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Adults' beliefs and knowledge about the state of the U.S. education system drive decisions about policy, funding, program adoption, student participation in programs, and the selection of decision makers to elected positions. Amie Rapaport and Anna Rosefsky Saavedra share national survey data showing that U.S. adults have little knowledge about what is being taught in schools, express neutrality about belief systems undergirding education policy, and report experiences misaligned with hard-data trends on student academic progress in recent years. With adults reporting they learn about issues crucial to our education system mainly from "personal experience," better information has the potential to improve U.S. education.

There has been intense debate within the autistic and autism communities about the use of autism biobanks -- repositories containing biological and phenotypic materials -- and of genomic autism research more broadly. Here, we sought to understand the views and experiences of those contributing to one specific biobank, the Australian Autism Biobank. We adopted a multi-informant approach, conducting semi-structured interviews with 77 people, including 18 autistic probands, 46 parents and seven siblings, all of whom donated material to the Biobank, as well as six researchers employed on the project. Specifically, we asked: what motivated participants and researchers to contribute to the Australian Autism Biobank? And how did they feel about their involvement in that process? We analysed the data using reflexive thematic analysis, adopting an inductive approach within an essentialist framework. We identified three themes, which revealed a wide diversity of viewpoints, including positive conceptualisations of autism linked to neurodiversity and more negative conceptualisations linked to hopes for the development of genetic screening and reproductive choice. These findings have implications for the meaning, value and future directions of autism science. This research has been conducted using the Australian Autism Biobank resource.

Autistic people often experience difficulties navigating face-to-face social interactions. Historically, the empirical literature has characterised these difficulties as cognitive 'deficits' in social information processing. However, the empirical basis for such claims is lacking, with most studies failing to capture the complexity of social interactions, often distilling them into singular communicative modalities (e.g. gaze-based communication) that are rarely used in isolation in daily interactions. The current study examined how gaze was used in concert with communicative hand gestures during joint attention interactions. We employed an immersive virtual reality paradigm, where autistic (n = 22) and non-autistic (n = 22) young people completed a collaborative task with a non-autistic confederate. Integrated eye-, head- and hand-motion-tracking enabled dyads to communicate naturally with each other while offering objective measures of attention and behaviour. Autistic people in our sample were similarly, if not more, effective in responding to hand-cued joint attention bids compared with non-autistic people. Moreover, both autistic and non-autistic people demonstrated an ability to adaptively use gaze information to aid coordination. Our findings suggest that the intersecting fields of autism and social neuroscience research may have overstated the role of eye gaze during coordinated social interactions.

'Autistic inertia' is part of the Autistic community's everyday lexicon, yet the condition has received scant attention in the academic literature. The little attention it has received has focused on the disabling impact of 'inertial rest' (difficulty initiating tasks), with minimal exploration of the potential benefits of inertial motion (difficulty stopping tasks). Here, we sought to investigate Autistic people's phenomenological experiences of inertial rest and motion and to identify factors that might moderate Autistic inertia. Autistic and non-Autistic researchers conducted semi-structured interviews with 24 Autistic adults. We analysed the data using reflexive thematic analysis, adopting an inductive approach within an essentialist framework. Interviewees spoke in-depth of their inertial 'difficulties moving from one state to another' and described how these challenges pervade 'every single day'. While inertia was described as 'the single most disabling part of being Autistic', interviewees also described ways to respond to inertia, including taking pleasure in states of flow, whereby they could become completely absorbed in a task. While inertial difficulties are pervasive, our findings reveal the extreme nature of these task-switching difficulties for Autistic people. Our findings also contribute to a more holistic characterisation of inertia as both a disabling and enabling condition.

For many students, project-based learning (PBL) can be more engaging than more traditional instructional approaches. Over the past 15 years, Anna Saavedra and Amie Rapaport studied seven inquiry-based approaches. Their research shows that PBL has a positive effect on students' achievement and development of important soft skills. Schools can maximize chances of success by providing expert-created, high-quality, adaptable materials; aligned professional learning opportunities; and a supportive schoolwide culture. Some of the challenges of PBL implementation include the tension between breadth and depth of content, keeping projects central to the curriculum, misalignment of standardized assessments with PBL, and financial requirements.

