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Using the social cognitive model of career self-management (CSM; Lent & Brown, 2013), we examined theory-based predictors of retirement planning goals, decisional anxiety, and level of decidedness. Participants were 525 older workers in the United States and Canada. We first examined the psychometric properties of new or revised social cognitive measures linked to retirement planning with part of the sample (n = 200) and then tested the stability of the factor structure with the remainder of the sample (n = 325). The measurement and structural models indicated good overall model-data fit in the larger sample and across most grouping variables (nationality, income level, and gender), and support was found for most of the paths predicting retirement planning, decisional anxiety, and level of decidedness. However, some gender differences were found in aspects of self-efficacy (confidence at time vs. financial management) that were predictive of decidedness. We consider the implications of the findings for future research and practice directions applying the social cognitive model to retirement planning. [ABSTRACT FROM AUTHOR]

The youth sport system in the United States is not achieving its full potential. There is a need to reimagine this system in ways that are evidence-based, innovative, and coordinated to best safeguard and promote the well-being of young people. The purpose of this expert commentary, composed by the President's Council on Sports, Fitness & Nutrition Science Board, is to propose a set of changes across multiple levels of influence (e.g., individual, family, school, organization) that could cultivate a more developmentally sound youth sport system. By advancing the vision of the National Youth Sports Strategy to provide quality youth sport to all young people in the country, these changes have substantial potential to benefit young people. [ABSTRACT FROM AUTHOR]

In addition to extensive preclinical testing, commercialization of medical devices in the United States under some circumstances may be supported with clinical data derived from single arm studies where the clinical endpoint is compared with a performance goal (PG). Since the performance is expected to be different between two clinically defined mutually exclusive patient subpopulations, the use of weighted PG is often adopted. In this article, we discuss the limitations of the current practice where weights need to be prespecified and fixed, and we propose an alternative approach that relaxes the fixed weight requirements. [ABSTRACT FROM AUTHOR]

Purpose: The purpose is to explore experiences transitioning home from acute hospital care from perspectives of younger traumatic brain injury (TBI) patients, family caregivers and healthcare providers (HCPs). Design/methodology/approach: The authors conducted 54 qualitative interviews (N = 36: 12 patients, 8 caregivers, 16 HCPs) and analyzed data using conventional content analysis. Findings: The transition from hospital to home was described as a negotiation, finding a way through these obstacles: (1) preparing for discharge home during acute hospital care; (2) navigating transitions in healthcare and health; (3) addressing recovery concerns, and (4) setting goals to return to normal. Factors influencing the negotiation process included social support, health-related knowledge or training, coping mechanisms, financial stability, and home environment stability. Originality/value: Younger TBI patients and caregivers have unique needs during the transition home from the hospital. Needed support from HCPs was inconsistently provided. Findings are foundational for integrated care research and practice with TBI. [ABSTRACT FROM AUTHOR]

Three experiments were conducted to test whether an enhanced degree of fair behavior could be obtained by making justice a goal, whether consciously set, primed, or both. Each experiment assessed fairness in a competitive negotiation context. All participants, across the three experiments, were asked to attain a base-level performance goal. The first experiment examined how a negotiation is affected by a consciously set goal for fairness as well as a primed fairness goal. The results revealed that both the conscious and the primed goal enhanced a participant's fairness. The second and third experiments examined the underlying mediating mechanisms of the effects found in the first experiment. Overall, the results of three experiments indicate that both conscious and primed goals, individually or in combination, can increase fair behavior by enhancing justice saliency. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Trade shows continue to be second only to personal selling in business-to-business promotion. Exhibitors around the world seek to attract the proper attendees into their booths (stands), but design advice for accomplishing exhibitor goals is lacking. Designs intended to appeal to attendees indiscriminately only crowd booths with nonbuyers. Given the diversity of exhibitor goals, attendee motives and potential booth designs, exhibitors need to carefully weigh competing design elements. The theoretical underpinnings of retail atmospherics, service escapes and prior trade show research are juxtaposed with observations from a very large international industrial trade show. A variety of observations and interviews with marketing managers provide data from small to large exhibitors. A framework is proposed linking various design elements to specific exhibitor goals and attendee roles. [ABSTRACT FROM PUBLISHER]

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on goal- and client-directed interventions to improve psychosocial outcomes for people with traumatic brain injury. [ABSTRACT FROM AUTHOR]

In the article, the author discusses the role of the U.S. Veterans Health Administration's (VHA) Innovators Network (iNET) in promoting innovative technologies in health care and cultural revolution. Other topics include various medical innovations over the years like the implantable cardiac pacemaker in 1960 and the nicotine patch in 1984, and the major human-centered design projects launched by Department of Veterans Affairs medical centers (VAMC) to promote innovation.

Background: During October 2016 through May 2018, a learning community was convened to focus on policies and programs to increase access to the full range of contraceptive options for women of reproductive age. The Increasing Access to Contraception (IAC) Learning Community included 27 jurisdictions, with teams from each jurisdiction consisting of state health department leaders, program staff, and provider champions. At the kick-off meeting, teams from each jurisdiction created action plans that outlined their goals. Methods: We contacted jurisdictions during May–June 2019, 1 year after the learning community ended, and invited them to complete a post-assessment of goal achievement and sustainment through semi-structured interviews over the telephone or via email. Results: Follow-up information was collected from 26 jurisdictions (96%) that participated in the learning community. The teams from these jurisdictions had created 79 total goals. At the time of the learning community closing meeting in May 2018, 35 goals (44%) had been achieved. Three jurisdictions achieved all their goals by the close of the learning community. At the time of the post-assessment 1 year later, jurisdictions were sustaining efforts for 69 (87%) of the total goals. In every jurisdiction, work on at least one goal that originated in the learning community was sustained. Conclusions: The jurisdictions that participated in the IAC Learning Community continued the work of their action plan goals 1 year after the formal closure of the learning community, indicating sustainability of the learning community activities, beyond what jurisdictions accomplished during formal participation. [ABSTRACT FROM AUTHOR]

