An analysis of Maria Montessori’s theory of normalization in light of emerging research in self-regulation

The regulation of behavior is a major issue in early childhood development, with important implications for children’s adaptive and maladaptive developmental outcomes. Emerging research suggests that the degree of successful self-regulation depends upon the efficiency of the child’s attentional system and that the ability to focus and sustain attention supports emotional self-regulation throughout the lifespan. The neural networks that underlie the development of attention are beginning to be charted. Studies have shown that the executive attention network undergoes considerable development between the ages of 2 and 7. To support this development, research scholars have suggested the need to develop curriculum to promote focused and sustained attention in preschool programs. One hundred years ago, Maria Montessori observed that when the environment was designed to promote concentration, children went through a transformative process, which she referred to as normalization. Is normalization the same as self-regulation? This study was designed to examine whether Montessori’s theory of normalization can be considered an applied theory of self-regulation. This was accomplished by analyzing Csikszentmihalyi’s optimal experience theory and Ryan and Deci’s self-determination theory to provide the requisite guidance for developing curriculum capable of nurturing multiple aspects of self-regulation, which led to a conceptual framework for the comparison with Montessori’s theory of normalization. Montessori’s theoretical perspective is not readily available in published literature. Therefore this study used qualitative methods to conduct interviews with 12 Montessori teacher trainers. These individuals are considered the highest authority regarding Montessori theory and practice. Though Montessori’s contributions to the field of Early Childhood Education are often mentioned in university textbooks, the underlying theory (normalization) that guides her work receives little discussion. Without a clear understanding of Montessori’s theoretical perspective, research scholars are not able to isolate distinguishing characteristics that can assess self-regulation as an outcome of the curriculum nor can they adequately compare this approach with other forms of education. By introducing Montessori’s theory of normalization and analyzing it as a theory of selfregulation, this study has created a conceptual framework to articulate the governing characteristics and educational principles necessary to enhance practices that support the development of self-regulation in early childhood

Meeting the Public Health Workforce’s Training Priorities in Georgia and the Southeast

Background: The mission of the Region IV Public Health Training Center (R-IV PHTC) is to build knowledge and skills in the public health workforce in the eight states of HHS Region IV by providing competency-based training. Workforce training needs are changing quickly and dramatically in light of new developments in public health practice and science, emerging diseases, changes in the health care environment, and the growing emphasis on inter-professional practice. Additionally, a 2014 survey conducted by the Association of State and Territorial Health Officials (ASTHO) found that at least 38% of the current public health workforce plans to retire by 2020. Therefore, it is increasingly crucial to prepare upcoming managers for leadership positions and to train entry-level workers to assume more advanced roles. Methods: To address current and emerging training needs in Georgia and the southeast, the R-IV PHTC continually identifies emerging priorities and effective training approaches. It explores training needs through a review of formal needs assessments, key stakeholder interviews, surveys of targeted audiences, informal partner communications, and training evaluation data. An interactive component of the GPHA session allowed participants to identify and discuss their own professional training needs. Results: Workforce development needs assessments data across several southeastern states identified recurring training needs for professionals in Tiers 1, 2 and 3 of the Council on Linkages Core Competency domains for Analytical/Assessment Skills and Financial Planning/Management. In Georgia, top competency training needs gathered from a variety of assessment methods included Cultural Competency, Communication, Financial Planning/Management, Public Health Science, and Leadership/Systems Thinking. Participants in the workshop’s interactive component expressed highest personal need for training in Financial Planning/Management, Analytical/Assessment Skills, and Policy Development/Program Planning. However, for others in their organizations, they identified a priority need for leadership training. Conclusions: The R-IV PHTC assesses training needs and provides training resources to respond to current and emerging public health workforce development needs in Georgia and the southeast

A Region-Wide Field Placement Program Built on the Foundation of Mentorship and Professionalism

