Barriers and Facilitators Regarding Awareness, Selection, and Implementation of School-Based Interventions Addressing Physical Activity and Healthy Eating Behaviors: Perspectives of South Carolina Public School Administrators and Personnel

Purpose: This dissertation explores the perceptions and experiences of South Carolina (SC) public school administrators and personnel regarding barriers and facilitators to school-based interventions, with a focus on physical activity (PA) and healthy eating behaviors, to address childhood obesity. An integrative review was completed to identify challenges and supports to school-based weight management interventions.1-35 Findings from the integrative review provided the framework for the dissertation study, which used a concurrent multi-methodological design to investigate the barriers and facilitators regarding awareness, selection, and implementation of school-based interventions addressing PA and healthy eating behaviors in the SC education system and to examine how the coronavirus disease 2019 (COVID-19) pandemic affected these interventions. Problem: In SC, approximately 37% of children and adolescents are overweight or obese, and the state ranks 3rd in the nation for the number of youth ages 10-17 who are obese.36,37 Behaviors that lead to excess weight gain include inadequate participation in PA and consumption of high-calorie, low-nutrient foods.38 Substantial negative health outcomes are associated with obesity, including increased rates of chronic illnesses, diminished quality of life, and shorter life span.38-42 Childhood obesity is also linked to psychological and social problems, such as anxiety, depression, and stigmatization.38,43,44 School-based weight management interventions have successfully improved PA and eating behaviors; however, not all schools offer these types of interventions and some interventions are not implemented to their fullest extent.45-49 It is important to understand the factors that hinder and promote the delivery of school-based interventions. The following research question guided the study: What do public school administrators and personnel in South Carolina perceive and experience as barriers and facilitators regarding awareness, selection, and implementation of school-based interventions addressing physical activity and healthy eating behaviors? The specific aims of the dissertation were: • Aim 1: Describe actual and perceived barriers and facilitators public school administrators and personnel in South Carolina encounter regarding awareness, selection, and implementation of school-based physical activity and healthy eating interventions. ‒ Aim 1a. Identify actual and perceived concerns and experiences within school settings regarding the use of weight-related terminology and any stigma that may exist. ‒ Aim 1b. Assess ability to recruit and engage public school administrators and personnel in South Carolina to participate in an exploratory study on school-based interventions. • Aim 2: Identify greatest challenges and supports, priority focal areas, and school-based interventions that have been implemented along with their outcomes. Design: A concurrent multi-methodological study, informed by the Social Ecological Model (SEM)50-54 and the Steps in Quality Intervention Development (6SQuID) Model,55,56 was completed to form a comprehensive understanding of the phenomena.57,58 The qualitative descriptive component included one-time Key Informant Interviews (KIIs) with SC public school administrators. The quantitative descriptive component involved conducting a needs assessment survey of SC public school personnel. Findings: KII participants (N = 28) reported that negative beliefs, comments, and bullying behaviors were more prevalent toward students perceived as being overweight. School administrators also indicated that school-based interventions addressing PA and healthy eating behaviors were present in schools. Participants identified insufficient time as the main barrier and adequate support as the primary facilitator to school-based interventions. These factors inhibited or enhanced intervention implementation, based on the extent to which they were present. Survey respondents (N = 1311) reported the foremost barriers as insufficient time for PA (n = 514, 39.2%) and limited access to healthy foods for healthy eating behaviors (n = 271, 20.7%). The key facilitators were adequate support from school-level administrators for PA (n = 264, 20.1%) and adequate support from cafeteria staff for healthy eating behaviors (n = 234, 17.8%). Both interview and survey participants described the COVID-19 pandemic as causing changes in school-based interventions addressing PA and healthy eating behaviors and in academic delivery impacting PA and healthy eating behaviors. Responses revealed that schools’ abilities to address PA and healthy eating behaviors were negatively affected by COVID-19, and the pandemic was predicted to disrupt future school-based interventions related to PA and healthy eating behaviors. Conclusions: Information from this dissertation provides the foundation for future studies on mitigating barriers and maximizing facilitators to school-based interventions addressing PA and healthy eating behaviors, with the ultimate goal of decreasing rates of childhood obesity. Additionally, findings may help school systems to adapt school-based interventions to changes from the COVID-19 pandemic so that students can still receive and benefit from content on healthy lifestyle practices.59,60 A promising opportunity for interprofessional collaboration exists for health care and education professionals to work together on school-based interventions that address students’ health and academic needs