This scoping review focused on answering key questions about the focus, quality and generalisability of the quantitative evidence on the determinants of adherence to social distancing measures in research during the first wave of COVID-19. The review included 84 studies. The majority of included studies were conducted in Western Europe and the USA. Many lacked theoretical input, were at risk for bias, and few were experimental in design. The most commonly coded domains of the TDF in the included studies were 'Environmental Context and Resources' (388 codes across 76 studies), 'Beliefs about Consequences' (34 codes across 21 studies), 'Emotion' (28 codes across 12 studies), and 'Social Influences' (26 codes across 16 studies). The least frequently coded TDF domains included 'Optimism' (not coded), 'Intentions' (coded once), 'Goals' (2 codes across 2 studies), 'Reinforcement' (3 codes across 2 studies), and 'Behavioural Regulation' (3 codes across 3 studies). Examining the focus of the included studies identified a lack of studies on potentially important determinants of adherence such as reinforcement, goal setting and self-monitoring. The quality of the included studies was variable and their generalisablity was threatened by their reliance on convenience samples. [ABSTRACT FROM AUTHOR]

Purpose: Speech-language pathologists (SLPs) who work with people with aphasia focus on assessment and intervention to support improved communication outcomes for their clients. Friendship, a key component of quality of life, often depends on communicative interaction, and many people with aphasia report having reduced social circles. The purpose of this study was to explore the perceptions of SLPs working with clients with aphasia on their role in supporting friendship development and maintenance. Method: An online survey composed of questions addressing SLP perspectives and goal setting, assessment, and treatment practices related to aphasia and friendship was distributed to SLPs across the United States. Survey data were analyzed using both quantitative and qualitative methods. Results: Forty-seven SLPs completed the survey. While many SLPs reported that the friendships of their clients with aphasia were impacted by aphasia and that it was within their scope of practice to support friendship development and maintenance, many did not specifically assess or target friendship and friendship outcomes in the treatment plan. SLPs identified barriers and facilitators to focusing on friendship within the context of speech and language therapy. Conclusions: Findings suggest the majority of participating SLPs were interested in addressing friendship with clients with aphasia; however, they experienced barriers in practice. Further examination of SLP perspectives and clinical practice regarding friendship and aphasia is warranted. Additionally, research investigating effective assessment and therapeutic methods that target friendship in aphasia is needed to support clinical practice and the well-being of clients with aphasia. [ABSTRACT FROM AUTHOR]

The importance of online learning has been highlighted by higher education, and online program administrators have looked for management strategies to establish competitive advantages through student satisfaction and loyalty. This research investigated the roles of various learning motivations (i.e., autonomous motivation, external motivation, need achievement, goal setting, social comparison, and reinforcement), perceived value, and satisfaction to predict students' loyalty toward an online program in the MBA context. Data were collected from online panel members of Qualtrics who were currently enrolled in online MBA programs in the United States. The empirical findings identify that perceived value was significantly influenced by external motivation, need achievement, goal setting, and reinforcement. MBA program satisfaction was positively affected by need achievement and reinforcement, and loyalty toward an MBA program was significantly influenced by perceived value and MBA program satisfaction. Overall, these results indicate the relative importance of each learning motivation for predicting online students' loyalty. [ABSTRACT FROM AUTHOR]

Importance: Occupational therapy practitioners can play a pivotal role in supporting breastfeeding mothers as they transition to and form new routines for this occupation. Objective: To explore whether occupational therapy programming can assist breastfeeding mothers in reaching their personal occupation-based wellness goals. Design: Mixed-methods design that involved development of an occupational profile and a goal attainment scale (GAS). After the intervention, participants rescored their GAS goals and completed a semistructured exit interview. Setting: Nonprofit lactation center located in the suburbs of a large mid-Atlantic U.S. city. Participants: Women recruited through convenience sampling who had been breastfeeding an infant for <6 mo, who were not currently weaning, and who had met with a lactation consultant at least once since giving birth were eligible (N = 17). Intervention: Group occupational therapy that consisted of 10 weekly 1-hr sessions. Topics were based on occupational profiles, GAS scores, and lactation consultant input. Outcomes and Measures: Each participant created and scored three goals using the GAS before and after the intervention. Results: Data from 14 of the 17 participants were analyzed. The average postintervention GAS score was 56.50 (M = 50), indicating that most personal wellness goals were reached. Thematic analysis revealed that occupational therapy programming helped mothers persevere with breastfeeding, feel more confident as new parents, and value both themselves and their baby. Conclusions and Relevance: There is an increasing role for occupational therapy practitioners in helping new mothers reach their personal wellness goals in ways that support their ability to continue breastfeeding. What This Article Adds: Maternal wellness and breastfeeding represent an emerging area of practice in which occupational therapy practitioners can provide new mothers with physical, social, and psychological supports that help them maintain self-efficacy related to breastfeeding and other meaningful occupations. This study provides foundational evidence in support of this collaboration. Maternal wellness and breastfeeding is an emerging area of practice in which occupational therapy practitioners can provide new mothers with supports that help them maintain self-efficacy related to breastfeeding and other meaningful occupations. [ABSTRACT FROM AUTHOR]

The main objective of this study was to examine the clearance rates of violent and non-violent offenses in the United States for the years 2011 to 2018. This study focused specifically on the differences in clearance rates of incidents involving crimes against persons, crimes against property, and crimes against society. The analyses are based on the FBI's NIBRS data that have been reported by local, state, and federal law enforcement agencies for 8 years combined. The analyses focused on the characteristics of the distribution of clearance rates by the types of incidents. The clearance rates were calculated based on the number of incidents that were cleared by arrest or exceptional means. The results show that the average clearance rate for incidents involving crimes against persons is 48.6%, for incidents involving property crimes is 18%, and for incidents involving crimes against society is 78%. The trend analyses show that the clearance rates are gradually decreasing for all three types of offense categories. [ABSTRACT FROM AUTHOR]