Background: The Region IV Public Health Training Center (R-IV PHTC) provides public health students from the eight states of HHS Region IV with essential practice experiences that demonstrate the value of working with underserved populations. The Pathways to Practice Scholars field placement program is built on a foundation of mentorship, professionalism, and community. Methods: Sixteen student scholars (13 graduate; 3 undergraduate) were selected to work during May-August 2015 in practiceoriented agencies serving underserved populations. Each scholar received a $1500 living allowance. Seven of 16 accepted an internship outside the state of their university. In conjunction with mentors, Scholars developed work plans based on Council on Linkages Core Competency domains. Requirements included a pre-, mid- and post-assessment, an executive summary/reflection, and a virtual webinar presentation. Results: Student Scholars worked at sites across eight states in state or local health departments, Area Health Education Centers (AHECs), and healthcare settings. Students identified Core Competency domains they developed most during the field placement: Communication, Analytical/Assessment, Leadership/Systems Thinking, and Community Engagement. The R-IV PHTC asked mentors to treat interns as valued employees and include them in activities beyond their specific project. Indicators of successful mentorship included expressed appreciation for student assistance and the desire to enrich the student experience while benefiting the agency mission. Mentors provided clearly defined projects for a short timeframe (10-12 weeks), adjusted to the students’ capacity and readiness, and offered opportunities to apply classroom skills to practice. They helped students develop immediately useful products in collaboration with community stakeholders. Conclusions: Mentors play a crucial role in the development and success of field placement students, but students and mentors share equal responsibility in fostering the relationship. Past case studies from this program demonstrate that some students find employment in these same agencies after graduation, and become mentors for future students, thus, creating a self-perpetuating learning community

Enhancing the Future Public Health Workforce Through Competency-Based Student Field Placements

Background: The Public Health Workforce Interest and Needs (PHWINS) 2014 survey from ASTHO (Association of State and Territorial Health Officials) demonstrated a dramatic need for succession planning and retention of the future public health workforce. To address this need, the Region IV Public Health Training Center’s (R-IV PHTC) Pathways to Practice Scholars Program places students from accredited schools and programs of public health into practical field placement positions across eight states. Skill- and competency-based student field placements reinforce the value of working with medically underserved areas/populations (MUA/Ps) through public health agencies. Field placements use adult learning theory through experiential learning to build essential skills from the Council on Linkage (COL) core competencies. Methods: Host agencies include state and local health departments, Area Health Education Centers, primary care settings, and community organizations in one of eight southeastern states serving MUA/Ps. Agencies propose practical projects using COL domains. Proposals are converted to job postings. Once an agency selects a student, the team collaboratively develops a detailed work plan using specific COL competencies. Results: A brief overview of evaluation findings will be shared but are not the focus of this workshop. Evaluation instruments included a pre-survey, work plan, mid-term survey, final evaluation, and alumni survey. Students submit a final report, reflection summary, webinar presentation and/or abstract worthy of submission to a professional conference. Findings demonstrated increases in students’ perceived ability to perform core competencies and future plans to work in MUA/Ps. Conclusions: This program builds leadership and real-world experience in the future workforce while serving immediate needs of public health agencies. The workshop focuses on interactive discussion about processes and tools to create COL competencybased field placement position descriptions and detailed work plans. Participants can engage in dialogue about developing student positions which enhance their work while training the future workforce

Helping Public Health Professionals Access Infectious Disease Trainings and Resources: The Region IV PHTC Infectious Diseases Training Database

Background: The Region IV Public Health Training Center (R-IV PHTC), located at Emory University’s Rollins School of Public Health, has a mission that includes providing training and educational offerings to strengthen the competency of the current public health workforce in HHS Region IV (which includes GA). Additionally, the R-IV PHTC has been charged with serving as a national resource in the area of infectious disease. To fulfill this charge, the R-IV PHTC conducted an environmental scan to identify and increase access to existing infectious disease trainings and resources currently available to the public health workforce. Methods: From June 2015 – February 2016, the R-IV PHTC systematically reviewed infectious disease-related trainings developed by credible organizations between 2011-2015. We reviewed the websites and learning management systems of 73 different organizations including but not limited to the TrainFinder Real-time Affiliated Integrated Network (TRAIN), Centers for Disease Control and Prevention, Association of State and Territorial Health Officials (ASTHO), and other PHTCs. Trainings were identified utilizing several search terms including infectious disease, vaccination, HIV/AIDS, tuberculosis (TB), Ebola, measles, etc. Results: Altogether, the R-IV PHTC identified over 500 training programs and resources in our designated content area of Infectious Disease developed by other public health organizations between 2011-2015. The final trainings are available in an easy-to-use searchable database and can be filtered by sponsor, title, year, provision of continuing education credits, addressed competencies, cost, length, infectious disease category, and modality. The database will be updated at least once yearly to ensure currency. Conclusions: This poster will describe the methodology that the R-IV PHTC used to conduct an environmental scan of infectious diseases trainings. In addition, the poster will explain how to locate and access infectious disease trainings in one database on the R-IV PHTC website using a variety of search filters

