Diseases Commons^™

Vitamin D Deficiency In Scheuermann's Disease Is Associated With Increased Adverse Outcomes, Shivan N. Chokshi, Srikanth Mudiganty, Rutledge Carter Clement, William Accousti

School of Medicine Faculty Publications

INTRODUCTION: Scheuermann's disease is a diagnosis of hyperkyphosis commonly encountered in pediatric patients. Studies in animal models suggest an association with vitamin D deficiency, however, extensive studies have not been performed in humans. This study analyzes the role of vitamin D deficiency on unfavorable results in patients with Scheuermann's disease. METHODS: The TriNetX database was utilized to perform a retrospective analysis. Patients in the United States aged 0-18 years with Scheuermann's disease were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes and categorized into those with and without a diagnosis of vitamin D deficiency. Comparison of patient groups …

The Bone Marrow Endothelial Progenitor Cell Response To Septic Infection, Xin Shi, Kevin J. Simms, Thomas J. Ewing, Yuan-Ping Lin, Yi-Ling Chen, John N. Melvan, Robert W. Siggins, Ping Zhang

School of Graduate Studies Faculty Publications

Early increase in the level of endothelial progenitor cells (EPCs) in the systemic circulation occurs in patients with septic infection/sepsis. The significance and underlying mechanisms of this response remain unclear. This study investigated the bone marrow EPC response in adult mice with septic infection induced by intravenous injection (i.v.) of . For experiments, sorted marrow stem/progenitor cells (SPCs) including lineage(lin)stem cell factor receptor (c-kit)stem cell antigen-1 (Sca-1), linc-kit, and lin cells were cultured with or without lipopolysaccharides (LPSs) and recombinant murine vascular endothelial growth factor (VEGF) in the absence and presence of anti-Sca-1 crosslinking antibodies. In a separate set of …

Effect Of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis On Medication Satisfaction And Out-Of-Pocket Costs: A Secondary Analysis Of A Randomized Clinical Trial, Nathan N O'Hara, Katherine P Frey, Deborah M Stein, Joseph F Levy, Gerard P Slobogean, Renan Castillo, Reza Firoozabadi, Madhav A Karunakar, Joshua L Gary, William T Obremskey, Rachel B Seymour, Joseph Cuschieri, C Daniel Mullins, Robert V O'Toole, Metrc

Faculty, Staff and Student Publications

BACKGROUND: Current guidelines recommend low-molecular-weight heparin for thromboprophylaxis after orthopaedic trauma. However, recent evidence suggests that aspirin is similar in efficacy and safety. To understand patients' experiences with these medications, we compared patients' satisfaction and out-of-pocket costs after thromboprophylaxis with aspirin versus low-molecular-weight heparin.

METHODS: This study was a secondary analysis of the PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT) trial, conducted at 21 trauma centers in the U.S. and Canada. We included adult patients with an operatively treated extremity fracture or a pelvic or acetabular fracture. Patients were randomly assigned to receive 30 mg of low-molecular-weight heparin (enoxaparin) …

Does An Early, Balanced Resuscitation Strategy Reduce The Incidence Of Hypofibrinogenemia In Hemorrhagic Shock?, David T Lubkin, Krislynn M Mueck, Gabrielle E Hatton, Jason B Brill, Mariela Sandoval, Jessica C Cardenas, Charles E Wade, Bryan A Cotton

Faculty, Staff and Student Publications

OBJECTIVES: Some centers have recommended including concentrated fibrinogen replacement in massive transfusion protocols (MTPs). Given our center's policy of aggressive early balanced resuscitation (1:1:1), beginning prehospital, we hypothesized that our rates of hypofibrinogenemia may be lower than those previously reported.