Women in the United States continue to experience intimate partner violence (IPV) at unprecedented rates, necessitating the development and implementation of personalized, effective healthcare-based interventions. Methods of developing patient-centered interventions for IPV should elicit the voice of the target population (i.e., women who experience IPV) while assuring that outcomes identified as important are incorporated into the refined intervention. This pilot study is part of a multiphase, larger study aiming to refine an IPV intervention and clinical outcome measurements prior to formal evaluation of the effectiveness of the intervention. Specifically, this study elucidates patient-centered outcomes identified by women who have experienced IPV. Women patients of the Veterans Health Administration (VHA) in New England participated in focus groups to provide feedback and desired outcomes of a new IPV intervention. Patient-centered outcomes were defined by the participants. Focus groups were transcribed and analyzed using conventional content analysis and matrix analysis. A total of 25 women participated in focus groups (n = 5) at two large VHA facilities. Participant feedback revealed five common themes related to desired outcomes. Women opined increased feelings of empowerment as a key outcome of engaging in an IPV intervention. Women desired increased social connectedness and support to be gained during treatment, citing providers and other survivors of IPV as exemplary sources. Self-esteem was viewed as critical to enhancing recovery, as was increased knowledge across domains of IPV (e.g., warning signs, the link between mental and physical health for self and children). Finally, women identified valued action and goal setting, such as achieving more independence, as an optimal outcome. Addressing IPV against women requires patient-centered interventions that specifically target the types of outcomes deemed important by the end users: women who experience IPV. Findings have implications for tailoring treatments for IPV and selecting measures that tap into women's desired outcomes. [ABSTRACT FROM AUTHOR]

AIM: The aim of this research was to identify factors that facilitated successful completion of a prelicensure registered nursing program for African American men. BACKGROUND: Successful completion of prelicensure nursing programs by African American men can increase diversity in the nursing profession. Further investigation is needed to understand the factors that can lead to success in completing prelicensure programs. METHOD: An explanatory, multiple-case study design was used to explore the personal characteristics, perspectives, and life events of African American men who completed prelicensure nursing programs. RESULTS; The five factors that influenced success were establishing goals, securing financial resources, maintaining family as a support system, meeting academic expectations, and developing a sense of belonging. CONCLUSION: Recommendations for how nurse educators can implement strategies to promote success for this population of students are discussed. [ABSTRACT FROM AUTHOR]

There is a dearth of available supports and services aimed specifically at parents with disabilities. The Parent-Centered Planning (PCP) intervention was developed to fill this gap, aiming to enhance supports for parenting for parents with disabilities. This brief approach was modeled after person-centered planning, with a focus specifically on parenting. This qualitative paper explores the experiences of a sample of parents (N = 13) with physical, intellectual and/or developmental disabilities who participated in a pilot study of PCP. Our study found that nearly all parents participating in the intervention strengthened relationships during the process of participation in PCP, clarified their goals related to parenting, and made progress toward their identified goals. The study also found that parents had mental health concerns, often related specifically to their disability supports. The article describes the nuances of these findings and discusses the implications for practice and future research. [ABSTRACT FROM AUTHOR]

Forty-four elementary grade teachers of deaf and hard of hearing students were surveyed about how they taught writing and their beliefs about writing. Beliefs about writing included their self-efficacy to teach writing, attitude toward writing, and epistemological beliefs about writing. These teachers from fifteen different states in the United States slightly agreed that they were efficacious writing teachers and they were slightly positive about their writing. They slightly agreed that learning to write involves effort and process, moderately disagreed that writing development is innate or fixed, slightly disagreed that knowledge about writing is certain, and were equally split about whether writing knowledge comes from authorities and experts. On average, teachers applied the twenty-two instructional writing practices surveyed at least once a month. They reported their students wrote weekly, and their writing was supported through goal setting, feedback, and prewriting activities. Writing instruction mostly focuses on teaching grammar and how to plan compositions. Teacher self-efficacy uniquely and statistically predicted reported teaching practices after attitude toward writing, and epistemological beliefs were first controlled. Recommendations for future research and implications for practice are presented. [ABSTRACT FROM AUTHOR]

This commentary is a call to action: that all patients with cancer and their families should receive care that aligns with their values and unique priorities. This is the vision of the Improving Goal Concordant Care (IGCC) Initiative, convened by the Alliance of Dedicated Cancer Centers (ADCC). [ABSTRACT FROM AUTHOR]

Context: Existing theoretical frameworks and empirical research support the applicability and usefulness of integrating mental skills throughout sport injury rehabilitation. Objective: To determine what, if any, mental skills athletes use during injury rehabilitation, and by who these skills were taught. Cross-cultural differences were also examined. Design: Cross-sectional design. Setting: College athletes from 5 universities in the United States and a mixture of collegiate, professional, and recreational club athletes from the United Kingdom and Finland were recruited for this study. Participants: A total of 1283 athletes from the United States, United Kingdom, and Finland, who participated in diverse sports at varying competitive levels took part in this study. Main Outcome Measures: As part of a larger study on athletes' expectations of injury rehabilitation, participants were asked a series of open-ended and closed-ended questions concerning their use of mental skills during injury rehabilitation. Results: Over half (64.0%) of the sample reported previous experience with athletic training, while 27.0% indicated that they used mental skills during injury rehabilitation. The top 3 mental skills reported were goal setting, positive self-talk/positive thoughts, and imagery. Of those athletes that used mental skills, 71.6% indicated that they felt mental skills helped them to rehabilitate faster. A greater proportion of athletes from the United States (33.4%) reported that they used mental skills during rehabilitation compared with athletes from the United Kingdom (23.4%) and Finland (20.3%). A small portion (27.6%) of the participants indicated that their sports medicine professional had taught them how to use mental skills; only 3% were taught mental skills by a sport psychologist. Conclusions: The low number of athletes who reported using mental skills during rehabilitation is discouraging, but not surprising given research findings that mental skills are underutilized by injured athletes in the 3 countries examined. More effort should be focused on educating and training athletes, coaches, and sports medicine professionals on the effectiveness of mental training in the injury rehabilitation context. [ABSTRACT FROM AUTHOR]

