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2022 opened with World War C, the first major cyber world war. Wanting to capitalize on history in the making, Information Systems faculty are integrating real time events to increase student engagement, comprehension, and application of IS concepts. This paper outlines a successful midterm evaluation pivot that leverages current events. We discuss two different actions taken and objectives, outcomes, and implications for teaching and educational research. We find that incorporating extreme current events motivates students towards self-learning and creative knowledge outlets, which in turn stimulate greater comprehension, application, and retention across the entire class.

The worsening global environmental crisis highlights the urgency of integrating Environmental Education (EE) throughout the curriculum including in English as a Foreign Language (EFL) curricula. However, challenges exist, such as the development of appropriate curriculum documents and educators' understanding of approaches to EE. This study looked at Indonesian EFL textbooks for elementary schools, focusing mainly on the images and how they can portray environmental themes. These images and some brief texts that accompany the images were examined using tools from ecolinguistics literature, including Stibbe's (2021) nine stories and the United Nations' EE objectives (UNESCO-UNEP, 1975). This study intends to fill a gap in the EE literature by analyzing images in elementary school textbooks in the specific context of Indonesia, generalizing the idea of EE to other contexts. Findings revealed that while some EE efforts were evident, the majority of the material leaned towards an anthropocentric (human centered) perspective, indicating a need for greater incorporation of insights from ecolinguistics to enhance the content. Moreover, in terms of EE objectives, the textbooks provided ecological knowledge but lacked emphasis on developing skills and encouraging student participation in solving environmental problems. Examples demonstrating the ability to evaluate and address environmental issues were also absent. Suggestions are made for future EE content in EFL materials.

This longitudinal, mixed-methods study reports on the development and implementation of an early phonological awareness screening and intervention program for struggling emergent readers in a French immersion school in Manitoba. The program was created by a professional learning community made up of the school administrator, teachers, and clinical support staff. This paper describes the process of developing the phonological awareness program and the intervention itself. Forty-two children participated in the phonological awareness intervention that lasted 10 weeks. The intervention was given in English in kindergarten. Significant gains were found in the phonological awareness skills of the children who participated in the intervention. Results also indicated that children's phonological awareness skills in English predicted their French reading levels in Grade 1. In addition, we provide insight into the roles played by key members of the school's PLC through qualitative analysis of a series of semi-structured interviews. The work of the school's professional learning community offers a model that may be implemented by other school teams to promote equity and accessibility for all learners in FI programs.

Most current statistics courses include some instruction relevant to causal inference. Whether this instruction is incorporated as material on randomized experiments or as an interpretation of associations measured by correlation or regression coefficients, the way in which this material is presented may have important implications for understanding causal inference fundamentals. Although the connection between study design and the ability to infer causality is often described well, the link between the language used to describe study results and causal attribution typically is not well defined. The current study investigates this relationship experimentally using a sample of students in a statistics course at a large western university in the United States. It also provides (non-experimental) evidence about the association between statistics instruction and the ability to understand appropriate causal attribution. The results from our experimental vignette study suggest that the wording of study findings impacts causal attribution by the reader, and, perhaps more surprisingly, that this variation in level of causal attribution across different wording conditions seems to pale in comparison to the variation across study contexts. More research, however, is needed to better understand how to tailor statistics instruction to make students sufficiently wary of unwarranted causal interpretation.

The personnel preparation of early intervention/early childhood special educator (EI/ECSE) candidates is a pivotal stage in supporting the development of professionals who can effectively work with young children with and at-risk of developmental disabilities, their families, and other service providers. This process encompasses a multifaceted approach to equip candidates with knowledge, skills, and attitudes/dispositions to successfully work within the field. This compilation article includes multiple authors of each section who share strategies, assignments, tools, and experiences to center the Initial Practice-Based Standards for Early Interventionists/Early Childhood Special Educators (Division for Early Childhood [DEC] of the Council for Exceptional Children [CEC], 2020; hereafter referred to as the EI/ECSE Standards) and DEC's Recommended Practices (RPs). These strategies are shared through a "spiraling curriculum" framework, and progress from an awareness level to reflection of candidates' own practice. In addition, this article shares related resources to consider in planning for innovative coursework and practicum/student teaching opportunities. Specific examples of spiraling experiences to deepen learning through opportunities to introduce content aligned to RPs and EI/ECSE Standards are included.

Preservice educators' attitudes and beliefs towards families can have a profound impact on family-centered practices (FCPs) and family-professional partnerships (FPPs); unfortunately, negative beliefs about families can surface during preservice early childhood preparation and can be a challenge for faculty in higher education to address. This article shares promising instructional practices (e.g., projects, assignments, teaching methods) that have been shown to reshape preservice educators' existing beliefs about families. In addition, these instructional practices aim to cultivate positive perspectives in preservice educators by aligning with the recent joint policy statement from the U.S. Department of Health and Human Services and the U.S Department of Education on inclusive early learning programs (2023) regarding engaging families as full partners. The purposes of this article are to: (a) briefly summarize the literature on relational FCPs and FPPs, (b) describe the connection between beliefs about families and their contribution to strengthen or hinder relational FCPs and FPPs, and (c) present instructional practices that faculty can use to support preservice EI/ECSE students' constructive beliefs about families. Examples of instructional practices are organized and presented as: in class activities with families (e.g., guest speakers); in class activities without families (e.g., role playing); and out of class activities with families (e.g., attending an Individualized Education Program [IEP] meeting). By integrating these instructional practices, faculty can equip preservice educators with necessary skills and attitudes to build authentic connections with families, which can lead to improved outcomes for young children with disabilities and their families.