Abstract Nature‐based coastal adaptation is a subset of nature‐based solutions that has to this point focused on the materiality of managing coastal risks: what our coastal protections are made of or where we put things that are in the way of harm. In our collaborative interdisciplinary work, we have been reimagining nature‐based coastal adaptation to start with first principles: how we think about the coast and what makes a good coastal life. In a nature‐based approach our shared sense of what is good and possible, also known as the social imaginary, needs shifting before any physical material. This paper presents a new nested framework for thinking about nature‐based coastal adaptation using five words starting with R: Reimagine, Reserve, Relocate, Restore, Reinforce. We use the nature‐based adaptation option of managed dyke realignment in Bay of Fundy agricultural dykelands to illustrate the utility of the framework in practice but assert its more generic applicability.

BACKGROUND: Functional mobility, comfort and the absence of pain are key goals of prosthetic treatment. Outcome measures (OMs) evaluate the impact of treatment and normative and minimal detectable change (MDC) values are key to interpreting these scores and measuring treatment outcomes. OBJECTIVES: This study seeks to 1) present practice-based normative values of four commonly used OMs at four prosthetic milestones and 2) explore the MDC of the measures over the treatment period. METHODOLOGY: A chart review was conducted of OMs collected with individuals with lower limb loss between January 1, 2015, and December 31, 2023. This included data for individuals with unilateral transtibial (TT), transfemoral (TF) and rotationplasty (RP) amputations and bilateral transtibial amputation (BTT). OMs included the Socket Comfort Score (SCS), Pain Scale (PS), 2 Minute Walk Test (2MWT), and Prosthetic Limb Users Survey of Mobility (PLUS-M). Data were collected at four milestone time points: (1) Baseline and (2) Discharge from Rehabilitation for those in initial prosthetic rehabilitation, and (3) Initial Evaluation and (4) Definitive Delivery for those receiving a replacement socket. Normative values and MDC values were calculated. FINDINGS: Data from 30 individuals undergoing in-patient rehabilitation and 74 individuals receiving a replacement socket were included. Practice-based normative data were different for each level of amputation and milestone and had the following ranges: SCS: 5.7 – 9.1, PS: 0.8 – 3.7, 2MWT: 68.4 – 146.3 m and PLUS-M: 38.9 – 57.3. MDC values also varied based on time in treatment (Rehabilitation: SCS = 2.5, PS = 1.6, 2MWT = 32.6, PLUS-M = 8.8; Replacement Socket: SCS = 3.1, PS = 2.6, 2MWT = 38.9, PLUS-M = 4.0). All measures had a statistically significant change over the intervention, however, no average scores changed by greater than the MDC. CONCLUSIONS: The normative data and MDC scores demonstrate the PS & PLUS-M are useful measures of pain and mobility at all points within treatment. The 2MWT is indicated for individuals in rehabilitation, while the SCS is indicated for those receiving a replacement socket, as both effectively measure treatment goals that are particularly important for each phase of rehabilitation. This provides clinicians with practice-based evidence that enables them to interpret OM scores, a critical part of the decision-making process along the treatment journey. Layman's Abstract When someone receives a prosthesis, the key goals are to promote mobility and comfort and to reduce pain. Outcome measures are questionnaires or performance-based tests that measure the impact of prosthetic treatment. The scores are interpreted by comparing them to normal values and assessing changes over time against a predetermined threshold for what constitutes a significant amount of change. This study analyzed outcome measure scores collected in clinical practice over a 9-year period, from 2015 - 2023. We included individuals with lower limb loss and presented normal values along with threshold change values taken from a clinical setting for four commonly used measures that assess comfort, pain, and mobility. The data included 30 individuals currently attending initial rehabilitation and 74 individuals who had prior experience using a prosthesis. All the normal values were different for each level of amputation and each milestone within rehabilitation. Suggestions are provided regarding which outcome measures are most useful for assessing changes at different points in time. By providing clinicians with evidence based on clinical practice, we can help them use outcome measures to inform decision-making throughout the rehabilitation journey. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/43890/33243 How To Cite: Pousett B.M, Harasym C.C, Rapaport M.S, Richardson T, Spellen J, Moe D.W, et al. Detecting changes in comfort, pain, and mobility over clinical milestones for individuals with lower limb loss. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.7. https://doi.org/10.33137/cpoj.v7i1.43890 Corresponding Author: Brittany Mae Pousett, CP(C), MSc. 540 SE Marine Dr, Vancouver, BC, Canada, V5X 2T4 Tel: 604.321.1115 E-Mail: brittany@pousett.ca ORCID ID: https://orcid.org/0000-0002-2272-7847

