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Human papillomavirus (HPV) is the most common sexually transmitted infection on U.S. college campuses. Although HPV vaccination is recommended through age 26, current efforts to improve vaccination rates have predominantly focused on adolescents. Consequently, vaccine uptake remains suboptimal among young adults. This represents a significant missed opportunity, as young adults face the highest risk for new HPV infections. To contextualize the factors impacting decision-making process for this vulnerable population, this study reports key themes that emerged from in-depth interviews with participants (N = 30) who had completed an online intervention study for HPV vaccination among college students. Twelve (40%) of the interviewees vaccinated after exposure to the intervention. Findings centered around empowerment among young adults as the facilitator to get the HPV vaccine: key themes emerged were (1) convenience is critical and empowering; (2) adulthood identity, marked by a heightened sense of autonomy, accountability, and responsibility for self/future self and others, is empowering; (3) equal access to health care and preventive resources is empowering, especially for participants with low socioeconomic status; and (4) accurate knowledge provided in the intervention destigmatized HPV vaccination to empower young adults to make informed decisions. Digital interventions with messages highlighting a newly gained autonomy, future-oriented self and social responsibility, inclusive and accurate knowledge, and providing navigation to improve access may enhance HPV vaccination among young adults.

In recent years, professional organizations in the United States have suggested undergraduate mathematics shift away from pure lecture format. Transitioning to a student-centered class is a complex instructional undertaking especially in the proof-based context. In this paper, we share lessons learned from a design-based research project centering instructional elements as objects of design. We focus on how three high leverage teaching practices (HLTP; established in the K-12 literature) can be adapted to the proof context to promote student engagement in authentic proof activity with attention to issues of access and equity of participation. In general, we found that HLTPs translated well to the proof setting, but required increased attention to navigating between formal and informal mathematics, developing precision around mathematical objects, supporting competencies beyond formal proof construction, and structuring group work. We position this paper as complementary to existing research on instructional innovation by focusing not on task trajectories, but on concrete teaching practices that can support successful adaption of student-centered approaches.

Service-learning models serve as noteworthy curriculum paradigms that can help students engage with their communities while continuously learning. This article recounts the implementation of a service-learning model within a student initiative aimed to help combat vaccine hesitancy and promote the uptake of vaccinations within the Rhode Island community. Through a collaborative effort between students, faculty, and the university, the student initiative was able to construct a credit-bearing course to help assess and alleviate vaccine hesitancy within Rhode Island. This article highlights the journey the organization took to develop a service-learning model within the course, the project details, and the impact of their project on the community. A detailed analysis of the service-learning model's impact on students as well as key takeaways of the project are also highlighted below.

Current educational research demonstrates the importance of equipping students to be active participants in their own learning. However, more work is needed to provide students with the metacognitive skills necessary to engage in Self-Regulated Learning (SRL). Feedback is a crucial component of the learning process and can be used by students to develop these skills but remains a source of dissatisfaction for students and educators. We contend that this is a result of a gap in students' understanding of the feedback process and the lack of dialogue between students and educators. This paper presents a methodology to conduct a feedback workshop as a means to improve the feedback experience while equipping students with the metacognitive skills needed to facilitate SRL. The methodology was evaluated in four workshops conducted with students from engineering and business at a university in the United Kingdom. In each workshop (excluding the pilot) students were requested to complete pre and post-workshop questionnaires and there was also opportunity for group discussion and reflection. Results demonstrate the potential benefits of such workshops in deepening the student understanding of the process and use of feedback.