An objective structured clinical examination (OSCE) has been recognised as a reliable but workload-intensive assessment method across health sciences studies. Though a variety of digital marking tools have been employed to improve marking and feedback provision for OSCEs, many of these require specialist software or maintenance. This pilot study examines the development and trialling of Microsoft Forms as a marking and feedback instrument for an OSCE within a Sport and Exercise Therapy module. This study aims to assess whether the use of a non-specialist digital tool, such as Microsoft Forms, might be able overcome limitations in current assessment procedures and ultimately provide a more effective method for marking and feedback provision for an OSCE. Results from OSCE examiners (N = 8) and students (N = 30) who participated in the pilot indicate that Microsoft Forms does have the potential to provide a more effective experience for examiners and ultimately improve upon feedback provision for students when compared with a paper-based marking tool. However, concerns around the form's ease-of-use may ultimately influence its adoption as a marking instrument above current paper-based methods.

The question whether money matters in education strikes at the foundation of America's democracy - an educated electorate. Despite decades of evidence that money does matter, the question still remains unanswered among many and even answered to the contrary of the evidence. It is important to fully understand that money does matter in American education, American lives, and America's future and to increase awareness of political and social factors that undermine that money matters for all students to learn.

The study investigates secondary students' understanding of "orbital" and "electron cloud" concepts in different quantum contexts (for values of the ?principal quantum number n = 1 and n = 2) on the basis of their verbal and pictorial representations, evaluating also their consistency. Participants, which were 192 12th-grade students from six urban secondary schools of Northern Greece, represented these two concepts through two corresponding tasks of a paper-and-pencil assessment tool, each of which comprised two parts for verbal and pictorial representations, respectively. Results provide evidence that although students struggle to express verbally the orbital and electron cloud concepts, their competences in the corresponding pictorial representations are relatively better, exhibiting inconsistencies between verbal and pictorial representations. Inconsistencies also exist between representations of the orbital and electron cloud concepts, since students appear to have verbally a better understanding of the electron cloud than the orbital, whereas the opposite holds true for their pictorial representations. Comparing verbal and pictorial representations, the pictorial ones appear to be more consistent tools, whereas a quantum context defined by n = 2 seems to be more challenging for students compared to that of n = 1. Furthermore, an analysis of student profiles leads to their categorization in four classes, providing additional relevant information. Implications for science education are also discussed.

The First2 Network is an alliance of higher education institutions across the State of West Virginia striving to improve science, technology, engineering, or math (STEM) education by supporting rural, first-generation, and underrepresented college students pursuing STEM majors. Over the summers of 2019 and 2020, the First2 Network delivered two-week summer research immersion experiences at various institutions throughout West Virginia, including our institutions. The 2019 program was delivered on-campus at four universities while the 2020 program was redesigned to be delivered virtually, due to the COVID-19 pandemic, across nine sites. Before and after the immersion experience, students who participated in the program completed a variety of survey questionnaires for the assessment of their interests, expectations, identity, and belonging in STEM. We found that the in-person research experience in 2019 had better outcomes compared to the virtual experience, suggesting that students conducting research directly under their faculty supervisors in-person and on-site will have a more positive impact on their STEM education and career. However, participation in the virtual research format with structured group activities still resulted in an improvement in belonging and STEM identity, indicating that connecting with students remotely is still worthwhile when it is the most viable option. The student population in West Virginia/Appalachia region faces a number of academic barriers, so there is much to gain by finding new ways to reach as many students as possible with early career development programs. Our virtually delivered program using citizen science projects, group discussions, and team building activities may be a useful template for other STEM programs to search for new ways to connect with a broader population of students offsite.

The gender digital divide (GDD) is a social phenomenon that denies citizens access to technologies, the internet, and the services associated with Education 4.0. Reducing this gap requires communicative literacy, which allows scaling knowledge, skills, and attitudes to create forms of media expression to interact effectively in virtual environments. Education 4.0 is a modern approach to education that focuses on preparing students to thrive in a digital and technological world. Additionally, Education 4.0 is based on three pedagogical principles, including Cyber pedagogy, Heutagogy, and Peeragogy, which emphasize the use of technology, self-determined learning, and collaboration, respectively. A mixed study was conducted with the participation of 124 Mexican students of technical-professional education. The study's objective was to analyze how they scaled their communicative literacy and complex thinking through a formative experience based on the pedagogical framework of Education 4.0 in digital environments called metaverses to bridge the GDD in Mexico. Quantitative results show only significant differences in systemic thinking (z = -2.113, p = 0.035 < 0.05), where women had a slightly higher mean (M = 25.36) than men (M = 25.11). Qualitative results support the finding of women excelling in systemic thinking, as participants expressed comments related to systemic thinking (90%). This suggests that immersive digital environments can effectively enhance communicative literacy and complex thinking. Additionally, they can be spaces where both women and men achieve similar levels of digital literacy.

Although research has extensively documented international students' adjustment and acculturation challenges, the role of academic advising in assisting with such challenges has received scarce empirical attention. This phenomenological study explored how international students' communications with their academic advisors influenced their educational adjustment and growth in a university setting. Semi structured interviews with 15 international students revealed three overarching themes: advisor-advisee interactions, quality of information, and advising limits vis-à-vis international student issues. Using validation theory, this study's discussion and recommendations centered on advising practices that fostered or hindered international students' perceptions of academic advising.

The didactic class is a pedagogical tool meant to increase classroom interactivity by encouraging student discussion of real-life cases in connection with theory. This paper evaluates the pedagogical impact of using a one-off didactic class where an external expert is brought in to discuss how to relate a cognitive psychology course's content to real-life problems. Using a mixed-methods approach, we measure the undergraduate students' sense of conceptual understanding, their perspective on applying cognitive sciences, their sense of belonging to the department, and their motivation to work. Students' sense of understanding and their perspective in applying cognitive sciences to real-world problems significantly increased after this class. However, we found no significant differences in their sense of belonging to the department or their motivation to study. This suggests didactic classes may further course-specific content but do not change broader aspects of motivation or belonging. The qualitative interviews support the quantitative results. Students reported that the didactic class made them think laterally about content from other modules and how they could apply theoretical insights to real-world problems, which boosted confidence. Students reported great satisfaction with the didactic class. Of course, the speaker must be relevant to the course content, and students should feel empowered and able to speak in class. However, these are practical concerns that should not discourage lecturers from exploring didactic classes as a fun and instructive tool that has significant pedagogical benefits.

