The Truth, Racial Healing & Transformation Center at The Citadel partnered with The Citadel's Office of Human Resources in the summer of 2022 to hold a structured conversation around campus safety in light of recent gun violence and mass shootings in the United States. This essay describes the work done to plan and conduct this circle for Citadel staff, faculty, and administrators. A detailed account is given for each part of the circle, from the opening ceremony designed to honor and reflect upon recent victims of mass shootings to the design of each prompt. Circle facilitators reflect on the 2022 experience a year later, and share future opportunities for meaningful collaborations that focus on a safe and supportive campus community.

In the U.S., approximately 11% of infants are born small for gestational age (SGA). While there are many known behavioral risk factors for SGA births, there are still many factors yet to be explored. The purpose of this study was to investigate the maternal early menarche (< 12 years old)- SGA birth association. Data were retrieved from the 2011-2017 National Survey of Family Growth, and multivariate logistic regression was used to evaluate the association. Approximately 4% of mothers reported having an SGA infant and 24% of mothers reported early age at menarche. After controlling for maternal age, race/ethnicity, and annual household income, early menarche was associated with 3% increased odds of SGA, although this finding was not statistically significant (adjusted odds ratio: 1.03, 95% CI: 0.70, 1.53). Additional research is needed on the long-term birth outcomes and health consequences of early menarche.

Background: The number of older people dying in long-term care facilities (LTCFs) is increasing and represents a public health challenge. Palliative care provision can be poor. Interventions to improve palliative care in LTCFs have been shown to be effective but little is known about their implementation. The aim of this review is to identify facilitators and barriers to implementing palliative care interventions in LTCFs and to describe the nature of implementation strategies Methods: A scoping review was undertaken: electronic databases including MEDLINE, EMBASE, PsycINFO, CINAHL, Proquest, the Cochrane Library and Web of Science were searched to identify studies published between January 2007 and January 2018. Controlled studies, non-controlled studies, qualitative studies and evaluations on the implementation of interventions to improve palliative care in long-term care facilities were included. Studies that met the inclusion criteria were selected and data extracted on key variables including, the implementation of the intervention and reported facilitators and barriers to implementation. Results: The review identified 8,071 abstracts, from which 55 studies were included in the review. Implementation strategies varied in four areas; internal and external facilitation, intended audience, extent of joint working and delivery of education/training. Support from managers, stakeholder involvement, flexibility in delivery of the intervention and adopting a ‘whole home’ approach to involvement were facilitators to implementation. High staff turnover, lack of physician involvement and failure to adopt changes into routine practice were identified as barriers to implementation. Conclusion: Limited implementation of interventions may lead to inequalities in palliative care among older adults who may benefit from it. The characteristics of palliative care interventions compared to their implementation can be difficult to separate and are often underreported. Further research is needed to understand the extent to which implementation can facilitate the uptake of palliative care interventions in long-term care facilities.

Research aims: Ensuring the delivery of prompt, comprehensive palliative care in long-term care facilities (LTCFs) requires a multidisciplinary approach, including involvement of the physician. This study aims to describe and compare among 6 European countries (1) to what extent physicians are involved in the care of residents living in LTCFs; (2) to what extent physicians recognize the resident's last phase of life and; (3) how (1) and (2) are associated. Study population: 1094 deceased residents of 239 LTCFs, about whom 505 physicians in Belgium (BE), Finland (FI), Poland (PL), Italy (IT), The Netherlands (NL) and England (EN) reported on the number of visits they paid to the resident, treatment goals, whether they recognized a resident's terminal illness and whether they expected death. Study design and methods: In each country, a cross-sectional study was conducted within representative samples of LTCFs. Participating LTCFs reported all deaths of residents in the previous 3 months, and structured questionnaires were sent to several proxies among which the treating physician. Method of statistical analysis: To control for clustering within LTCFs and countries, differences in involvement in care and recognition of the last phase of life were analyzed using multilevel analyses. Results and interpretation: Physician involvement varied widely between countries; in the last 3 months of life, residents from PL were visited most often (median: 15 times), compared to residents from FI (12), NL (10), BE (7), IT (6) and EN (5). In the last week of life, this ranged from 4 visits (NL) to 1 visit (EN). Among all countries, physicians from PL and IT least often recognized the resident's terminal phase in the last week of life (63.0% in PL up to 80.3% in NL), and least often initiated a palliative treatment (31.8% in IT up to 92.6% in NL). On overall level though, positive associations were found between the level of involvement and the recognition of the last phase of life and initiation of palliative care. LTCFs should therefore work together with and involve physicians as much as possible in caring for their residents.