METHODS: In this retrospective cohort study, patients presenting to our trauma center November 2017 to April 2021 were reviewed. Patients were defined as hypofibrinogenemic (HYPOFIB) if admission fibrinogen

RESULTS: Of 29 782 patients, 6618 level 1 activations, and 1948 patients receiving emergency release blood,

CONCLUSIONS: Low rates of hypofibrinogenemia were found in our center which treats hemorrhage with early, balanced …

Aortic Stenosis Management In Patients With Acute Hip Fracture, Juan A. Terré, Juan Torrado, Isaac George, Rafael Harari, Pedro R. Cox-Alomar, Pedro A. Villablanca, Robert T. Faillace, Juan F. Granada, George Dangas, Mario J. Garcia, Azeem Latib, José Wiley

School of Medicine Faculty Publications

The treatment of severe aortic stenosis (SAS) has evolved rapidly with the advent of minimally invasive structural heart interventions. Transcatheter aortic valve replacement has allowed patients to undergo definitive SAS treatment achieving faster recovery rates compared to valve surgery. Not infrequently, patients are admitted/diagnosed with SAS after a fall associated with a hip fracture (HFx). While urgent orthopedic surgery is key to reduce disability and mortality, untreated SAS increases the perioperative risk and precludes physical recovery. There is no consensus on what the best strategy is either hip correction under hemodynamic monitoring followed by valve replacement or preoperative balloon aortic …

Artificial Intelligence Predictive Analytics In Heart Failure: Results Of The Pilot Phase Of A Pragmatic Randomized Clinical Trial, Konstantinos Sideris, Charlene R Weir, Carsten Schmalfuss, Heather Hanson, Matt Pipke, Po-He Tseng, Neil Lewis, Karim Sallam, Biykem Bozkurt, Thomas Hanff, Richard Schofield, Karen Larimer, Christos P Kyriakopoulos, Iosif Taleb, Lina Brinker, Tempa Curry, Cheri Knecht, Jorie M Butler, Josef Stehlik

Faculty, Staff and Students Publications

OBJECTIVES: We conducted an implementation planning process during the pilot phase of a pragmatic trial, which tests an intervention guided by artificial intelligence (AI) analytics sourced from noninvasive monitoring data in heart failure patients (LINK-HF2).

MATERIALS AND METHODS: A mixed-method analysis was conducted at 2 pilot sites. Interviews were conducted with 12 of 27 enrolled patients and with 13 participating clinicians. iPARIHS constructs were used for interview construction to identify workflow, communication patterns, and clinician's beliefs. Interviews were transcribed and analyzed using inductive coding protocols to identify key themes. Behavioral response data from the AI-generated notifications were collected.

RESULTS: Clinicians …

Harnessing Rna Technology To Advance Therapeutic Vaccine Antigens Against Chagas Disease, Chiara Mancino, Jeroen Pollet, Assaf Zinger, Kathryn M Jones, Maria José Villar, Ana Carolina Leao, Rakesh Adhikari, Leroy Versteeg, Rakhi Tyagi Kundu, Ulrich Strych, Federica Giordano, Peter J Hotez, Maria Elena Bottazzi, Francesca Taraballi, Cristina Poveda

Center for Medical Ethics and Health Policy Staff Publications

Chagas disease (CD) (American trypanosomiasis caused by Trypanosoma cruzi) is a parasitic disease endemic in 21 countries in South America, with increasing global spread. When administered late in the infection, the current antiparasitic drugs do not prevent the onset of cardiac illness leading to chronic Chagasic cardiomyopathy. Therefore, new therapeutic vaccines or immunotherapies are under development using multiple platforms. In this study, we assessed the feasibility of developing an mRNA-based therapeutic CD vaccine targeting two known T. cruzi vaccine antigens (Tc24—a flagellar antigen and ASP-2—an amastigote antigen). We present the mRNA engineering steps, preparation, and stability of the lipid …

Deep-Learning-Based Group Pointwise Spatial Mapping Of Structure To Function In Glaucoma, Zhiqi Chen, Hiroshi Ishikawa, Yao Wang, Gadi Wollstein, Joel Schuman

Wills Eye Hospital Papers

PURPOSE: To establish generalizable pointwise spatial relationship between structure and function through occlusion analysis of a deep-learning (DL) model for predicting the visual field (VF) sensitivities from 3-dimensional (3D) OCT scan.

DESIGN: Retrospective cross-sectional study.

PARTICIPANTS: A total of 2151 eyes from 1129 patients.