Opportunities for professional development (PD) are the key for teachers to improve their skills in a variety of areas and situations, including, but not limited to, technology in the classroom, positive behavior management strategies, effective collaboration, and making instructional accommodations for students with disabilities. These areas of PD are especially important for special education teachers. However, opportunities to access PD may vary greatly, especially for special educators who work in rural locations. Therefore, the purpose of this study was to survey special education teachers serving rural or non-rural (i.e., suburban or urban) communities in the U.S. state of Nebraska about their unique PD experiences. Results indicated that special educators in rural areas often use their regional service agency to access PD opportunities and perceive those experiences positively. Suggestions for improving PD include providing relevant content during training and allocating resources to increase PD attendance. Recommendations for improvements are provided.

Maori and Pacific learners in Aotearoa New Zealand have been identified as 'priority learners' by the Ministry of Education. The 'Pacific picturebook project' is ongoing research focussed on picturebooks selected to support the languages, cultures, and identities of Pacific learners in keeping with our government, Teaching Council and Ministry of Education expectations. This phase of the research was located in a kindergarten where teachers and children identify as Maori, Pakeha and from several Pacific Island nations. Teachers shared a selection of Pacific picturebooks with the children and recorded their own and the children's responses to them over a kindergarten term. Thematic analysis of data showed that Pacific picturebooks were significant pedagogical tools for language learning, to support identity, and to contribute to the kindergarten's emergent and localised curriculum. These findings clearly illustrate what pedagogy looks like when it is entrenched in key documents relevant to early learning in this country.

We examined the relations between mothers' reading skills, home literacy environment (HLE), and children's emergent literacy skills and word reading and whether their relations vary across urban and rural contexts in China. Four hundred third-year kindergarten Chinese children (M[subscript age] = 74.50 ± 3.77 months) were recruited from Jining (N = 232) and the small towns of Luqiao and Mapo (N = 168). The children were assessed on emergent literacy skills (pinyin letter knowledge, phonological awareness, rapid automatized naming [RAN], and vocabulary) and word reading. Their mothers were also assessed on reading skills and completed a questionnaire on HLE (direct teaching, shared book reading, and access to literacy resources [ALR]). Results of structural equation modeling showed that (a) mothers' reading skills correlated with shared book reading and ALR in both groups, (b) direct teaching predicted children's pinyin letter knowledge, and ALR predicted phonological awareness and vocabulary in both groups after controlling for mothers' reading skills and parents' education, and (c) mothers' reading skills had an indirect effect on children's word reading through vocabulary (in the urban group) or phonological awareness (in the rural group). Multigroup analyses further showed that the effect of direct teaching on RAN was stronger in the rural group. These findings suggest that HLE exerts its effect on children's emergent literacy skills and word reading across contexts, even after controlling for mothers' reading skills.

In this essay, the authors explore the dilemmas facing researchers, educators, and policymakers in how to refer to multilingual students who are deemed in need of language support in school. There is a growing concern with the label "English learner," the term currently used in U.S. federal legislation, as focusing exclusively on students' English language acquisition and ignoring their multilingual resources. Alternative terms such as "emergent bilingual" and "multilingual learner" that underscore students' multilingual assets have become widespread alternatives. The authors argue that the critiques of the term "English learner" must be taken seriously. They also argue that, given that being classified as English learners in schools has material consequences for students' academic and occupational trajectories, this label cannot simply be wished away. In fact, debating over labels alone carries the danger of mislocating the primary site of struggle for equity and justice in the labels themselves, rather than in the systems that position and frame linguistically minoritized students in a deficit light in the first place. As researchers who have worked with this population for years, the authors, too, are grappling with how to refer to them. Each of them shares the dilemmas they have encountered, and they conclude by offering a multidimensional tool that might assist scholars, educators, and policymakers in reflecting on what is gained and lost by using different terms.

Background: Children with intellectual and developmental disabilities are at a higher risk of developing dental caries. Few scoping reviews have been conducted in India to understand their issues. We aimed to summarise the distribution and risk factors of dental caries among children and adolescents with intellectual disabilities in India. Methods: A scoping review was conducted based on the Arksey O Malley framework. Quality assessment of studies, descriptive and thematic analyses were also conducted. Results: We charted, collated, and summarised from four databases. Thirty-one studies met the study criteria consisting of children and adolescents with intellectual disabilities. Median caries prevalence was 70%, decayed missing and fIlled permenant teeth (DMFT) was 2.4, decayed missing and filled decidous teeth (dmft) was 2.36, and DMFS was 3.7. Major determinants were the severity of disability, socioeconomic status and parents' education. Oral care and dental visits were inadequate. Conclusion: Further exploration is required to improve access and reduce caries experience and prevalence among children with intellectual and developmental disabilities in India.

Effective treatment of challenging behaviors in young children with autism spectrum disorder requires identifying consequences that maintain the behavior under specific environmental circumstances. Assessment strategies help to identify environmental factors setting the occasion for the behaviors to continue to occur. Many studies have used antecedent-behavior-consequence (ABC) data collection strategies, but few have examined its ability to effectively identify the function. Research supports the use of the trial-based functional analysis (TBFA) but few studies examine its effectiveness in the home setting. The current study attempted to answer which assessments might work best in the home setting. Treatment was implemented for each participant based on the results of their assessments. All assessments identified the function of behavior as verified by function-based treatments, but the ABC assessment identified additional functions for three of the participants while the TBFA was more precise. Implications and limitations are reviewed, along with future directions for behavioral assessment in the home.