An Interesting Case of Factitious Disorder Superimposed on Self: Factitious Disorder vs Somatic Symptom Disorder

Factitious disorder superimposed on self (FDIS) was first described in 1951by Richard Asher, who associated the disorder with Baron Munchhausen, who narrated unrealistic and exaggerated stories about his life. Suspicion for FDIS should be raised when patients with atypical presentations of medical disorders seek excessive use of healthcare services despite ongoing lack of clinical evidence. Patients with FDIS often demand hospitalization for their symptoms, leading to unnecessary tests and treatments. These patients show signs of pathological lying, deceitfulness, are obstinate with medical staff, and display erratic behavior. When medical investigation does not support their symptoms, patients often develop new “symptoms” or “disease”, and often exhibit symptoms only when they are being observed. FDIS is a diagnosis of exclusion, therefore other disorders with similar presentations must be considered. One of these conditions is somatic symptom disorder (SSD). When FDIS is recognized by providers, it often leads to countertransference, frustration, and unwillingness for follow-up treatment by the provider. These patients deny falsifying symptoms and fail to acknowledge the presence of this mental illness. This further perpetuates a pattern of excessive hospitalizations or consultations when the patient’s demands aren’t met

The Effects of Simulated Herbivory on the Growth of Wisconsin Fast Plants

Wisconsin Fast Plant (Brassica rapa, Brassicaceae) seeds were planted in three six-celled containers with 15 seeds in each tray. After a week of germination in standard potting soil and tap water, we started our manipulation of simulating herbivory with scissors. E1 plants had both cotyledons of each plant removed, E2 plants had half of the cotyledons of each plant removed, and the control group was allowed to grow. E2 plants had its foliage leaves cut when they exceeded 1 cm from that week on. Every week (seven-day intervals), the height of all the plants were recorded as well as the number of flowers and foliage leaves. By the fourth week of recording data, the average height (in cm) of the control plants was 12.15, E1 plants was 8.14, and E2 plants was 8.806. The average number of flowering plants during the fourth week of measurement was 8 plants for the control group, 4 for E1, and 9 for E2. The t-test for the height of control plants vs E1 plants was statistically significant (p=.009803). The control plants vs E2 plants was also significant (p=0.010953). The E1 vs E2 plants was not statistically significant (p= 0.292112). Our hypothesis that plants that experience a loss of half of their cotyledons will have a lower biomass than the plants that undergo continuous herbivory was not supported. We suspect that herbivory, regardless of whether it is continuous, may have an equal effect on the fast plants because we were unable to reject the null hypothesis

Improving language-focused comprehension instruction in primary-grade classrooms:impacts of the Let’s Know! experimental curriculum

This quasi-experimental study was designed to test the impacts of a curriculum supplement, Let’s Know! on the quantity and quality of language-focused comprehension instruction in pre-Kindergarten to third grade classrooms. Sixty classrooms (12 per each of pre-K to grade 3) were enrolled in the study, with 40 teachers assigned to implement one of two versions of the experimental Let’s Know! curriculum and 20 assigned to a control condition, in which they maintained their typical language-arts curriculum. Classroom observations, 90 minutes in duration, were collected near the end of the first unit’s completion, about four to five weeks into the academic year. These observations were coded to examine impacts of Let’s Know! instruction on two outcomes: (a) teachers’ use of 18 language-focused comprehension supports, and (b) general classroom quality. Study results using quantile regression showed that Let’s Know! teachers used a significantly higher number of language-focused comprehension supports during Let’s Know! instruction compared to the control teachers during language-arts instruction; the same finding was also true for general classroom quality. Quantile regression results showed the greatest differentiation in instructional quality, when comparing experimental and control teachers, for teachers in the middle of the distribution of general classroom quality. Study findings highlight the value of language-focused curricula for heightening comprehension-specific supports in pre-K to grade 3 settings

It Depends: The Conditional Correlation Between Frequency of Storybook Reading and Emergent Literacy Skills in Children At Risk for Language Difficulty