Amid evidence of limited financial benefit, universities in the United States continue increasing their commitment to the NCAA's highest level of competition. Consequently, it is believed that such behavior is the result of more intangible motivations by university decision makers. Using escalation of commitment theory as a framework, the authors explored social and structural determinants of increasing commitment, specifically examining the role of organizational status, former performance, and side-bets in commitment escalation. Applying a collective case study approach, the authors examined institutions (N = 10) having increased their commitment to Division I athletics within the last 10 years. Serving as the primary data source, participants (n = 35) included decision makers involved in the implementation of escalation initiatives. QSR International's NVivo 10 software was employed for data analysis in the application of a three-step coding process. Findings revealed unique theoretical advancement in the emergence and role of organizational status in commitment escalation. Further, decision makers identified the impact of former organizational performance in the decision to increase athletic commitment. Finally, findings revealed the increased significance of organizational side-bets serving as the sole means for sustaining course of action commitment. [ABSTRACT FROM AUTHOR]

Problem: Medical students perceive honors grading during core clerkships as unfair and inequitable, and negatively impacting their learning and wellbeing. Eliminating honors grading, a powerful extrinsic motivator, and emphasizing formative feedback may address these problems and promote intrinsic motivation and learning. However, it is unknown how transitioning from honors to pass/fail grading with enhanced formative feedback in the core clerkship year may affect student learning experiences, wellbeing, and perceptions of the learning environment. Intervention: Core clerkship grading was transitioned from honors/pass/fail to pass/fail at one US medical school. In addition, the requirement for students to obtain formative supervisor feedback was formalized to twice per week. Context: This qualitative study utilized semi-structured interviews to explore the perceptions among core clerkship students of learning and assessment. Interview questions addressed motivation, wellbeing, learning behaviors, team dynamics, feedback, and student and supervisor attitudes regarding assessment changes. The authors analyzed data inductively using thematic analysis informed by sensitizing concepts related to theories of motivation (goal orientation theory and self-determination theory). Impact: Eighteen students participated, including five with experience in both honors-eligible and pass/fail clerkships. The authors identified three major themes in students' descriptions of the change in approach to assessment: student engagement in clerkships, wellbeing, and recognition of learning context. Student engagement subthemes included intrinsic motivation for patient care rather than performing; sense of agency over learning, including ability to set learning priorities, seek and receive feedback, take learning risks, and disagree with supervisors, and collaborative relationships with peers and team members. Positive wellbeing was characterized by low stress, sense of authenticity with team members, prioritized physical health, and attention to personal life. Learning context subthemes included recognition of variability of clerkship contexts with pass/fail grading mitigating fairness and equity concerns, support of the grading change from residents and some attendings, and implications surrounding future stress and residency selection. Lessons Learned: Students perceive a transition from honors grading to pass/fail with increased feedback as supporting their engagement in learning, intrinsic motivation, and wellbeing. Drivers of wellbeing appear to include students' feelings of control, achieved through the ability to seek learning opportunities, teaching, and constructive feedback without the perceived need to focus on impressing others. Ongoing evaluation of the consequences of this shift in assessment is needed. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the extent to which social work PhD students are achieving the aspirational goals set forth by the Group for the Advancement of Doctoral Education in Social Work (GADE). Topics covered include the productivity rates of students on the job market with regards to publication, author order, presentations and teaching, and their productivity measures based on the ranking of the school of social work that are offering the PhD program.

The construct of flow has been associated with a plethora of positive work outcomes such as performance, engagement, and reduced burnout. However, flow is understudied in the domain of work and there is a lack of empirical examinations of flow interventions. Additionally, until recently, the vast majority of research examining flow at work assumes that individuals are passive agents who only experience flow when their working conditions facilitate the state. Therefore, the study tested a 'SMART' goal‐setting nudge intervention for individuals, aimed at increasing flow at work and its positive outcomes. Results of a 5‐day experimental experience sampling study with 65 American MTurk workers (who work full‐time besides MTurk) indicate that those in the goal‐setting condition experienced more flow at work and subsequently experienced less daily stress, as well as higher engagement and subjective performance when compared to the control group. Exploratory analyses revealed that flow decreased later in the week within‐day for participants in the control group, whereas flow remained relatively stable within‐day for those in the goal‐setting condition. Moreover, certain categories of goals, such as mastery goals, resource acquisition goals, and understanding goals, were found to be significant predictors of daily flow. Practitioner points: Flow at work predicted daily stress, daily performance, and work engagement.Self‐determination strategies (Occupat Health Sci, 1, 2017, 47), such as goal setting, can increase the amount of flow experienced at work and its subsequent positive outcomes.Nudges (Nudge: Improving decisions about health, wealth, and happiness, Yale University Press, 2008) can provide reminders for individuals to engage in behaviors that help them to experience flow and its positive work outcomes.A proposed model was supported as a framework practitioners can use to better understand flow at work along with its antecedents and outcomes. [ABSTRACT FROM AUTHOR]

Objective: Dual Eligible Special Needs Plans (D-SNPs) were intended to provide better care for beneficiaries eligible for both Medicare and Medicaid through better coordination of these two programs.Data Sources: 671 913 dual eligible (DE) respondents to the 2009-2019 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.Study Design: We compared the 2015-2019 experiences of DE beneficiaries in D-SNPs relative to fee-for-service Medicare (FFS) and non-SNP Medicare Advantage (MA) using propensity-score weighted linear regression. Comparisons were made to 2009-2014. 12 patient experience measures were considered.Data Collection Methods: Annual mail survey with telephone follow-up of non-respondents.Principal Findings: More than 65% of DE beneficiaries enrolled in FFS. Of 12 measures, D-SNP performance was higher than non-SNP MA on two (P < .05), lower than non-SNP MA on two (P < .05), and higher than FFS on four (P < .01). DE beneficiaries did not report better coordination of care in D-SNPs. D-SNP performance was often worse than other coverage types in prior periods.Conclusions: Relative to FFS Medicare, DE beneficiaries report higher immunization rates in D-SNPs, but slight or no better performance on other dimensions of patient experience. New requirements in 2021 may help D-SNPs attain their goal of better care coordination. [ABSTRACT FROM AUTHOR]