Participation in student peer leader roles, roles in which more senior students serve as mentors and educators to their peers, have continued to grow in their application and importance to institutions of higher education around the globe. Using a theoretical approach based in Legitimate Peripheral Participation and drawing from the International Survey of Peer Leaders, our paper explored the role of the quality and quantity of participation in important outcomes of the college experience: leadership development, skill development, and academic success. The results showed that the number of hours per week spent on peer leadership activities and the total number of peer leadership positions contributed to positive quality of engagement and enhanced students' academic outcomes, overall leadership skills, and career readiness. Moreover, findings showed that the quality of engagement moderated the influences of the quantity of participation particularly for measures of academic success. As students develop relationships with faculty, staff, and peers throughout their time in peer leader roles and feel a deepening sense of connection and belonging to the college or university, students in peer leader roles become fuller participants in the academic community and, as a result, develop the knowledge, skills, and ways of doing, thinking, knowing, and being that are critical for student success.

First-generation college students (FGCS) experience high rates of attrition compared to continuing generation college students. FGCS frequently identify with several other historically marginalized identities on college campuses. The development of a sense of belonging on-campus is one of the main drivers of retention. The current study examines how sense of belonging on-campus develops during the first-year of college for different FGCS and how attitudes about on-campus relationships evolve over time. Thirteen participants were interviewed at three time points during their first year of college. Grounded theory analysis revealed four themes: 1) higher education provides a cultural learning environment; 2) multiple factors create challenges to relationship building; 3) extreme value differences create hard limits around friendships; and 4) within group friendships provide social and psychological value. Findings extend the current literature on the importance of social belonging for retention of diverse FGCS and highlight the importance of intersectionality in this work.

Background: The COVID-19 pandemic and the shift to digital learning materials have dramatically reduced the use of paper-based textbooks in higher education. In the field of engineering, students need a comprehensive understanding of mathematical concepts, which can be achieved through the use of e-textbooks. These digital learning materials can provide a more comprehensive and effective learning experience by incorporating a variety of multimedia elements, such as audio, visual aids, and interactive features. Rationale/Relevance: Mathematics students are expected to possess critical problem-solving skills, yet they are rarely asked to elaborate on and explain their mathematical reasoning and concepts through written argument in the engineering mathematics classroom. While students may excel in formula manipulation, they may still possess misconceptions about mathematical principles and concepts. A reliance on mechanical and procedural approaches, such as formula application, without proper conceptual understanding can result in serious misunderstandings of mathematics and its real-world applications. Without the ability to reason about mathematical concepts, students may struggle to connect what they are learning in class with real-world scenarios, leading to difficulties in solving practical problems. It is, therefore, crucial to foster conceptual understanding and critical reasoning skills in mathematics education, rather than solely relying on memorisation, in order to equip students with the necessary skills to succeed in their careers. Research Problem/ Research Question: This study will answer the following research question:How effective are e-textbooks in promoting conceptual understanding of engineering mathematics? Aim of the Study/Focus: The purpose of this study is to investigate conceptual learning in engineering mathematics using an e-textbook as a learning tool. Methodology: This qualitative case study explores e-textbooks as adaptive technology, with functionalities that include artificial intelligence allowing students to develop their understanding by interacting with digital text, watching videos of real-world mathematics concepts, and responding to quick quizzes on concepts; as well as practising and mastering further mathematical principles and concepts. It focuses on first-year engineering students and lecturers at a University of Technology in South Africa. The analysis of interview recordings was done with ATLAS.ti. analytical software. Theoretical Framework: The data from this study was analyzed through the lenses of cultural historical activity theory (CHAT) and Vosniadou's notion of conceptual change, allowing the researchers to explain complex real-world situations that students experience when engaging with the e-textbook to solve mathematics problems. Recommendations: The work presented here has implications for future studies of conceptual learning in mathematics research and may provide opportunities around learning engineering mathematical concepts, particularly in the context of developing countries. This is because it offers novel instructional approaches that are tailored to the specific needs and challenges of these countries.

Schools have increasingly relied on paraeducators in elementary settings to help address student needs. Research demonstrates that simple prevention strategies, like active supervision (e.g., moving, scanning, interacting), can reduce problem behavior in areas where paraeducators are assigned; however, less is known about how to best support paraeducators in implementing these practices. For this study, four paraeducators participated in a brief training on recess active supervision and then engaged in self-management by filling out a checklist and direct behavior ratings (DBRs). Using a multiple baseline across participants design, we introduced the intervention to participants in a randomly assigned order and examined effects, fidelity, and social validity. Results suggest that training and self-management may lead to changes in the interacting behavior of active supervision at recess with more frequent prompting and praising by the paraeducators. Despite limitations, this exploratory study has implications for schools and researchers.

The purpose of this study was to determine differences in students' perceived benefits of chess by gender and age after being exposed to chess during instruction for an entire academic year as part of a Chess in Schools initiative in a southeastern state of the United States. Data were collected during the 2017-2018 academic year. The sample consisted of 1,286 students across elementary, middle, and high school levels. Data were collected using a retrospective pretest survey. Seven constructs of the students' perceptions were generated ("increased enjoyment of mathematics," "improvement in academic self-efficacy," "improvement in collaborative skills," "improvement in organizational skills," "enjoyment of chess," "confidence in chess playing ability," and "increased engagement in learning"), and all had high reliability coefficients. Data were analyzed using a two-way multivariate analysis of variance. The results showed that elementary students consistently tended to have higher ratings of perceived benefits than middle and high school students across all constructs. The differences between middle and high school students were low and not statistically significant.

