BACKGROUND: In 2013, the Chicago Public Schools (CPS) district passed a policy requiring schools to deliver comprehensive sexual health education (SHE) to all K-12th grade students. A performance improvement case study was conducted in the 2019-2020 school year to evaluate the implementation of the policy and identify lessons learned to support implementation in schools.
METHODS: Key informant interviews were conducted with 11 school principals and 29 teachers to discuss SHE implementation at their school. Interviews were recorded, transcribed, and analyzed to assess school and classroom factors that affect implementation. Themes that cut across these factors were then identified and summarized by 2 evaluators.
RESULTS: The following themes were identified across key informant interviews: (a) principal prioritization of SHE helps ensure SHE is implemented, (b) the expansion of school and teacher capacity facilitates SHE implementation, and (c) the creation of accountability mechanisms in classrooms and schools fosters adherence to SHE policy.
CONCLUSIONS: Principals play a crucial role in building capacity to deliver SHE and ensuring SHE accountability mechanisms are implemented in their school. CPS is using these findings to adjust technical assistance and resources provided to principals and SHE instructors.

Knee osteoarthritis (KOA) significantly contributes to the global disability burden, with its incidence expected to escalate by 74.9% by 2050. The urgency to comprehend and tackle this condition is critical, necessitating an updated and thorough review of KOA. A systematic review up to February 26, 2024, has elucidated the principal aspects of KOA\'s pathogenesis, risk factors, clinical manifestations, and contemporary management paradigms. The origins of KOA are intricately linked to mechanical, inflammatory, and metabolic disturbances that impair joint function. Notable risk factors include age, obesity, and previous knee injuries. Diagnosis predominantly relies on clinical assessment, with radiographic evaluation reserved conditionally. The significance of rehabilitation assessments, informed by the International Classification of Functioning, Disability, and Health framework, is highlighted. Treatment strategies are diverse, prioritizing nonpharmacological measures such as patient education, exercise, and weight management, with pharmacological interventions considered adjuncts. Intra-articular injections and surgical options are contemplated for instances where conventional management is inadequate. KOA stands as a predominant disability cause globally, characterized by a complex etiology and profound effects on individuals\' quality of life. Early, proactive management focusing on nonpharmacological interventions forms the cornerstone of treatment, aiming to alleviate symptoms and enhance joint function. This comprehensive review underscores the need for early diagnosis, individualized treatment plans, and the integration of rehabilitation assessments to optimize patient outcomes. Further research is needed to refine prevention strategies and improve management outcomes for KOA patients.

A health workforce capable of implementing genomic medicine requires effective genomics education. Genomics education interventions developed for health professions over the last two decades, and their impact, are variably described in the literature. To inform an evaluation framework for genomics education, we undertook an exploratory scoping review of published needs assessments for, and/or evaluations of, genomics education interventions for health professionals from 2000 to 2023. We retrieved and screened 4,659 records across the two searches with 363 being selected for full-text review and consideration by an interdisciplinary working group. 104 articles were selected for inclusion in the review-60 needs assessments, 52 genomics education evaluations, and eight describing both. Included articles spanned all years and described education interventions in over 30 countries. Target audiences included medical specialists, nurses/midwives, and/or allied health professionals. Evaluation questions, outcomes, and measures were extracted, categorized, and tabulated to iteratively compare measures across stages of genomics education evaluation: planning (pre-implementation), development and delivery (implementation), and impact (immediate, intermediate, or long-term outcomes). They are presented here along with descriptions of study designs. We document the wide variability in evaluation approaches and terminology used to define measures and note that few articles considered downstream (long-term) outcomes of genomics education interventions. Alongside the evaluation framework for genomics education, results from this scoping review form part of a toolkit to help educators to undertake rigorous genomics evaluation that is fit for purpose and can contribute to the growing evidence base of the contribution of genomics education in implementation strategies for genomic medicine.