BackgroundHuman papillomavirus (HPV) infections can cause cancers of the cervix, vagina, vulva, penis, anus, and oropharynx. The most recently approved HPV vaccine, Gardasil-9, protects against HPV infection and can prevent HPV-associated invasive cancers. However, Gardasil-9 is one of the most underused vaccines in the US today. Young adults are at risk for HPV infection, but many are not vaccinated. This study uses a randomized controlled trial (RCT) to test an innovative multilevel intervention to increase HPV vaccination rates among young adults. In this paper, we describe the research protocol.MethodsThe study uses a two by three factorial design. A total of 1200 young adults in Texas, age 18-26 years, who have not been previously fully vaccinated against HPV will be randomly assigned to one of six conditions to receive: (1) standard CDC information about HPV vaccination (control); (2) video narratives about HPV vaccination; (3) written narratives about HPV vaccination; or (4-6) enhanced access to HPV vaccine combined with (4) standard CDC information, (5) video narratives, or (6) written narratives. The two primary outcomes are the rate of HPV vaccination initiation by 3-month follow-up and rate of HPV vaccination completion by 9-month follow-ups. We will determine the impact of the individual level intervention (i.e., persuasive narratives through video or written format), the systemic level intervention (i.e., enhanced access to HPV vaccines), and the combination of both levels, on HPV vaccination initiation and completion. We will also use purposive sampling to select participants to take part in semi-structured interviews/focus groups to better understand the mechanisms of the intervention.DiscussionRecruitment and data collection began in March 2022. We expect to complete data collection by March 2026. We expect that narratives, enhanced access, and the combination of both will improve HPV vaccination initiation and completion rates among young adults. If proven successful, these individual- and system-level interventions can be easily disseminated in regions with low HPV vaccination rates to improve HPV vaccination, and ultimately decrease HPV-related cancer burden.Trial registrationNCT05057312.

Abstract Improving health and social equity for persons living with a rare disease (PLWRD) is increasingly recognized as a global policy priority. However, there is currently no international alignment on how to define and describe rare diseases. A global reference is needed to establish a mutual understanding to inform a wide range of stakeholders for actions. A multi-stakeholder, global panel of rare disease experts, came together and developed an Operational Description of Rare Diseases. This reference describes which diseases are considered rare, how many persons are affected and why the rare disease population demands specific attention. The operational description of rare diseases is framed in two parts: a core definition of rare diseases, complemented by a descriptive framework of rare diseases. The core definition includes parameters that permit the identification of which diseases are considered rare, and how many persons are affected. The descriptive framework elaborates on the impact and burden of rare diseases on patients, their caregivers and families, healthcare systems, and society overall. The Operational Description of Rare Diseases establishes a common point of reference for decision-makers across the world who strive to understand and address the unmet needs of persons living with a rare disease. Adoption of this reference is essential to improving the visibility of rare conditions in health systems across the world. Greater recognition of the burden of rare diseases will motivate new actions and policies to address the unmet needs of the rare disease community.

Objective: We investigated the preliminary efficacy of a tailored human papillomavirus (HPV) vaccination on-line intervention designed to increase HPV vaccination intention. Participants: Female college students (N = 101; 18-26 years), who have not received the HPV vaccine. Methods: Participants were randomized to either a control group to read standard Center for Disease Control information or a narrative intervention group to read two narrative messages about HPV/HPV vaccination that were tailored based on the individual's sexual history and told from the perspectives from a peer and an expert. Participants were assessed at baseline (T1) and immediately after the intervention (T2). Results: The narrative intervention group reported a greater increase from T1 to T2 in vaccination intention compared with control group. Both groups reported increases in knowledge, positive attitude, self-efficacy, social norm, and perceived susceptibility to HPV from T1 to T2. Conclusions: A narrative intervention is promising to effectively increase HPV vaccination intention.

This article offers the construct "unitizing predicates" to name mental actions important for students' reasoning about logic. To unitize a predicate is to conceptualize (possibly complex or multipart) conditions as a single property that every example has or does not have, thereby partitioning a universal set into examples and nonexamples. This explains the cognitive work that supports students to unify various statements with the same logical form, which is conventionally represented by replacing parts of statements with logical variables p or P(x). Using data from a constructivist teaching experiment with two undergraduate students, we document barriers to unitizing predicates and demonstrate how this activity influences students' ability to render mathematical statements and proofs as having the same logical structure.