The current study aimed to benefit from the experience of the United States of America in supporting the competencies of STEM schools principals in Egypt, To achieve this goal the study used the comparative approach, by addressing the theoretical framework for science, technology, engineering and mathematics (STEM) education, and addressing the competencies of STEM schools principals as mentioned in contemporary educational literature. The study also presented the most important features of the United States of America experience in supporting the competencies of STEM schools principals in light of the cultural context. Then the study touched upon the Egyptian efforts in the field of interest in supporting the competencies of STEM schools principals in light of the cultural context, in addition to clarify the most important problems facing STEM school principals, then to highlight the similarities and differences in the area of interest in supporting the competencies of STEM schools principals, and in the end the study reached some proposed mechanisms that contribute to supporting the competencies of STEM schools principals in Egypt in light of the benefit from the United States of America experience. [ABSTRACT FROM AUTHOR]

Purpose: This article reviews the missions of the U.S. Department of Veterans Affairs (VA) and the evolution of its electronic health record (EHR), the Veterans Health Information Systems and Technology Architecture (VistA). This system, along with its clinical graphical user interface the Computerized Patient Record System, form a key link in VA health care. A Veteran who receives healthcare through the VA can have their EHR accessed by clinicians at any VA healthcare facility across the United States and its territories. Data aggregated daily at a corporate data warehouse supports VA quality improvement and research. Organizing Construct: Serving over 9 million Veterans, the VA is one of the largest integrated healthcare systems in the United States. It has been a leader in the development and use of healthcare informatics, EHR, and big data analytics for over 30 years. Nurses engaged in major roles in the evolution of these developments. Conclusions: With over 500 nurses as members, the Office of Nursing Informatics' Field Alliance demonstrates the VA's continuing commitment to fostering nursing informatics. The commitment includes investment by the VA to develop nursing informaticists from among its own staff. Clinical Relevance: Exemplars of the impact of nursing informatics are shared. Future directions include an EHR that begins during military service and follows the Veteran into VA health care. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. OBJECTIVE: The aim of this study was to measure structural empowerment (SE) and capture short-term changes in perception for senior nurse leaders before and after a formal development experience. BACKGROUND: The body of literature related to SE in senior nurse leaders is limited. Applying the SE concept to senior levels of nursing leadership provides a vehicle to impact nurse leader retention and ultimately the organization beyond singular units. METHODS: The Advanced Leadership Program (ALP) was designed in collaboration with the American Nurses Association to support personal and professional development for senior nurse leaders. The sample included 28 participants from the United States and the United Kingdom over a 6-month period. RESULTS: The effect of the intervention was seen in the postintervention survey rating SE higher in 5 of 7 domains as compared with the preintervention survey, reduction in overall turnover, and improvements in patient experience scores. Additionally, the participants evaluated the program in top categories, and comments were highly positive around peer support, improved working relationships, and expectations. CONCLUSION: The ALP has shown promise in strengthening SE for senior nurse leaders by supporting leadership skill development, follow-up training, and peer network development. [ABSTRACT FROM AUTHOR]

Nursing leadership is impactful now more than ever. With over 4 million nurses in the United States, the positive power of nursing leadership is making a significant difference in improving the nation's health by promoting a culture of health and addressing the social determinants of health in communities across America. [ABSTRACT FROM AUTHOR]

Ambidextrous firms are those that can simultaneously manage exploitative and explorative innovation, which is why ambidexterity is key for firms that desire to pursue strategic entrepreneurship. Researchers have explored many of the reasons why some firms are more ambidextrous than others. However, little attention has been devoted to understanding how attributes of top decision makers can influence their firms' ambidexterity. By drawing on upper echelons theory and goal orientations research, we explain how firms' ambidexterity can be affected by top decision makers' motivations in achievement situations (i.e., goal orientations). Testing our hypotheses on a sample of 274 top decision makers of firms in the United States, we find that top decision makers' learning goal orientation – their desire to take risks and maximize learning–has an inverted U-shaped relationship with ambidexterity while top decision makers' performance prove goal orientation – their desire to demonstrate competence with existing skills – has a U-shaped relationship with ambidexterity. These effects are weaker for top decision makers who have greater role experience. [ABSTRACT FROM AUTHOR]

Background: Palliative care-related postdoctoral training opportunities are critical to increase the quantity and quality of palliative care research. Objective: To describe the history, activities, challenges, and future goals of the National Postdoctoral Palliative Care Research Training Collaborative. Design: National web-based survey of participating program leaders. Measurements: Information about participating programs, trainees, challenges faced, and future goals. Results: Nine participating programs at academic institutions across the United States focus on diverse aspects of palliative care research. The majority of 73 current and former fellows are female (75%) and white (84%). In total, 38% of fellows (n = 28) have MD backgrounds, of whom less than half (n = 12) completed hospice and palliative medicine fellowships. An additional 38% of fellows (n = 28) have nursing PhD backgrounds and 23% (n = 17) have other diverse types of PhD backgrounds. Key challenges relate to recruiting diverse trainees, fostering a shared identity, effectively advocating for trainees, and securing funding. Future goals include expanding efforts to engage clinician and nonclinician scientists, fostering the pipeline of palliative care researchers through expanded mentorship of predoctoral and clinical trainees, increasing the number of postdoctoral palliative care training programs, and expanding funding support for career development grants. Conclusion: The National Postdoctoral Palliative Care Research Training Collaborative fills an important role in creating a community for palliative care research trainees and developing strategies to address shared challenges. [ABSTRACT FROM AUTHOR]