Improving Rates of Influenza Vaccination Through Electronic Health Record Portal Messages, Interactive Voice Recognition Calls and Patient-Enabled Electronic Health Record Updates: Protocol for a Randomized Controlled Trial

BACKGROUND: Clinical decision support (CDS), including computerized reminders for providers and patients, can improve health outcomes. CDS promoting influenza vaccination, delivered directly to patients via an electronic health record (EHR) patient portal and interactive voice recognition (IVR) calls, offers an innovative approach to improving patient care. OBJECTIVE: To test the effectiveness of an EHR patient portal and IVR outreach to improve rates of influenza vaccination in a large multispecialty group practice in central Massachusetts. METHODS: We describe a nonblinded, randomized controlled trial of EHR patient portal messages and IVR calls designed to promote influenza vaccination. In our preparatory phase, we conducted qualitative interviews with patients, providers, and staff to inform development of EHR portal messages with embedded questionnaires and IVR call scripts. We also provided practice-wide education on influenza vaccines to all physicians and staff members, including information on existing vaccine-specific EHR CDS. Outreach will target adult patients who remain unvaccinated for more than 2 months after the start of the influenza season. Using computer-generated randomization and a factorial design, we will assign 20,000 patients who are active users of electronic patient portals to one of the 4 study arms: (1) receipt of a portal message promoting influenza vaccines and offering online appointment scheduling; (2) receipt of an IVR call with similar content but without appointment facilitation; (3) both (1) and (2); or (4) neither (1) nor (2) (usual care). We will randomize patients without electronic portals (10,000 patients) to (1) receipt of IVR call or (2) usual care. Both portal messages and IVR calls promote influenza vaccine completion. Our primary outcome is percentage of eligible patients with influenza vaccines administered at our group practice during the 2014-15 influenza season. Both outreach methods also solicit patient self-report on influenza vaccinations completed outside the clinic or on barriers to influenza vaccination. Self-reported data from both outreach modes will be uploaded into the EHR to increase accuracy of existing provider-directed EHR CDS (vaccine alerts). RESULTS: With our proposed sample size and using a factorial design, power calculations using baseline vaccination rate estimates indicated that 4286 participants per arm would give 80% power to detect a 3% improvement in influenza vaccination rates between groups (alpha=.05; 2-sided). Intention-to-treat unadjusted chi-square analyses will be performed to assess the impact of portal messages, either alone or in combination with the IVR call, on influenza vaccination rates. The project was funded in January 2014. Patient enrollment for the project described here completed in December 2014. Data analysis is currently under way and first results are expected to be submitted for publication in 2016. CONCLUSIONS: If successful, this study\u27s intervention may be adapted by other large health care organizations to increase vaccination rates among their eligible patients. CLINICALTRIAL: ClinicalTrials.gov NCT02266277; https://clinicaltrials.gov/ct2/show/NCT02266277 (Archived by WebCite at http://www.webcitation.org/6fbLviHLH)

Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial

BACKGROUND: Patient reminders for influenza vaccination, delivered via an electronic health record patient portal and interactive voice response calls, offer an innovative approach to engaging patients and improving patient care. OBJECTIVE: The goal of this study was to test the effectiveness of portal and interactive voice response outreach in improving rates of influenza vaccination by targeting patients in early September, shortly after vaccinations became available. METHODS: Using electronic health record portal messages and interactive voice response calls promoting influenza vaccination, outreach was conducted in September 2015. Participants included adult patients within a large multispecialty group practice in central Massachusetts. Our main outcome was electronic health record-documented early influenza vaccination during the 2015-2016 influenza season, measured in November 2015. We randomly assigned all active portal users to 1 of 2 groups: (1) receiving a portal message promoting influenza vaccinations, listing upcoming clinics, and offering online scheduling of vaccination appointments (n=19,506) or (2) receiving usual care (n=19,505). We randomly assigned all portal nonusers to 1 of 2 groups: (1) receiving interactive voice response call (n=15,000) or (2) receiving usual care (n=43,596). The intervention also solicited patient self-reports on influenza vaccinations completed outside the clinic. Self-reported influenza vaccination data were uploaded into the electronic health records to increase the accuracy of existing provider-directed electronic health record clinical decision support (vaccination alerts) but were excluded from main analyses. RESULTS: Among portal users, 28.4% (5549/19,506) of those randomized to receive messages and 27.1% (5294/19,505) of the usual care group had influenza vaccinations documented by November 2015 (P=.004). In multivariate analysis of portal users, message recipients were slightly more likely to have documented vaccinations when compared to the usual care group (OR 1.07, 95% CI 1.02-1.12). Among portal nonusers, 8.4% (1262/15,000) of those randomized to receive calls and 8.2% (3586/43,596) of usual care had documented vaccinations (P=.47), and multivariate analysis showed nonsignificant differences. Over half of portal messages sent were opened (10,112/19,479; 51.9%), and over half of interactive voice response calls placed (7599/14,984; 50.7%) reached their intended target, thus we attained similar levels of exposure to the messaging for both interventions. Among portal message recipients, 25.4% of message openers (2570/10,112) responded to a subsequent question on receipt of influenza vaccination; among interactive voice response recipients, 72.5% of those reached (5513/7599) responded to a similar question. CONCLUSIONS: Portal message outreach to a general primary care population achieved a small but statistically significant improvement in rates of influenza vaccination (OR 1.07, 95% CI 1.02-1.12). Interactive voice response calls did not significantly improve vaccination rates among portal nonusers (OR 1.03, 95% CI 0.96-1.10). Rates of patient engagement with both modalities were favorable. TRIAL REGISTRATION: ClinicalTrials.gov NCT02266277; https://clinicaltrials.gov/ct2/show/NCT02266277. Lloyd Fisher, Peggy Preusse, Devi Sundaresan, Lawrence Garber, Kathleen M Mazor, Sarah L Cutrona. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 25.09.2020

Spot and Cumulative Urine Samples Are Suitable Replacements for 24-Hour Urine Collections for Objective Measures of Dietary Exposure in Adults Using Metabolite Biomarkers

BACKGROUND: Measurement of multiple food intake exposure biomarkers in urine may offer an objective method for monitoring diet. The potential of spot and cumulative urine samples that have reduced burden on participants as replacements for 24-h urine collections has not been evaluated. OBJECTIVE: The aim of this study was to determine the utility of spot and cumulative urine samples for classifying the metabolic profiles of people according to dietary intake when compared with 24-h urine collections in a controlled dietary intervention study. METHODS: Nineteen healthy individuals (10 male, 9 female, aged 21-65 y, BMI 20-35 kg/m2) each consumed 4 distinctly different diets, each for 1 wk. Spot urine samples were collected ∼2 h post meals on 3 intervention days/wk. Cumulative urine samples were collected daily over 3 separate temporal periods. A 24-h urine collection was created by combining the 3 cumulative urine samples. Urine samples were analyzed with metabolite fingerprinting by both high-resolution flow infusion electrospray mass spectrometry (FIE-HRMS) and proton nuclear magnetic resonance spectroscopy (1H-NMR). Concentrations of dietary intake biomarkers were measured with liquid chromatography triple quadrupole mass spectrometry and by integration of 1H-NMR data. RESULTS: Cross-validation modeling with 1H-NMR and FIE-HRMS data demonstrated the power of spot and cumulative urine samples in predicting dietary patterns in 24-h urine collections. Particularly, there was no significant loss of information when post-dinner (PD) spot or overnight cumulative samples were substituted for 24-h urine collections (classification accuracies of 0.891 and 0.938, respectively). Quantitative analysis of urine samples also demonstrated the relation between PD spot samples and 24-h urines for dietary exposure biomarkers. CONCLUSIONS: We conclude that PD spot urine samples are suitable replacements for 24-h urine collections. Alternatively, cumulative samples collected overnight predict similarly to 24-h urine samples and have a lower collection burden for participants