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School staff increasingly seek to implement evidence-based school mental health services to promote student mental health. However, barriers to accessing programming and support mean that implementing these programs is difficult. Popular strategies to address these challenges, like one time professional development, often fail to be effective or sustainable. This study used mixed methods to evaluate how a set of training activities--sequential online learning modules combined with interprofessional telementoring, following the extension for community healthcare outcomes (ECHO) model--influenced provision of school mental health services. School counselors, nurses, psychologists, and social workers (n = 46) participated in training activities, which included nine, cohort-based ECHO sessions and 12 modules. We used a concurrent mixed methods design in which quantitative (implementation data and pre-post surveys) and qualitative (posttraining focus groups with a subset of participants, n = 11) data were used to evaluate training. Quantitative results indicated statistically significant pre-post improvements in participants' clinical self-efficacy (d = 0.83) and knowledge of evidence-based practices (d = 0.37). Qualitative data corroborated quantitative results. Post training, focus groups described positive reactions, learning, and behavior change, particularly with respect to equitable service provision and interprofessional teaming. ECHO appeared to facilitate the application of evidence-based strategies to real-life practice and improved participants' understanding of effective coordination of services. Taken together, findings suggest that group-based telementoring may be a high-impact strategy for supporting the implementation of effective, culturally specific, and collaborative school mental health services.

This study assesses adults' perceptions of and predictors of intention to use prescription drug take-back boxes. This mixed methods study utilized focus groups and an online survey to examine factors related to intention to use a prescription drug take-back box. This study was conducted in [State] during the spring and summer of 2018. Themes identified in focus group data included the importance of take-back box location, benefits of take-back box use (such as reducing opportunities for medication misuse), and barriers to take-back box use (such as lack of awareness, stigma associated with law enforcement). Survey results indicate that pharmacies are the most preferred take-back box location and that attitudes, subjective norms, and perceived behavioral control are statistically significant predictors of intention to use a take-back box. Results suggest that individuals are open to using take-back boxes in secure, convenient locations, but many arsoe unaware of take-back boxes as an option for safe disposal. These findings have implications for health communication and policy efforts designed to increase the use of take-back boxes for prescription drug disposal.

Objective: The aim of this study was to investigate the perceptions of university students who served as outside facilitators for evidence-based nutrition education for elementary-age children. Design: Qualitative case study. Methods: Thirteen undergraduate university students facilitated four nutrition education sessions for elementary-age students in an after-school programme using the Choice, Control, Change model as part of service learning curriculum. University students completed pre- and post-participation surveys. Elementary-age participants completed surveys after each session. Results: University students saw the benefit of this type of experiential learning with the following themes: knowledge application, learning about diverse perspectives and having a positive impact. Before the first nutrition education session, the university students felt excited, nervous and/or enthusiastic, and during and immediately after the sessions reported they felt confident. Participant engagement was low/mixed and classroom management was challenging, which may be linked to the university students' perceptions that they were underprepared to work in a distracting social environment, and with behaviour typical to elementary-age children. The education session recipients reported they gained knowledge about healthy behaviours and believed that eating healthy foods is important. Conclusion: There are gaps in nutrition education programme theory and implementation by outside facilitators. These findings are relevant to those who provide health education services for surrounding communities. This study provides information about implementation barriers when outside facilitators lead nutrition education, alongside recommendations to improve these types of programmes in the future.