This article presents an inquiry-oriented lesson for teaching Lagrange's theorem in abstract algebra. This lesson was developed and refined as part of a larger grant project focused on how to "Orchestrate Discussions Around Proof" (ODAP, the name of the project). The lesson components were developed and refined with attention to how well they supported active and broad student participation. By guiding student exploration of a few key example groups and structuring the exploration to identify recurrent structure, students formulate key lemmas that they can combine to prove Lagrange's theorem.

Abstract DNA hydroxymethylation (5hmC), the most abundant oxidative derivative of DNA methylation, is typically enriched at enhancers and gene bodies of transcriptionally active and tissue-specific genes. Although aberrant genomic 5hmC has been implicated in age-related diseases, its functional role in aging remains unknown. Here, using mouse liver and cerebellum as model organs, we show that 5hmC accumulates in gene bodies associated with tissue-specific function and restricts the magnitude of gene expression changes with age. Mechanistically, 5hmC decreases the binding of splicing associated factors and correlates with age-related alternative splicing events. We found that various age-related contexts, such as prolonged quiescence and senescence, drive the accumulation of 5hmC with age. We provide evidence that this age-related transcriptionally restrictive function is conserved in mouse and human tissues. Our findings reveal that 5hmC regulates tissue-specific function and may play a role in longevity.

Abstract This paper reviews a large number of scholarly articles in the housing field spanning the last thirty years, from 1993 to 2022 by implementing bibliometric analysis method. We examine scientific outputs, identify influential articles, journals, international collaboration and evolution of research trends. Keywords such as “Housing price,” “Housing policy,” “Affordable housing,” “Homeownership,” “Housing market,” “Urban planning,” and “Neighborhood” have been identified as the most prevalently cited terms during this period. Furthermore, the prominence of terms such as “China,” “Gentrification,” “Public housing,” “Social housing,” “Homelessness,” “Migration,” “Urbanization,” “Energy,” “Inequality,” “Land use,” “Gender,” and “Foreclosure” have grown in importance, pointing to future research trends. The analysis also reveals that articles pertaining to the COVID-19 pandemic predominantly address the comprehensive effects of the virus on aspects of mental and physical health, consumer behavior, and economic and societal challenges.

Abstract Although the gross morphology of the heart is conserved across mammals, subtle interspecific variations exist in the cardiac phenotype, which may reflect evolutionary divergence among closely-related species. Here, we compare the left ventricle (LV) across all extant members of the Hominidae taxon, using 2D echocardiography, to gain insight into the evolution of the human heart. We present compelling evidence that the human LV has diverged away from a more trabeculated phenotype present in all other great apes, towards a ventricular wall with proportionally greater compact myocardium, which was corroborated by post-mortem chimpanzee (Pan troglodytes) hearts. Speckle-tracking echocardiographic analyses identified a negative curvilinear relationship between the degree of trabeculation and LV systolic twist, revealing lower rotational mechanics in the trabeculated non-human great ape LV. This divergent evolution of the human heart may have facilitated the augmentation of cardiac output to support the metabolic and thermoregulatory demands of the human ecological niche.

Abstract Background Human papillomavirus (HPV) infections can cause cancers of the cervix, vagina, vulva, penis, anus, and oropharynx. The most recently approved HPV vaccine, Gardasil-9, protects against HPV infection and can prevent HPV-associated invasive cancers. However, Gardasil-9 is one of the most underused vaccines in the US today. Young adults are at risk for HPV infection, but many are not vaccinated. This study uses a randomized controlled trial (RCT) to test an innovative multilevel intervention to increase HPV vaccination rates among young adults. In this paper, we describe the research protocol. Methods The study uses a two by three factorial design. A total of 1200 young adults in Texas, age 18–26 years, who have not been previously fully vaccinated against HPV will be randomly assigned to one of six conditions to receive: (1) standard CDC information about HPV vaccination (control); (2) video narratives about HPV vaccination; (3) written narratives about HPV vaccination; or (4–6) enhanced access to HPV vaccine combined with (4) standard CDC information, (5) video narratives, or (6) written narratives. The two primary outcomes are the rate of HPV vaccination initiation by 3-month follow-up and rate of HPV vaccination completion by 9-month follow-ups. We will determine the impact of the individual level intervention (i.e., persuasive narratives through video or written format), the systemic level intervention (i.e., enhanced access to HPV vaccines), and the combination of both levels, on HPV vaccination initiation and completion. We will also use purposive sampling to select participants to take part in semi-structured interviews/focus groups to better understand the mechanisms of the intervention. Discussion Recruitment and data collection began in March 2022. We expect to complete data collection by March 2026. We expect that narratives, enhanced access, and the combination of both will improve HPV vaccination initiation and completion rates among young adults. If proven successful, these individual- and system-level interventions can be easily disseminated in regions with low HPV vaccination rates to improve HPV vaccination, and ultimately decrease HPV-related cancer burden. Trial Registration NCT05057312.

