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BackgroundStroke systems of care differ between larger urban and smaller rural settings and it is unclear to what extent this may impact on patient outcomes. Ethnicity influences stroke risk factors and care delivery as well as patient outcomes in nonstroke settings. Little is known about the impact of ethnicity on poststroke care, especially in Māori and Pacific populations. ObjectiveOur goal is to describe the protocol for the Reducing Ethnic and Geographic Inequities to Optimise New Zealand Stroke Care (REGIONS Care) study. MethodsThis large, nationwide observational study assesses the impact of rurality and ethnicity on best practice stroke care access and outcomes involving all 28 New Zealand hospitals caring for stroke patients, by capturing every stroke patient admitted to hospital during the 2017-2018 study period. In addition, it explores current access barriers through consumer focus groups and consumer, carer, clinician, manager, and policy-maker surveys. It also assesses the economic impact of care provided at different types of hospitals and to patients of different ethnicities and explores the cost-efficacy of individual interventions and care bundles. Finally, it compares manual data collection to routine health administrative data and explores the feasibility of developing outcome models using only administrative data and the cost-efficacy of using additional manually collected registry data. Regarding sample size estimates, in Part 1, Study A, 2400 participants are needed to identify a 10% difference between up to four geographic subgroups at 90% power with an α value of .05 and 10% to 20% loss to follow-up. In Part 1, Study B, a sample of 7645 participants was expected to include an estimated 850 Māori and 419 Pacific patients and to provide over 90% and over 80% power, respectively. Regarding Part 2, 50% of the patient or carer surveys, 40 provider surveys, and 10 focus groups were needed to achieve saturation of themes. The main outcome is the modified Rankin Scale (mRS) score at 3 months. Secondary outcomes include mRS scores; EQ-5D-3L (5-dimension, 3-level EuroQol questionnaire) scores; stroke recurrence; vascular events; death; readmission at 3, 6, and 12 months; cost of care; and themes around access barriers. ResultsThe study is underway, with national and institutional ethics approvals in place. A total of 2379 patients have been recruited for Part 1, Study A; 6837 patients have been recruited for Part 1, Study B; 10 focus groups have been conducted and 70 surveys have been completed in Part 2. Data collection has essentially been completed, including follow-up assessment; however, primary and secondary analyses, data linkage, data validation, and health economics analysis are still underway. ConclusionsThe methods of this study may provide the basis for future epidemiological studies that will guide care improvements in other countries and populations. International Registered Report Identifier (IRRID)DERR1-10.2196/25374

We conducted a meta-analysis using individual participant data from three, two-dose psilocybin trials for depression (N = 102) with the aim of assessing the risk of symptom worsening. Clinically significant symptom worsening occurred for a minority of participants in the psilocybin and escitalopram conditions (∼10%) and for a majority of participants in the waitlist condition (63.6%). Using data from the two trials with control arms, the psilocybin arm showed a lower likelihood of symptom worsening versus waitlist, and no difference in the likelihood of symptom worsening versus escitalopram. The limitation of a relatively small sample size should be addressed in future studies.

PurposeAlcohol use among adolescents and emerging adults is an important public health issue requiring prevention approaches. Herein, we describe outcomes from a randomized controlled trial testing the efficacy of group-based social media interventions targeting risky drinking among youth.ProceduresUsing social media advertisements to screen potential participants, we recruited 955 youth (ages 16-24) reporting recent risky drinking. After completing a baseline assessment, participants were randomized to 8-week secret Facebook group conditions: Social Media Intervention + Incentives for engagement, Social Media Intervention only, and attention-placebo control. Electronic coaches trained in motivational interviewing facilitated interaction in intervention groups. Primary outcomes include past 3-month alcohol use and consequences over 3-, 6-, and 12-month follow-ups. Secondary outcomes include other drug use, consequences, and impaired driving. We also measured intervention engagement and acceptability.ResultsThe interventions were well-received, with significantly greater acceptability ratings and engagement in the SMI+I condition relative to other groups. In adjusted analyses, there were no significant differences between interventions and control on alcohol-related outcomes, with all groups showing reductions. Regarding secondary outcomes (70.4% used other drugs), compared to control, the incentivized group reduced other drug use, consequences, and cannabis-impaired driving; the non-incentivized group did not significantly differ from the control condition.ConclusionsAmong this predominantly poly-substance using sample, findings were mixed, with significant effects of the incentivized social media intervention on drug (but not alcohol) outcomes. Future studies are needed to further refine social media-delivered interventions to reduce alcohol and other drug use.Trial registrationClinicalTrials.gov NCT02809586; University of Michigan HUM#00102242.