Background:Stroke is the leading cause of serious long-term disability in the United States. Barriers to rehabilitation include cost, transportation, lack of trained personnel, and equipment. Telerehabilitation (TR) has emerged as a promising modality to reduce costs, improve accessibility, and retain patient independence. TR allows providers to remotely administer therapy, potentially increasing access to underserved regions. Objectives:To describe types of stroke rehabilitation therapy delivered through TR and to evaluate whether TR is as effective as traditional in-person outpatient therapy in improving satisfaction and poststroke residual deficits such as motor function, speech, and disability. Methods:A literature search of the term "telerehabilitation and stroke" was conducted across three databases. Full-text articles with results pertaining to TR interventions were reviewed. Articles were scored for methodological quality using the PEDro scale. Results:Thirty-four articles with 1,025 patients were included. Types of TR included speech therapy, virtual reality (VR), robotic, community-based, goal setting, and motor training exercises. Frequently measured outcomes included motor function, speech, disability, and satisfaction. All 34 studies reported improvement from baseline after TR therapy. PEDro scores ranged from 2 to 8 with a mean of 4.59 ± 1.94 (on a scale of 0–10). Studies with control interventions, randomized allocation, and blinded assessment had significantly higher PEDro scores. All 15 studies that compared TR with traditional therapy showed equivalent or better functional outcomes. Home-based robotic therapy and VR were less costly than in-person therapy. Patient satisfaction with TR and in-person clinical therapy was similar. Conclusions:TR is less costly and equally as effective as clinic-based rehabilitation at improving functional outcomes in stroke patients. TR produces similar patient satisfaction. TR can be combined with other therapies, including VR, speech, and robotic assistance, or used as an adjuvant to direct in-person care. [ABSTRACT FROM AUTHOR]

The author reflects on the challenges in pain management amidst the acute global public health crisis of coronavirus disease 2019 (COVID-19) pandemic. Other topics include the causal comorbidity of pain like suicide, depression, and substance use disorder, the preexisting global public health issues like hunger, chronic pain, and depression, as well as the opioid crisis in the U.S.

Policy PointsThe historical mission of public health is to ensure the conditions in which people can be healthy, and yet the field of public health has been distracted from this mission by an excessive reliance on randomized‐control trials, a lack of formal theoretical models, and a fear of politics.The field of population health science has emerged to rigorously address all of these constraints. It deserves ongoing and formal institutional support. [ABSTRACT FROM AUTHOR]

This study aims to provide practice-oriented evidence regarding the implementation of healthcare data analytics and its impact on the use of new data analytics tools and relevant analytical skills improvement. A quasi-experimental pre-test/post-test controlled study was conducted in a large medical system in the eastern United States. Healthcare data analytics training program participants (N = 21) and a comparison group comprising trainee-identified peers completing comparable work (N = 27) were compared at the start of training and one year later. Results showed that both trainees and peers demonstrated improved healthcare data analytics skills over time, related to concomitant increases in their healthcare data analytics-related learning and performance goals. This study suggests that healthcare organizations aiming at successfully implementing a new data analytics infrastructure should provide well-designed training that enables trainees to develop specific learning and performance goals as well as improve relevant skills and ability to use new tools. [ABSTRACT FROM AUTHOR]

Groundwater management plans are an important tool for preventing and addressing degradation and depletion of the resource. Through plans, water users and regulators set forth goals and identify strategies to address the needs of multiple resource users while considering physical constraints of the groundwater resource. This research examines the status of groundwater management plans in the United States, identifying in which states groundwater management plans are produced and the circumstances that lead to the inclusion of quantifiable goals in those plans. Findings indicate that legal and regulatory requirements for quantifiable goals can lead to the development of more comprehensive groundwater management plans, and, that such goals can be set even when uncertainties exist. [ABSTRACT FROM AUTHOR]

Background: Advanced cancer affects the emotional and physical well-being of both patients and family caregivers in profound ways and is experienced both dyadically and individually. Dyadic interventions address the concerns of both members of the dyad. A critical gap exists in advanced cancer research, which is a failure of goals research and dyadic research to fully account for the reciprocal and synergistic effects of patients' and caregivers' individual perspectives, and those they share. Aim: We describe the feasibility and acceptability of the Me in We dyadic intervention, which is aimed at facilitating communication and goals-sharing among caregiver and patient dyads while integrating family context and individual/shared perspectives. Design: Pilot study of a participant-generated goals communication intervention, guided by multiple goals theory, with 13 patient-caregiver dyads over two sessions. Setting/participants: Patients with advanced cancer and their self-identified family caregivers were recruited from an academic cancer center. Dyads did not have to live together, but both had to consent to participate and all participants had to speak and read English and be at least 18 years or age. Results: Of those approached, 54.8% dyads agreed to participate and completed both sessions. Participants generated and openly discussed their personal and shared goals and experienced positive emotions during the sessions. Conclusions: This intervention showed feasibility and acceptability using participant-generated goals as personalized points of communication for advanced cancer dyads. This model shows promise as a communication intervention for dyads in discussing and working towards individual and shared goals when facing life-limiting or end-of-life cancer. [ABSTRACT FROM AUTHOR]

Background Vancomycin dosing strategies targeting trough concentrations of 15–20 mg/L are no longer supported due to lack of efficacy evidence and increased risk of nephrotoxicity. Area-under-the-curve (AUC24) nomograms have demonstrated adequate attainment of AUC24 goals ≥ 400 mg h/L with more conservative troughs (10–15 mg/L). Objective The purpose of this study is to clinically validate a vancomycin AUC24 dosing nomogram compared to conventional dosing methods with regards to therapeutic failure and rates of acute kidney injury. Setting This study was conducted at a tertiary, community, teaching hospital in the United States. Method This retrospective, cohort study compared the rates of therapeutic failures between AUC24-extrapolated dosing and conventional dosing methods. Main outcome measure Primary outcome was treatment failure, defined as all-cause mortality within 30 days, persistent positive methicillin-resistant Staphylococcus aureus blood culture, or clinical failure. Rates of acute kidney injury in non-dialysis patients was a secondary endpoint. Results There were 96 participants in the extrapolated-AUC24 cohort and 60 participants in the conventional cohort. Baseline characteristics were similar between cohorts. Failure rates were 11.5% (11/96) in the extrapolated-AUC24 group compared to 18.3% (11/60) in the conventional group (p = 0.245). Reasons for failure were 6 deaths and 5 clinical failures in the extrapolated-AUC24 cohort and 10 deaths and 1 clinical failure in the conventional group. Acute kidney injury rates were 2.7% (2/73) and 16.4% (9/55) in the extrapolated-AUC24 and conventional cohorts, respectively (p = 0.009). Conclusion Extrapolated-AUC24 dosing was associated with less nephrotoxicity without an increase in treatment failures for bloodstream infections compared to conventional dosing. Further investigation is warranted to determine the relationship between extrapolated-AUC24 dosing and clinical failures. [ABSTRACT FROM AUTHOR]