BACKGROUND: Refeeding syndrome is the gravest possible medical complication in malnourished patients undergoing refeeding in the hospital. We previously reported that males with malnutrition secondary to eating disorders required more calories and had longer hospital stays than females; however, sex differences in electrolyte abnormalities indicating refeeding syndrome risk remain unknown. The objective of this study was to assess differences in electrolyte abnormalities indicating refeeding syndrome risk among male and female adolescents and young adults with eating disorders hospitalized for medical instability. METHODS: We retrospectively reviewed the electronic medical records of 558 patients aged 9-25 years admitted to the University of California, San Francisco Eating Disorders Program for medical instability between May 2012 and August 2020. Serum was drawn per standard of care between 5 and 7 am each morning and electrolyte abnormalities indicating refeeding syndrome risk were defined as: hypophosphatemia (

OBJECTIVE: The StRONG trial demonstrated the safety and efficacy of higher calorie refeeding (HCR) in hospitalized adolescents and young adults with malnutrition secondary to restrictive eating disorders. Here we compare refeeding outcomes in patients with atypical anorexia nervosa (atypical AN) versus anorexia nervosa (AN) and examine the impact of caloric dose. METHOD: Patients were enrolled upon admission and randomized to meal-based HCR, beginning 2000 kcal/day and advancing 200 kcal/day, or lower calorie refeeding (LCR), beginning 1400 kcal/day and advancing 200 kcal every other day. Atypical AN was defined as %median BMI (mBMI) > 85. Independent t-tests compared groups; multivariable linear and logistic regressions examined caloric dose (kcal/kg body weight). RESULTS: Among n = 111, mean ± SD age was 16.5 ± 2.5 yrs; 43% had atypical AN. Compared to AN, atypical AN had slower heart rate restoration (8.7 ± 4.0 days vs. 6.5 ± 3.9 days, p = .008, Cohens d = -.56), less weight gain (3.1 ± 5.9%mBMI vs. 5.4 ± 2.9%mBMI, p

In this paper, I draw together myriad theoretical and philosophical sources to think through the intensification of emotion amid and emerging from the COVID-19 pandemic. I begin with three narratives from my own teaching and learning, which ground the subsequent conversation. I then characterize the current movement in educational theorizing known as the affective turn. The affective turn, I suggest, attunes educational inquiry to small, yet vital, moments of classroom interaction often taken for granted in public education. Toward considering those vital moments in more nuance, I discuss psychoanalyst Wilfred R. Bion's notion of the alpha function -- a nonconscious digestion of emotion we perform for others when they are overwhelmed. When coupled with Nel Noddings' evocation of the ethics of care in education, the alpha function offers an understanding of the hidden emotional labour in teaching. This hidden dimension of the teacher's task, the portion of the job that deals in regulating our own emotions and in helping students make sense of theirs, I suggest, is becoming more difficult amid the affective situation of the COVID-19 pandemic. I conclude the paper by gesturing toward a threefold response to be taken up more fully elsewhere: humility before the task of teaching, a reverence for the work of feeling, and a willingness to organize toward a more caring school system.

Community-Based Research (CBR) presents a wide range of benefits in higher education to students, community partners, and universities. Yet on our campus (and many others), CBR remains less common than other high-impact practices (HIPs) such as service learning and undergraduate research due to lack of effective institutionalization. Moreover, when CBR projects are undertaken, they result in a level of engagement with CBR that produces fewer of the expected benefits than is ideal. Here we detail our efforts to institutionalize CBR on our campus to appropriately expand the practice and its resulting benefits. These efforts focus on three initiatives: raising the visibility of CBR, diffusing expertise to implement CBR, and providing critical support for designing and implementing CBR. We also include our assessment plan which had to be postponed due to the COVID-19 pandemic. This plan utilizes a mixed-methods approach and will explore how our initiatives have made an impact on faculty and community partners involved with CBR, as well as assess interest and knowledge about CBR among faculty and community partners who are currently involved in service learning but not yet involved in CBR. We present our efforts as a model for other universities seeking to increase implementation of CBR.

The purpose of this paper is to describe a state-wide process used to determine which Teaching Works High Leverage Practices (Ball, 2016) pre-service teachers could be expected to implement at a proficient level by the completion of their preparation program (Initial HLPs), followed by two sets of high leverage practices novice teachers could master during their induction years (Induction and Expert HLPs) (Ball & Forzani, 2011; McLeskey & Brownell, 2015). Data were collected from a wide variety of stakeholders, including K-12 teachers, administrators, and educator preparation program faculty from across the state (N=203). Findings identified five High Leverage Practices that the majority of stakeholders indicated should be a priority for educator preparation programs in the state.