METHODS: A DL model was trained to predict 52 VF sensitivities of 24-2 standard automated perimetry from 3D spectral-domain OCT images of the optic nerve head (ONH) with 12 915 OCT-VF pairs. Using occlusion analysis, the contribution of each individual cube covering a 240 × 240 × 31.25 μm region of the ONH to the model's …

Neutrophil Elastase Remodels Mammary Tumors To Facilitate Lung Metastasis, Amriti R Lulla, Said Akli, Cansu Karakas, Joseph A Caruso, Lucas D Warma, Natalie W Fowlkes, Xiayu Rao, Jing Wang, Kelly K Hunt, Stephanie S Watowich, Khandan Keyomarsi

Faculty, Staff and Student Publications

Metastatic disease remains the leading cause of death due to cancer, yet the mechanism(s) of metastasis and its timely detection remain to be elucidated. Neutrophil elastase (NE), a serine protease secreted by neutrophils, is a crucial mediator of chronic inflammation and tumor progression. In this study, we used the PyMT model (NE+/+ and NE-/-) of breast cancer to interrogate the tumor-intrinsic and -extrinsic mechanisms by which NE can promote metastasis. Our results showed that genetic ablation of NE significantly reduced lung metastasis and improved metastasis-free survival. RNA-sequencing analysis of primary tumors indicated differential regulation of tumor-intrinsic actin cytoskeleton signaling pathways …

Early Screening Of Colorectal Cancer Using Feature Engineering With Artificial Intelligence-Enhanced Analysis Of Nanoscale Chromatin Modifications, Andrew Chang, Sravya Prabhala, Ali Daneshkhah, Jianan Lin, Hariharan Subramanian, Hemant Kumar Roy, Vadim Backman

Faculty, Staff and Students Publications

Colonoscopy is accurate but inefficient for colorectal cancer (CRC) prevention due to the low (~ 7 to 8%) prevalence of target lesions, advanced adenomas. We leveraged rectal mucosa to identify patients who harbor CRC field carcinogenesis by evaluating chromatin 3D architecture. Supranucleosomal disordered chromatin chains (~ 5 to 20 nm, ~1 kbp) fold into chromatin packing domains (~ 100 to 200 nm, ~ 100 to 1000 kbp). In turn, the fractal-like conformation of DNA within chromatin domains and the folding of the genome into packing domains has been shown to influence multiple facets of gene transcription, including the transcriptional plasticity …

Education Of Ventilator-Associated Pneumonia Prevention In Adult Intensive Care Patients, Carlin Morgan

Scholars Week

The purpose of this project was to improve knowledge related to evidence-based ventilator-associated pneumonia (VAP) preventative measures that decrease the prevalence of VAP in adult patients in the intensive care unit (ICU). An educational presentation was provided to twelve critical care nurses at a 349-bed hospital in western Kentucky. A pretest was obtained to measure the nurse’s knowledge prior to the presentation. A PowerPoint and pamphlet containing VAP prevention techniques were presented to the twelve critical care nurses during each meeting. A posttest was then administered after the presentation to measure the efficacy of the educational presentation. The mean of …

Malaria, A Burden For Sub-Saharan Africa, Alpha Mamadou Hady Barry

Health and Kinesiology Theses

Malaria has been a worldwide health problem for centuries causing between 1.5 to 2.7 million deaths annually, and mostly affecting children aged 5 and under and pregnant women in Sub-Saharan Africa (SSA) (Phillips, 2001). The discovery of malaria parasites by Laveran in 1880 as well as the finding of mosquitoes as vectors for avian malaria by Ross in 1897, made scientific studies about malaria possible. Between 1898 and 1900, the Italian scientists Grassi, Bignami, Bastianelli, Celli, Golgi and Marchiafava discovered human malaria (Cox, 2010). Malaria has been eradicated from developed countries such as the United Staes and most European countries …

Diabetic Self-Management Programs As An Intervention To Decrease A1c Levels, Amanda Hughes

Master of Science in Nursing Family Nurse Practitioner

This paper discusses and examines the impact of a technology-integrated diabetes self-management program on HbA1c levels in adults with Type 2 diabetes, compared to traditional diabetic care and education methods. Utilizing a theoretical framework of Social Cognitive Theory, which would be applied to this project, the research would investigate whether integrating technological tools, such as mobile applications and online platforms, into diabetes self-management can provide better glycemic control. A randomized controlled trialis proposed that would involve 200 adult participants with Type 2 diabetes, divided into two groups: one receiving the technology-integrated program and the other following conventional care protocols. Over …

Primary Hypertrophic Osteoarthropathy: A Case Series, Varuni Pragya, Mahabaleshwar Mamadapur Dr, Rahul Bisaralli Dr, Deepak Benny Dr, Purna Bansal

Digital Journal of Clinical Medicine

Skeletal dysplasia encompasses a spectrum of over 400 rare inheritable skeletal abnormalities typically manifested early in childhood. Hypertrophic Osteoarthropathy is a clinical syndrome marked by abnormal skin and osseous tissue proliferation at the distal extremities. It is characterized by unique clinical features such as digital clubbing, periostosis of tubular bones, and synovial effusions.