Purpose: Strategic goal achievement in every sector of a company relies fundamentally on the firm's employees. This study aims to disclose the factors that spur employees of major Information Technology (IT) companies in the United States (US). Design/methodology/approach: In this paper, 15,000 reviews from the top 15 United States IT companies were collected from the social media platform Glassdoor to uncover the factors that satisfy IT employees. To learn the most meaningful features that influence the scores, positive and negative remarks, as well as advice to the management team, were analyzed through a support vector machine. Findings: Results highlight a positive attitude of coworkers, contributing to a positive environment and job satisfaction. However, unsatisfied IT employees reveal that work exhaustion is the main reason for their job dissatisfaction. Practical implications: IT human resource departments can use these valuable insights to align their strategies in accordance with their employees' desires and expectations in order to thrive. Originality/value: The study highlights the relevance of IT companies to understand the reasons behind their employees' satisfaction. Up until now, little is known concerning the variants of job satisfaction among IT employees, enriching the understanding in this particular professional area. [ABSTRACT FROM AUTHOR]

The article presents guidelines on medication-use evaluation released by the American Society of Health-System Pharmacists (ASHP). The guidelines include the steps in the FOCUS-PDCA model and indicators suggesting a need for a drug use evaluation (DUE). The ASHP also issued a list of characteristics may help prioritize the selection of a particular medication or medication-use process and identifies the roles of pharmacists and other healthcare professionals in the MUE process.

Background and Objectives: The passage of the Affordable Care Act has ignited a shift from the pay-for-performance model to value-based care with a particular relevance in critical care settings. Provider incentive programs are widely considered as a means to reward providers based on the achievement of preset quality metrics. This article aims to demonstrate the effects of a provider incentive program in the critical care delivery system in a large academic center in the Northeastern United States. Methods: This article describes the results of a retrospective analysis of a performance-driven quality improvement initiative at a critical care facility of an academic medical center using a quasi-experimental pre-/posttest design. A set of quality measures was selected as outcome metrics. Selection criteria for the process measures are as follows: (i) the metric goals should be influenced by the physician's input to a large degree; (ii) the measure must be transparent and accessible within the hospital-wide data reporting system; (iii) the metric that required group effort and interdisciplinary collaboration to achieve; and (iv) the measure must directly affect patient outcome. The outcome metrics are central line--associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs), standardized infection ratio (SIR), Foley catheter and central line utilization standardized utilization ratio (SUR), hand hygiene compliance, and adherence to respiratory recovery pathway goals. These metrics were tracked from for 3 years with success defined as achieving set benchmarks for each metric. Results: The average CLABSI SIR and CAUTI SIR across all intensive care units (ICUs) decreased by 44% (P= .05) and 87% (P= .02) over 3 years as well as the central line and Foley catheter utilization falling by 41% and 30%, respectively. Hand hygiene compliance in the ICUs improved for the same period by 27 percentage points, as did compliance with the respiratory recovery pathway program by 4 percentage points. Conclusion: The use of a physician-driven financial incentive model in a critical care setting measured by outcome metrics dependent on physician input is successful with rigorous implementation and careful evaluation. [ABSTRACT FROM AUTHOR]

Background: Goal Attainment Scaling (GAS) is advocated as a meaningful outcome measure for parents and clinicians using an Ayres Sensory Integration® Intervention (ASI) approach. Although used in several treatment effectiveness studies, reliability of therapist goal writing and scoring has not been established in this area. Method: Ten occupational therapists and 40 parents of children receiving ASI participated across two clinical sites. The interview therapists and inter-rater therapists wrote GAS goals based on the same goalsetting interviews conducted with parents. Follow-up parent interviews were conducted post-ASI intervention, and the GAS goals were rated by both the interview therapists and inter-rater therapists. Results: Seventy-eight percent of interview therapist and inter-rater therapist-written goals agreed on content. Intra Class Correlation coefficient of agreement between the two sets of raters was .70 for the total score. Control of bias for establishing and rating the projected level of performance and scaled GAS goals was within an acceptable range. Conclusion: Findings contribute reliability evidence for use of GAS with children with sensory processing and integration challenges. Two therapists, from different clinical sites who were unfamiliar with the child, identified goal areas, wrote similar GAS goals based on the same parent interview, and scored goals post intervention with good inter-rater reliability. [ABSTRACT FROM AUTHOR]

Tipping is ubiquitous in countries such as the United States. Given the importance of examining the experiential side of marketing, we examine tipping—a participative pricing context and introduce it to the literature in behavioral pricing. We propose that consumers use tips as an impression management strategy, tipping more when their goal is to impress others. We examine the robustness of these impression management goals when overall bills are small (vs. large, study 1), customers pay using credit card (vs. cash, study 2), and hold different denominations of cash (study 3), as bill size, and payment modes could attenuate the effect of impression management goals on tipping intentions. These findings allow us to better understand the underlying antecedents of tipping behavior, and the consequences of impression management motivations. As such, the article cross-fertilizes the hospitality, economic psychology, and behavioral pricing literatures with applications to consumer research. [ABSTRACT FROM AUTHOR]