Background and purposeClinicians use reference values to contextualize physical performance scores, but data are sparse in individuals 90 years and older and racial/ethnic diversity is limited in existing studies. Gait speed provides valuable information about an individual's health status. Slow gait speed is associated with falls, cognitive decline, and mortality. Here, we report gait speed reference values in a racially/ethnically diverse oldest-old cohort.MethodsLifeAfter90 is a multiethnic cohort study of individuals 90 years and older. Participants are long-term members of an integrated healthcare delivery system without a dementia diagnosis at enrollment. We assessed gait speed using the 4-m walk test and calculated means, standard deviations, and percentiles by age, sex, assistive device use, and device type. We used linear regression to compare means by sex, age, device use and type, living situation and arrangement, and race/ethnicity.Results and discussionThe mean age of the 502 participants was 92.9 (range 90.1-102.8) years. Of these, 62.6% were women, 34.7% were college educated, 90.8% lived in a private residence, 20.9% self-reported as Asian, 22.5% as Black, 11.8% as Hispanic, 35.7% as White, and 9.2% as multiple, "other," or declined to state. The overall mean gait speed was 0.54 m/s (women = 0.51 m/s, men = 0.58 m/s). Mean gait speeds were 0.58 m/s, 0.53 m/s, and 0.48 m/s in the 90 to 91, 92 to 93, and 94+ age categories, respectively. In those without a device, mean gait speed was 0.63 m/s compared to 0.40 m/s in those with a device (cane = 0.44 m/s, walker = 0.37 m/s). Mean gait speed was significantly slower in women compared to men, age category 94+ compared to 90 to 91, participants with a device compared to those without, participants with a walker compared to a cane, and Black participants compared to Asian and White participants. However, differences by race/ethnicity were attenuated when chronic health conditions were considered.ConclusionsReference values developed from this multiethnic 90+ cohort will help clinicians interpret gait speed measures and tailor recommendations toward a 90+ population that is growing in number and in racial/ethnic diversity.

Lactate, a product of glycolysis, is formed under aerobic conditions. Extensive work has shown lactate flux in young and exercising humans; however, the effect of age is not known. We tested the hypothesis that postprandial lactate shuttling (PLS) would be diminished in older adults. We used [3-13C]lactate and [6,6-2H]glucose tracers, an oral glucose tolerance test (OGTT), and arterialized blood sampling to determine postprandial lactate rates of appearance (Ra), disappearance (Rd), and oxidation (Rox) in 15 young (28.1 ± 1.4 yr) and 13 older (70.6 ± 2.4 yr) healthy men and women. In young participants, fasting blood [lactate] (≈0.5 mM) rose after the glucose challenge, peaked at 15 min, dipped to a nadir at 30 min, and rose again peaking at 60 min (≈1.0 mM). Initial responses in lactate Ra of older participants were delayed and diminished until 90 min rising by 0.83 mg·kg-1·min-1. Lactate Rox was higher throughout the entire trial in young participants by a difference of ∼0.5 mg·kg-1·min-1. Initial peaks in lactate Ra and concentration in all volunteers demonstrated the presence of an enteric PLS following an OGTT. Notably, in the systemic, but not enteric, PLS phase, lactate Ra correlated highly with glucose Rd (r2 = 0.92). Correspondence of second peaks in lactate Ra and concentration and glucose Rd shows dependence of lactate Ra on glucose Rd. Although results show both enteric and systemic PLS phases in young and older study cohorts, metabolic responses were delayed and diminished in healthy older individuals.NEW & NOTEWORTHY We used isotope tracers, an oral glucose tolerance test, and arterialized blood sampling to determine postprandial lactate flux rates in healthy young and older men and women. Lactate rates of appearance and oxidation and the lactate-pyruvate exchange were delayed and diminished in both enteric and systemic postprandial lactate shuttle phases in older participants.

Introduction: The United States lacks a national interfacility patient transfer coordination system. During the coronavirus 2019 (COVID-19) pandemic, many hospitals were overwhelmed and faced difficulties transferring sick patients, leading some states and cities to form transfer centers intended to assist sending facilities. In this study we aimed to explore clinician experiences with newly implemented transfer coordination centers.Methods: This mixed-methods study used a brief national survey along with in-depth interviews. The American College of Emergency Physicians Emergency Medicine Practice Research Network (EMPRN) administered the national survey in March 2021. From September–December 2021, semi-structured qualitative interviews were conducted with administrators and rural emergency clinicians in Arizona and New Mexico, two states that started transfer centers during COVID-19.Results: Among 141 respondents (of 765, 18.4% response rate) to the national EMPRN survey, only 30% reported implementation or expansion of a transfer coordination center during COVID-19. Those with new transfer centers reported no change in difficulty of patient transfers during COVID-19 while those without had increased difficulty. The 17 qualitative interviews expanded upon this, revealing four major themes: 1) limited resources for facilitating transfers even before COVID-19; 2) increased number of and distance to transfer partners during the COVID-19 pandemic; 3) generally positive impacts of transfer centers on workflow, and 4) the potential for continued use of centers to facilitate transfers.Conclusion: Transfer centers may have offset pandemic-related transfer challenges brought on by the COVID-19 pandemic. Clinicians who frequently need to transfer patients may particularly benefit from ongoing access to such transfer coordination services.

Global epidemiological data show that the incidence of invasive fungal disease (IFD) has increased in recent decades, with the rising frequency of infections caused by Aspergillus and Mucorales order species. The number and variety of patients at risk of IFD has also expanded, owing in part to advances in the treatment of hematologic malignancies and other serious diseases, including hematopoietic stem cell transplantation (HCT) and other therapies causing immune suppression. Isavuconazonium sulfate (active moiety: isavuconazole) is an advanced-generation triazole antifungal approved for the treatment of invasive aspergillosis and mucormycosis that has demonstrated activity against a variety of yeasts, moulds, and dimorphic fungi. While real-world clinical experience with isavuconazole is sparse in some geographic regions, it has been shown to be effective and well tolerated in diverse patient populations, including those with multiple comorbidities who may have failed to respond to prior triazole antifungal therapy. Isavuconazole may be suitable for patients with IFD receiving concurrent QTc-prolonging therapy, as well as those on venetoclax or ruxolitinib. Data from clinical trials are not available to support the use of isavuconazole prophylactically for the prevention of IFD or for the treatment of endemic IFD, such as those caused by Histoplasma spp., but real-world evidence from case studies suggests that it has clinical utility in these settings. Isavuconazole is an option for patients at risk of IFD, particularly when the use of alternative antifungal therapies is not possible because of toxicities, pharmacokinetics, or drug interactions.