Background Only a third of people with dementia receive a diagnosis and post-diagnostic support. An eight session, manualised, modular post-diagnostic support system (New Interventions for Independence in Dementia Study (NIDUS) – family), delivered remotely by non-clinical facilitators is the first scalable intervention to improve personalised goal attainment for people with dementia. It could significantly improve care quality. Aims We aimed to explore system readiness for NIDUS–family, a scalable, personalised post-diagnostic support intervention. Method We conducted semi-structured interviews with professionals from dementia care services; the Consolidated Framework for Implementation Research guided interviews and their thematic analysis. Results From 2022 to 2023, we interviewed a purposive sample of 21 professionals from seven English National Health Service, health and social care services. We identified three themes: (1) potential value of a personalised intervention – interviewees perceived the capacity for choice and supporting person-centred care as relative advantages over existing resources; (2) compatibility and deliverability with existing systems – the NIDUS–family intervention model was perceived as compatible with service goals and clients’ needs, but current service infrastructures, financing and commissioning briefs constraining resources to those at greatest need were seen as barriers to providing universal, post-diagnostic care; (3) fit with current workforce skills – the intervention model aligned well with staff development plans; delivery by non-clinically qualified staff was considered an advantage over current care options. Conclusions Translating evidence for scalable and effective post-diagnostic care into practice will support national policies to widen access to support and upskill support workers, but requires a greater focus on prevention in commissioning briefs and resource planning.

Myrtus communis is a Mediterranean shrub cultivated in Israel for traditional, ceremonial use only, with more than 98 % of the crop biomass, equivalent to 26–27 tons per ha per annum, considered agricultural waste. Therefore, potentially profitable use for this excess is being highly sought. As Myrtus is also known for its unique terpene and terpenoid content, this work evaluated the impact of essential oil (EO) extracted from several M. communis cultivars on storage insects, nematodes, fungi, and pathogens. In addition, the allelopathic effect of M. communis litter on the germination success of wheat seeds was evaluated. The EO extracts demonstrated an insecticidal effect on several storage insects in fumigation experiment and a potentially inhibiting effect on wheat development in allelopathy experiments. No significant impact of M. communis EOs on the examined fungi, pathogens, and nematodes was recorded. Additional uses of the M. communis biomass suggest supplying additional income to the farmer through the circular agriculture approach. In addition, the use of this local crop can contribute to sustainable intensification by increasing farming efficiency, providing nature-based substitutes for chemical pesticides, and possibly, improving the future design of agriculture through the integration of Myrtus in monoculture crops.

We use data collected between April 2020 and March 2021 from the Understanding America Survey, a nationally representative internet panel of approximately 1,450 households with school-age children, to document the access of American households to K-12 education during the COVID-19 crisis. We also explore disparities by parent race/ethnicity, income, urbanicity, partisanship, and grade level (i.e., elementary school vs. middle/high school). Results shed light on the vectors of inequality that occurred throughout the pandemic in access to technology, instruction, services (e.g., free and reduced-price meals), and in-person learning opportunities. Our work highlights the equity implications of the pandemic and suggests the importance of encouraging widespread in-person learning opportunities and attendance by the beginning of the 2021-2022 school year for addressing COVID-19's educational effects.

