Changing Priorities Research Articles

English

BACKGROUND Due to changing priorities of medical students in the present day scenario, an insight of their Emotional Intelligence (EI) can serve as a predictor of their compassionate and understanding domain. The relation of EI with academic performance will give an idea on how the emotional or indirectly psychological component plays a role in the manner the medical students perform. Importance of Emotional Intelligence (EI) is increasingly recognised. It is more relevant in medical professionals who have an inbuilt touch of emotions to the profession. The study was conducted to evaluate EI of 7th semester MBBS students and also to determine the relation if any of EI with their academic performances. METHODS This descriptive cross sectional study was conducted in a Government Medical College in Central India. The study was carried out among 159 medical students. Data collection was done with the aid of a structured, pretested questionnaire which had questions based on the Quick Emotional Intelligence self-administered questionnaire. Academic scores of previous MBBS years were considered. The relation between emotional intelligence and academic scores was studied. Data was entered in Microsoft excel. Statistical analysis was done with help of Open Epi Info. RESULTS Mean ± Standard Deviation of Emotional awareness, Emotional Management, Social Emotional Awareness, and Relationship Management scores were 23.94 ± 4.86, 24.56 ± 6.49, 27.75 ± 5.77 and 25.91 ± 6.46 respectively. Mean total Emotional Intelligence score including all domains was 102.16 ± 18.38. A weak positive correlation was established between EI and academic scores. CONCLUSIONS EI of medical students was directly associated with their academic scores. KEY WORDS Emotional Intelligence, Medical, Academic Scores, Students

Publishing Environmental Assessment and Management Science: Crossing the Hurdles.

Benefits accrue to scientists, resource managers, companies, and policymakers when environmental scientists publish in peer-reviewed journals. However, environmental scientists and practitioners face challenges, including the sometimes low value placed on journal articles, institutional vested interests in outcomes, and the changing priorities of employers and project sponsors. Confidentiality agreements can also lead scientists to assume publication is not an option. Case studies may be viewed by potential authors as too routine for peer-reviewed journals. On the basis of 30 years of experience, we suggest that publishing hurdles can be overcome and that environmental scientists have a range of options. The topics of manuscripts can include not only results from case studies and perspectives based on them but also byproducts of assessments, including definitions, plans, monitoring methods and models, and decision frameworks. Environmental scientists have unique opportunities to move science forward with their practical knowledge if they can move across the institutional, logistical, data-related, and content-related hurdles.

Caregiver experiences of paediatric inpatient cardiac services: A qualitative systematic review.

Advances in paediatric care have contributed to an increasing survival of children with complex heart disease. Yet, life-saving management demands prolonged inpatient admissions, which contribute to emotional and psychological distress for parents and other caregivers in a role of main custody. The purpose of this study was to identify, appraise and synthesise qualitative studies exploring caregivers' experiences of paediatric inpatient cardiac services, generating an understanding of their needs in hospital and informing priorities for change in healthcare delivery. Searches were conducted in Medline, Allied and Complimentary Medicine Database, Cumulative Index of Nursing and Allied Health Literature, EMCARE, Scopus, PsychINFO, Proquest, OpenGrey and ETHOs from 2008-2019, reflecting recent advances in cardiac healthcare. Articles were selected using predetermined eligibility criteria dictating qualitative inquiry into caregiver perspectives whilst their child received hospital-based interventions for heart disease. All eligible studies underwent quality appraisal. Framework synthesis was used to analyse and summarise findings. Twenty-seven studies involving 689 caregivers from 11 countries were included. Three overarching themes were identified: 'emotional capacity to care', 'practicalities of caring', and 'the bigger picture of caring'. Through analysis and summary of qualitative primary research, this review captures the emotional challenges that caregivers face and practicalities of undertaking a caregiver role, whilst looking after their child with heart disease in hospital. The results widen the context of the caregiver role, encompassing the whole family unit beyond the hospital environment. This review exposes the impact of these challenges on caregiver competence, wellbeing and attachment to their unwell child, informing priorities for development of family-centred paediatric inpatient cardiac services.

A quality improvement project to standardise decontamination procedures in a single NHS board in Scotland.