BackgroundClinical trials using psilocybin therapy to treat anorexia nervosa (AN) are currently underway. The safety and tolerability of psilocybin is of utmost importance in individuals with AN who may present unique medical vulnerabilities. The purpose of this review is to describe how the common physiologic adverse effects of psilocybin may impact medical complications experienced by individuals with AN in clinical trials of psilocybin therapy.Main bodyThe physiologic underpinnings of common adverse effects following psilocybin administration are described, including tachycardia, hypertension, electrocardiogram changes, nausea, headache, and lightheadedness. These anticipated physiologic changes are described in relation to the common medical correlates seen in individuals with AN. Risk mitigation strategies for each adverse effect are proposed.ConclusionEarly evidence suggests that psilocybin therapy is well-tolerated in individuals with AN. Understanding the unique medical complications of AN, and how they may be impacted by common physiologic adverse effects of psilocybin administration, leads to tailored risk mitigation strategies to enhance safety and tolerability of this novel intervention.

Nontraditional grading methods have recently become more common, and as with any large pedagogical shift, there are a number of questions to consider when applying a new grading scheme to a course. This article summarizes four types of nontraditional grading and shares experiences from the authors who have applied them to a variety of courses in statistics. This article is structured as a set of questions and answers, seeking to address many of the concerns and considerations that one may face as they transition a course's grading structure. Supplementary materials for this article are available online.

Alternative grading methods, such as standards-based grading, provide students multiple opportunities to demonstrate their understanding of the learning outcomes in a course. These grading methods allow for more flexibility and help promote a growth mindset by embracing constructive failure for students. Implementation of these alternative grading methods requires developing specific, transparent, and assessable standards. Moving away from traditional methods also requires a mindset shift for how both students and instructors approach assessment. While providing multiple opportunities is important for learning in any course, these methods are particularly relevant to an upper level mathematical statistics course where topics covered often provide an additional challenge for students as they lie at the intersection of both theory and application. By providing multiple opportunities, students have the space for constructive failure as they tackle learning both a conceptual understanding of statistics and the supporting mathematical theory. In this article we share our experiences--including both challenges and benefits for students and instructors--in implementing standards-based grading in the first semester of a mathematical statistics course (i.e., focus primarily on probability). Supplementary materials for this article are available online.

Knowledge exchange (KE) is increasingly important in higher education internationally, yet relatively little attention has been paid to it as a pedagogic opportunity for students. This paper draws on 26 interviews with stakeholders within and outside HE to develop a model of student-led knowledge exchange as a guide for learning through KE. The model includes the following elements: Preconditions, Prior Knowledge, Planning and Place, Pedagogic Context and Product, and offers an analysis of different forms of KE which occur between individuals in a learning triad consisting of student, facilitator and external participant. The research foregrounds a social view of learning where valid knowledge comes from diverse participants in the exchange, including students themselves. Students act as a catalyst for multi-directional KE -- a finding which challenges the implied hierarchies evident in much of the literature on this topic. The model is offered as a starting point for developing a pedagogy of KE in higher education.

Recent decades have seen a global shift in educational policy and practice towards various forms of "joining-up," through partnerships and networks. These networks have differing aims but are broadly geared towards increasing quality and/or innovation in educational provision, although many prove messy and problematic. Policy makers in England have encouraged schools to collaborate, although parallel market pressures can also drive competition, leading to an argument that schools must engage in "coopetition." More recently, policy has encouraged schools to form or join a multi-academy trust (MAT) and the government's stated aim is that all 21,000 schools in England will be part of a MAT by 2030. A MAT is a formal legal entity with a board and Chief Executive which oversees multiple schools. The headline question we address is whether pre-existing partnerships between schools predict eventual membership of multi-academy trusts? We do this through an analysis of ego network and case study interview data collected from 20 schools across two local areas. We track these networks over a seven-year period, identifying which schools join which MATs. We find that schools do not form or join MATs with other local schools they have collaborated with in the past. We assess this somewhat counter-intuitive finding through the lens of socio-spatial theory, presenting a framework for assessing the interactions between place, scale and networks and considering the implications for policy, practice and research.

