White Paper #4: Summary and recommendations

This is the fourth and last white paper in the series describing an implementation science evaluation of Utah’s Care About Childcare (CAC) QRIS program. CAC is a voluntary, strengths-based program wherein providers report the quality criteria met by their child care program. CAC is administered by the Utah Office of Child Care (OCC) and the regional CCR&R offices. OCC staff and CCRR directors and staff involved in CAC were interviewed for this white paper series. Their responses are organized according to an implementation science framework. Methods are reported in the first white paper. In this paper we report on CAC’s measures of success as summarized by CCR&R interviewees. We then summarize overall strengths and opportunities for growth noted during the interview

White Paper #3: Implementation Drivers

This paper summarizes the results from interviews with CCR&R and the Utah Office of Child Care (OCC) about the implementation of Care About Child Care (CAC) relative to implementation drivers. As was discussed in the first white paper, implementation drivers describe groups of behaviors that build and maintain the program. Drivers are split into three categories including competency drivers that support the capability of staff; organization drivers that support the infrastructure necessary to implement a program; and leadership drivers, or characteristics of those who successfully manage the program implementation

White Paper #2: Structure of Care About Childcare

In this white paper we describe interviewees’ perceptions of the implementation process for Utah’s Care About Childcare (CAC). White paper #1 outlined the research methods used and the components of implementation science that were under investigation. This white paper summarizes interviewees’ observations on the implementation components of source, destination, communication link, feedback loop, and sphere of influence

Early Childhood Workforce Index

The existing early care and education (ECE) system does a disservice to the educators — largely women and often women of color — who nurture and facilitate learning for millions of the nation's youngest children every day. Despite their important, complex labor, early educators' working conditions undermine their wellbeing and create devastating financial insecurity well into retirement age. These conditions also jeopardize their ability to work effectively with children. As we find ourselves in the middle of a global pandemic, child care has been hailed as essential, yet policy responses to COVID-19 have mostly ignored educators themselves, leaving most to choose between their livelihood and their health. Unlike public schools, when child care programs close, there's no guarantee that early educators will continue to be paid. Even as many providers try to keep their doors open to ensure their financial security, the combination of higher costs to meet safety protocols and lower revenue from fewer children enrolled is leading to job losses and program closures. Many of these closures and lost jobs are expected to become permanent. Over the course of the first eight months of the pandemic, 166,000 jobs in the child care industry were lost. As of October 2020, the industry was only 83 percent as large as it was in February, before the pandemic began.

Impact of the 2016 American College of Surgeons Guideline Revision on Overlapping Lumbar Fusion Cases at a Large Academic Medical Center

OBJECTIVE: The American College of Surgeons (ACS) u pdated its guidelines on overlapping surgery in 2016. The objective was to examine differences in postoperative outcomes after overlapping surgery either pre-ACS guide-line revision or post-guideline revision, in a coarsened exact matching sample. -METHODS: A total of 3327 consecutive adult patients u ndergoing single-level posterior lumbar fusion from 2013 to 2019 were retrospectively analyzed. Patients were separated into a pre-ACS guideline revision cohort (surgery before April 2016) or a post-guideline revision cohort (surgery after October 2016) for comparison. The primary outcomes were proportion of cases performed with any degree of overlap, and adverse events including 30-day and 90-day rates of readmission, reoperation, emergency department visit, morbidity, and mortality. Subsequently, coarsened exact matching was used among overlapping surgery patients only to assess the impact of the ACS guideline revision on overlapping outcomes, and control-ling for attending surgeon and key patient characteristics known to affect surgical outcomes. -RESULTS: After the implementation of the ACS guide-lines, fewer cases were performed with overlap (22.0% vs. 53.7%; P \u3c 0.001). Patients in the post-ACS guideline revi-sion cohort experienced improved rates of readmission and reoperation within 30 and 90 days. However, when limited to overlapping cases only, no differences were observed in overlap outcomes pre-ACS versus post-ACS guideline revision. Similarly, when exact matched on risk-associated patient characteristics and attending surgeon, overlapping surgery patients pre-ACS and post-ACS guideline revision experienced similar rates of 30-day and 90-day outcomes. -CONCLUSIONS: After the ACS guideline revision, no discernable impact was observed on postoperative out-comes after lumbar fusion performed with overlap

A systematic review and meta-analysis on the prevalence of dietary supplement use by military personnel

BACKGROUND: Although a number of studies have been conducted on the prevalence of dietary supplement (DS) use in military personnel, these investigations have not been previously summarized. This article provides a systematic literature review of this topic. METHODS: Literature databases, reference lists, and other sources were searched to find studies that quantitatively examined the prevalence of DS use in uniformed military groups. Prevalence data were summarized by gender and military service. Where there were at least two investigations, meta-analysis was performed using a random model and homogeneity of the prevalence values was assessed. RESULTS: The prevalence of any DS use for Army, Navy, Air Force, and Marine Corps men was 55%, 60%, 60%, and 61%, respectively; for women corresponding values were 65%, 71%, 76%, and 71%, respectively. Prevalence of multivitamin and/or multimineral (MVM) use for Army, Navy, Air Force, and Marine Corps men was 32%, 46%, 47%, and 41%, respectively; for women corresponding values were 40%, 55%, 63%, and 53%, respectively. Use prevalence of any individual vitamin or mineral supplement for Army, Navy, Air Force, and Marine Corps men was 18%, 27%, 25%, and 24%, respectively; for women corresponding values were 29%, 36%, 40%, and 33%, respectively. Men in elite military groups (Navy Special Operations, Army Rangers, and Army Special Forces) had a use prevalence of 76% for any DS and 37% for MVM, although individual studies were not homogenous. Among Army men, Army women, and elite military men, use prevalence of Vitamin C was 15% for all three groups; for Vitamin E, use prevalence was 8%, 7%, and 9%, respectively; for sport drinks, use prevalence was 22%, 25% and 39%, respectively. Use prevalence of herbal supplements was generally low compared to vitamins, minerals, and sport drinks, ≤5% in most investigations. CONCLUSIONS: Compared to men, military women had a higher use prevalence of any DS and MVM. Army men and women tended to use DSs and MVM less than other service members. Elite military men appeared to use DSs and sport drinks more than other service members

