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Course-based undergraduate research experiences (CUREs) offer students opportunities to engage in critical thinking and problem solving. However, quantitating the impact of incorporating research into undergraduate courses on student learning and performance has been difficult since most CUREs lack a comparable traditional course as a control. To determine how course-based research impacts student performance, we compared summative assessments of the traditional format for our upper division immunology course (2013-2016), in which students studied known immune development and responses, to the CURE format (2017-2019), in which students studied the effects of genetic mutations on immune development and responses. Because the overall class structure remained unaltered, we were able to quantitate the impact of incorporating research on student performance. Students in the CURE format class performed significantly better on quizzes, exams, and reports. There were no significant differences in academic levels, degree programs, or grade point averages, suggesting improved performance was due to increased engagement of students in research.

Use of high-stakes exams in a course has been associated with gender, racial, and socioeconomic inequities. We investigated whether offering students the opportunity to retake an exam makes high-stakes exams more equitable. Following the control value theory of achievement emotions, we hypothesized that exam retakes would increase students' perceived control over their performance and decrease the value of a single exam attempt, thereby maximizing exam performance. We collected data on exam scores and experiences with retakes from three large introductory biology courses and assessed the effect of optional exam retakes on gender, racial/ethnic, and socioeconomic disparities in exam scores. We found that Black/African American students and those who worked more than 20 h a week were less likely to retake exams. While exam retakes significantly improved student scores, they slightly increased racial/ethnic and socioeconomic disparities in scores partly because of these differences in participation rates. Most students reported that retake opportunities reduced their anxiety on the initial exam attempt. Together our results suggest that optional exam retakes could be a useful tool to improve student performance and reduce anxiety associated with high-stakes exams. However, barriers to participation must be examined and reduced for retakes to reduce disparities in scores.

Positive outcomes from undergraduate research experiences (UREs) have resulted in calls to broaden and diversify participation in research. However, we have little understanding of what demographics are reported and considered in the analyses of student outcomes from UREs. Without this information, it is impossible to assess whether participation in UREs has been diversified and how outcomes may vary by participant identity. Through a comprehensive literature search, we systematically identified 147 peer-reviewed research articles on student participation in UREs in the natural sciences, published between 2014 and 2020. We coded each paper to document which student demographic variables are reported and considered in analyses. The majority (88%) of articles on UREs reported at least one demographic variable and 62% incorporate demographics into their analyses, but demographics beyond gender and race/ethnicity were infrequently considered. Articles on independent research apprenticeships included demographics in their analyses more frequently than studies on course-based undergraduate research experiences (CUREs). Trends in reporting and analyzing demographics did not change from 2014 to 2020. Future efforts to collect these data will help assess whether goals to diversify UREs are being met and inform how to design UREs to meet the needs of diverse student groups.

Higher education has evolved in ways that may increase the challenges life science faculty face in providing accommodations for students with disabilities. Guided by Expectancy-Value Theory, we interviewed 34 life sciences faculty instructors from institutions nationwide to explore faculty motivation to create disability-inclusive educational experiences. We found that faculty in our sample perceive that providing most standard accommodations is a manageable but often challenging task. Further, faculty in our sample feel that improving accommodations necessitates additional support from their institutions. Most faculty had high attainment value for providing accommodations, in that they strongly believed that supporting students with disabilities is the fair and right thing to do. However, faculty did not perceive much utility value or intrinsic value in their task of providing accommodations, and most reported that providing accommodations can be a substantial burden on faculty. These findings imply that current approaches to providing inclusive educational experiences for students with disabilities rely primarily on the personal belief that providing accommodations is the right thing to do, which likely results in a flawed and inequitable system given that not all faculty equally share this conviction.

LGBTQ+ undergraduates have higher attrition from science and engineering (S&E) than straight and cisgender undergraduates and perceive that having LGBTQ+ instructors would benefit them. However, it is unknown how many S&E instructors are LGBTQ+, the extent to which they disclose this information to students, and how disclosure affects "all" students, both LGBTQ+ and non-LGBTQ+. In study I, we surveyed 108 LGBTQ+ S&E instructors across the U.S. to explore the extent to which they reveal their LGBTQ+ identities across professional contexts and why they reveal or conceal their identities to undergraduates. Overall, 75% of instructors came out to at least some colleagues but only 48% came out to any undergraduates. Instructors most commonly chose to conceal LGBTQ+ identities from undergraduates because they perceived their identities to be irrelevant to course content and anticipated negative student reactions. In study II, 666 introductory biology undergraduates were randomly assigned to evaluate one of two identical teaching demonstration videos except the instructor revealed her LGBTQ+ identity in one but not the other. We assessed differences in students' impressions of the instructor across conditions. We found no differences in most ratings of the instructor except participants reported higher rapport with the instructor when she came out.

Concealable stigmatized identities (CSIs) are identities that can be kept hidden and carry negative stereotypes. To understand the potential influence instructors have as role models, we must first explore the identities instructors have and whether they disclose those identities to undergraduates. We surveyed national samples of science instructors (n = 1248) and undergraduates (n = 2428) at research institutions to assess the extent to which instructors hold CSIs, whether they reveal those identities to undergraduates, how the prevalence of CSIs among instructors compares to their prevalence among undergraduates, and the reasons instructors reveal or conceal their CSIs. The most common CSIs instructors reported were having anxiety (35%) and being a first-generation college student (29%). Relatively few instructors revealed CSIs to students. The largest mismatches of CSI prevalence were for struggling academically in college (-30%) and having anxiety (-25%); all mismatches grew when accounting for instructor CSI disclosure, highlighting that students perceive fewer role models of scientists with CSIs than actually exist.