Purpose: This study aims to describe and illuminate the ways in which Kwantlen Polytechnic University (KPU)--an urban, undergraduate institution with a strong focus on teaching, learning and related research and scholarship, and a substantial international student population--adapted to pandemic conditions in 2020 in an effort to meet community and pedagogical priorities, institutional/legal responsibilities and strategic goals. Design/methodology/approach: Three institutional leaders at KPU draw together their respective insights and experiences, reflecting on how governance, pedagogy and operations were impacted by COVID-19. Findings: After two years of continuous operation during the COVID-19 pandemic, and with the strong support of its learners and the faculty, KPU has undergone significant pedagogical and technological shifts to become a multi-modal university for study, teaching and administration. Research limitations/implications: This is a "practitioner paper" with a practical focus on institutional leadership and adaptation in a period of rapid adjustment. It is more of an accounting and reflection piece than a critical analysis. Practical implications: It offers post-secondary leaders' insights into ways in which institutional values and community needs inform policy-making, operations and innovation in education. Social implications: KPU's domestic and international student constituencies are complex and required unconventional post-secondary strategies regarding faculty autonomy and growth, de-colonization and inclusion. Originality/value: KPU has a distinctive mandate in British Columbia and its commitment to experiential learning--typically associated with hands-on education--presented unusual challenges for delivery. While research-and-teaching universities were tested by COVID-19, their tests were largely alike. KPU's experience illustrates what practical- and teaching-focused institutions confronted.

Objective: Campus sexual assault (SA) prevention programs are widely implemented, despite few having strong empirical support. To inform the development and refinement of prevention programs, we collected pilot qualitative data to capture undergraduates' perspectives regarding desirable program characteristics. Participants: Undergraduates completed an audio-taped interview (n = 19) or a focus group (n = 16) in June - November 2016. Methods: We double-coded transcripts for a priori and emerging themes using NVivo 11. A third coder resolved disagreements; we assessed intercoder reliability using Cohen's Kappa. Results: Participants preferred SA prevention programming to be delivered in-person to small, coed groups of unfamiliar students. Students preferred programming with peer-facilitated, candid conversation about SA outcomes and prevention strategies. Participants also preferred for the tone of these training sessions to match the serious subject matter. Conclusions: Students' perceptions of desirable program characteristics differ somewhat from current evidence-based programs in several ways, highlighting important future directions for SA prevention research.

Understanding factors influencing risky drinking among emerging adults could enhance interventions to reduce adverse outcomes. As a motivational construct, the dualistic model of passion (i.e., obsessive passion: drinking is compelling and conflicts with other life activities/values; harmonious passion: drinking is an important, but not overwhelming, part of life) offers a novel explanation for persistent alcohol use. Yet, the dualistic model of passion has not yet been evaluated in this at-risk population. Therefore, we examined whether the variables proposed by the dualistic model of passion were associated with sex, binge-drinking, and alcohol-related consequences among young risky drinkers. We analyzed cross-sectional baseline data collected as part of an ongoing randomized controlled trial of emerging adults (n=327; M age=22.6, SD=1.1, range 21-24; 61% female; 76% White non-Hispanic) engaged in risky drinking (AUDIT-C score ≥ 4 females, ≥ 5 males) recruited nationally via social media advertisements. A path analysis revealed significant positive direct effects between obsessive passion and binge drinking and alcohol-related consequences, and significant negative direct effects between male sex and harmonious passion and binge drinking. There was also a positive direct effect between binge drinking and alcohol-related consequences. Male sex and obsessive passion were both indirectly related to alcohol-related consequences via binge drinking. Type of passion and male sex differentiates risky drinkers who binge drink and who experienced alcohol-related consequences. Future research should examine whether targeting obsessive passion reduces binge drinking and negative outcomes.

We examine a hypothesis implied by Steffe's constructivist model of children's numerical reasoning: a child's "spontaneous" additive strategy may relate to a foundational form of multiplicative reasoning, termed multiplicative double counting (mDC). To this end, we mix quantitative and qualitative analyses of 31 fourth graders' responses during clinical, task-based interviews. All participants spontaneously used one of three additive strategies--counting-on, doubling, or break-apart-make-ten (BAMT)--to correctly solve an addition word problem (8 + 7). We found between-group differences, with asymmetric association of those ordinal variables. We found counting-on to be mainly related to premultiplicative reasoning and BAMT to mDC reasoning. We discuss the theoretical significance and implications of this corroboration of Steffe's model.