Context: Height velocity (HV) is difficult to assess because growth is very slow. The current practice of calculating it from measurements taken at several-month intervals is insufficient for managing children with growth disorders. We identified a bone growth by-product (collagen X biomarker, CXM) in blood that in preliminary analysis in healthy children correlated strongly with conventionally determined HV and displayed a pattern resembling published norms for HV vs age.Objective: The goal was to confirm our initial observations supporting the utility of CXM as an HV biomarker in a larger number of individuals and establish working reference ranges for future studies.Design, Settings, and Participants: CXM was assessed in archived blood samples from 302 healthy children and 10 healthy adults yielding 961 CXM measurements. A total of 432 measurements were plotted by age, and sex-specific reference ranges were calculated. Serial values from 116 participants were plotted against observed HV. Matched plasma, serum, and dried blood spot readings were compared.Results: A correlation of blood CXM with conventional HV was confirmed. Scatter plots of CXM vs age showed a similar pattern to current HV norms, and CXM levels demarcated the pubertal growth spurt both in girls and boys. CXM levels differed little in matched serum, plasma, and dried blood spot samples.Conclusions: Blood CXM offers a potential means to estimate HV in real time. Our results establish sex-specific, working reference ranges for assessing skeletal growth, especially over time. CXM stability in stored samples makes it well suited for retrospective studies. [ABSTRACT FROM AUTHOR]

Background: The expanding population of older adults with multiple sclerosis (MS) likely experiences many of the same benefits of physical activity (PA) as younger and middle-aged adults with MS. However, participation in PA is exceedingly low in this segment of the MS population. This study examined variables from social cognitive theory (SCT) as correlates of PA in older adults with MS to inform the subsequent development of behavioral interventions. Methods: Older adults with MS (≥60 years of age, N = 180) completed an online survey including demographic and clinical characteristics, SCT variables (exercise self-efficacy, exercise goal setting, social support, and outcome expectations), and PA (total PA [TPA] and moderate-to-vigorous PA [MVPA]). Results: Bivariate correlation analyses indicated that all SCT variables were significantly associated with TPA and MVPA (all P ≤ .001). Hierarchical linear regression analyses indicated that disability status was a significant correlate of TPA ( β = --0.48, R2 = 0.23) and MVPA ( β = --0.44, R2 = 0.19) in step 1; disability and self-efficacy were significant correlates of TPA (disability β = --0.20, self-efficacy β = 0.59, R2 = 0.50) and MVPA (disability β = --0.16, self-efficacy β = 0.60, R2 = 0.47) in step 2; and disability, self-efficacy, and exercise goal setting were significant correlates of TPA (disability β = --0.21, self-efficacy β = 0.50, exercise goal setting β = 0.14, R2 = 0.55) and MVPA (disability β = --0.17, self-efficacy β = 0.51, exercise goal setting β = 0.15, R2 = 0.51) in step 3. Conclusions: These results suggest that behavioral interventions focusing on self-efficacy and exercise goal setting as targets from SCT may be appropriate for increasing PA in older adults with MS. [ABSTRACT FROM AUTHOR]

Purpose: Development of individualized student goals is integral to special education. Although United States federal legislation and state, local, and professional guidelines outline preferred goal development processes, actual practice does not always reflect ideal practice. The purposes of this research were to understand how physical therapists develop student goals and to identify facilitators and barriers to development of participation-based goals. Methods: Twenty school-based physical therapists participated in one of five semi-structured focus groups. Two researchers conducted thematic analysis of transcriptions of audio recordings to identify qualitative themes; a third researcher reviewed the analysis. Results: Five themes emerged related to therapists' recommendations for goal development: (1) Understand the student: The foundation for individualized goal development, (2) Teaming: The critical component to integrate varied perceptions and establish a common vision, (3) Relevant focus of goal: Addressing what is meaningful for a student's day, (4) Best practices: Embracing professional advances, and (5) Develop and write the goal: The art and science of writing goals. The first four themes also reflected facilitators and barriers to development of participation-based goals. Conclusions: Therapists' comments reflected striving to follow ideal practice recommendations despite identified challenges. This research helps educational teams understand and reflect on goal development processes. Although writing goals is a foundational task in school-based practice, meaningful goal development is a complex process. School-based physical therapists recommend working closely with students, parents, teachers, and other members of the educational team to establish good communication, trust, and a shared philosophy of collaboration and responsibility for student goals A thorough understanding of the student serves as the foundation for developing individualized student goals. Educational teams are encouraged to understand professional, federal, state, and local guidelines and embrace professional advances in goal development practices. [ABSTRACT FROM AUTHOR]

• An unacceptable number of safety hazards remain unrecognized in construction workplaces. • There is an insufficient understanding of why workers fail to recognize particular hazards. • Results show that workers are more likely to recognize hazards that impose relatively higher levels of safety risk. • Existing hazard recognition interventions can be improved based on the study findings. Introduction: Evidence from the global construction industry suggests that an unacceptable number of safety hazards remain unrecognized in construction workplaces. Unfortunately, there isn't a sufficient understanding of why particular safety hazards remain unrecognized. Such an understanding is important to address the issue of poor hazard recognition and develop remedial interventions. A recent exploratory effort provided anecdotal evidence that workers often fail to recognize safety hazards that are expected to impose relatively lower levels of safety risk. In other words, the research demonstrated that the underlying risk imposed by a safety hazard can affect whether a hazard will be recognized or not. Method: The presented research focused on empirically testing this preliminary finding. More specifically, the study tested the proposition that Construction workers are more likely to recognize safety hazards that impose higher levels of safety risk than those that impose relatively lower levels of safety risk. The research goals were accomplished through a number of steps. First, a set of 16 construction case images depicting a variety of construction operations that included a number of known safety hazards was presented to a panel of four construction safety experts. The experts were tasked with examining each of the known safety hazards and providing a rating of the relative safety risk that the individual hazards impose. Having obtained an estimate of the underlying safety risk, a hazard recognition activity was administered to 287 workers recruited from 57 construction workplaces in the United States. The hazard recognition activity involved the examination of a random sample of two construction case images that were previously examined by the expert panel and reporting relevant safety hazards. Results: The results of the study provided support for the proposition that workers are more likely to recognize hazards that impose relatively higher levels of safety risk. Practical Applications: The findings of the study can be leveraged to improve existing hazard recognition methods and develop more robust interventions to address the issue of poor hazard recognition levels. [ABSTRACT FROM AUTHOR]