This study aimed at averting challenges of overweight and obesity among African Americans in rural Alabama. Focus group discussions and surveys were used to design a 12-week nutrition education and physical activity program. Results showed a significant improvement (p<0.05) in participants' knowledge scores. Values for systolic blood pressure significantly reduced (p<0.00). There was an increase in number of participants with normal blood pressure and a reduction in number of participants with stage 2 hypertension. The study highlights that nutrition education and physical activity can lead to improved health outcomes among African Americans in rural Alabama.

The COVID-19 pandemic has had broad ranging impacts on the delivery of education at universities. In this context, hybrid-flexible teaching, or HyFlex (HF), has been offered at my university as a mode of delivery ostensibly suitable to what is ultimately a disrupted teaching environment. HF involves the delivery of a subject simultaneously in three modes: synchronous face-to-face, synchronous online and asynchronous. In this article I adopt a 'small data' research approach and examine my personal memos documenting my own implementation of a HF version of one undergraduate subject in two consecutive iterations. Existing research on HF is clear that students appreciate the convenience afforded, and while there is some general mention of the impact of HF on teacher workload, I set out to develop detailed insights by documenting and reflecting on my own experiences. Conclusions I reach are that attendance becomes complex and problematic in HF subjects, impacting curriculum design, teacher confidence and workload. Also, it is not practically possible to adapt existing synchronous subjects to HF without significant redesign, and this is to develop timely feedback interventions and create a sense of belonging for students. Hybrid-flexible learning is predicted to continue and expand in higher education, making the detailed account outlined here a valuable example.

In many advanced mathematics courses, comprehending theorems and proofs is an essential activity for both students and mathematicians. Such activity requires readers to draw on relevant meanings for the concepts involved; however, the ways that concept meaning may shape comprehension activity is currently undertheorized. In this paper, we share a study of student activity as they work to comprehend the First Isomorphism Theorem and its proof. We analyze, using an onto-semiotic lens, the ways that students' meanings for quotient group both support and constrain their comprehension activity. Furthermore, we suggest that the relationship between understanding concepts and proof comprehension can be reflexive: understanding of concepts not only influences comprehension activity, but engaging with theorems and proofs can serve to support students in generating more sophisticated understanding of the concepts involved.