Implementation of genomic medicine into healthcare requires a workforce educated through effective educational approaches. However, ascertaining the impact of genomics education activities or resources is limited by a lack of evaluation and inconsistent descriptions in the literature. We aim to support those developing genomics education to consider how best to capture evaluation data that demonstrate program outcomes and effectiveness within scope. Here, we present an evaluation framework that is adaptable to multiple settings for use by genomics educators with or without education or evaluation backgrounds. The framework was developed as part of a broader program supporting genomic research translation coordinated by the Australian Genomics consortium. We detail our mixed-methods approach involving an expert workshop, literature review and iterative expert input to reach consensus and synthesis of a new evaluation framework for genomics education. The resulting theory-informed and evidence-based framework encompasses evaluation across all stages of education program development, implementation and reporting, and acknowledges the critical role of stakeholders and the effects of external influences.

OBJECTIVE: Among the provisions within the Affordable Care Act (ACA), expanding Medicaid was arguably the greatest contributor to increasing access to care. For over a decade, researchers have investigated how Medicaid expansion impacted cancer outcomes. Over this same decade, statistical theory illuminated how state-based policy research could be compromised by invalid inference. After reviewing the literature to identify the inference strategies of state-based cancer registry Medicaid expansion research, this study aimed to assess how inference decisions could change the interpretation of Medicaid expansion\'s impact on staging, treatment, and mortality in cancer patients.
METHODS: Cancer case data (2000-2019) was obtained from the Surveillance, Epidemiology, End Results (SEER) programme. Cases included all cancer sites combined, top 10 cancer sites combined, and three screening amenable cancers (colorectal, female breast, female cervical).
METHODS: A Difference-in-Differences design estimated the association between Medicaid expansion and four binary outcomes: distant stage, initiating treatment >1 month after diagnosis, no surgery recommendation, and death. Three inference techniques were compared: (1) traditional, (2) cluster, and (3) Wild Cluster Bootstrap.
METHODS: Data was accessed via SEER*Stat.
RESULTS: Estimating standard errors via traditional inference would suggest that Medicaid expansion was associated with delayed treatment initiation and surgery recommendations. Traditional and clustered inference also suggested that Medicaid expansion reduced mortality. Inference using Wild Cluster Bootstrap techniques never rejected the null hypotheses.
CONCLUSIONS: This study reiterates the importance of explicit inference. Future state-based, cancer policy research can be improved by incorporating emerging techniques. These findings warrant caution when interpreting prior SEER research reporting significant effects of Medicaid expansion on cancer outcomes, especially studies that did not explicitly define their inference strategy.

BACKGROUND: The increasing number of vaccines and the complexity of immunization programs, along with continuous changes in the epidemiology of infectious diseases, necessitate a systematic approach to vaccine effectiveness (VE) evaluation. This study presents a preliminary survey to establish a VE evaluation framework in Korea, focusing on the National Immunization Program.
METHODS: Experts\' opinions were collected through a two-round online survey targeting key stakeholders. The first round consisted of two multiple-choice questions and two open-ended questions. The second round was a quantitative survey with 17 questionnaires based on five domains derived by analyzing the results of the first-round survey.
RESULTS: The results emphasize the necessity and urgency of a government-led VE evaluation system and the establishment of a multidisciplinary evaluation organization. Key considerations include personnel, budget, data integration, legal standards, and surveillance system enhancements.
CONCLUSIONS: These findings provide valuable insights for policymakers, emphasizing the need for collaboration, financial support, and robust data management in developing evidence-based vaccination policies.

BACKGROUND: Faculty development programs are crucial for promoting continuous learning, enhancing teaching effectiveness, and encouraging professional growth among medical educators. Problem-based learning was introduced as a teaching strategy in our Faculty of Medicine in 2007. Thereafter, several rounds of a faculty development program were conducted to help teachers recognize their role as facilitators and assess areas for improvement.
METHODS: We conducted a mixed-methods study with a sample of 284 third-year medical students answering a questionnaire and 21 faculty members participating in focus groups. A validated 13-item questionnaire was used to investigate the students\' evaluation of their tutors\' performance in problem-based learning. Three sessions were then conducted with faculty members involved in problem-based learning to gain in-depth insights into their experiences and perspectives.
RESULTS: The mean performance ranking for tutors awarded by the students was above halfway. There was a significant positive correlation between tutors\' performance ranking and all five of the learning approaches examined herein: constructive/active learning, self-directed learning, contextual learning, collaborative learning, and intra-personal behavior (p < 0.05). The data from the focus groups were analyzed under five broad themes: tutors\' insights into their strengths and weaknesses, challenges in conducting problem-based learning, tutors\' ways of preparing for problem-based learning, feedback, and suggestions for improving problem-based learning workshops.
CONCLUSIONS: This study recommends improvements and future directions for advanced program evaluation. Faculty development programs can be tailored to effectively address students and faculty members\' goals and needs, which can benefit the teaching and learning process and foster a culture of continuous improvement and professional growth.