Effect of Carbohydrate-Protein Supplement Timing on Acute Exercise-Induced Muscle Damage

Purpose: To determine if timing of a supplement would have an effect on muscle damage, function and soreness. Methods: Twenty-seven untrained men (21 ± 3 yrs) were given a supplement before or after exercise. Subjects were randomly assigned to a pre exercise (n = 9), received carbohydrate/protein drink before exercise and placebo after, a post exercise (n = 9), received placebo before exercise and carbohydrate/protein drink after, or a control group (n = 9), received placebo before and after exercise. Subjects performed 50 eccentric quadriceps contractions on an isokinetic dynamometer. Tests for creatine kinase (CK), maximal voluntary contraction (MVC) and muscle soreness were recorded before exercise and at six, 24, 48, 72, and 96 h post exercise. Repeated measures ANOVA were used to analyze data. Results: There were no group by time interactions however, CK significantly increased for all groups when compared to pre exercise (101 ± 43 U/L) reaching a peak at 48 h (661 ± 1178 U/L). MVC was significantly reduced at 24 h by 31.4 ± 14.0%. Muscle soreness was also significantly increased from pre exercise peaking at 48 h. Conclusion: Eccentric exercise caused significant muscle damage, loss of strength, and soreness; however timing of ingestion of carbohydrate/protein supplement had no effect

Postoperative Outcomes and Resource Utilization Following Open vs Endoscopic Far Lateral Lumbar Discectomy

Background: Operative approaches for far lateral disc herniation (FLDH) repair may be classified as open or minimally invasive. The present study aims to compare postoperative outcomes and resource utilization between patients undergoing open and endoscopic (one such minimally invasive approach) FLDH surgeries. Methods: A total of 144 consecutive adult patients undergoing FLDH repair at a single, university health system over an 8-year period (2013-2020) were retrospectively reviewed. Patients were divided into 2 cohorts: open (n = 92) and endoscopic (n = 52). Logistic regression was performed to evaluate the impact of procedural type on postoperative outcomes, and resource utilization metrics were compared between cohorts using & chi;2 test (for categorical variables) or t test (for continuous variables). Primary postsurgical outcomes included readmissions, reoperations, emergency department visits, and neurosurgery outpatient office visits within 90 days of the index operation. Primary resource utilization outcomes included total direct cost of the procedure and length of stay. Secondary measures included discharge disposition, operative length, and duration of follow- up. Results: No differences were observed in adverse postoperative events. Patients undergoing open FLDH surgery were more likely to attend outpatient visits within 30 days (P = 0.016). Although direct operating room cost was lower (P \u3c 0.001) for open procedures, length of hospital stay was longer (P \u3c 0.001). Patients undergoing open surgery also demonstrated less favorable discharge dispositions, longer operative length, and greater duration of follow- up. Conclusions: While both procedure types represent viable options for FLDH, endoscopic surgeries appear to achieve comparable clinical outcomes with decreased perioperative resource utilization. Clinical Relevance: The present study suggests that endoscopic FLDH repairs do not lead to inferior outcomes but may decrease utilization of perioperative resources. Level of Evidence: 3

Outcomes Following Discectomy for Far Lateral Disc Herniation Are Not Predicted by Obstructive Sleep Apnea

Introduction: Previous studies have demonstrated that obstructive sleep apnea (OSA) is associated with adverse postoperative outcomes, but few studies have examined OSA in a purely spine surgery population. This study investigates the association of the STOP-Bang questionnaire, a screening tool for undiagnosed OSA, with adverse events following discectomy for far lateral disc herniation (FLDH). Methods: All adult patients (n = 144) who underwent FLDH surgery at a single, multihospital, academic medical center (2013-2020) were retrospectively enrolled. Univariate logistic regression was performed to evaluate the relationship between risk of OSA (low- or high-risk) according to STOP-Bang score and postsurgical outcomes, including unplanned hospital readmissions, ED visits, and reoperations. Results: Ninety-two patients underwent open FLDH surgery, while 52 underwent endoscopic procedures. High risk of OSA according to STOP-Bang score did not predict risk of readmission, ED visit, outpatient office visit, or reoperation of any kind within either 30 days or 30-90 days of surgery. High risk of OSA also did not predict risk of reoperation of any kind or repeat neurosurgical intervention within 30 days or 90 days of the index admission (either during the same admission or after discharge). Conclusion: The STOP-Bang questionnaire is not a reliable tool for predicting post-operative morbidity and mortality for FLDH patients undergoing discectomy. Additional studies are needed to assess the impact of OSA on morbidity and mortality in other spine surgery populations