The current study examined the association between frequency of storybook reading and emergent literacy in 212 children at risk for language impairment, assessed during the fall semester of kindergarten. Measures included parent-reported storybook reading, as well as direct assessments of print knowledge, letter awareness, and expressive vocabulary. Results suggested nonsignificant to moderate (r = .11 to .25) correlations between frequency of storybook reading and child emergent literacy across the entire range of environment and ability. Quantile regression results suggested that the association was highest at low frequency of storybook reading, particularly for print knowledge, approaching r = .50. Moreover, the association between frequency of storybook reading and emergent literacy was highest at higher levels of emergent literacy for print knowledge, but particularly for letter naming, approaching r = .80. These results suggest that in children with language difficulties, the relationship between aspects of the home environment and emergent literacy is conditional upon the quality of the home environment as well as child’s proficiency in emergent literacy skills

What does it mean to be “prepared for work”? Perceptions of new engineers

Background: Engineering education seeks to prepare students for engineering practice, but the concept of preparedness is often ill-defined. Moreover, findings from studies of different populations or in different contexts vary regarding how well new graduates are prepared. These variations, coupled with the lack of clarity, suggest the need to better understand what it means to be prepared for engineering work. Purpose: This study contributes to research on workplace preparation by exploring how new graduates describe being prepared for engineering work. Method: Applying secondary analysis to data from the multi-institution Capstone To Work (C2W) project, we used thematic analysis to explore new engineers\u27 descriptions of preparedness. We analyzed written responses to structured questions about the school-to-work transition collected weekly during participants\u27 first 12 weeks of work; 105 graduates drawn from four universities provided 956 responses, with a mean of 9 (out of 12 possible) responses per participant. Results: Participants\u27 descriptions of preparedness included applying concrete skills, recognizing familiar situations, and having strategies for approaching challenging tasks even when they lacked relevant knowledge or skill. Conclusion: Our findings suggest that although many discussions about workplace preparation implicitly focus narrowly on mastery of skills and knowledge, that focus may not fully capture new graduates\u27 experiences, and may limit discussions about the ways in which school can (and cannot) prepare students for work. A more expansive understanding may better support both student learning and workplace onboarding, though more research is needed across stakeholders to establish shared understanding

Mediation analysis for a survival outcome with time-varying exposures, mediators, and confounders

We propose an approach to conduct mediation analysis for survival data with time-varying exposures, mediators, and confounders. We identify certain interventional direct and indirect effects through a survival mediational g-formula and describe the required assumptions. We also provide a feasible parametric approach along with an algorithm and software to estimate these effects. We apply this method to analyze the Framingham Heart Study data to investigate the causal mechanism of smoking on mortality through coronary artery disease. The risk ratio of smoking 30 cigarettes per day for ten years compared with no smoking on mortality is 2.34 (95 % CI = (1.44, 3.70)). Of the overall effect, 7.91% (95% CI: = 1.36%, 19.32%) is mediated by coronary artery disease. The survival mediational g-formula constitutes a powerful tool for conducting mediation analysis with longitudinal data

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Non-selective Primary Human Tumor Cell Line Generation from Surgical Resections to be Paired With Flash Frozen and Paraffin Embedded Tissue: Advancements in Democratizing Translational Research Materials to Rural Institutions

Translational cancer research relies on the availability of human patient tissue demonstrating the specific disease process under investigation. Biobanks of human tissue have historically been and remain to date the primary access point for cancer research samples. Biorepositories routinely supply researchers with varying sample types for use in biomedical studies; most commonly formalin-fixed and paraffin-embedded (FFPE) tissue, or fresh snap-frozen tissue. In conjunction with preserved tissue samples, viable tumor cell lines derived from patient tissue have emerged to be a new gold standard in cancer research particularly in drug discovery and functional prognostic assays. Tissue banks providing these samples are being termed “next-generation” and are adapting to directly assist researchers by performing high throughput technical studies such as routine histology and immunostaining of donor tissue. These high quality, next-generation biorepositories are a relatively scarce resource in the broader research community in the United States and have traditionally been associated with large centralized and very well established university medical centers. This article describes the next-generation resources now available at the Edwards Comprehensive Cancer Center with its association with the Marshall University Joan C. Edwards School of Medicine in Huntington, West Virginia. This manuscript details the procedures, protocols, and success rates of the Tissue Procurement Program (TPP) to generate a growing cohort of viable primary human tumor cell lines representing varying malignancies to be used in conjunction with matched formalin-fixed and paraffin-embedded (FFPE) and snap-frozen tissue samples for comprehensive translational research