Background:A project was designed to improve decontamination procedures in our hospitals. This included: improving skills with training provided within clinical areas, simplifying procedures to reduce variation and increasing access to decontamination products.Aim:To make it easy for healthcare workers (HCWs) to do the right thing and for HCWs to be confident that they were doing the right thing.Methods:A pre-intervention survey of 120 HCWs in 10 wards on three hospital sites identified variations in the products used, variations in precautions taken and deficits in HCWs’ capabilities due to unmet training needs.Intervention:We streamlined the available products, provided an education programme and then undertook a second survey involving 133 HCWs in 12 wards.Results:Significant improvements were attained in the reported time taken to clean and disinfect (P < 0.0001) and in HCW capability (P < 0.0001) (reported training received); other improvements in the use of appropriate products and the use of personal protective equipment were evident. The key finding was that a large, previously unrecognised, unmet training need existed; only 44% of HCWs in the pre-intervention survey reported having received training on the topic.Conclusion:The utility of a pre-intervention survey is critical to knowing whether any change becomes improvement and to set the priorities for change. By focusing on the process rather than the outcomes, greater improvements can be attained. The assumption that all nurses know how to clean is erroneous.

Socio-psychological criteria for mutual selection of adoptive parents and children deprived of parental care as prognostic signs of the mental health of their future family

Socio-psychological criteria for mutual selection of adoptive parents and children deprived of parental care as prognostic signs of the mental health of their future family

The impact of end-userś participation (cancer patients) during the optimization process

Abstract End-user (e.g. patients or the public) testing of information material is becoming more common in the German public health care system. However, including the end-user (in this case patients) in an optimisation process and thus enabling a close collaboration while developing PIMs is still rare. This is surprising, given the fact that patients provide the exact perspective one is trying to address. Within the isPO project, a patient organization is included as a legal project partner to act as the patient representative and provide the patient's perspective. As such, the patient organization was included in the PHR approach as part of the PIM-optimisation team. During the optimisation process, the patients gave practical insights into the procedures of diagnosing and treating different types of cancer as well as into the patient's changing priorities and challenges at different time points. This was crucial information for the envisioned application of the individual PIMs and their hierarchical overview. Moreover, the developed PIM-checklist enabled the patients to give detailed feedback to the PIMs. With their experience of being in the exact situation in which the PIMs will be applied, their recommendations, especially on the wording and layout of the materials, have been a valuable contribution to the PIM optimisation process. In this part of the seminar, we will take a closer look at the following skill building aspects: What is gained from including patients as end-users in the development and optimization of PIM?How can we reach patients to contribute to a PIM optimization process? Which requirements and prerequisites do patients have to provide to successfully work on an optimisation team?How to compromise and weigh opinions when different ideas occur? Altogether, this part will construct a structured path of productive patient involvement and help to overcome uncertainties regarding a collaboration with patient organizations.

From the carer's mouth: A phenomenological exploration of carer experiences with head and neck cancer patients.

Receiving a diagnosis of head and neck cancer is devastating for patients and family carers and causes high levels of distress. Previous studies report that carer distress levels exceed that of patients, but go largely unnoticed by health professionals. To date, there is a paucity of studies that have described carers' perspectives of the lived experience of caring for a loved one diagnosed with head and neck cancer. The aim of this study was to explore the lived experiences of carers of patients diagnosed with head and neck cancer. This qualitative study was informed by descriptive phenomenology. Carers of patients who had been diagnosed with head and neck cancer within the last 6 years were recruited from participating hospitals in Perth, Western Australia. Semi-structured interviews were conducted with 20 carers of patients diagnosed with head and neck cancer. Thematic analysis was conducted to gain an understanding of participants lived experiences. Key themes identified were: Silent Suffering, Gamut of Emotions, Causal Attribution, Changing Priorities, Gaining Support, and Coping. The changing priorities themes highlights that carers prioritised (a) being available for their loved one and (b) taking an active role in managing head and neck cancer symptoms and side effects. Carers of patients diagnosed with head and neck cancer experience distress. Instead of seeking support, carers often elected to suffer in silence. Implications for practice include screening for carer distress and providing specific interventions focused on caring for someone diagnosed with head and neck cancer.

