes associated with treatment resistance, and specific responses can be validated using xenografts in vivo. Our studies indicate that patient-derived bladder tumor organoids represent a faithful model system for studying tumor evolution and treatment response in the context of precision cancer medicine.
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•Efficient generation of a biobank of patient-derived bladder cancer organoids•Organoids recapitulate the histological and molecular spectrum of human bladder cancer•Bladder tumor organoids display clonal evolution in culture and as xenografts•Drug response of organoids can be validated in xenografts
A biobank of patient-derived bladder tumor organoids faithfully recapitulates features of human cancer and enables analysis of clonal evolution and drug responses.
The demographics of patients undergoing heart transplantation in the United States have shifted over the last 10 years, with an increasing number of racial and ethnic minorities undergoing heart ...transplant. Multiple studies have shown that survival of African American patients after heart transplantation is lower compared with other ethnic groups. We review the data supporting the presence of this outcome disparity and examine the multiple mechanisms that contribute. With an increasingly diverse population in the United States, knowledge of these disparities, their mechanisms, and ways to improve outcomes is essential.
Current measures of food insecurity focus on economic access to food, but not on the physical aspect of food insecurity that captures the inability to access food or prepare meals. This is ...particularly relevant among the older adult population who are at a high risk of functional impairments.
To develop a short-form physical food security (PFS) tool among older adults using statistical methods based on the Item Response Theory (Rasch) model.
Pooled data from adults aged ≥60 y of the NHANES (2013-2018) (n = 5892) were used. The PFS tool was derived from the physical limitation questions included in the physical functioning questionnaire of NHANES. Item severity parameters, fit and reliability statistics, and residual correlation between items were estimated using the Rasch model. The construct validity of the tool was assessed by examining associations with the Healthy Eating Index (HEI)-2015 scores, self-reported health, self-reported diet quality, and economic food insecurity, using weighted multivariable linear regression analysis, controlling for potential confounders.
A 6-item scale was developed, which had adequate fit statistics and high reliability (0.62). It was categorized based on raw score severity into high, marginal, low, and very low PFS. Very low PFS was associated with respondent's self-reported poor health (OR = 23.8; 95% CI: 15.3, 36.9; P < 0.0001), self-reported poor diet (OR = 3.9; 95% CI: 2.8, 5.5; P < 0.0001), low and very low economic food security (OR = 6.08; 95% CI: 4.23, 8.76; P < 0.0001), and with lower mean HEI-2015 index score, in comparison to older adults with high PFS (54.5 compared with 57.5, P = 0.022).
The proposed 6-item PFS scale captures a new dimension of food insecurity that can inform on how older adults experience food insecurity. The tool will require further testing and evaluation in larger and different contexts to demonstrate its external validity.
Web-based surveys have become increasingly popular but response rates are low and may be prone to selection bias. How people are invited to participate may impact response rates and needs further ...study as previous evidence is contradictory. The purpose of this study was to determine whether response to a web-based survey of healthcare workers would be higher with a posted or an emailed invitation. We also report results of the pilot study, which aims to estimate the percentage of adults vaccinated against influenza who report recurrent systemic adverse events (the same systemic adverse event occurring successively following receipt of influenza vaccines).
The pilot study was conducted in November 2016 in Toronto, Canada. Members of a registry of adults (18 years and older and predominantly healthcare workers) who volunteered to receive information regarding future studies about influenza were randomly assigned to receive either an email or postal invitation to complete a web-based survey regarding influenza vaccinations. Non-respondents received one reminder using the same mode of contact as their original invitation.
The overall response rate was higher for those sent the invitation by email (34.8%) than by post (25.8%; p < 0.001) and for older versus younger participants (p
< 0.001). Of those who responded, 387/401 had been vaccinated against influenza at least once since adulthood. Of those responding to the question, 70/386 (18.1%) reported a systemic adverse event after their most recent influenza vaccine including 22 (5.7%) who reported a recurring systemic event. Systemic adverse events were reported more often by males 18-49 years old than by other groups (p = 0.01). Recurrent systemic adverse events were similar by age and sex with muscle ache being the most commonly reported recurrent reaction. More respondents who reported only a local adverse event (93.1%) planned to be vaccinated again next year than those with a systemic adverse event (69.7%; p = 0.04).
In this convenience sample of registry volunteers, response rates were generally low, but were higher for the emailed than posted invitations and for older than younger adults.
Purpose: Infant age at introduction of solid foods was examined, as were maternal characteristics associated with adherence to recommendations. Methods: In a telephone survey, 2153 mothers living in ...Ontario were asked questions about the age at which foods were introduced to their infants. Results: Eighteen percent of respondents introduced infant cereal before age four months, while 5% introduced it at age seven months or later. Mothers who introduced cereal either earlier or later than recommended had a lower household income and were less likely to have attended prenatal classes than were those who followed recommendations. Mothers who introduced cereal before their infants were four months old were more likely than were other mothers to be younger, not to be breastfeeding at three months, to have smoked during pregnancy, and to have someone who smoked inside the home. Mothers who introduced infant cereal after age seven months were more likely to be older, breastfeeding at three months, and mothering their second or later-born child than were mothers who introduced infant cereal as recommended. Conclusions: Small but distinct groups of mothers are introducing solid foods earlier or later than recommended. Educational and informational initiatives that target these parents may help increase the number of infants being fed as recommended.
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