We report three cases of HPOA for further understanding and insight into this infrequent cause of clubbing. Case 1 involved a 25-year-old male presenting with joint pain, primarily in wrists and knees, accompanied by progressive swelling in both lower limbs for the past 3 years. Case 2 …

Changing The Way Providers Order Blood Return To Intensive Care Patients, Chloe Morris

Spring Showcase for Research and Creative Inquiry

Patients with anemia and other conditions resulting in loss of blood often come with orders to return wasted blood to them. While using typical blood draw practices, patients are placed at an increased risk of infection when their blood is exposed to the outside world. My question is, will using a closed system decrease the instances of infection in patients who receive their waste blood after draws? By utilizing a waste syringe attached to the IV line, nurses can avoid detaching and reattaching syringes to collect and give back the patient's blood. Patients who are already at an increased risk …

Retrorectal Hernia: A Rare Cause Of Constipation Diagnosed On Magnetic Resonance (Mr) Defecography, Olanrewaju Ogunleye, Abeer H Abdelhafez, Eduardo Matta, Larry Kramer

Faculty, Staff and Student Publications

Retrorectal herniation of the sigmoid colon is a rare condition characterized by the protrusion of a segment of the colon into the pre-sacral space and posterior to the rectum. This herniation occurs through a defect in the peritoneum, which may have developed secondary to congenital mechanisms, surgery, trauma, or inflammatory processes. Here, a case of retrorectal herniation of the sigmoid colon in an elderly female patient presenting with constipation is reported, with a review of the literature.

Short-Term Larval Surveys Reveal Rainy Season Breeding Site Preferences Of Malaria Vector Anopheles Spp. In Zanzibar City, Kaeden K. Hill

Independent Study Project (ISP) Collection

Malaria is a serious illness that causes over 500,000 deaths annually worldwide, with Tanzania alone contributing to approximately 4% of those deaths. Malaria is caused by Plasmodium spp. parasites, and it is vectored by mosquitoes in the Anopheles genus. In Zanzibar City, the incidence of malaria has decreased over the past few decades due to standardized treatment protocols and public health interventions targeting adult mosquitoes. However, the incidence remains between 1-2%, with an increasing trend observed over the past few years likely stemming from continued exchange of Plasmodium spp. from other malaria-endemic areas. Because larvicidal strategies can be useful in …

2nd Place Contest Entry: Physician Visits For Patients With Diabetes By Gender, Age And Race In The United States, Daniel Umoru, Olajide Adekunle, Adeola Bakare

Eric M. Scandrett Graduate Library Research Prize

This is Daniel Umoru, Olajide Adekunle, and Adeola Bakare's submission for the 2024 Eric M. Scandrett Graduate Research Prize, which won second place. It contains their essay on using library resources, their bibliography, and a summary of their research project (with Dr. Lawrence "LB" Brown) on the complex demographic landscape of diabetes prevalence in the United States.

Daniel, Adeola, and Olajide are doctoral students in the School of Pharmacy at Chapman University. Their faculty mentor is Dr. Enrique Seoane-Vazquez.

Mediating Effect Of Bmi On The Association Of Economic Status And Coexistence Of Hypertension And Diabetes In Bangladesh: A Counterfactual Framework-Based Weighting Approach, Foyez , Md. Jamal Hossain Ahmmed, Md. Jamal Hossain, Md Tareq Ferdous Khan, Muhammad Mahabub Rahaman Manik, Saimon Shahriar, Dulal Chandra Nandi, Md Parvej Hussain

Mathematics and Statistics Faculty Publications

Background and Aims

Non-communicable diseases such as hypertension and diabetes are matters of huge concern worldwide, with an increasing trend in prevalence over the previous decade. First of all, this study aimed to evaluate the association between economic status (ES) and body mass index (BMI), ES and comorbidity of hypertension and diabetes, and BMI and comorbidity independently. Second, it explored the mediating role of BMI in the association between ES and comorbidity of hypertension and diabetes. Finally, it investigated whether the mediating effect differs with the place of residence, gender, and education levels.