UNASSIGNED: The COVID-19 pandemic prompted varied policy responses globally, with Latin America facing unique challenges. A detailed examination of these policies\' impacts on health systems is crucial, particularly in Bolivia, where information about policy implementation and outcomes is limited.
UNASSIGNED: To describe the COVID-19 testing trends and evaluate the effects of quarantine measures on these trends in Cochabamba, Bolivia.
UNASSIGNED: Utilizing COVID-19 testing data from the Cochabamba Department Health Service for the 2020-2022 period. Stratified testing rates in the health system sectors were first estimated followed by an interrupted time series analysis using a quasi-Poisson regression model for assessing the quarantine effects on the mitigation of cases during surge periods.
UNASSIGNED: The public sector reported the larger percentage of tests (65%), followed by the private sector (23%) with almost double as many tests as the public-social security sector (11%). In the time series analysis, a correlation between the implementation of quarantine policies and a decrease in the slope of positive rates of COVID-19 cases was observed compared to periods without or with reduced quarantine policies.
UNASSIGNED: This research underscores the local health system disparities and the effectiveness of stringent quarantine measures in curbing COVID-19 transmission in the Cochabamba region. The findings stress the importance of the measures\' intensity and duration, providing valuable lessons for Bolivia and beyond. As the global community learns from the pandemic, these insights are critical for shaping resilient and effective health policy responses.
Main findings: The findings highlight the importance of stringent quarantine measures in managing infectious disease outbreaks, offering valuable insights for policymakers worldwide in strategizing effective public health interventions.Added knowledge: By providing a detailed analysis of testing disparities and quarantine policies’ effectiveness within a specific Latin American context, our research fills a critical gap in understanding their impacts on health system responses and disease control.Global health impact for policy and action: The findings highlight the importance of stringent quarantine measures in managing infectious disease outbreaks, offering valuable insights for policymakers worldwide in strategizing effective public health interventions.

BACKGROUND: Few studies have evaluated the frequency of and the reasons behind the refusal of listing liver transplantation candidates.
OBJECTIVE: To assess the ineligibility rate for liver transplantation and its motivations.
METHODS: A single-center retrospective study was conducted on adult patients which entailed a formal multidisciplinary assessment for liver transplantation eligibility. The predictors for listing were evaluated using multivariable logistic regression.
RESULTS: In our center, 314 patients underwent multidisciplinary work-up before liver transplantation enlisting over a three-year period. The most frequent reasons for transplant evaluation were decompensated cirrhosis (51.6%) and hepatocellular carcinoma (35.7%). The non-listing rate was 53.8% and the transplant rate was 34.4% for the whole cohort. Two hundred and five motivations for ineligibility were collected. The most common contraindications were psychological (9.3%), cardiovascular (6.8%), and surgical (5.9%). Inappropriate or premature referral accounted for 76 (37.1%) cases. On multivariable analysis, a referral from another hospital (OR: 2.113; 95%CI: 1.259-3.548) served as an independent predictor of non-listing.
CONCLUSIONS: A non-listing decision occurred in half of our cohort and was based on an inappropriate or premature referral in one case out of three. The referral from another hospital was taken as a strong predictor of non-listing.

Microneedles, as a new efficient and safe transdermal drug delivery technology, has a wide range of applications in drug delivery, vaccination, medical cosmetology, and diagnostics. The degree of microneedles penetration into the skin determines the reliability of the delivery dose, but its evaluation is not yet well-established, which is one of the major constraints in the commercialization of microneedles. In this paper, a novel visual simulated skin model was developed with reference to the physical properties of real skin. The simulated skin model was well-designed and its prescription was optimized to make the thickness, hardness, elasticity, and other parameters close to those of real skin. It not only meets the need to assess the degree of insertion of microneedles but also provides a visual observation of the insertion state of microneedles.