THE PERSPECTIVE OF QUALITY MANAGEMENT SYSTEM DEVELOPMENT IN THE ERA OF INDUSTRY 4.0

Purpose of the study: This study tried to examine the level of awareness and vision of prospects for the development of quality management and its corresponding systems in the era of transition to the technologies and principles of Industry 4.0 among quality management professionals of Russian companies.&#x0D; Methodology: The study is based on the survey conducted in April - May 2019 among the expert community in the field of quality management. A total of 50 experts from Russian industrial and service companies participated in the survey. The survey was organized in accordance with the stages of 'the Deming Plan-Do-Check-Act cycle. The data analyzed by using the Spearman correlation to determine the relationship between the understanding of current priority and anticipation of future changes in quality management concepts, principles, and tools in the era of Industry 4.0.&#x0D; Main Findings: The survey results show how innovative quality management methods can be applied practically with relevance to 4th industrial revolution technologies. The authors conclude that the changes in the core concepts of quality management are necessary for the Industry 4.0 era and offer a 4.0 quality definition through the revision of quality management principles.&#x0D; Applications of the study: The finding of this study is useful for the development of a digital transformation strategy of the business companies by showing the correlation between quality management principles awareness and implementation of digital tools. The study shows the necessity to offer interdisciplinary training for quality management professional and IT specialists on the digital transformation of quality management.&#x0D; Novelty/Originality of the study: The originality is in the design of the survey that covered issues that haven't been studied in correlation with each other before the influence of Industry 4.0 tools and key provisions on quality management and development strategy of the company. In the survey, the perception of new quality management principles was investigated for the first time.

Process Planning in Industry 4.0—Current State, Potential and Management of Transformation

The implementation of the Industry 4.0 concept enables the flexibility, modularity and self-optimization of the manufacturing process. Process planning, placed in the value chain between construction and physical manufacturing, therefore, also demands digital transformation, while management of the transformation towards the new digital framework represents one of the most demanding challenges. Continuing the research on its structure and role within the smart factory, the main motivation for this work was to recognize the potential of the digital transformation of process planning elements, and to define the key dimensions that are essential for the readiness factor calculation and later transformational strategy formation, but also to recognize the current level of awareness of the Industry 4.0 concept among the process planners, along with the current use of its elements and key priorities for the transformation. The research has therefore been conducted in 34 Croatian metal machining companies, within which the influence of company size, level of education and familiarity with Industry 4.0 on final results and the stage of development have been investigated. The results have shown that the company size has a significant influence on the development stage and the use of certain elements wherein small and medium enterprises (SMEs) have already implemented certain digital elements, while they also tend to have a better fundamental infrastructure when using complex process planning methods, unlike others, which are still highly traditional. Organization and human resources have been ranked with the highest priority for change, while target goals for hardware and software have been set, with the managerial challenges of transformation defined and discussed.

Can Australia transition to an agroecological future?

ABSTRACT Australia faces seemingly impossible barriers to transitioning to agroecology. Nonetheless, many possibilities for a distinctively Australian agroecology exist. Some Australian farmers have helped create methods for rehydrating landscapes, while Indigenous peoples are reclaiming crops and farming methods well-adapted to Australia’s diverse regions.To appraise the prospects for agroecological changes in Australia, I modify in two ways the Multi-Level Perspective framework widely used in transitions research. First, I elaborate the notion of lock-ins that impede systemic change.Looking at Australia reveals an array of socio-ecological lock-ins that matter alongside the more familiar political economy lock-ins. These include settler colonialism, climate/environmental change, and scientific & technological priorities. Second, I add ‘massification’ (or the growth of a movement supporting change toward agroecology) as one possible process for overcoming these lock-ins. I work through several key drivers of the process of taking agroecology to scale to show how agroecological transition might happen.

Fuzzy monitoring of in-bed postural changes for the prevention of pressure ulcers using inertial sensors attached to clothing.

Postural changes while maintaining a correct body position are the most efficient method of preventing pressure ulcers. However, executing a protocol of postural changes over a long period of time is an arduous task for caregivers. To address this problem, we propose a fuzzy monitoring system for postural changes which recognizes in-bed postures by means of micro inertial sensors attached to patients' clothes. First, we integrate a data-driven model to classify in-bed postures from the micro inertial sensors which are located in the socks and t-shirt of the patient. Second, a knowledge-based fuzzy model computes the priority of postural changes for body zones based on expert-defined protocols. Results show encouraging performance in the classification of in-bed postures and high adaptability of the knowledge-based fuzzy approach.

COVID-19 and Racial Disparities: Moving Towards Surgical Equity.

COVID-19 and Racial Disparities: Moving Towards Surgical Equity.

Defining Occupational Competence and Occupational Identity in the Context of Recovery in Schizophrenia.