Objective: Identify barriers to the adoption of the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) in behavioral healthcare organizations and match these barriers to implementation strategies to inform future implementation efforts. Participants: Twenty behavioral health providers. Design: Qualitative study involving individual, semi-structured interviews regarding barriers to adopting the OSU TBI-ID. Data were thematically analyzed around constructs from the Consolidated Framework for Implementation Research (CFIR). Results were matched to strategies using the Expert Recommendations for Implementing Change (CFIR/ERIC) matching tool. Results: Ten barriers were identified across 4 CFIR domains. Inner-Setting barriers were inadequate leadership engagement, priorities, resources, and organizational incentives. Individual-Characteristics barriers were insufficient knowledge about the connection between TBI and behavioral health and how to conduct the OSU TBI-ID with fidelity, low self-efficacy to conduct screening, and inadequate motivation and buy-in to conduct screening. Outer-Setting barriers were lack of state-level mandates and inadequate incentives to conduct screenings. The Process domain barrier was an insufficient engagement of key personnel. Strategy recommendations include: identify and prepare champions; alter incentive and allowance structures; inform local opinion leaders; build a coalition; access new funding; conduct local consensus discussions; involve executive boards; capture/share local knowledge; conduct educational meetings; assess for readiness and identify determinants; identify early adopters; fund and contract for the clinical innovation; create a learning collaborative; and conduct a local needs assessment. Conclusions: This is the first study to examine barriers to adopting the OSU TBI-ID in real-world practice settings. Our results suggest that multilevel implementation strategies addressing mechanisms of change are necessary at the provider, organizational, and systems levels to overcome the complex barriers affecting TBI screening adoption and implementation. Future research is needed to test these strategies and their mechanisms of action on the adoption, implementation, and sustainment of TBI screening, as well as their effect on client-level outcomes. [ABSTRACT FROM AUTHOR]

We sought to identify patterns of psychedelic use among United States military veterans, compare demographic variables and perspectives of those who did and did not report use, and characterize benefits and adverse outcomes associated with use. Respondents (N = 426) were recruited to complete an online cross-sectional survey. Approximately one-half (51%) reported using psychedelics. Most did so for healing/treatment (70%) and/or spiritual purposes (48%), and most (85%) reported benefiting from use. Those who used psychedelics reported they would be more likely to use VA services (p < .001, d = 0.64) and to return to the VA for care (p < .001, d = 0.79) if psychedelic therapy was offered. Almost two-thirds (59%) reported adverse outcomes associated with use. Equivalent proportions rated their psychedelic experiences as beneficial among those who did (89%) and did not (81%) report adverse outcomes. Fewer adverse outcomes were associated with being older, using psilocybin, feeling prepared and confident in the reasons for use, being in a comfortable setting, and being able to “trust, let go, and be open” (Rc = 0.77; p < .001). Psychedelics may offer benefits but may also lead to adverse outcomes without proper preparation and support. Future research should examine the utility of psychedelic-based approaches for veteran mental health care. [ABSTRACT FROM AUTHOR]

This study translated and tested the psychometric properties of acute psychedelic effects measures among Spanish-speaking people. The Psychological Insight Questionnaire (PIQ), Challenging Experiences Questionnaire (CEQ), and Mystical Experiences Questionnaire (MEQ) were translated before being incorporated into a web-based survey. We recruited native Spanish-speakers (N = 442; Mage = 30.8, SD = 10.9; Latino/Latina = 62%; Hispanic = 91.4%; male = 71.5%) to assess their previous experience with one of two psychedelics (LSD = 58.4%; Psilocybin = 41.6%) and their acute and enduring effects. Confirmatory factor analysis (confirming factor structure based on the English version) revealed a good fit for the MEQ, PIQ and the CEQ. Repeating our analysis in each drug subsample revealed consistency in factor structure for each assessment tool. Construct validity was supported by significant positive associations between the PIQ and MEQ, and between the PIQ and MEQ and changes in cognitive fusion and negative associations between changes in prosocial behaviors. As a signal of predictive validity, persisting effects (PEQ) were strongly related to scores on the MEQ and PIQ. Findings demonstrate that the Spanish versions of these measures can be reliably employed in studies of psychedelic use or administration in Spanish-speaking populations. [ABSTRACT FROM AUTHOR]

Children learn to find answers when multiplying two whole numbers (e.g., 3 × 7 = 21). To this end, they may repeatedly add one number (e.g., 7 + 7 + 7 = 21). But what meanings do they have for multiplication? The authors address this issue while sharing an innovative, playful task called Please Go and Bring for Me (PGBM). Drawing on the Concrete-Representational-Abstract approach (Witzel, 2005), the first author designed PGBM to promote children's meaning-making in multiplication and division (Tzur et al., 2013). This article is grounded in a collaboration with Year 3-5 teachers in USA public schools serving primarily underserved children of colour. The authors observed teachers implementing PGBM and experienced children's enthusiasm first-hand. The research (Tzur et al., 2018), along with teachers' reports, indicated PGBM can promote children's motivation for and success in learning multiplication. PGBM is described after depicting the intended meaning of multiplication.

