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Though scholars agree that professional development (PD) is a key mechanism for implementing education policies that call for teacher change, and that PD generally needs to be content-focused, active, collaborative, coherent, and sustained, the application of this framework has yielded mixed results. In this qualitative study, we employed structured interviewing methods to explore how district leaders across five states are implementing college- and career- readiness (CCR) standards across the United States by creatively adapting and integrating the features of this PD framework in order to meet the demands of this mandated educational policy. We illustrate a revised model for how 70 district officials are conceptualizing these features of PD to support CCR standards-based learning.

Using state-representative teacher surveys in three states--Texas, Ohio, and Kentucky--we examine teachers' implementation of college- and career-readiness (CCR) standards. What do teachers report about the specificity, authority, consistency, power, and stability of their standards environment? How does their policy environment predict standards-emphasized instruction? Do these relationships differ for those who teach different subjects (math and English Language Arts [ELA]), different grades (elementary or high school), different populations (English Language Learners [ELLs], students with disabilities [SWDs]), and in different areas (rural, urban, or suburban)? We found elementary math teachers taught significantly more standards-emphasized content than elementary ELA teachers, whereas secondary ELA teachers taught significantly more standards-emphasized content than secondary math teachers. Teachers of SWDs and rural teachers taught significantly less of the emphasized content. In all three states, we found greater buy-in (authority) predicted increased emphasized content coverage among ELA teachers but not among math teachers. [For the corresponding grantee submission, see ED593919.]

Purpose: Our primary purpose is to examine the implementation of college- and- career- readiness content standards in Kentucky, Ohio, and Texas through the lens of distributed leadership theory, and to determine the affordances and challenges of this distributed leadership through the lens of policy attribute theory. Research Methods/Approach: We analyze data from 66 hour-long interviews of state and district administrators across the three states collected from Spring 2016 to Spring 2017. Using a deductive coding approach, we developed themes around distributed leadership as they pertain to the five attributes of policy implementation: specificity, consistency, authority, power, and stability. Findings: Using the distributed leadership and policy attribute theories, we find similar trends in state leaders distributing instructional leadership to regional, district, and organizational leaders to add specificity to the college and career readiness standards at the expense of compromising the consistency and power of the reform. This distribution of leadership is thought to contribute to the authority of the reform, though this authority is made tenuous by the instability of educational policies at the national and state levels. Implications: We highlight the need to examine the implementation of education policy using leadership frameworks and to understand leadership relationships between the state their regional and district partners. We extend the use of the distributed leadership theory beyond the K-16 level and the use of policy attribute theory to showcase where state actors can strengthen their reform initiatives. [The grantee submission for this article is ED589658.]

Mentoring is a common form of support for beginning teachers. State and district mentoring policies vary along a number of dimensions, yet policymakers have little evidence to draw on in designing effective mentoring programs. We use quantitative and qualitative data from a study of beginning middle school mathematics teachers in 10 districts to investigate the relationship of mentor policy features with the quality of mentoring received by new teachers. We find a strong and significant association indicating that mentors who have time during the day to meet with their new teachers are associated with higher-quality mentoring interactions. These results are supported through teacher interviews, and interviews also suggest that teachers experience better outcomes when mentors are located in the same school and have an evaluative role. These results suggest that proximity and availability may be particularly important features if mentors are to provide high-quality support to new teachers.

This article describes a community-based Patient Navigation (PN) project conducted to identify potential barriers to seeking follow-up cervical cancer care in southeastern Kentucky. Patient navigators (PNs) were placed in cervical cancer programs within county public health departments where they interviewed patients about their perceived barriers to seeking follow-up care after receiving a positive Pap test result. Participants identified various potential barriers at three levels: the individual/personal level, the health care system level and the community/environmental level. One identified barrier that was unique to this study was a lack of consistency between follow-up recommendations and follow-up guidelines for patients under age 21. Implications are discussed. [ABSTRACT FROM PUBLISHER]