Abstract Background Over 850,000 people in the UK currently have dementia, and that number is expected to grow rapidly. One approach that may help slow or prevent this growth is personalized dementia prevention. For most people, this will involve targeted lifestyle changes. These approaches have shown promise in trials, but as of yet, the evidence for how to scale them to a population level is lacking. In this pre-implementation study, we aimed to explore stakeholder perspectives on developing system-readiness for dementia prevention programs. We focused on the APPLE-Tree program, one of several low-intensity, lifestyle-based dementia prevention interventions currently in clinical trials. Methods We conducted semi-structured interviews with health and social care professionals without previous experience with the APPLE-Tree program, who had direct care or managerial experience in services for older adults with memory concerns, without a dementia diagnosis. We used the Consolidated Framework for Implementation Research to guide interviews and thematic analysis. Results We interviewed 26 stakeholders: commissioners and service managers (n = 15) and frontline workers (n = 11) from eight NHS and 11 third sector organizations throughout England. We identified three main themes: (1) favorable beliefs in the effectiveness of dementia prevention programs in enhancing cognition and wellbeing and their potential to fill a service gap for people with memory concerns, (2) challenges related to funding and capacity to deliver such programs at organizations without staff capacity or higher prioritization of dementia services, and (3) modifications to delivery and guidance required for compatibility with organizations and patients. Conclusion This study highlights likely challenges in scale-up if we are to make personalized dementia prevention widely available. This will only be possible with increased funding of dementia prevention activities; integrated care systems, with their focus on prevention, may enable this. Scale-up of dementia prevention programs will also require clear outlines of their core and adaptable components to fit funding, patient, and facilitator needs.

BackgroundAmorphous calcium carbonate (ACC) is a potential new treatment for canine osteoarthritis (OA) with novel mechanisms based on local pH modulation and targeting bone remodeling, inflammation, and pain. The aim of this pilot exploratory clinical study was to obtain initial data on the potential efficacy and safety of ACC in OA dogs and to determine if further investigation was appropriate using similar assessment methods.Materials and methodsIn this prospective, randomized, double-blind, controlled pilot study, 41 client-owned dogs were allocated in a 2:1 ratio to ACC: placebo given orally for 56 days. Efficacy assessments included improvements in pain and mobility using owner questionnaires [Canine Brief Pain Inventory (CBPI), Client Specific Outcome Measure (CSOM), and Veterinary Orthopedic Scores (VOS)]. Safety in the study population was monitored by veterinary examinations, clinical pathology, and adverse events.ResultsFifty-three dogs were screened, of which 41 enrolled and served for the safety assessment. Thirty-six dogs were found evaluable for initial efficacy assessment. Three dogs given placebo (21.4%) and one given ACC (4.5%) were removed before day 56 due to owner-perceived pain and were considered treatment failures. There were no serious adverse events or clinically significant treatment-related effects in the study. Overall, ACC was found safe in the small study population. On day 56, proportionally more ACC than placebo dogs were treatment successes based on CBPI (45.5% vs. 21.4%) and CSOM (63.6% vs. 30.8%, respectively); however, these differences were not statistically significant (p = 0.15 and 0.06, respectively). On day 56, within the ACC group but not the placebo group, the CBPI, CSOM, and VOS assessments were lower compared to day 0 and day 14 (p

IntroductionWe present the evolution of GHD in adolescent males with persistent growth failure, in whom the diagnosis was established after a second GH stimulation test (GST).MethodsWe performed a retrospective chart review of children who presented for short stature (height less < 2SD for mean/mid-parental height) and/or growth failure (sustained growth velocity < 0 SD) to pediatric endocrinology at Mount Sinai Kravis Children’s Hospital, New York and who had 2 GSTs. Data collected from electronic medical records were analyzed using SPSS v28.0ResultsOf 53 patients included, 42 were males. Average GH peak on initial GST was 15.48 ± 4.92 ng/ml, at 10.07 ± 2.65 years, mean height -1.68 ± 0.56SD(28% had

Harnessing a cluster randomized controlled trial, we estimated the impact on students' advanced placement (AP) examination performance of a project-based learning (PBL) approach to AP compared with a lecture-based AP approach. Through PBL, teachers primarily play a facilitator role, while students work on complex tasks organized around central questions leading to a final product. We estimated positive and significant treatment effects on AP exam performance for the overall sample, within both AP courses studied, and within low- and high-income student groups. Results support teacher-driven adoption of the PBL AP approach within both courses studied, among districts with open-enrollment AP policies and supportive of PBL, for students from low- and high-income households.