Methods

A total of 11,291 complete cases …

Outcomes Of Virtual Diabetes Cook Along Classes, April Litchford, Jenna Dyckman, Cindy Jenkins, Andrea Schmutz, Carrie Durward

Outcomes and Impact Quarterly

USU Extension Diabetes Cook Along classes provide diabetes education to the public while removing barriers to participation. These classes teach relevant topics through hands-on activities to increase participants’ ability to effectively self-manage their diabetes symptoms. Evaluation results show that participants experienced high satisfaction (86%) and substantial knowledge gain (92%) after the classes.

Dynamic Imaging Of Blood Coagulation Within The Hematoma Of Patients With Acute Hemorrhagic Stroke, Muhammad E Haque, Seth B Boren, James Mills, Kerry G Schneider, Maria Parekh, Stuart M Fraser, Ivo Bach, Praveen Hariharan, Pamela J Zelnick, Felix S Guerra Castanon, Asim Naveed, Muhammad Tariq, Octavio D Arevalo, Khader M Hasan, Miguel Escobar, Xiurong Zhao, Clark Sitton, Ponnada A Narayana, James C Grotta, Jaroslaw Aronowski, Sean I Savitz

Faculty, Staff and Student Publications

BACKGROUND: The dynamics of blood clot (combination of Hb [hemoglobin], fibrin, and a higher concentration of aggregated red blood cells) formation within the hematoma of an intracerebral hemorrhage is not well understood. A quantitative neuroimaging method of localized coagulated blood volume/distribution within the hematoma might improve clinical decision-making.

METHODS: The deoxyhemoglobin of aggregated red blood cells within extravasated blood exhibits a higher magnetic susceptibility due to unpaired heme iron electrons. We propose that coagulated blood, with higher aggregated red blood cell content, will exhibit (1) a higher positive susceptibility than noncoagulated blood and (2) increase in fibrin polymerization-restricted localized diffusion, …

Prediction Of Cancer Incidence And Mortality In Korea, 2024, Kyu-Won Jung, Mee Joo Kang, Eun Hye Park, E Hwa Yun, Hye-Jin Kim, Jeong-Eun Kim, Hyun-Joo Kong, Jeong-Soo Im, Hong Gwan Seo

Faculty, Staff and Student Publications

PURPOSE: This study aimed to report the projected cancer incidence and mortality for the year 2024 to estimate Korea's current cancer burden.

MATERIALS AND METHODS: Cancer incidence data from 1999 to 2021 were obtained from the Korea National Cancer Incidence Database, and cancer mortality data from 1993 to 2022 were acquired from Statistics Korea. Cancer incidence and mortality were projected by fitting a linear regression model to observed age-specific cancer rates against their respective years and multiplying the projected age-specific rates by the anticipated age-specific population for 2024. A joinpoint regression model was used to determine the year in which …

Clinical Efficacy Of Blood Derivatives On Wound Healing: A Systematic Review And Network Meta-Analysis, Yanhong Wu, Guang Peng, Yuzhi Wang, Jianwu Chen, Bin Zhang, Jianbing Tang, Biao Cheng

Faculty, Staff and Student Publications

This study aims to evaluate the clinical effects of different blood derivatives on wound healing using network meta-analysis. PubMed, Embase, OVID, Web of Science, SCOPUS and Cochrane Central were searched to obtain studies about blood derivatives on wound healing until October 2023. R 4.2.0 and Stata 15.0 softwares were used for data analysis. Forty-four studies comprising 5164 patients were included. The results of network meta-analysis showed that the healing area from high to low was GF + ORCCB, ORCCB, GF, PRF, Unnas paste dressing, APG, PRP injection, PRP, PRP + thrombin gel, PPP, HPL, CT. The healing time from low …

Congenital Heart Defects And Autism: Understanding The Breakdown Of Associated Risk Factors In A Clinically Referred Sample, Elizabeth Raines, Amanda Strasser, Amanda Manderfeld, Paul Glasier, Elizabeth J. Willen