BackgroundHow housing insecurity might affect patients with heart failure (HF) is not well characterized. Housing insecurity increases risks related to both communicable and non-communicable diseases. For patients with HF, housing insecurity likely increases the risk for worse outcomes and rehospitalizations.Methods and resultsWe analyzed U.S. HF hospitalizations using the 2020 National Inpatient Sample (NIS) and Nationwide Readmissions Database (NRD) to evaluate the impacts of housing insecurity on HF outcomes and hospital utilization. Individuals were identified as having housing insecurity using diagnostic ICD-10 codes. Demographics and comorbidities were compared between HF patients with and without housing insecurity. An adjusted logistic regression was performed to evaluate the relationships between housing insecurity and socioeconomic status on in-hospital mortality. Using a Cox proportional hazards model, HF patients with and without housing insecurity were evaluated for the risk of all-cause and HF-specific readmissions over time. Of the 1,003,270 hospitalizations for HF in the U.S. in 2020, 16,150 were identified as having housing insecurity (1.6%) and 987,120 were identified as having no housing insecurity (98.4%). The median age of patients with housing insecurity hospitalized for HF was 57, as compared to 73 in the population with no housing insecurity. A higher proportion of patients in the housing insecurity group were Black (35% vs 20.1%) or Hispanic (11.1% vs 7.3%). Patients with housing insecurity were more likely to carry a diagnosis of alcohol use disorder (15.2% vs 3.3%) or substance use disorder (70.2% vs 17.8%), but were less likely to use tobacco (18.3% vs 28.7%). Patients with housing insecurity were over 4.5 times more likely to have Medicaid (52.4% vs 11.3%). Median length of stay did not differ between patients with housing insecurity versus those without. Patients with housing insecurity were more likely to discharge Against Medical Advice (11.4% vs 2.03%). After adjusting for patient characteristics, housing insecurity was associated with lower in-hospital mortality (OR 0.60, 95% CI 0.39 - 0.92). Housing insecurity was associated with a higher risk of all-cause readmissions at 180 days (HR 1.13, 95% CI 1.12 - 1.14). However, there was no significant difference in the risk of HF-specific readmissions at 180 days (HR 1.07, 95% CI 0.998 - 1.14) CONCLUSIONS: Patients with HF and housing insecurity have distinct demographic characteristics. They are also more likely to be readmitted after their initial hospitalization when compared to those without housing insecurity. Identifying and addressing specific comorbid conditions for patients with housing insecurity who are hospitalized for HF may allow clinicians to provide more focused care, with the goal of preventing morbidity, mortality, and unnecessary readmissions.

Mean cardiovascular health has improved over the past several decades in the United States, but it is unclear whether the benefit is shared equitably. This study examined 30-year trends in cardiovascular health using a suite of income equity metrics to provide a comprehensive picture of cardiovascular income equity. The study evaluated data from the 1988-2018 National Health and Nutrition Examination Survey. Survey groupings were stratified by poverty-to-income ratio (PIR) category, and the mean predicted 10-year risk of a major cardiovascular event or death based on the pooled cohort equations (PCE) was calculated (10-year PCE risk). Equity metrics including the relative and absolute concentration indices and the achievement index-metrics that assess both the prevalence and the distribution of a health measure across different socioeconomic categories-were calculated. A total of 26 633 participants aged 40 to 75 years were included (mean age, 53.0-55.5 years; women, 51.9%-53.0%). From 1988-1994 to 2015-2018, the mean 10-year PCE risk improved from 7.8% to 6.4% (P

Heart failure (HF) is a common disease with increasing prevalence around the world. There is high morbidity and mortality associated with poorly controlled HF along with increasing costs and strain on healthcare systems due to a high rate of rehospitalization and resource utilization. Despite the establishment of clear evidence-based guideline directed medical therapies (GDMT) proven to improve HF morbidity and mortality, there remains significant clinical inertia to optimizing HF patients on GDMT. Only a minority of HF patients are prescribed on all four classes of GDMT. To bridge the gap between the vulnerable population of HF patients and lifesaving GDMT, HF implementation is of increasing importance. HF implementation involves strategies and techniques to improve GDMT optimization along with other modalities to improve HF management. HF implementation meets patients where they are, including at the time of acute decompensation in the inpatient setting, at the vulnerable discharge stage, and at the chronic management stage in the outpatient setting. Inpatient HF implementation strategies include protocolized rapid titration of GDMT, site-level audit-and-feedback, virtual GDMT optimization teams, and electronic health record notifications and alerts. Discharge HF implementation strategies include education at patient and provider levels, discharge summaries, and HF transitional programs. Outpatient HF implementation strategies include digital innovations such as electronic health record utilization and mobile applications, population level strategies such as registries and clinical dashboards), changes in HF team structure and member roles, remote monitoring with implanted devices and telemonitoring, and hospital at home care model. With a growing population of HF patients, there is an increasing need for novel and creative HF implementation and monitoring methods.

BACKGROUND: Large introductory lecture courses are frequently post-secondary students first formal interaction with science, technology, engineering, and mathematics (STEM) disciplines. Grade outcomes in these courses are often disparate across student populations, which, in turn, has implications for student retention. This study positions such disparities as a manifestation of systemic inequities along the dimensions of sex, race/ethnicity, income, and first-generation status and investigates the extent to which they are similar across peer institutions. RESULTS: We examined grade outcomes in a selected set of early STEM courses across six large, public, research-intensive universities in the United States over ten years. In this sample of more than 200,000 STEM course enrollments, we find that course grade benefits increase significantly with the number of systemic advantages students possess at all six institutions. The observed trends in academic outcomes versus advantage are strikingly similar across universities despite the fact that we did not control for differences in grading practices, contexts, and instructor and student populations. The findings are concerning given that these courses are often students first post-secondary STEM experiences. CONCLUSIONS: STEM course grades are typically lower than those in other disciplines; students taking them often pay grade penalties. The systemic advantages some student groups experience are correlated with significant reductions in these grade penalties at all six institutions. The consistency of these findings across institutions and courses supports the claim that inequities in STEM education are a systemic problem, driven by factors that go beyond specific courses or individual institutions. Our work provides a basis for the exploration of contexts where inequities are exacerbated or reduced and can be used to advocate for structural change within STEM education. To cultivate more equitable learning environments, we must reckon with how pervasive structural barriers in STEM courses negatively shape the experiences of marginalized students. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40594-024-00474-7.