Abstract Antibiotic resistance of bacteria is considered one of the most alarming developments in modern medicine. While varied pathways for bacteria acquiring antibiotic resistance have been identified, there still are open questions concerning the mechanisms underlying resistance. Here, we show that alpha phenol-soluble modulins (PSMαs), functional bacterial amyloids secreted by Staphylococcus aureus, catalyze hydrolysis of β-lactams, a prominent class of antibiotic compounds. Specifically, we show that PSMα2 and, particularly, PSMα3 catalyze hydrolysis of the amide-like bond of the four membered β-lactam ring of nitrocefin, an antibiotic β-lactam surrogate. Examination of the catalytic activities of several PSMα3 variants allowed mapping of the active sites on the amyloid fibrils’ surface, specifically underscoring the key roles of the cross-α fibril organization, and the combined electrostatic and nucleophilic functions of the lysine arrays. Molecular dynamics simulations further illuminate the structural features of β-lactam association upon the fibril surface. Complementary experimental data underscore the generality of the functional amyloid-mediated catalytic phenomenon, demonstrating hydrolysis of clinically employed β-lactams by PSMα3 fibrils, and illustrating antibiotic degradation in actual S. aureus biofilms and live bacteria environments. Overall, this study unveils functional amyloids as catalytic agents inducing degradation of β-lactam antibiotics, underlying possible antibiotic resistance mechanisms associated with bacterial biofilms.

Electrically controlled photonic circuits hold promise for information technologies with greatly improved energy efficiency and quantum information processing capabilities. However, weak nonlinearity and electrical response of typical photonic materials have been two critical challenges. Therefore, hybrid electronic-photonic systems, such as semiconductor exciton polaritons, have been intensely investigated for their potential to allow higher nonlinearity and electrical control, with limited success so far. Here we demonstrate an electrically gated waveguide architecture for field induced dipolar polaritons that allows enhanced and electrically controllable polariton nonlinearities, enabling an electrically tuned reflecting switch (mirror) and transistor of the dipolar polaritons. The polariton transistor displays blockade and antiblockade by compressing a dilute dipolar-polariton pulse exhibiting very strong dipolar interactions. The large nonlinearities are explained using a simple density-dependent dipolar polarization field that very effectively screens the external electric field. We project that a quantum blockade at the single polariton level is feasible in such a device.

Abstract Background The numbers of older people experiencing both homelessness and memory problems are growing, yet their complex health, housing and care needs remain undelineated and unmet. There is a critical gap in understanding what can improve the care, support and experiences of this group. In this qualitative study we explore how stakeholders understand memory problems among older people in the context of homelessness and consider what they judge gets in the way of achieving positive outcomes. Method We conducted reflexive thematic analysis of qualitative interviews (n = 49) using a semi-structured topic guide, with 17 older people (aged ≥ 50 years) experiencing memory problems and homelessness, 15 hostel staff and managers, and 17 health, housing and social care practitioners. We recruited participants from six homelessness hostels, one specialist care home and National Health and Local Authority Services in England. Results We identified four overarching themes. The population is not taken seriously; multiple causes are hard to disentangle; risk of exploitation and vulnerability; and (dis)connection and social isolation. The transience and lack of stability associated with homelessness intensified the disorienting nature of memory and cognitive impairment, and those providing direct and indirect support required flexibility and persistence, with staff moving beyond traditional roles to advocate, provide care and safeguard individuals. Memory problems were perceived by frontline staff and older people to be overlooked, misinterpreted, and misattributed as being caused by alcohol use, resulting in pervasive barriers to achieving positive and desired outcomes. Conclusions Efforts to meet the needs of older people living with memory problems and experiencing homelessness and future interventions must reflect the complexity of their lives, often in the context of long-term alcohol use and current service provision and we make suggestions as to what could be done to improve the situation.