The Occupational Self Assessment (OSA) measures two constructs from the Model of Human Occupation: occupational competence and occupational identity. In the field of mental health, the recovery movement has sparked discussions about what constitutes personal, clinical, and functional recovery. However, how occupation-based terminologies are related to the recovery framework is unclear. To elucidate how domains of recovery and psychological constructs are related to the OSA's constructs of occupational competence and occupational identity in order to inform occupational therapy practice in the recovery arena. Cross-sectional study. Outpatient mental health unit. Sixty-six community-dwelling adults with schizophrenia recruited through convenience sampling. Participants completed the OSA and clinical, functional, and personal recovery assessments. They also completed five scales that measured psychological constructs of recovery such as hope, resilience, empowerment, internalized stigma, and subjective well-being. Participants also identified up to four OSA items that were priorities for change. Tests of association and multiple regression analyses were conducted to identify predictors of occupational competence and occupational identity. Personal recovery predicted occupational competence, whereas depressive symptoms and hope predicted occupational identity. Functional and clinical recovery did not predict occupational competence. The top three OSA priorities for change were performance items: "managing my finances," "concentrating on my tasks," and "taking care of myself." Occupational therapy interventions should not be limited to functional improvement. Instead, they should account for clients' affective states and seek to instill recovery-oriented psychological states such as hope and efficacy. Occupational competence is achieved by enhancing personal states of self-efficacy in fulfilling valued occupations rather than through functional improvement. The top three occupations prioritized for change were performance tasks that were observable by service users and immediate caregivers. Empowering clients to partake in these everyday performance tasks such as finance management, concentrating on tasks, and self-care may pave the way to enhancing occupational competence and identity.

Globalization as a challenge for professional education

&lt;p&gt;Niniejszy artykuł dotyczy edukacji zawodowej jako elementu globalizacji we współczesnym świecie. Celem artykułu jest ustalenie podstawowej problematyki w zakresie miejsca edukacji zawodowej w czasach globalizacji. W artykule skoncentrowano się na takich kwestiach, jak specyfika edukacji zawodowej w Polsce i na świecie, znaczenie edukacji zawodowej dla współczesnego świata, pojęcie i cechy globalizacji, jak również determinanty/ uwarunkowania globalizacji we współczesnym świecie i edukacja zawodowa jako efekt globalizującego się świata. Człowiek, z obywatela danego państwa, stał się obywatelem świata. Fakt ten niesie ze sobą zarówno dużo zalet, jak i zagrożeń, w tym w sferze edukacji zawodowej, dla której wszechobecne przemiany przyniosły wiele nowych wyzwań. Dotyczy to zwłaszcza przystosowania programów nauczania do potrzeb społeczeństw funkcjonujących w nowych warunkach gospodarczych, społecznych i kulturowych, w tym podjęcia działań zmniejszających dysproporcję między opanowywaną przez uczniów wiedzą a umiejętnościami czy rozszerzenia kształcenia specjalistycznego. Szkolnictwo zawodowe musi zmierzyć się z koniecznością zmiany priorytetów, aby zgodnie z trendami globalizacyjnymi kształcić mobilnych pracowników gospodarki rynkowej, aktywnych i zdolnych do ciągłego samokształcenia.&lt;/p&gt;

Successful Project Consulting

Successful project consulting is both an art and a science, combining project planning and project management, communicating the vision of the work while tending to details, and satisfying the needs of executive stakeholders as well as those impacted by the change. Successful project consulting requires that pitfalls are avoided. A consensus and categorized list of seven common pitfalls experienced by consultants identifies scope creep, failure to identify stakeholders, misaligned expectations, miscommunications, lack of ownership, and changing priorities. While pitfalls can happen at each phase of a consulting project, these pitfalls may be avoided through purposeful communication, cooperation, supportive stakeholders, alignment with business objectives, a well-defined and approved project scope, and well-established processes for implementation. Typically, the five phases of a consulting project include 1) relationship building in the initial client meeting, 2) developing a conceptual agreement, 3) creating a scope of work document, 4) implementing the project work, and 5) identifying the completed results and next steps. During the first phase, the consultant and the client must identify the key stakeholders and a plan to build an ongoing communications pathway with the stakeholders. Before implementing the project, the consultant must develop the conceptual agreement and create a scope of work document. The conceptual agreement allows for planning the objectives and measures of success. The scope of work clarifies expectations including the selection of project team members, ensuring that skillsets match the project scope and the organization continues to be developed with a culture that remembers how to avoid common pitfalls.