IntroductionAlthough adverse childhood experiences (ACEs) have been positively associated with adiposity, few studies have examined long-term race-specific ACE-BMI relationships.MethodsA Black and White all-women cohort (N=611; 48.6% Black) was followed between 1987 and 1997 from childhood (ages 9-10 years) through adolescence (ages 19-20 years) to midlife (ages 36-43 years, between 2015 and 2019). In these 2020-2022 analyses, the interaction between race and individual ACE exposures (physical abuse, sexual abuse, household substance abuse, multiple ACEs) on continuous BMI at ages 19-20 years and midlife was evaluated individually through multivariable linear regression models. Stratification by race followed as warranted at α=0.15.ResultsRace only modified ACE-BMI associations for sexual abuse. Among Black women, sexual abuse was significantly associated with BMI (Badjusted=3.24, 95% CI=0.92, 5.57) at ages 19-20 years and marginally associated at midlife (Badjusted=2.37, 95% CI= -0.62, 5.35); among White women, corresponding associations were null. Overall, having ≥2 ACEs was significantly associated with adolescent BMI (Badjusted=1.47, 95% CI=0.13, 2.80) and was marginally associated at midlife (Badjusted=1.45, 95% CI= -0.31, 3.22). This was similarly observed for physical abuse (adolescent BMI: Badjusted=1.23, 95% CI= -0.08, 2.54; midlife BMI: Badjusted=1.03, 95% CI= -0.71, 2.78), but not for substance abuse.ConclusionsDirect exposure to certain severe ACEs is associated with increased BMI among Black and White women. It is important to consider race, ACE type, and life stage to gain a more sophisticated understanding of ACE-BMI relationships. This knowledge can help strengthen intervention, prevention, and policy efforts aiming to mitigate the impacts of social adversities and trauma on persistent cardiometabolic health disparities over the lifecourse.

PurposeThe National Heart, Lung and Blood Institute Growth and Health Study (NGHS) prospectively collected anthropometric, biospecimens, clinical, health behaviour and psychosocial measures associated with cardiovascular disease from childhood to young adulthood. The aim of the current study was to assess the impact of stress, dysregulated eating and social genomic biomarkers on cardiometabolic risk factors among the original participants now in midlife and their children.ParticipantsBeginning in 1987-1988, NGHS recruited black and white girls (age 9-10 years) from socioeconomically diverse backgrounds from from three sites: Cincinnati, Ohio; Washington, DC; and Western Contra Costa County, California (N=2379) and followed them for 10 years. The study maintained an 89% retention rate. The current study is 30 years after the start of the original study and focused on the participants of California (n=887) and their children aged 2-17 years. We re-enrolled 624 of 852 eligible participants (73%): 49.2% black and 50.8% white. The mean age was 39.5 years. Among the 645 eligible biological children, 553 were enrolled; 49% black and 51% white, with 51.5% girls and 48.5% boys. The mean age was 9.3 years.Findings to dateLongitudinal analysis of adolescent drive for thinness predicted higher scores for drive for thinness during midlife, which was indirectly associated with greater adult body mass index through adult drive for thinness. Latent trajectory modelling of adolescent growth over 10 years found that women with persistently high weight trajectory had twice the odds of having children who met the definition for obesity compared with the persistently normal group, adjusting for adult weight.Future plansNew studies on neighbourhood socioeconomic status, food insecurity and additional biomarkers of chronic stress, microbiome and accelerated ageing (ie, telomere length and epigenetic clock) are underway. We are developing a 10-year follow-up to understand changes in ageing biomarkers of the participants and their children.Trial registration numberNCT00005132.

Abstract Background Some of the most consistent factors associated with college students’ evolution acceptance are how much they know about evolution (understanding), and the extent to which they identify as religious (religiosity). However, few studies explore how the relationship between understanding and acceptance can be impacted by student religiosity levels. Further, students show different levels of acceptance of evolution depending on the scale of evolution and context of evolution, but few studies explore how evolution understanding is related to acceptance at different scales and in different contexts. In this study, we analyzed survey responses from 11,409 college biology students sampled from across the United States. Using linear mixed models, we explored the relationship between students’ understanding and acceptance of evolution and how their religiosity impacted that relationship. We also explored how these relationships changed based on scale and context of evolution. Results We found evidence of six different scales or contexts of evolution ranging from acceptance of microevolution to accepting that all life on Earth shares a common ancestor. We found that students were most likely to accept microevolution while they were the least likely to accept the common ancestry of life. Interactions between student religiosity and understanding of evolution were significant predictors of their acceptance of macroevolution, human evolution within the species, human common ancestry with other apes, and the common ancestry of life. Notably, among highly religious students, how much they understood about evolution was not related to how much they accepted the common ancestry of life. Conclusions This study provides evidence for six different scales or contexts of evolution for which college students have different levels of acceptance. Students accepted the common ancestry of life the least indicating that this might be important to expand upon in future research. Further, we provide evidence that the relationship between evolution acceptance and understanding depends on scale and context of evolution as well as student religiosity levels. These results indicate that acceptance of evolution among college students is more multifaceted than previously thought and that highly religious students may find it particularly difficult to translate their understanding of evolution to their acceptance.

We examine whether one of the most popular observation systems in teacher evaluation--the Framework for Teaching (FFT)--captures the range of instructional skills teachers need to be effective. We focus on the case of special educators, who are likely to use instructional approaches that, although supported by research, are de-emphasized in common observation systems. Drawing on 206 lessons from 51 teachers, we compare FFT scores to an observation system from special education. We find that FFT's psychometric properties are consistent with previous studies, but the system is limited in assessing the quality of instructional practices used in special education. We discuss implications of these findings for two practical uses of observations--supporting teacher development and informing human capital decisions.