Here we present the development of nanoparticles (NPs) formulations specifically designed for targeting the antiapoptotic Bcl-2 proteins on the outer membrane of mitochondria with the drug agent ABT-737. The NPs which are self-assembled by the natural polypeptide poly gamma glutamic acid (ϒPGA) and a designed cationic and amphiphilic peptide (PFK) have been shown to target drugs toward mitochondria. In this study we systematically developed the formulation of such NPs loaded with the ABT-737 and demonstrated the cytotoxic effect of the best identified formulation on MDA-MB-231 cells. Our findings emphasize the critical role of solutions pH and the charged state of the components throughout the formulation process as well as the concentrations of the co-components and their mixing sequence, in achieving the most stable and effective cytotoxic formulation. Our study highlights the potential versatility of designed peptides in combination with biopolymers for improving drug delivery formulations and enhance their targeting abilities.

Introduction Many people living with dementia experience sleep disturbance and there are no known effective treatments. Non-pharmacological treatment options should be the first-line sleep management. For family carers, relatives’ sleep disturbance leads to interruption of their sleep, low mood and breakdown of care. Our team developed and delivered DREAMS START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives), a multimodal non-pharmacological intervention, showing it to be feasible and acceptable. The aim of this randomised controlled trial is to establish whether DREAMS START is clinically cost-effective in reducing sleep disturbances in people living with dementia living at home compared with usual care.Methods and analysis We will recruit 370 participant dyads (people living with dementia and family carers) from memory services, community mental health teams and the Join Dementia Research Website in England. Those meeting inclusion criteria will be randomised (1:1) either to DREAMS START or to usual treatment. DREAMS START is a six-session (1 hour/session), manualised intervention delivered every 1–2 weeks by supervised, non-clinically trained graduates. Outcomes will be collected at baseline, 4 months and 8 months with the primary outcome being the Sleep Disorders Inventory score at 8 months. Secondary outcomes for the person with dementia (all proxy) include quality of life, daytime sleepiness, neuropsychiatric symptoms and cost-effectiveness. Secondary outcomes for the family carer include quality of life, sleep disturbance, mood, burden and service use and caring/work activity. Analyses will be intention-to-treat and we will conduct a process evaluation.Ethics and dissemination London—Camden & Kings Cross Ethics Committee (20/LO/0894) approved the study. We will disseminate our findings in high-impact peer-reviewed journals and at national and international conferences. This research has the potential to improve sleep and quality of life for people living with dementia and their carers, in a feasible and scalable intervention.Trial registration number ISRCTN13072268.

The COVID-19 pandemic has affected virtually all aspects of US life. It has disrupted education and employment and may have shifted the trade-off between employment and higher education in prospective students' minds. The pandemic may have especially disrupted the educational trajectories of traditionally underserved postsecondary students, such as those from low-income and/or racially minoritized backgrounds, who often work while pursuing their degrees. If the pandemic has affected current and potential students' subjective value of postsecondary education relative to its often-substantial costs, it may have affected their aspirations to enroll. Such effects may have lasting impacts on postsecondary enrollment and attainment, so are essential considerations. We provide suggestive evidence of such effects using data from the Understanding America Study, a nationally representative panel of US households. Using multilevel (respondent within household) ordered logistic models, we find that the pandemic has increased the subjective valuation of postsecondary education for non-white respondents relative to white respondents, for respondents in the South and West relative to the Northeast and Midwest, and over time for households with postsecondary students. We find no evidence for pandemic-driven differences in the subjective value of postsecondary education by household income level.

Background Success of psychosocial interventions in reducing aggressive challenging behaviour is likely to be related not only to mechanistic aspects but also to therapeutic and system factors. The study aims to examine the facilitators and barriers that influence whether psychosocial interventions for aggressive challenging behaviour in adults with intellectual disabilities lead to positive change. We conducted 42 semi-structured interviews with adults with intellectual disabilities who display aggressive challenging behaviour, family/paid carers, and professionals engaged in or delivering a psychosocial intervention across the UK. Data were analysed thematically using a framework approach. Stakeholders considered therapeutic and supportive relationships and personalised care as facilitating factors in addressing aggressive challenging behaviour. The operational structure of community intellectual disability services and conflicting expectations of professionals and carers were the main contextual barriers that impeded the implementation of psychosocial interventions in adults with intellectual disabilities. Findings highlight the valued components that maximise positive change in adults with intellectual disabilities who display aggressive challenging behaviour. Several operational adjustments including referral criteria, roles of professionals and workforce issues need to be addressed in services to maximise the implementation of psychosocial interventions leading to reduction in aggressive challenging behaviour in this population.