A child in pain: A psychologist's perspective on changing priorities in scientific understanding and clinical care.

My research and clinical career followed a trajectory of increasing appreciation for the importance of social factors as determinants of pain experience and expression. The social contexts of children’s lives determine whether infants and children are exposed to pain, how socialization in family and ethnocultural contexts lead to pain as a social experience, comprised of thoughts and feelings as well as sensory input, how others shape pain experience and expression, less so for automatic/reflexive features than purposeful representations, and how other's appraisals of children’s pain reflect the observer's unique background and capacities for intervening in the child’s interests. A greater understanding of the social dimensions of pain, as reflected in the social communication model of pain, would support innovation of psychological and social interventions.

SO016SPREAD OF ACUTE KIDNEY INJURY IMPROVEMENT PROGAMME ACROSS A LARGE MULTI SITED NHS HOSPITAL

Abstract Background and Aims Acute kidney injury (AKI) is a widely recognised serious health care issue. Up to 25% of hospital patients can develop it, with worse outcomes compared non AKI. A UK–wide audit in 2009 and our local audit in 2014 showed consistently poor AKI care including delays in detection and inconsistent management of cases. The trust set up the AKI Team in 2014 to improve AKI detection, care and outcomes. Successful implementation of a Multifaceted Quality Improvement (QI) Programme for AKI across the main hospital campus since 2015 saw significant improvement in AKI care and outcomes; recognition within 24hrs improved from 52% to 100% since 2016; there has been a 34% reduction in AKI incidence, 26% reduction in AKI length of stay (LoS) ,42% reduction in AKI days (time to recovery) and 10% less AKI associated mortality. The Trust being one of the largest acute trusts in the UK (10 hospitals across 6 sites, over 2000 beds), the QI spread represented a formidable challenge. We describe the methodology and outcomes of AKI QI spread across the trust. Method Central Campus Hospitals Improvement on this site involved setting a bespoke electronic alert coupled with education, key stake holder engagement, gradual culture change and AKI Priority Care Checklist (PCC) and use of change agent (AKI Clinical Nurse Specialist-CNS) visiting local teams and empowering them to manage AKI using Demming’s Model for Improvement A stepwise staggered similar approach was implemented first in the Women’s and Eye Hospitals followed by Children’s Hospital after a local adaptation and testing of algorithm, PCC and appointment of local change agent, a Paediatric AKI CNS. West Campus Hospital A DGH with 230 beds, 1-2 incident cases of AKI/day required a bespoke approach. The central AKI team runs an AKI alerts report and remotely alert the local multidisciplinary teams and empowering them to implement the PCC. South Campus Hospitals A large tertiary hospital merged in 2018 with an existing AKI CNS team. Detection algorithms, education material, PCC, reporting, and approach have been progressively harmonized using the Central Campus model. Data is expressed using SPC charts and analysed by t-test. Results Care process and outcome measures have seen a consistent improvement across all sites. As reported in the Central Campus, recognition of AKI within 24hrs has improved from 52% to 100% since 2016; there has been a 34% reduction in AKI incidence (p&amp;lt;0.00001), 26% reduction in AKI LoS and a 42% reduction in AKI days (time to recovery). The Children’s Hospital had 24% reduction (p&amp;lt;0.0001) in AKI incidence and a 34% reduction in hospital acquired AKI. Recognition of AKI has improved from 42% to 100%; 15% reduction in AKI LoS and 22% reduction in AKI days. In the South Campus recognition of AKI has improved from 67% to 100% and 19% reduction (p&amp;lt;0.0015) in AKI incidence. LoS and AKI days data yet to be reported whilst IT systems are been harmonised. In West Campus recognition is 100% but the small numbers prevent any meaningful analysis of other outcomes. Conclusion This study demonstrates how a cluster of simple interventions and approach to AKI detection and care were successfully rolled out across a multisite large complex acute care organization taking into account the local realities of each site/Hospitals whilst maintaining the core interventions.

Prevalence of Healthy Behaviors among Cancer Survivors in the United States: How Far Have We Come?