Background: Large introductory lecture courses are frequently post-secondary students' first formal interaction with science, technology, engineering, and mathematics (STEM) disciplines. Grade outcomes in these courses are often disparate across student populations, which, in turn, has implications for student retention. This study positions such disparities as a manifestation of systemic inequities along the dimensions of sex, race/ethnicity, income, and first-generation status and investigates the extent to which they are similar across peer institutions. Results: We examined grade outcomes in a selected set of early STEM courses across six large, public, research-intensive universities in the United States over ten years. In this sample of more than 200,000 STEM course enrollments, we find that course grade benefits increase significantly with the number of systemic advantages students possess at all six institutions. The observed trends in academic outcomes versus advantage are strikingly similar across universities despite the fact that we did not control for differences in grading practices, contexts, and instructor and student populations. The findings are concerning given that these courses are often students' first post-secondary STEM experiences. Conclusions: STEM course grades are typically lower than those in other disciplines; students taking them often pay grade penalties. The systemic advantages some student groups experience are correlated with significant reductions in these grade penalties at all six institutions. The consistency of these findings across institutions and courses supports the claim that inequities in STEM education are a systemic problem, driven by factors that go beyond specific courses or individual institutions. Our work provides a basis for the exploration of contexts where inequities are exacerbated or reduced and can be used to advocate for structural change within STEM education. To cultivate more equitable learning environments, we must reckon with how pervasive structural barriers in STEM courses negatively shape the experiences of marginalized students.

Reforming the professionalization experiences of future faculty members, including their undergraduate experience, provides a possible means to create scalable change in higher education. However, this requires an understanding of where faculty undergraduate training occurs. We analyze data from 7748 tenure-line faculty members across 611 U.S. physics departments, including their undergraduate alma mater and their employer university. The resulting undergraduate professionalization network reveals a prestige hierarchy similar in strength to those previously found in hiring networks at the Ph.D. level, indicating that the road to faculty jobs begins during undergraduate admissions. Furthermore, 42% of physics faculty members earned their undergraduate degrees from institutions outside of the United States. These results reinforce the importance of institutional prestige in academia and offer a potential strategy for driving systemic change.

The tension between religion and science as a long-standing barrier to science education has led researchers to explore ways of improving the experiences of Christian students in biology who can experience their Christianity as stigmatized in academic biology environments. As undergraduate science classes become student-centered, interactions among students increase, and Christians may feel a need to conceal their religious identities during peer discussions. In this interview study, we used the social psychology framework of concealable stigmatized identities to explore 30 Christian students' experiences during peer interactions in undergraduate biology courses to find potential ways to improve those experiences. We found that students felt their religious identity was salient during peer interactions in biology, and students thought revealing their religious identity to peers in their biology courses could be beneficial, yet few actually did so. Additionally, though most students "anticipated" stigma, comparatively few had "experienced" stigma from other students in their biology courses, despite the prior documented cultural stigma against Christians in biology. These results indicate a need for future studies exploring the impact of learning environments in which students are given the opportunity to share their religious identities with one another, which could reduce their anticipated and perceived stigma.

To increase participation of students of color in science graduate programs, research has focused on illuminating student experiences to inform ways to improve them. In biology, Black students are vastly underrepresented, and while religion has been shown to be a particularly important form of cultural wealth for Black students, Christianity is stigmatized in biology. Very few studies have explored the intersection of race/ethnicity and Christianity for Black students in biology where there is high documented tension between religion and science. Since graduate school is important for socialization and Black students are likely to experience stigmatization of their racial and religious identity, it is important to understand their experiences and how we might be able to improve them. Thus, we interviewed 13 Black Christian students enrolled in biology graduate programs and explored their experiences using the theoretical lens of stigmatized identities. Through thematic content analysis, we revealed that students negotiated experiences of cultural isolation, devaluation of intelligence, and acts of bias like other racially minoritized students in science. However, by examining these experiences at the intersection of race/ethnicity and religion, we shed light on interactions students have had with faculty and peers within the biology community that cultivated perceptions of mistrust, conflict, and stigma. Our study also revealed ways in which students' religious/spiritual capital has positively supported their navigation through biology graduate school. These results contribute to a deeper understanding of why Black Christian graduate students are more likely to leave or not pursue advanced degrees in biology with implications for research and practice that help facilitate their success.

BackgroundAlthough maternal stressor exposure has been associated with shorter telomere length (TL) in offspring, this literature is based largely on White samples. Furthermore, timing of maternal stressors has rarely been examined. Here, we examined how maternal stressors occurring during adolescence, pregnancy, and across the lifespan related to child TL in Black and White mothers.MethodMothers (112 Black; 110 White; Mage = 39) and their youngest offspring (n = 222; Mage = 8) were part of a larger prospective cohort study, wherein mothers reported their stressors during adolescence (assessed twice during adolescence for the past year), pregnancy (assessed in midlife for most recent pregnancy), and across their lifespan (assessed in midlife). Mother and child provided saliva for TL measurement. Multiple linear regression models examined the interaction of maternal stressor exposure and race in relation to child TL, controlling for maternal TL and child gender and age. Race-stratified analyses were also conducted.ResultsNeither maternal adolescence nor lifespan stressors interacted with race in relation to child TL. In contrast, greater maternal pregnancy stressors were associated with shorter child TL, but this effect was present for children of White but not Black mothers. Moreover, this effect was significant for financial but not social pregnancy stressors. Race-stratified models revealed that greater financial pregnancy stressors predicted shorter telomeres in offspring of White, but not Black mothers.ConclusionsRace and maternal stressors interact and are related to biological aging across generations, but these effects are specific to certain races, stressors, and exposure time periods.