Sea levels are rising faster than ever, limiting the effectiveness of hard infrastructure-based coastal protection. Scientists and policymakers are exploring alternative adaptation approaches that use nature's capacity to buffer flooding and erosion – a strategy we refer to as nature-based coastal adaption (NbCA). They involve changes from site-level to landscape scales, and employ design interventions and change in land use behaviour. They can have significant social implications and therefore encounter social barriers with unique underlying characteristics. Since NbCA is a relatively new adaptation approach, empirically driven knowledge about its barriers is less known. To help overcome this knowledge gap, we systematically searched empirical studies and characterized and synthesized social barriers to implementing NbCA. They include institutional, governance, economic, knowledge and informational, cultural, political, and psychological barriers. The properties of these barriers help us to see that: (i) barriers are interconnected; (ii) managing barriers requires alignment of key actors and targeted resources across scales; and (iii) psychological and institutional barriers can be trapped in path-dependency. We conclude that attention to the institutional and social-psychological barriers can help manage other barriers.

Cognitive impairment related to major depressive disorder (MDD) is highly prevalent, debilitating and is lacking in effective treatments; dysregulated inflammatory physiology is a putative mechanism and may represent a therapeutic target. In depressed individuals exhibiting a pro-inflammatory phenotype who were enrolled in a 12-week randomized placebo-controlled trial of 3 doses of omega-3 polyunsaturated fatty acids (ω-3-FA), we examined: (i) the relationship between dysregulated inflammatory physiology and baseline cognitive impairment; (ii) improvement in cognitive impairment following treatment; and (iii) the association between baseline inflammatory biomarkers and change in cognitive impairment for those receiving treatment. We randomized 61 unmedicated adults aged 45.50 years (75% female) with DSM-5 MDD, body mass index >25 kg/m2, and C-reactive protein (CRP) ≥3.0 mg/L to three doses of ω-3-FA (1, 2, or 4 g daily) or matching placebo. Analyses focused on 45 study completers who had inflammatory biomarkers assessed [circulating CRP, interleukin-6 (IL-6) and tumor necrosis factor-α (TNFα) as well as lipopolysaccharide (LPS)-stimulated concentrations of IL-6 and TNFα in peripheral blood mononuclear cells (PBMC)] and on the highest dose ω-3-FA (4 g daily; n = 11) compared to placebo (n = 10). Impairment in motivational symptoms (e.g., alertness, energy, enthusiasm) and higher-order cognitive functions (e.g., word-finding, memory) were assessed by a validated self-report measure. Among all 45 participants at baseline, lower concentrations of IL-6 in LPS-stimulated PBMC were associated with greater impairment in higher-order cognitive functions (r = −0.35, p = .02). Based on hierarchical linear modeling, individuals receiving 4 g/day of ω-3-FA reported significant improvement in motivational symptoms compared to placebo (B = −0.07, p = .03); in the 4 g/day group, lower baseline concentrations of TNFα in LPS-stimulated PBMC were associated with significant improvement in motivational symptoms (Ρ = .71, p = .02) following treatment. In this exploratory clinical trial, daily supplementation with 4 g of ω-3-FA improves motivational symptoms in depressed individuals exhibiting an inflammatory phenotype.

A team of researchers wanted to learn whether AP teachers using a project-based learning (PBL) approach could develop students' deep learning of knowledge and skills while preparing them for their AP exams. They used a randomized controlled trial to evaluate the Knowledge in Action (KIA) project-based curricula for AP courses. KIA students outperformed non-KIA students on AP exams, including within subgroups. Though the shift to PBL required considerable pedagogical changes, teachers and students perceived benefits beyond AP performance, and the majority of teachers planned to continue using PBL after the study. The pattern of results was consistent for two years and in two courses, AP U.S. Government and AP Environmental Science. Results support teacher-driven adoption of KIA for students from both lower- and higher-income households and in both courses.