Posters

Background: Children with Congenital Heart Disease (CHD) have higher odds of developing social difficulties and/or an Autism Spectrum Disorder (AuSD) than the general population (i.e., ~10% vs. ~1%). However, there is a paucity of nuanced understanding of specific drivers of the increased rates of AuSD in extant literature. The purpose of this study is to identify the rates of co-occurring cardiac, neurological, and genetic conditions to better understand associated risk factors in a patient sample from a medium-size children’s hospital. Methods: Our population includes a clinically referred sample of children (i.e., medical history of CHD and neurodevelopmental risk) under 18 …

”To Be Or Not To Be – It’S Good”: Actor And Student Experiences In A Drama Club For People With Aphasia, Jade K. Hannan

Senior Theses

Individuals with aphasia, a disorder caused by damage to the brain’s language network, confront a variety of social and emotional struggles. While leaving their cognition largely intact, aphasia tremendously impacts a person’s ability to communicate confidently, fracturing their social network and contributing to feelings of loneliness and frustration. To address this persistent need in the chronic aphasia population, the Play on Words drama club at the University of South Carolina provides a forum for people with aphasia (PWA) to engage in dramatic exercises focused on non-verbal communication of emotions, ideas, and stories, culminating the production of an original devised play. …

Elucidating The Role Of Protease-Activated Receptor 2 In Elastase-Induced Abdominal Aortic Aneurysms, John Pitstick

Senior Theses

Cardiovascular diseases (CVDs) remain the leading cause of mortality in the world despite extensive research. As a type of CVD, abdominal aortic aneurysm (AAA) represents a critical medical condition characterized by the localized dilation of the abdominal aorta. Complications from aneurysm development results in catastrophic aortic rupture, which leads to mortality more than 80% of the time. As aneurysm development is typically asymptomatic, many AAAs remain untreated until they present a serious risk of rupture. Additionally, no pharmaceutical treatment exists for AAAs, with the only option being surgical intervention. Despite advancements in diagnostic methods and surgical techniques, the pathogenesis of …

Adolescent Marijuana Use And The Contribution To The Development Of Schizophrenia, Jocelyn Spandikow

Psychology Student Papers and Posters

Schizophrenia is an often debilitating mental condition that has become a popular topic of psychological research in recent years. Current research examines the correlation between drug use, genetics, and environment on the development of schizophrenia. Research looks at the structure of the brain in individuals with and without schizophrenia. However, research has failed to look at the specific correlation between marijuana use in adolescent youth and the developmental impact on the brain, including in the development of schizophrenia. The legalization of many recreational drugs, including marijuana, has come to fruition in recent years. This has raised concerns over adolescent access …

Acute Coronary Syndrome Patterns In The Young: Risk Factor Profile And In-Hospital Outcomes In A Tertiary Referral Hospital In Kenya, Nadeem Kassam, Mzee Ngunga, Mohamed Varwani, Miriam Msunza, Jeilan Mohamed

Internal Medicine, East Africa

Introduction: Acute coronary syndrome (ACS) accounts for coronary artery disease (CAD) –related morbidity and mortality. There has been growing concern about the rising incidence of ACS among young individuals globally both in developed and developing countries, including Sub-Saharan Africa. This group’s phenotypic characteristics; risk factors and clinical outcomes are not well described. contextual and regional studies are necessary to understand the magnitude of ACS among young Individuals and help highlight challenges and opportunities for improved ACS outcomes in the region. The study aimed to describe the demographic and clinical characteristics of young individuals hospitalized with ACS and report on in-hospital …

Maintaining Program Fidelity In A Changing World: National Implementation Of A School-Based Hiv Prevention Program, Elizabeth Schieber, Lynette Deveaux, Lesley Cotrell, Xiaoming Li, Stephenie C Lemon, Arlene S Ash, Karen Macdonell, Samiran Ghosh, Maxwell Poitier, Glenda Rolle, Sylvie Naar, Bo Wang

Faculty, Staff and Student Publications

Large-scale, evidence-based interventions face challenges to program fidelity of implementation. We developed implementation strategies to support teachers implementing an evidence-based HIV prevention program in schools, Focus on Youth in The Caribbean (FOYC) and Caribbean Informed Parents and Children Together (CImPACT) in The Bahamas. We examined the effects of these implementation strategies on teachers' implementation in the subsequent year after the initial implementation during the COVID-19 pandemic. Data were collected from 79 Grade 6 teachers in 24 government elementary schools. Teachers completed training workshops and a pre-implementation questionnaire to record their characteristics and perceptions that might affect their program fidelity. School …