BackgroundIn 2020, the Veterans' Affairs (VA) healthcare system deployed a heart failure (HF) dashboard for use nationally. The initial version was notably imprecise and unreliable for the identification of HF subtypes. We describe the development and subsequent optimization of the VA national HF dashboard.Materials and methodsThis study describes the stepwise process for improving the accuracy of the VA national HF dashboard, including defining the initial dashboard, improvement of case definitions, utilization of natural language processing for patient identification, and incorporation of an imaging quality hierarchy model. Optimization further included evaluating whether to require concurrent ICD-codes for inclusion in the dashboard and assessing various imaging modalities for patient characterization.ResultsThrough multiple rounds of optimization, the dashboard accuracy (defined as the proportion of true results to the total population) was improved from 54.1% to 89.2% for the identification of HF with reduced ejection fraction (HFrEF) and from 53.9% to 88.0% for the identification of HF with preserved ejection fraction (HFpEF). To align with current guidelines, HF with mildly reduced ejection fraction (HFmrEF) was added to the dashboard output with 88.0% accuracy.ConclusionsThe inclusion of an imaging quality hierarchy model and natural language processing algorithm improved the accuracy of the VA national HF dashboard. The revised dashboard informatics algorithm has higher utilization rates and improved reliability for population health management.

The COVID-19 pandemic resulted in nearly all universities transitioning their in-person courses to online instruction. Recent work from our research team conducted in Spring 2020 established that the immediate transition to online learning presented novel challenges for students with disabilities: students were unable to access previously established accommodations and there was a lack of information from Disability Resource Centers (DRCs) about adapting accommodations to online environments. In this study, we aimed to determine the extent to which these issues still were present 1 year later. In Spring 2021, we conducted a survey of 114 students with disabilities who were registered with the DRC and taking online science courses at a public research-intensive institution. We used our previous interviews with students to develop closed- and open-ended questions to assess the extent to which students with disabilities were being properly accommodated in their courses, document any new accommodations they were using, and elicit any recommendations they had for improving their experiences in online science courses. We used logistic regression to analyze the closed-ended data and inductive coding to analyze the open-ended data. We found that more than half of students with disabilities reported not being properly accommodated, and this was more likely to be reported by students who experienced new challenges related to online learning. When students were asked what accommodations they would have wanted, students often described accommodations that were being offered to some students but were not universally implemented. This study summarizes recommendations for making online science learning environments more inclusive for students with disabilities.

Student incivility, defined as a student behavior perceived to be disrespectful or disruptive to the overall learning environment in a course, can negatively affect the science learning environment and instructors. The transition to online science courses during the COVID-19 pandemic created a unique environment for student incivility to take place in undergraduate courses. There are few studies that examine student incivility in online synchronous courses, and we know of no studies that have investigated student incivility during the COVID-19 pandemic. In this study, we surveyed 283 instructors across U.S. institutions who taught undergraduate science courses with synchronous online components. We probed their experiences with student incivility during the fall 2020 term. Over half of instructors surveyed reported experiencing student incivility, with women being more likely than men to report student incivility. Compared with white instructors, people of color were more likely to perceive an increase in student incivility in fall 2020 relative to previous in-person terms. This work indicates that student incivility is perceived in the online synchronous learning environment and that the negative impacts of perceived student incivility during COVID-19 online instruction were not distributed equally among instructors, disproportionately burdening women and people of color.

Many researchers have considered recent and intergenerational immigrant children's perspectives on immigration policies. Fewer have investigated nonimmigrant children's views despite children's sociopolitical identities forming long before they can vote. Drawing from data generated in spring 2017, the author illustrates how young children at an urban, midwestern school argued against the Republican administration's (anti-)immigration policies. Framed as an ethnographic case study, the author focuses on how third graders enacted justice-oriented identities as they wrote to congressional representatives about contemporary immigration policies. By attuning to how children embedded multiple institutional and political contexts in their written rationale, the author explicates the tensions and possibilities for nonimmigrant children in writing policies and possibilities for tomorrow. Ultimately, the author argues adults must intentionally sustain children's civic participation in ways beyond the niceties that plague early years classrooms.

Evolution is one of the most important concepts in biology, but it is rejected by a substantial percentage of religious students due to a perceived conflict with their religious beliefs. The use of religious cultural competence in evolution education (ReCCEE) has been shown to effectively increase evolution acceptance among religious students during in-person instruction, but there is no research that we know of that indicates the effectiveness of these practices during online instruction. In this study, we explored the efficacy of online culturally competent practices for religious students on students' evolution understanding, evolution acceptance, and comfort learning evolution at a religious university. Before and after evolution instruction, we surveyed 178 students in online introductory biology courses and compared these student outcomes to 201 students in the same instructor's in-person introductory biology courses. We found that evolution acceptance and understanding increased in online classes with culturally competent practices, and these gains were similar to those observed in the in-person courses. Despite these similarities, we found that students were more comfortable learning evolution in person than online, but this difference was small. Our findings suggest that the use of culturally competent practices online can be as effective as their use for in-person instruction for improving students' attitudes toward evolution, but in-person instruction may be more effective for cultivating students' comfort while learning evolution.