This document describes performance measures for heart failure that are appropriate for public reporting or pay-for-performance programs and is meant to serve as a focused update of the "2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures." The new performance measures are taken from the "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines" and are selected from the strongest recommendations (Class 1 or Class 3). In contrast, quality measures may not have as much evidence base and generally comprise metrics that might be useful for clinicians and health care organizations for quality improvement but are not yet appropriate for public reporting or pay-for-performance programs. New performance measures include optimal blood pressure control in patients with heart failure with preserved ejection fraction, the use of sodium-glucose cotransporter-2 inhibitors for patients with heart failure with reduced ejection fraction, and the use of guideline-directed medical therapy in hospitalized patients. New quality measures include the use of sodium-glucose cotransporter-2 inhibitors in patients with heart failure with mildly reduced and preserved ejection fraction, the optimization of guideline-directed medical therapy prior to intervention for chronic secondary severe mitral regurgitation, continuation of guideline-directed medical therapy for patients with heart failure with improved ejection fraction, identifying both known risks for cardiovascular disease and social determinants of health, patient-centered counseling regarding contraception and pregnancy risks for individuals with cardiomyopathy, and the need for a monoclonal protein screen to exclude light chain amyloidosis when interpreting a bone scintigraphy scan assessing for transthyretin cardiac amyloidosis.

Measures of attention and memory were evaluated in 6- to 9-month-old infants from two diverse contexts. One sample consisted of African infants residing in rural Malawi (N = 228, 118 girls, 110 boys). The other sample consisted of racially diverse infants residing in suburban California (N = 48, 24 girls, 24 boys). Infants were tested in an eye-tracking version of the visual paired comparison procedure and were shown racially familiar faces. The eye tracking data were parsed into individual looks, revealing that both groups of infants showed significant memory performance. However, how a look was operationally defined impacted some-but not other-measures of infant VPC performance. RESEARCH HIGHLIGHTS: In both the US and Malawi, 6- to 9-month-old infants showed evidence of memory for faces they had previously viewed during a familiarization period. Infant age was associated with peak look duration and memory performance in both contexts. Different operational definitions of a look yielded consistent findings for peak look duration and novelty preference scores-but not shift rate. Operationalization of look-defined measures is an important consideration for studies of infants in different cultural contexts.

PURPOSE OF REVIEW: In this review, we discuss the status of novel radiation shielding and other methods to reduce radiation exposure and its associated health risks within the CCL. RECENT FINDINGS: There are many devices on the market each with its unique advantages and inherent flaws. Several are available for widespread use with promising data, while others still in development. The field of percutaneous transcatheter interventions includes complex procedures often involving significant radiation exposure. Increased radiation exposes the proceduralist and CCL staff to potential harm from both direct effects of radiation but also from the ergonomic consequences of daily use of heavy personal protective equipment. Here we discuss several innovative efforts to reduce both radiation exposure and orthopedic injury within the CCL that are available, leading to a safer daily routine in a lead [apron]-free environment.

Chlorine exposure can cause severe airway injuries. While the acute effects of chlorine inhalation are well-documented, the structural changes resulting from the post-acute, high-level chlorine exposure remain less understood. Airway sloughing is one of the standards for doctors to evaluate the lung function. Here, we report the application of a high-resolution swept-source optical coherence tomography system to investigate the progression of injury based on airway sloughing evaluation in a chlorine inhalation rabbit model. This system employs a 1.2 mm diameter flexible fiberoptic endoscopic probe via an endotracheal tube to capture in vivo large airway anatomical changes before and as early as 30 min after acute chlorine exposure. We conducted an animal study using New Zealand white rabbits exposed to acute chlorine gas (800 ppm, 6 min) during ventilation and monitored them using optical coherence tomography (OCT) for 6 h. To measure the volume of airway sloughing induced by chlorine gas, we utilized deep learning for the segmentation task on OCT images. The results showed that the volume of chlorine induced epithelial sloughing on rabbit tracheal walls initially increased, peaked around 30 min, and then decreased. Furthermore, we utilized a spectral encoded interferometric microscopy system to study ex vivo airway cilia beating dynamics based on Doppler shift, aiding in elucidating how chlorine gas affects cilia beating function. Cilia movability and beating frequency were decreased because of the epithelium damage. This quantitative approach has the potential to enhance the diagnosis and monitoring of injuries from toxic gas inhalation and to evaluate the efficacy of antidote treatments for these injuries.

Human African trypanosomiasis, or sleeping sickness, is a neglected tropical disease caused by Trypanosoma brucei rhodesiense and Trypanosoma brucei gambiense and is invariably fatal unless treated. Current therapies present limitations in their application, parasite resistance, or require further clinical investigation for wider use. Our work, informed by previous findings, presents novel 4-[4-(4-methylpiperazin-1-yl)phenyl]-6-arylpyrimidine derivatives with promising antitrypanosomal activity. In particular, 32 exhibits an in vitro EC50 value of 0.5 µM against Trypanosoma brucei rhodesiense, and analogues 29, 30 and 33 show antitrypanosomal activities in the

ObjectivesObeticholic acid (OCA) treatment for primary biliary cholangitis (PBC) was conditionally approved in the phase 3 POISE trial. The COBALT confirmatory trial assessed whether clinical outcomes in PBC patients improve with OCA therapy.MethodsPatients randomized to OCA (5-10 mg) were compared with placebo (randomized controlled trial [RCT]) or external control (EC). The primary composite endpoint was time to death, liver transplant, model for end-stage liver disease score ≥15, uncontrolled ascites, or hospitalization for hepatic decompensation. A prespecified propensity score-weighted EC group was derived from a US healthcare claims database.ResultsIn the RCT, the primary endpoint occurred in 28.6% of OCA (n=168) and 28.9% of placebo patients (n=166; intent-to-treat [ITT] analysis hazard ratio [HR]=1.01, 95% CI=0.68-1.51), but functional unblinding and crossover to commercial therapy occurred, especially in the placebo arm. Correcting for these using inverse probability of censoring weighting (IPCW) and as-treated analyses shifted the HR to favor OCA. In the EC (n=1051), the weighted primary endpoint occurred in 10.1% of OCA and 21.5% of non-OCA patients (HR=0.39; 95% CI=0.22-0.69; P=0.001). No new safety signals were identified in the RCT.ConclusionsFunctional unblinding and treatment crossover, particularly in the placebo arm, confounded the ITT estimate of outcomes associated with OCA in the RCT. Comparison with the real-world EC showed that OCA treatment significantly reduced the risk of negative clinical outcomes. These analyses demonstrate the value of EC data in confirmatory trials and suggest that treatment with OCA improves clinical outcomes in patients with PBC.