Background: An emerging literature suggests that violence against women (VAW), particularly sexual violence, may increase the risk of acquiring a sexually transmitted infection (STI) and, therefore, may be associated with cervical cancer development. The purpose of this cross-sectional analysis was to determine if women who had experienced violence had higher prevalence rates of invasive cervical cancer. Methods: Women aged 18–88 who joined the Kentucky Women's Health Registry (2006–2007) and completed a questionnaire were included in the sample. Multivariate logistic regression analyses were used to adjust odds ratio (OR) for confounders (e.g., age, education, current marital status, lifetime illegal drug use, and pack-years of cigarette smoking). Results: Of 4732 participants with no missing data on violence, cervical cancer, or demographic factors, 103 (2.1%) reported ever having cervical cancer. Adjusting for demographic factors, smoking, and illegal drug use, experiencing VAW was associated with an increased prevalence of invasive cervical cancer (adjusted OR [aOR] = 2.6, 95% CI = 1.7-3.9). This association remained significant when looking at three specific types of VAW: intimate partner violence (IPV) (aOR = 2.7, 95% CI = 1.8-4.0), adult exposure to forced sex (aOR = 2.6, 95% CI = 1.6-4.3), and child exposure to sexual abuse (aOR = 2.4, 95% CI = 1.4-4.0). Conclusions: Rates of cervical cancer were highest for those experiencing all three types of VAW relative to those never experiencing VAW. Because VAW is common and has gynecological health effects, asking about VAW in healthcare settings and using this information to provide tailored healthcare may improve women's health outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Adherence to National Comprehensive Cancer Network (NCCN) guidelines for ovarian cancer treatment improves patient outcomes. The aim of this study was to assess disparities associated with ovarian cancer treatment in the state of Kentucky and central Appalachia.Methods: Data on patients diagnosed as having ovarian cancer from 2007 through 2011 were extracted from administrative claims-linked Kentucky Cancer Registry data. NCCN compliance was defined by stage, grade, surgical procedure, and chemotherapy. Selection criteria were reviewed carefully to ensure data quality and accuracy. Descriptive analysis, logistic regression, and Cox regression analyses were performed to examine factors associated with guidelines compliance and survival.Results: Most women were aged 65 years or older (62.5%) and had high-grade (65.9%) and advanced-stage (61.0%) ovarian cancer. Two-thirds of cases (65.9%) received NCCN-recommended treatment for ovarian cancer. The hazard ratio of death for women who did not receive NCCN-compliant care was 62% higher compared with the women who did receive NCCN-compliant treatment. Results from the logistic regression showed that NCCN-compliant treatment was more likely for women aged 65 to 74 years compared with women aged 20 to 49 years, late-stage compared with early-stage cancers, receipt of care at tertiary care hospitals, and privately insured compared with Medicaid or Medicare.Conclusions: When the treatment of ovarian cancer did not follow NCCN recommendations, patients had a significantly higher risk of death. Women were less likely to receive NCCN-compliant care if they were younger (20-49 years), had early-stage disease, did not have private insurance, or had care provided at a nontertiary care hospital. [ABSTRACT FROM AUTHOR]

Objectives: Uterine cancer is the nation's most common gynecologic malignancy, but it is understudied in the geographically and socioeconomically diverse state of Kentucky (KY). Our aim was to assess the frequency, distribution, and survival of uterine corpus malignancies in KY, and specifically the differences between Appalachia (AP) and non-Appalachia (NAP) KY.Methods: This population-based cohort study used Surveillance, Epidemiology, and End Results data and the Kentucky Cancer Registry to study uterine corpus malignancy between January 1, 2000 and December 31, 2014. The analysis looked at the incidence between diagnoses in AP and NAP. The evaluation criteria included tumor histology (type I, type II, sarcoma, and mixed uterine malignancy), age, race, smoking status, stage at diagnosis, insurance status, and county of residence at diagnosis.Results: The overall age-adjusted incidence rate and survival are similar for US and KY populations; however, histologic types and distribution differ. Compared with the United States, the incidence of corpus cancers in KY is higher for type I (P = 0.03), but lower for type II (P = 0.003), sarcoma (P = 0.006), and mixed (P < 0.001). AP KY has a higher incidence of type I (P < 0.0001) and mixed malignancy (P = 0.04), younger age at diagnosis (P < 0.0001), larger non-Hispanic white population (P < 0.0001), fewer smokers (P = 0.002), and more uninsured and Medicaid recipients (P < 0.0001) compared with NAP KY. The hazard ratio for death is similar in AP and NAP KY (0.896; 95% confidence interval 0.795-1.009).Conclusions: Type I and mixed uterine corpus cancers have a higher age-adjusted incidence and a younger age at diagnosis in AP compared with NAP KY. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To identify prognostic factors influencing cervical cancer survival for patients referred to a tertiary care center in Kentucky. Methods: A cohort study was performed to assess predictive survival factors of cervical cancer patients referred to the University of Kentucky from January 2001 to May 2010. Eligibility criteria included those at least 18years-old, cervical cancer history, and no prior malignancy. Descriptive statistics were compiled and univariable and multivariable Cox proportional hazard analysis were performed. Results: 381 patients met entry criteria. 95% were Caucasian (N=347) and 66% (N=243) lived in Appalachian Kentucky. The following covariates showed no evidence of a statistical association with survival: race, body mass index, residence, insurance status, months between last normal cervical cytology and diagnosis, histology, tumor grade, and location of primary radiation treatment. After controlling for identified significant variables, stage of disease was a significant predictor of overall survival, with estimated relative hazards comparing stages II, III, and IV to stage I of 3.09 (95% CI: 1.30, 7.33), 18.11 (95% CI: 7.44, 44.06), and 53.03(95% CI: 18.16, 154.87), respectively. The presence of more than two comorbid risk factors and unemployment was also correlated with overall survival [HR 4.25 (95% CI: 1.00, 18.13); HR 2.64 (95% CI 1.29, 5.42), respectively]. Conclusions: Residence and location of treatment center are not an important factor in cervical cancer survival when a tertiary cancer center can oversee and coordinate care; however, comorbid risk factors influence survival and further exploration of disease comorbidity related to cervical cancer survival is warranted. [Copyright &y& Elsevier]