Human health and well-being are directly and indirectly dependent on the life of river systems. Life in river systems is increasingly dependent on human actions that bring river health into being. Rather than describing river health as thing, problem or management challenge, this paper explores how river health is brought into being, through the citizen science practices of the Amanzi Ethu Nobuntu project in the upper uMngeni catchment in South Africa. The study draws on focal data produced by citizen science practitioners, as interpreted by them in collaboration with partners in the catchment, and their reflections on the meaning(s) of river health and how it came into being. Drawing on the concepts of citizen science as a co-learning process, integrative views of One Health, and commoning as activity, the study offers a rich interpretation on how river health comes into being. The study shows the complex interrelated practices involved, including practices of resolving leaks and pollution challenges, social and community engagement, and the co-learning involved in citizen science practices itself. It offers insight into the social-ecological and ethical-political ontological dynamics of river health commoning activity, thus offering alternatives to reductionist approaches to bringing river health into being, potentially also enriching tools for river health reporting. Significance: The significance of the main findings of Sustainability Science Engagement and Engaged Sustainability Sciences includes how citizen science can be key for engaging local communities in sustainability research around sustainability challenges, such as river health, by linking to the health of the people and their everyday engagements with the river. Further contributions include conceptualising sustainability science engagement co-learning processes of being in common around a shared matter of concern, such as bringing river health into being beyond technical specifications. Contributions are also made by highlighting how sustainability science engagement can result in richness in terms of knowing sustainability challenges.

Objectives This study aims to describe the patterns of concurrent opioid and psychotropic drug use (CU) during pregnancy and the characteristics of the mothers dispensed these drugs. Methods Pregnancies between 2000-2020 were identified using administrative data from Manitoba and British Columbia, Canada. Prenatal opioid and psychotropic drug dispensations were assessed, and exposure groups created based on the number of dispensations within each drug category. Descriptive statistics are reported. Results Approximately 1.4% of 1,040,021 pregnancies involved CU. Odds of CU were greater for 2+ opioid pregnancies compared to pregnancies with only 1 opioid (OR=4.05). Among CU pregnancies, it was more likely for 2+ types of psychotropics to be dispensed for those involving 2+ opioids compared to 1 (OR=2.23). Percent of CU pregnancies did not change over time, while opioid pregnancies decreased, and psychotropic pregnancies increased. Average morphine equivalent dose of opioids/pregnancy was higher in CU than opioid only pregnancies. Compared to mothers without exposure, CU exposed mothers were of similar age, more likely to live rurally, in lower income areas, and have lower care continuity. Conclusion CU pregnancies remained stable over time. It was more likely for mothers dispensed 2+ opioids to be CU than mothers dispensed only 1 opioid, and more likely for CU mothers dispensed 2+ opioids to be dispensed 2+ psychotropic types. Overall strength of opioids was higher for CU mothers compared to opioid only exposed mothers. Implications Studies measuring the impact of CU on maternal and child outcomes should be conducted to inform safe prescribing practices.

This study aimed to identify factors associated with healthy development after experiencing household challenge adversity in early childhood. A cohort of 42,505 children born in Manitoba, Canada was created using linkable health, social, and education administrative data. Children were divided into 5 groups according to whether they experienced adversity between birth and four years of age in the following categories: 1) having a parent diagnosed with a mental health disorder, 2) having a parent diagnosed with a substance use disorder, 3) having a parent who received income assistance for at least 2 months, 4) experiencing at least one of the 3 adversities, and 5) having none of the adversities listed. For each group, multiple linear regression models were computed to determine the association of the independent variables (age, sex, birth order, team parenting, neighbourhood-level socio-economic status, parent high school completion, being an established resident in Canada, not having a major illness, residential stability, program participation, and connectedness to health care services) on child development, represented by their Early Development Instrument scores. In each group, factors associated with healthy development included at minimum: older age, being female, being firstborn, team parenting, higher neighbourhood-level socio-economic status, parent high school completion, being an established resident in Canada, and not having a major illness. Several of these factors are associated with increased access to material resources. As such, policies that facilitate the delivery of resources to lower-income families and neighbourhoods with lower socioeconomic status could translate into improved developmental outcomes for children.

Objective To provide rigorous quantitative evidence about the impact of out-of-home care on children’s outcomes. Approach Guided by an Advisory Circle of First Nations (FN) Knowledge Keepers and conducted in partnership with FN researchers, we used linked administrative data to identify all Manitoba children served by Child Protection Services (CPS) at FN agencies (FNA) and other agencies (OA) (2007-2018). We compared health, education, and legal system outcomes of those in care (FNA n=10,856; OA n=8,468) to those with protection concerns but not in care (FNA n=12,896; OA n=14,394). Using instrumental variable analysis with CPS agency rate of out-of-home care as the instrument, outcomes between groups were compared using 2-stage multivariate probit regressions adjusted for child and family factors. Results Odds of teen pregnancy (FNA OR 3.69, 95% CI 1.40-9.77; OA 5.10 (1.83-14.25)), teen birth (FNA 3.23 (1.10-9.49); OA 5.06 (1.70-15.03)), and positive STI tests (FNA ns; OA 7.21 (3.63-14.32)) were higher and odds of vaccination at age 2 (FNA ns; OA 0.49 (0.29-0.80)) were lower for children in care than children not in care. Odds of being accused (FNA ns; OA 2.71 (1.27-5.75)), victim (FNA ns; OA 1.68 (1.10-2.56)), or charged with a crime (FNA ns; OA 2.68 (1.21-5.96)), and odds of being incarcerated (FNA 3.64 (1.95-6.80); OA 1.19 (1.19-8.04)) were higher for children in care. Conclusions Out-of-home care negatively affects children’s health, social and legal system outcomes. Implications CPS agencies should work with FN leaders to develop and implement strategies to reduce the number of children taken into care.

Introduction Children who experience maltreatment have worse health and development outcomes than other children. Early prevention relies on opportunities to respond to system contacts that reliably indicate the population burden of children’s future developmental risk. Objectives and Approach We quantified the population burden of developmental vulnerability at age five by the type, timing, and frequency of child protection contacts before school, among children in two Australian states. We used linked whole-population births, child protection and Australian Early Development Census (AEDC) data (2009-2018 cycles) in New South Wales (NSW) and South Australia (SA). Results 56,650/398,702 (14%) NSW and 12,617/80,731 (16%) SA children had ≥1 child protection contacts before school. The risk of developmental vulnerability on ≥1 domains was lowest in the no child protection group (NSW, 17-18%; SA, 19%), with higher risks in the child protection report (NSW, 28-29%; SA, 32-35%) through to the OOHC (NSW, 35-38%; SA, 39-50%) groups, with a similar pattern for the risk of medically diagnosed conditions. Children with only one child protection report before school had a higher developmental risk than the no child protection group (NSW, 34% versus 21%; SA, 42% versus 24%). Conclusions/Implications Even a single child protection report in the first 2000 days of children’s lives was a robust indicator of developmental risk at age five, with higher developmental risks among children with more serious child protection contacts before school. Child protection reports represent an under-utilised asset to inform early universal and targeted support from health, human and early education services.