Are today's students able to discern quality information from sham online? In the largest investigation of its kind, we administered an assessment to 3,446 high school students. Equipped with a live internet connection, the students responded to six constructed-response tasks. The students struggled on all of them. Asked to investigate a site claiming to "disseminate factual reports" on climate science, 96% never learned about the organization's ties to the fossil fuel industry. Two thirds were unable to distinguish news stories from ads on a popular website's home page. More than half believed that an anonymously posted Facebook video, shot in Russia, provided "strong evidence" of U.S. voter fraud. Instead of investigating the organization or group behind a site, students were often duped by weak signs of credibility: a website's "look," its top-level domain, the content on its About page, and the sheer quantity of information it provided. The study's sample reflected the demographic profile of high school students in the United States, and a multilevel regression model explored whether scores varied by student characteristics. Findings revealed differences in student abilities by grade level, self-reported grades, locality, socioeconomic status, race, maternal education, and free/reduced-price lunch status. Taken together, these findings reveal an urgent need to prepare students to thrive in a world in which information flows ceaselessly across their screens.

Background: Success of psychosocial interventions in reducing aggressive challenging behaviour is likely to be related not only to mechanistic aspects, but also to therapeutic and system factors. The study aims to examine the facilitators and barriers that influence whether psychosocial interventions for aggressive challenging behaviour in adults with intellectual disabilities lead to positive change. Methods: We conducted 42 semi-structured interviews with adults with intellectual disabilities and aggressive challenging behaviour, family/paid carers, and professionals engaged in or delivering a psychosocial intervention across the UK. Data were analysed thematically using a framework approach. Results: Stakeholders considered therapeutic and supportive relationships and personalised care as facilitating factors of psychosocial interventions to address aggressive challenging behaviour. The operational structure of community intellectual disability services and conflicting expectations of professionals and carers were the main contextual barriers that impeded the implementation of psychosocial interventions addressing aggressive challenging behaviour in adults with intellectual disabilities. Conclusions: Findings highlight the valued components that maximise positive change in adults with intellectual disabilities who display aggressive challenging behaviour. Several operational adjustments including referral criteria, roles of professionals and workforce issues need to be addressed in services to maximise the implementation of psychosocial interventions to reduce aggressive challenging behaviour in adults with intellectual disabilities.

BackgroundMultimorbidity is associated with an increased risk of poor surgical outcomes among older adults; however, identifying multimorbidity in the clinical setting can be a challenge. ObjectiveWe created the Multimorbid Patient Identifier App (MMApp) to easily identify patients with multimorbidity identified by the presence of a Qualifying Comorbidity Set and tested its feasibility for use in future clinical research, validation, and eventually to guide clinical decision-making. MethodsWe adapted the Qualifying Comorbidity Sets’ claims-based definition of multimorbidity for clinical use through a modified Delphi approach and developed MMApp. A total of 10 residents input 5 hypothetical emergency general surgery patient scenarios, common among older adults, into the MMApp and examined MMApp test characteristics for a total of 50 trials. For MMApp, comorbidities selected for each scenario were recorded, along with the number of comorbidities correctly chosen, incorrectly chosen, and missed for each scenario. The sensitivity and specificity of identifying a patient as multimorbid using MMApp were calculated using composite data from all scenarios. To assess model feasibility, we compared the mean task completion by scenario to that of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (ACS-NSQIP-SRC) using paired t tests. Usability and satisfaction with MMApp were assessed using an 18-item questionnaire administered immediately after completing all 5 scenarios. ResultsThere was no significant difference in the task completion time between the MMApp and the ACS-NSQIP-SRC for scenarios A (86.3 seconds vs 74.3 seconds, P=.85) or C (58.4 seconds vs 68.9 seconds,P=.064), MMapp took less time for scenarios B (76.1 seconds vs 87.4 seconds, P=.03) and E (20.7 seconds vs 73 seconds, P