Production of hard X-ray via inverse Compton scattering at photon energies below 100 keV range aimed at potential applications in medicine and material research is reported. Experiments have been performed at the Brookhaven National Laboratory, Accelerator Test Facility, employing the counter collision of a 70 MeV, 0.3 nC electron beam with a near infra-red Nd: YAG laser (1064 nm wavelength) pulse containing ~ 100 mJ in a single shot basis. The radiation distribution of the scattered photon beam is assessed to be sufficiently quasi monochromatic to produce clear contrast from the Au K- edge at 80.7 keV.

Scrub typhus, a vector-borne bacterial infection, is an important but neglected disease globally. Accurately characterizing the burden is challenging because of nonspecific symptoms and limited diagnostics. Prior seroepidemiology studies have struggled to find consensus cutoffs that permit comparisons of estimates across contexts and time. In this study, we present a novel approach that does not require a cutoff and instead uses information about antibody kinetics after infection to estimate seroincidence. We use data from three cohorts of scrub typhus patients in Chiang Rai, Thailand, and Vellore, India, to characterize antibody kinetics after infection and two population serosurveys in the Kathmandu Valley, Nepal, and Tamil Nadu, India, to estimate seroincidence. The samples were tested for IgM and IgG responses to Orientia tsutsugamushi-derived recombinant 56-kDa antigen using commercial enzyme-linked immunosorbent assay kits. We used Bayesian hierarchical models to characterize antibody responses after scrub typhus infection and used the joint distributions of the peak antibody titers and decay rates to estimate population-level incidence rates in the cross-sectional serosurveys. Median responses persisted above an optical density (OD) of 1.8 for 23.6 months for IgG and an OD of 1 for 4.5 months for IgM. Among 18- to 29-year-olds, the seroincidence was 10 per 1,000 person-years (95% CI, 5-19) in Tamil Nadu, India, and 14 per 1,000 person-years (95% CI: 10-20) in the Kathmandu Valley, Nepal. When seroincidence was calculated with antibody decay ignored, the disease burden was underestimated by more than 50%. The approach can be deployed prospectively, coupled with existing serosurveys, or leverage banked samples to efficiently generate scrub typhus seroincidence estimates.

Our purpose was to determine how age affects metabolic flexibility and underlying glucose kinetics in healthy young and older adults. Therefore, glucose and lactate tracers along with pulmonary gas exchange data were used to determine glucose kinetics and respiratory exchange ratios [RER = carbon dioxide production (V̇co2)/oxygen consumption (V̇o2)] during a 2-h 75-g oral glucose tolerance test (OGTT). After an 12-h overnight fast, 28 participants, 15 young (21-35 yr; 7 men and 8 women) and 13 older (60-80 yr; 7 men and 6 women), received venous primed-continuous infusions of [6,6-2H]glucose and [3-13C]lactate with a [Formula: see text] bolus. After a 90-min metabolic stabilization and tracer equilibration period, volunteers underwent an OGTT. Arterialized glucose concentrations ([glucose]) started to rise 15 min post glucose consumption, peaked at 60 min, and remained elevated. As assessed by rates of appearance (Ra) and disposal (Rd) and metabolic clearance rate (MCR), glucose kinetics were suppressed in older compared to young individuals. As well, unlike in young individuals, fractional gluconeogenesis (fGNG) remained elevated in the older population after the oral glucose challenge. Finally, there were no differences in 12-h fasting baseline or peak RER values following an oral glucose challenge in older compared to young men and women, making RER an incomplete measure of metabolic flexibility in the volunteers we evaluated. Our study revealed that glucose kinetics are significantly altered in a healthy aged population after a glucose challenge. Furthermore, those physiological deficits are not detected from changes in RER during an OGTT.NEW & NOTEWORTHY To determine metabolic flexibility in response to an OGTT, we studied healthy young and older men and women to determine glucose kinetics and changes in RER. Compared to young subjects, glucose kinetics were suppressed in older healthy individuals during an OGTT. Surprisingly, the age-related changes in glucose flux were not reflected in RER measurements; thus, RER measurements do not give a complete view of metabolic flexibility in healthy individuals.

IMPORTANCE: There are consistent data demonstrating that socioeconomic disadvantage is associated with risk of premature mortality, but research on the relationship between neighborhood socioeconomic factors and premature mortality is limited. Most studies evaluating the association between neighborhood socioeconomic status (SES) and mortality have used a single assessment of SES during middle to older adulthood, thereby not considering the contribution of early life neighborhood SES. OBJECTIVE: To investigate the association of life course neighborhood SES and premature mortality. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included Black and White participants of the multicenter Atherosclerosis Risk in Communities Study, a multicenter study conducted in 4 US communities: Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and the northwestern suburbs of Minneapolis, Minnesota. Participants were followed up for a mean (SD) of 18.8 (5.7) years (1996-2020). Statistical analysis was performed from March 2023 through May 2024. EXPOSURE: Participants residential addresses during childhood, young adulthood, and middle adulthood were linked with US Census-based socioeconomic indicators to create summary neighborhood SES scores for each of these life epochs. Neighborhood SES scores were categorized into distribution-based tertiles. MAIN OUTCOMES AND MEASURES: Premature death was defined as all-cause mortality occurring before age 75 years. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs. RESULTS: Among 12 610 study participants, the mean (SD) age at baseline was 62.6 (5.6) years; 3181 (25.2%) were Black and 9429 (74.8%) were White; and 7222 (57.3%) were women. The lowest, compared with the highest tertile, of neighborhood SES score in middle adulthood was associated with higher risk of premature mortality (HR, 1.28; 95% CI, 1.07-1.54). Similar associations were observed for neighborhood SES in young adulthood among women (HR, 1.25; 95% CI, 1.00-1.56) and neighborhood SES in childhood among White participants (HR, 1.25; 95% CI, 1.01-1.56). Participants whose neighborhood SES remained low from young to middle adulthood had an increased premature mortality risk compared with those whose neighborhood SES remained high (HR, 1.25; 95% CI, 1.05-1.49). CONCLUSIONS AND RELEVANCE: In this study, low neighborhood SES was associated with premature mortality. The risk of premature mortality was greatest among individuals experiencing persistently low neighborhood SES from young to middle adulthood. Place-based interventions that target neighborhood social determinants of health should be designed from a life course perspective that accounts for early-life socioeconomic inequality.