Background In England, the number of older adults residing in long-term care facilities, or care homes, is expected to rise from the current level of around 350,000 to almost 600,000 by 2030. As majority of older adults admitted to care homes will reside there until death, it is unsurprising that mortality rates are higher compared to the general population. Little routine, individual level data are collected in care homes, and there is ongoing debate regarding whether it is appropriate to incorporate mortality rates or length of stay as predictors of care quality. Less is known of how mortality and length of stay vary within and between care homes. Previous studies have used a range of methods to extract and analyse data on these outcomes, including linked administrative records, census data and longitudinal studies. To date, there has been no international review of these studies. This study aims to collate factors associated with variation in mortality rates and length of stay in care homes for the elderly, at an individual and institutional level. Method A systematic literature search of health related databases was conducted to identify relevant research papers. The databases included MEDLINE, EMBASE, CINAHL and the Cochrane Library. Papers were sourced if they included adults aged over 65 years residing in long-term care settings; and measured mortality or length of stay as one of the outcomes. Studies using observational designs, either retrospective or prospective, were included for data extraction. Data were extracted on individual and institutional characteristics, study design, and primary outcomes. Results The review will identify the predictive power of individual and institutional characteristics associated with mortality and length of stay. It is anticipated that this will include age, sex and self-reported health, co-morbidities and the use of health services leading up to death. Comparisons between the types of care provided by care homes, such as nursing and residential, will also be reviewed. Conclusion Mortality and length of stay in care home residents varies between individuals and between care homes. The findings on characteristics associated with length of stay could be used by health care professionals to facilitate training staff on end of life care, inform treatment choices and support service development. The use of mortality rates as indicators of quality of care or quality of dying is contentious, however the variation in mortality across care homes warrants further research, especially in countries where care is financially supported.

Background: Nursing home residents are potentially some of the most vulnerable health service users; however, there is limited internationally comparable data on the health of this population. Basic epidemiological data can show how residents use nursing homes, and inform future service provision to serve an ageing population. Aims: This analysis aims to explore factors associated with shorter lengths of stay before death in nursing homes across six European countries. Methods: The PACE study, a mortality followback survey design. This analysis used a subset of data collected on residents who died in nursing homes providing onsite nursing care and offsite physician care across the six countries. Data on all residents who died in a retrospective three month period were collected from nursing home staff and the residents’ relative. Cox proportional hazard modelling was used to model the data and is reported as hazard ratios (HR). Results: Analysis was conducted on 869 residents across the six countries. Admission to a nursing home at older ages (HR 1.05), being male (HR 1.49), being either married or in a civil partnership (HR 1.56) or having a cancer diagnosis (HR 1.50) were significant risk factors for shorter lengths of stay before death. Admission from either a hospital (HR 1.78) or another nursing home (HR 1.78) and residence in a private, non-profit owned nursing home compared to a public, non-profit owned nursing home (HR 1.37) were also associated with shorter lengths of stay. Comparing between countries, Italy (HR 1.58), Poland (HR 1.68), and England (HR 1.66) had significantly shorter lengths of stay than Belgium (ref), the Netherlands (HR 1.17) and Finland (HR 1.23). Conclusions: This analysis highlights variation in nursing home use across residents. The relationship between experiences prior to nursing home admission, the availability of other types of long-term care and their influence on subsequent length of stay requires further research.

Background: The profile of nursing home residents across Europe is changing; residents are older, frailer and likely to have comorbidities. An understanding of anticipated length of stay is important in developing care plans, healthcare resource allocation and informing the decisions of residents and their relatives. Length of stay before death in European nursing homes is not well understood. Aims: This paper aims to explore resident and facility characteristics associated with length of stay in nursing homes across six European countries: Belgium, England, Finland, Italy, the Netherlands and Poland. Methods: Data from the PACE study, a mortality followback survey comparing the effectiveness of health care systems with and without formal palliative care structures. All residents who died in a three month period residing in nursing homes across six European countries during 2015 were included. Data on the residents was collected from the nursing home, the general practitioner and relative. Resident characteristics previously identified as possibly being related to length of stay, including age, gender, diagnoses, physical functioning, contact with health service and facility characteristics were included in a prediction model. Length of stay was calculated from date of admission to date of death. Results: Data was collected using questionnaires on 1,707 residents in 322 nursing homes. The mean length of stay was 31.0 months (SD 43.3) (Belgium 40.0 (SD 46.7), England 24.4 (SD 32.2), Finland 28.2 (SD 36.3), Italy 27.0 (SD 47.4), Netherlands 34.0 (SD 36.7), Poland 28.7 (SD 50.1). Within one year of admission, 45% of residents had died, and within five years of admission, 84% of residents had died. Factors associated with shorter lengths of stay included being male, history of stroke and shortness of breath. Conclusions: The identification of shorter stay residents is possible from data collected by nursing homes, allowing the prediction of anticipated residence to be made by care staff on admission. Further research is needed on the trajectories of nursing home residents from admission to death.