Children with special health needs (SHN) may be more likely to experience mental disorders compared to their peers without SHN. The aim of this study was to establish and contextualize the risk of mental disorders among children flagged as having SHN at school entry. We linked data from the Early Development Instrument (EDI), a teacher-completed questionnaire of children’s developmental health in kindergarten, collected in Manitoba between 2006 and 2015, with provincial health administrative data up to 2019. Using binary logistic regressions, we examined the odds of receiving a diagnosis of any mental disorder, by categories of SHN: special needs, impairments in physical, vision/hearing, learning, speech, behaviour, and emotions, needing further assessment, and having 2+ SHN categories. Of the 36,462 children with EDI data linked to health administrative data, 5,882 (16.1%) were identified as having a SHN in kindergarten. The odds of developing a mental disorder varied by subtype of SHN. Children needing further assessment, with special needs, 2+ SHN categories, or with a learning, behavioural, or emotional impairment had between 1.35 and 3.27 times the odds of receiving a mental health diagnosis than their peers without these issues. Having a behavioural impairment increased a child’s odds the most. Having a physical, visual, or hearing impairment was not associated with a mental disorder. Having a special needs designation and impairments in behaviour and emotions in kindergarten puts children at risk of a future mental disorder. These findings may help generate wider mental health supports in schools for children with SHN.

Drawing from data generated during the 2016-2017 academic year, this study centred on U.S. children's design of two critical literacies compositions--a letter to Congress and a persuasive multimodal text. Situated within an integrated unit focused on (im)migrants, children asked legislators to act on the GOP Administration's proposed border wall and the #MuslimBan. Simultaneously, their teacher took steps to engage students in critical literacies conversations about access in/to the United States. Using a case study design, I investigated the following: "How might traditional perceptions of 'expert' shift as children engage in critical literacies using varied materials and technologies?" Specifically, I highlight how, by engaging an expansive skill set of communicative practices, children designed texts and enacted identities related to civic agency. Through multimodal composing, one nine-year-old white boy exemplified how children highlight knowledge beyond what is captured in a written text. His multimodal response illuminated his deep understanding of the obstacles faced by (im)migrants as they traverse boundaries. To alleviate such challenges, he "invented" both a transportable water filter cup and a fishing tool and engaged in critical making. When provided with opportunities to compose multimodally, the child--a white boy marked as "behind" in literacy--demonstrated rich content knowledge not readily visible in his written responses. His compositions disrupted understandings of expert with regard to elementary writing and critical literacies.

This meta-analysis synthesized 97 effect sizes extracted from 37 intervention studies for students with reading difficulties (RDs) in Grades 6 to 12 published between 1982 and 2021 to identify the overall impact of reading interventions and the moderating effects of intervention characteristics and study design characteristics. Random-effects robust variance estimation (RVE) was used to account for dependencies within studies. Overall, interventions designed to improve reading comprehension outcomes for adolescents with RDs were effective (g = 0.63). Meta-regression analyses identified several significant moderators that were associated with intervention efficacy, such as text content, duration of intervention, agent of intervention, status of student, type of dependent measure, and study quality. We provide study limitations as well as implications for research and practice.

Abstract Most lung cancer patients with metastatic cancer eventually relapse with drug-resistant disease following treatment and EGFR mutant lung cancer is no exception. Genome-wide CRISPR screens, to either knock out or overexpress all protein-coding genes in cancer cell lines, revealed the landscape of pathways that cause resistance to the EGFR inhibitors osimertinib or gefitinib in EGFR mutant lung cancer. Among the most recurrent resistance genes were those that regulate the Hippo pathway. Following osimertinib treatment a subpopulation of cancer cells are able to survive and over time develop stable resistance. These ‘persister’ cells can exploit non-genetic (transcriptional) programs that enable cancer cells to survive drug treatment. Using genetic and pharmacologic tools we identified Hippo signalling as an important non-genetic mechanism of cell survival following osimertinib treatment. Further, we show that combinatorial targeting of the Hippo pathway and EGFR is highly effective in EGFR mutant lung cancer cells and patient-derived organoids, suggesting a new therapeutic strategy for EGFR mutant lung cancer patients.

Undergraduate research is lauded as a high-impact practice owing to the array of benefits that students can reap from participating. One unexplored construct that may affect student intent to persist in research is research anxiety, defined as the sense of worry or apprehension associated with conducting research. In this study, we surveyed 1272 undergraduate researchers across research-intensive, master's-granting, and primarily undergraduate institutions to assess the relationship among student demographics, research anxiety, and intent to pursue a research career. Using structural equation modeling, we identified that women and students with higher grade point averages (GPAs) were more likely to report higher levels of research anxiety compared with men and students with lower GPAs, respectively. Additionally, research anxiety was significantly and negatively related to student intent to pursue a research-related career. We coded students' open-ended responses about what alleviates and exacerbates their anxiety and found that experiencing failure in the context of research and feeling underprepared increased their research anxiety, while a positive lab environment and mentor--mentee relationships decreased their anxiety. This is the first study to examine undergraduate anxiety in the context of research at scale and to establish a relationship between research anxiety and students' intent to persist in scientific research careers.