The ENIGMA research consortium develops and applies methods to determine clinical significance of variants in hereditary breast and ovarian cancer genes. An ENIGMA BRCA1/2 classification sub-group, formed in 2015 as a ClinGen external expert panel, evolved into a ClinGen internal Variant Curation Expert Panel (VCEP) to align with Food and Drug Administration recognized processes for ClinVar contributions. The VCEP reviewed American College of Medical Genetics and Genomics/Association of Molecular Pathology (ACMG/AMP) classification criteria for relevance to interpreting BRCA1 and BRCA2 variants. Statistical methods were used to calibrate evidence strength for different data types. Pilot specifications were tested on 40 variants and documentation revised for clarity and ease of use. The original criterion descriptions for 13 evidence codes were considered non-applicable or overlapping with other criteria. Scenario of use was extended or re-purposed for eight codes. Extensive analysis and/or data review informed specification descriptions and weights for all codes. Specifications were applied to pilot variants with pre-existing ClinVar classification as follows: 13 uncertain significance or conflicting, 14 pathogenic and/or likely pathogenic, and 13 benign and/or likely benign. Review resolved classification for 11/13 uncertain significance or conflicting variants and retained or improved confidence in classification for the remaining variants. Alignment of pre-existing ENIGMA research classification processes with ACMG/AMP classification guidelines highlighted several gaps in the research processes and the baseline ACMG/AMP criteria. Calibration of evidence strength was key to justify utility and strength of different data types for gene-specific application. The gene-specific criteria demonstrated value for improving ACMG/AMP-aligned classification of BRCA1 and BRCA2 variants.

The Cerebellar Cognitive Affective/Schmahmann Syndrome (CCAS) manifests as impaired executive control, linguistic processing, visual spatial function, and affect regulation. The CCAS has been described in the spinocerebellar ataxias (SCAs), but its prevalence is unknown. We analyzed results of the CCAS/Schmahmann Scale (CCAS-S), developed to detect and quantify CCAS, in two natural history studies of 309 individuals Symptomatic for SCA1, SCA2, SCA3, SCA6, SCA7, or SCA8, 26 individuals Pre-symptomatic for SCA1 or SCA3, and 37 Controls. We compared total raw scores, domain scores, and total fail scores between Symptomatic, Pre-symptomatic, and Control cohorts, and between SCA types. We calculated scale sensitivity and selectivity based on CCAS category designation among Symptomatic individuals and Controls, and correlated CCAS-S performance against age and education, and in Symptomatic patients, against genetic repeat length, onset age, disease duration, motor ataxia, depression, and fatigue. Definite CCAS was identified in 46% of the Symptomatic group. False positive rate among Controls was 5.4%. Symptomatic individuals had poorer global CCAS-S performance than Controls, accounting for age and education. The domains of semantic fluency, phonemic fluency, and category switching that tap executive function and linguistic processing consistently separated Symptomatic individuals from Controls. CCAS-S scores correlated most closely with motor ataxia. Controls were similar to Pre-symptomatic individuals whose nearness to symptom onset was unknown. The use of the CCAS-S identifies a high CCAS prevalence in a large cohort of SCA patients, underscoring the utility of the scale and the notion that the CCAS is the third cornerstone of clinical ataxiology.

OBJECTIVES: Chronic inflammation promotes cardiovascular risk in rheumatoid arthritis (RA). Biological disease-modifying antirheumatic drugs (bDMARDs) improve disease activity and cardiovascular disease outcomes. We explored whether bDMARDs influence the impact of disease activity and inflammatory markers on long-term cardiovascular risk in RA. METHODS: We studied 4370 participants without cardiovascular disease in a 10-country observational cohort of patients with RA. Endpoints were (1) major adverse cardiovascular events (MACE) encompassing myocardial infarction, stroke and cardiovascular death; and (2) any ischaemic cardiovascular events (iCVE) including MACE plus revascularisation, angina, transient ischaemic attack and peripheral arterial disease. RESULTS: Over 26 534 patient-years, 239 MACE and 362 iCVE occurred. The interaction between 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) and bDMARD use was significant for MACE (p=0.017), suggesting the effect of DAS28-CRP on MACE risk differed among bDMARD users (n=515) and non-users (n=3855). DAS28-CRP (per unit increase) is associated with MACE risk in bDMARD non-users (HR 1.21 (95% CI 1.07 to 1.37)) but not users (HR 0.69 (95% CI 0.40 to 1.20)). The interaction between CRP (per log unit increase) and bDMARD use was also significant for MACE (p=0.011). CRP associated with MACE risk in bDMARD non-users (HR 1.16 (95% CI 1.04 to 1.30)), but not users (HR 0.65 (95% CI 0.36 to 1.17)). No interaction was observed between bDMARD use and DAS28-CRP (p=0.167) or CRP (p=0.237) for iCVE risk. CONCLUSIONS: RA activity and inflammatory markers associated with risk of MACE in bDMARD non-users but not users suggesting the possibility of biological-specific benefits locally on arterial wall independently of effects on systemic inflammation.