The 16.9 million cancer survivors in the United States are at increased risk for comorbidities and recurrence. However, this risk may be attenuated by a healthy lifestyle. This study describes health behaviors by cancer history to inform behavior change priorities. We analyzed 2013-2017 data from the National Health Interview Survey. There were 164,692 adults, of whom 12,648 reported a cancer history. We calculated prevalence of smoking, physical activity, alcohol consumption, body mass index (BMI), and sleep duration by cancer history, age, and cancer site. We conducted logistic regression to determine odds of meeting lifestyle recommendations by cancer history. Overall, those with a cancer history were less likely to report current smoking (14.1% vs. 16.8%) and moderate/heavy drinking (18.8% vs. 21.9%) than those without a cancer history. However, a lower percentage of cancer survivors met physical activity guidelines (14.2% vs. 21.1%) or reported a healthy BMI (31.6% vs. 34.7%) compared with those without a cancer history. Cancer survivors were more likely to report excessive sleep (6.8% vs. 3.6%). In adjusted logistic regression, survivors were more likely to meet recommendations on smoking, physical activity, and BMI but were less likely to meet alcohol recommendations; meeting sleep recommendations did not differ by cancer history. While cancer survivors had lower prevalence of smoking and moderate/heavy drinking, they also had lower prevalence of physical activity and healthy BMI, and reported longer sleep duration. Regression analyses suggested survivors only showed poorer behaviors for alcohol. Targeted health promotion interventions among cancer survivors are needed.

Understanding Adaptation Finance Allocation: Which Factors Enable or Constrain Vulnerable Countries to Access Funding?

The most vulnerable countries often face a double burden in relation to climate change—they are at high risk to the impacts and are least equipped to cope and adapt. Global climate policy since the Convention in 1992, until most recently with the global goal on adaptation in the Paris Agreement, has manifested the importance of prioritizing adaptation support to the most vulnerable countries. The main objective of this study is to understand the enabling and constraining factors that play a role in the process of allocating and accessing global adaptation assistance. We adopted a mixed-methods approach combining two major streams of analysis. First, this paper aims to track bilateral adaptation finance to all so-called developing countries, as bilateral support has been the largest share of international adaptation finance. Second, the paper draws on semi-structured expert interviews and looks at the country level to identify the factors beyond vulnerability that play a role in the distribution of adaptation finance from a recipient’s and a donor’s perspective, using India and Germany as examples. The analysis yields three main findings. First, countries’ vulnerability as measured by standard metrics does not seem to be the prime factor explaining the distribution of available bilateral adaptation assistance. This is in contrast to the political narrative in the emerging climate finance architecture. Second, interview data identified other factors beyond vulnerability that play a role from a donor perspective, such as the perceived capacity to manage and implement projects, the commitment given to climate change and other political priorities. Third, from a recipient perspective, rather than its vulnerability level in a global comparison, strong institutional capacity played a prominent role in attracting adaptation finance. Looking out into the future, the findings underscore the practical and political challenges in relation to a vulnerability-oriented prioritization of funding and they point towards the need to increase countries’ capacities to attract and manage international adaptation support. The findings also raise questions on how to overcome the vexing conflict in the emerging adaptation finance architecture between accommodating for donors’ requirements of high fiduciary standards and enabling access by the most vulnerable countries, which are often short of resources and institutional capacities.

Impact of a Capacity-Building Intervention on Food Marketing Features in Recreation Facilities

ObjectiveTo explore the impact of a capacity-building intervention (CBI) to support implementing provincial nutrition guidelines on food marketing in recreation facilities (RFs). DesignRandomized controlled trial within a natural experiment: food marketing in RFs from 3 guideline provinces randomly assigned to intervention (GL+CBI) or comparison (GL-ONLY) was compared with facilities in 1 province without guidelines (NO-GL). Food marketing was assessed by the Food and Beverage Marketing Assessment Tool for Settings. SettingCanadian provinces with/without voluntary nutrition guidelines for RFs. Participants51 RFs. Intervention18-month CBI. Main Outcome MeasuresChange in Food and Beverage Marketing Assessment Tool for Settings scores and marketing features between baseline and follow-up across groups. AnalysisKruskal–Wallis with post hoc Mann–Whitney U tests. ResultsNo significant differences in food marketing features between baseline and follow-up across groups except for a change in food marketing frequency (P = 0.045). The increase in frequency in NO-GL (median, 6.0; interquartile range, −2.0 to 8.5) was significantly greater than changes in the GL+CBI (P = 0.033) and GL-ONLY sites (P = 0.049). Conclusions and ImplicationsCapacity-building was not associated with improved food marketing features potentially because of nonmandated nutrition guidelines, low priority for change, and vague or narrow facility goals and guidelines. Nutrition guidelines with specific unhealthy food marketing restrictions should be mandated and supported.