Aims Personality disorders (PDs) involve persistent deviations from societal norms causing distress, particularly in older UK adults. ICD–11 distinguishes general personality dysfunction from traits. Despite a low reported prevalence among the elderly, underdiagnosis and undertreatment are concerns, suggesting higher actual prevalence. PD presentations in older adults differ, with increasing prevalence noted. Existing research lacks large-scale, population-based studies, longitudinal perspectives, and diagnostic tools sensitive to age-related changes. Overlapping symptoms and delayed diagnosis challenge accurate assessment, while misdiagnosis can lead to repeat hospitalisations. A UK mental health organisation observed such issues, prompting a diagnostic pathway review and a service evaluation study to identify healthcare professionals' challenges in diagnosing personality disorders in older adults. Methods An online survey, conducted from January to March 2023, targeted healthcare professionals in the Trust. It gathered demographic data and focused on professionals' knowledge, and confidence in diagnosing personality disorders, along with limitations and suggestions for improvement. Responses were qualitative, involving community mental health team managers, doctors, healthcare assistants, mental health nurses, occupational therapists, and psychologists. Results, collected in March 2023, aimed to provide detailed insights into professionals' experiences with PDs when treating older adults. Results Among 35 surveyed professionals (15 Consultant Psychiatrists, 2 community team managers, 6 nurses, 1 occupational therapist, 2 psychologists, and 9 junior doctors), 75% routinely conducted personality disorder assessments. They lacked specific diagnostic tools, relying on history and ICD–10/DSM–5 criteria. Confidence levels varied, with only 1 reporting high confidence and 37% not confident at all, citing a need for training and structured tools. Challenges in diagnosing older adults were acknowledged by 34 responders, attributing difficulties to comorbidities and ageing. All emphasised the importance of accurate diagnosis for tailored therapy, care, service workload, and healthcare financial implications. Conclusion Underdiagnosis and undertreatment of personality disorders in older adults impact their quality of life, posing challenges to healthcare services with financial implications. This local survey and service evaluation study revealed healthcare professionals' lower confidence in diagnosing PDs in older adults, attributed to the complexity of presentation and lack of diagnostic tools. Professionals may underestimate PD prevalence, emphasizing the need for improved education and training. The review calls for validated diagnostic tools tailored to older adults and suggests a need for larger-scale, mixed-methods research to explore factors affecting diagnosis accuracy. It underscores gaps in knowledge and emphasises the importance of understanding and addressing PDs in this population through research, education of professionals, and improved screening.

BackgroundDifferential access to healthcare has contributed to a higher burden of illness and mortality among First Nations compared to other people in Canada. Throughout the Coronavirus Disease 2019 (COVID-19) pandemic, First Nations organizations in Manitoba partnered with public health and Manitoba government officials to ensure First Nations had early, equitable and culturally safe access to COVID-19 diagnostic testing and vaccination. In this study, we examined whether prioritizing First Nations for vaccination was associated with faster uptake of COVID-19 vaccines among First Nations versus All Other Manitobans (AOM).Methods and findingsIn this retrospective cohort study, we used linked, whole-population administrative data from the Manitoba healthcare system (February 2020 to December 2021) to determine rates of COVID-19 diagnostic testing, infection, and vaccination, and used adjusted restricted mean survival time (RMST) models to test whether First Nations received their first and second vaccine doses more quickly than other Manitobans. The cohort comprised 114,816 First Nations (50.6% female) and 1,262,760 AOM (50.1% female). First Nations were younger (72.3% were age 0 to 39 years) compared to AOM (51% were age 0 to 39 years) and were overrepresented in the lowest 2 income quintiles (81.6% versus 35.6% for AOM). The 2 groups had a similar burden of comorbidities (65.8% of First Nations had none and 6.3% had 3 or more; 65.9% of AOM had none and 6.0% had 3 or more) and existing mental disorders (36.9% of First Nations were diagnosed with a mood/anxiety disorder, psychosis, personality disorder, or substance use disorder versus 35.2% of AOM). First Nations had crude infection rates of up to 17.20 (95% CI 17.15 to 17.24) COVID-19 infections/1,000 person-months compared with up to 6.24 (95% CI 6.16 to 6.32) infections/1,000 person-months among AOM. First Nations had crude diagnostic testing rates of up to 103.19 (95% CI 103.06 to 103.32) diagnostic COVID-19 tests/1,000 person-months compared with up to 61.52 (95% CI 61.47 to 61.57) tests/1,000 person-months among AOM. Prioritizing First Nations to receive vaccines was associated with faster vaccine uptake among First Nations versus other Manitobans. After adjusting for age, sex, income, region of residence, mental health conditions, and comorbidities, we found that First Nations residents received their first vaccine dose an average of 15.5 (95% CI 14.9 to 16.0) days sooner and their second dose 13.9 (95% CI 13.3 to 14.5) days sooner than other Manitobans in the same age group. The study was limited by the discontinuation of population-based COVID-19 testing and data collection in December 2021. As well, it would have been valuable to have contextual data on potential barriers to COVID-19 testing or vaccination, including, for example, information on social and structural barriers faced by Indigenous and other racialized people, or the distrust Indigenous people may have in governments due to historical harms.ConclusionIn this study, we observed that the partnered COVID-19 response between First Nations and the Manitoba government, which oversaw creation and enactment of policies prioritizing First Nations for vaccines, was associated with vaccine acceptance and quick uptake among First Nations. This approach may serve as a useful framework for future public health efforts in Manitoba and other jurisdictions across Canada.

Danielson's Framework for Teaching (FFT) is currently used in more than 20 states to inform teacher evaluation and professional learning. To investigate whether FFT promotes instruction that appropriately responds to the needs of students with learning disabilities, we conduct a systematic content analysis of the instructional approach emphasized in the FFT's Instructional Domain (Domain 3) of Danielson's FFT. We frame our study using cognitive load theory and research regarding effective instruction for students with disabilities. We end by discussing implications regarding the evaluation and development of effective teaching for students with learning disabilities.