Alexis Ceecee Britten-Jones,1– 3 Lauren N Ayton,1– 3 Kelley Graydon,4 Jessica O Boyce,4 Ruth Braden,4 Rosie Dawkins,2,3,&ast; Kwang Meng Cham1,&ast; On behalf of The Stickler Syndrome Awareness Study Group1Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia; 2Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Victoria, Australia; 3Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia; 4Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, Victoria, Australia&ast;These authors contributed equally to this workCorrespondence: Alexis Ceecee Britten-Jones, Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry & Health Sciences, the University of Melbourne, Parkville, Victoria, 3010, Australia, Tel +61 3 8344 5980, Email ac.brittenjones@unimelb.edu.auPurpose: Stickler Syndromes are multisystem collagenopathies affecting 1 in 7500– 9000 individuals and are associated with craniofacial, ocular, auditory, and musculoskeletal complications. Prophylactic retinopexy treatment reduces the risk of retinal detachment, emphasising the need for early detection and multidisciplinary referral. This study evaluated knowledge and awareness of Stickler Syndromes among allied health professionals and their perceived needs for targeted education to improve multidisciplinary care.Methods: A cross-sectional survey was undertaken among audiologists, speech pathologists, optometrists, orthoptists, and physiotherapists in Australia. Survey questions included practitioner demographics, awareness and knowledge of Stickler Syndromes, confidence managing Stickler Syndromes, and perception of multidisciplinary care needs for Stickler Syndromes.Results: Of 180 healthcare professions who participated (79% female; 78% aged between 25 and 44 years), 55% indicated that they had heard of Stickler Syndrome, and 14% had directly worked with patients known to have Stickler Syndromes. Practitioners who had were either optometrists, orthoptists, or audiologists. The most recognised clinical sign of Stickler Syndromes was retinal detachment (selected by 66% of optometrists and orthoptists and 16% of other professions), but only 41% of optometrists and orthoptists (27% all respondents) selected cryopexy as a potential management strategy. Vitreous anomaly was recognised as a clinical feature by 20% of all respondents. Overall, 69% of allied health professionals did not feel confident managing Stickler Syndromes, and a similar number of practitioners (69%) indicated that they were willing to attend professional development courses for complex conditions such as Stickler Syndromes.Conclusion: This study provides meaningful insights on awareness and knowledge of Stickler Syndromes among allied healthcare professionals. Targeted clinician education, enhanced communication between healthcare entities, and multidisciplinary care programs can significantly improve the integrated care of Stickler Syndromes leading to better patient outcomes.Keywords: high myopia, vitreous anomalies, cleft palate, hearing loss, syndromic conditions, clinical education, Stickler Syndrome

Objectives. To describe the characteristics and outcomes of COVID-19 cases in Jamaica and to explore the risk factors associated with severe COVID-19 from 9 March to 31 December 2020. Methods. A cross-sectional analysis of national surveillance data was conducted using confirmed COVID-19 cases in Jamaica. Definitions of a confirmed case, disease severity, and death were based on World Health Organization guidelines. Chi-square and Fisher exact tests were used to determine association with outcomes. Logistic regression models were used to determine predictors of severe COVID-19. Results. This analysis included 12 169 cases of COVID-19 (median age, 36 years; 6 744 females [ 55.4%]) of which 512 cases (4.2%) presented with severe disease, and of those, 318 patients (62.1%) died (median age at death, 71.5 years). Severe disease was associated with being male (OR 1.4; 95% CI, 1.2-1.7) and 40 years or older (OR, 6.5; 95% CI, 5.1-8.2). COVID-19 death was also associated with being male (OR, 1.4; 95% CI, 1.1-1.7), age 40 years or older (OR, 17.9; 95% CI, 11.6-27.7), and in the Western versus South East Health Region (OR 1.7; 95% CI, 1.2-2.3). Conclusions. The findings of this cross-sectional analysis indicate that confirmed cases of COVID-19 in Jamaica were more likely to be female and younger individuals, whereas COVID-19 deaths occurred more frequently in males and older individuals. There is increased risk of poor COVID-19 outcomes beginning at age 40, with males disproportionately affected. COVID-19 death also varied by geographic region. This evidence could be useful to other countries with similar settings and to policymakers charged with managing outbreaks and health.

For decades, health professional organizations have recommended increased diversity in the workforce and education. To address persistent inequities in health care, the racial composition of the nursing workforce needs be congruent with the U.S. population. Without first addressing structural inequity in nursing education programs, the nursing profession cannot begin to address structural racism in health care. The lack of nursing student diversity is reflective of barriers in program admissions. This article is a call to nursing accreditation bodies to operationalize anti-racism to improve U.S. nursing workforce diversity by introducing accountability structures that require evidence-based holistic admission review and analysis of admission data to ensure that student cohorts are diverse across nursing programs, thereby ensuring a future workforce that reflects the diversity of the U.S. population.