This paper explores the integration of Open Educational Practices (OEP) into an institutional strategy to develop distinctive excellence in teaching, learning and scholarship. The institution in the case study is a public polytechnic university serving a metropolitan area in Canada. If emerging Open Educational Practices are to flourish at our university, support for OEP must integrate with and contribute to our broader efforts to clarify and enhance our strategic position. We have identified three focal points where our institution can focus attention in order to ensure that our use of emerging Open Educational Practices will best align with, contribute to, and benefit from our institutional strategy for distinctive excellence in teaching and learning: (1) Opening up the pedagogy underlying exemplary OER, to enable a deeper faculty engagement in integrating and mobilizing diverse sources of knowledge in teaching; (2) Opening up that process by which individual faculty improve teaching and learning, as a model for our students' own engagements with knowledge; (3) Opening up our collective faculty work in innovation networks, as a model for students and as a signature institutional strength and outcome. We summarize the rationale and planned next steps for each of these focal points, which are intended to cumulatively build on each other as a value chain to support the development of distinctive graduate capabilities as signature outcomes of our teaching and learning. [This paper was presented at the Open Education Consortium Global Conference (Banff, Canada, April 22-24, 2015).]

This study aimed to replicate, revise, and validate the model of Institutional Performance in Graduation Rate developed by Fung based on Tinto and Astin theories. The sample included 706 public, 4-year, Title IV postsecondary institutions in the United States. Two CFA-SEM models were conducted with the IPEDS 2011–2017 data. The relationships among student background, finance, academic and social environment, retention rate, and graduation rate were reevaluated and remodeled. The final best fitting model reflects possible changes in the factors of student finance and academic environment in higher education since 2010. The practical application of the best fitting model was discussed, including the evaluation of an institution's graduation rate performance based on four latent factors. [ABSTRACT FROM AUTHOR]

Background and Aims: Stroke is a leading cause of death in Aotearoa (New Zealand), and stroke reperfusion therapy is a key intervention. Sex differences in stroke care have previously been asserted internationally. This study assessed potential differences in stroke reperfusion rates and quality metrics by sex in Aotearoa (New Zealand). Methods: This study used data from three overlapping sources. The National Stroke Reperfusion Register provided 4‐year reperfusion data from 2018 to 2021 on all patients treated with reperfusion therapy (intravenous thrombolysis and thrombectomy), including time delays, treatment rates, mortality and complications. Linkage to Ministry of Health administrative and REGIONS Care study data provided an opportunity to control for confounders and explore potential mechanisms. T‐test and Wilcoxon rank‐sum analyses were used for continuous variables, while the chi‐squared test and logistic regression were used for comparing dichotomous variables. Results: Fewer women presented with ischaemic stroke (12 186 vs 13 120) and were 4.2 years older than men (median (interquartile range (IQR)) 79 (68–86) vs 73 (63–82) years). Women were overall less likely to receive reperfusion therapy (13.9% (1704) vs 15.8% (2084), P < 0.001) with an adjusted odds ratio of 0.83 (0.77–0.90), P < 0.001. The adjusted odds ratio for thrombolysis was lower for women (0.82 (0.76–0.89), P < 0.001), but lower rates of thrombectomy fell just short of statistical significance ((0.89 (0.79–1.00), P = 0.05). There were no significant differences in complications, delays or documented reasons for non‐thrombolysis. Conclusions: Women were less likely to receive thrombolysis, even after adjusting for age and stroke severity. We found no definitive explanation for this disparity. [ABSTRACT FROM AUTHOR]

Working in a research collaborative between Denver Public Schools and the University of Colorado Denver, the authors selected Bruce Randolph High School (BRHS) as a case study because of its growth on state academic achievement tests and because of its multilingual learners. After a difficult beginning, BRHS has established an inclusive culture of expectation for learning and community participation, a reciprocal instructional culture emphasizing instructional coaching and continuous improvement, a strong emphasis on language development and literacy across the curriculum, and interventions to prevent course failure. These characteristics, facilitated by the school's Innovation Status in the district, are central to its emerging success.