This paper revisits the well-known and often-taught novel "The Chrysalids" toward a reconsideration of the novel's place within curriculum and the pedagogies it may offer. Framed as a mourning ceremony, a way of revisioning what the novel could mean in the present by saying goodbye to what it has meant in the past, the paper progresses in two major moments. The first looks at the novel in the author's lived experience and discusses personal mourning. The second engages affect theory toward a (re)reading of the material resistances and erasures within one copy of the text. The author concludes by expressing the need for a (re)visioning of what curricular fixtures such as "The Chrysalids" could mean today.

Nontraditional grading methods have recently become more common, and as with any large pedagogical shift, there are a number of questions to consider when applying a new grading scheme to a course. This article summarizes four types of nontraditional grading and shares experiences from the authors who have applied them to a variety of courses in statistics. This article is structured as a set of questions and answers, seeking to address many of the concerns and considerations that one may face as they transition a course’s grading structure. Supplementary materials for this article are available online.

Alternative grading methods, such as standards-based grading, provide students multiple opportunities to demonstrate their understanding of the learning outcomes in a course. These grading methods allow for more flexibility and help promote a growth mindset by embracing constructive failure for students. Implementation of these alternative grading methods requires developing specific, transparent, and assessable standards. Moving away from traditional methods also requires a mindset shift for how both students and instructors approach assessment. While providing multiple opportunities is important for learning in any course, these methods are particularly relevant to an upper level mathematical statistics course where topics covered often provide an additional challenge for students as they lie at the intersection of both theory and application. By providing multiple opportunities, students have the space for constructive failure as they tackle learning both a conceptual understanding of statistics and the supporting mathematical theory. In this article we share our experiences—including both challenges and benefits for students and instructors—in implementing standards-based grading in the first semester of a mathematical statistics course (i.e., focus primarily on probability). Supplementary materials for this article are available online.

Abstract Placenta Accreta Spectrum (PAS) and pre-eclampsia are obstetric disorders associated with significant maternal morbidity and mortality. As pre-eclampsia is characterised by shallow placental invasion and PAS by abnormally deep invasion, we sought to compare the biological processes dysregulated in PAS to those reported in pre-eclampsia. We demonstrate that many of the processes contributing to unregulated placental invasion in PAS are the mirror findings of those previously reported in pre-eclampsia. These comparisons of PAS to a more common obstetric condition allow a greater understanding of the biological processes contributing to PAS, which remains a very rare obstetric complication.

Background: Frailty, rather than age, is associated with postoperative morbidity and mortality. We sought to determine whether preoperative frailty as defined by a novel scoring system could predict the outcomes among older patients undergoing esophagectomy. Methods: We identified patients 65 years or older who underwent esophagectomy between 2011 and 2021 at our institution. Frailty was assessed using the MSK-FI, which consists of 1 component related to functional status and 10 medical comorbidities. We used a multivariable logistic regression model to test for the associations between frailty and short-term outcomes, with continuous frailty score as the predictor and additionally adjusted for age and Eastern Cooperative Oncology Group performance status. Results: In total, 447 patients were included in the analysis (median age of 71 years [interquartile range, 68–75]). Most of the patients underwent neoadjuvant treatment (81%), an Ivor Lewis esophagectomy (86%), and minimally invasive surgery (55%). A total of 22 patients (4.9%) died within 90 days of surgery, 144 (32%) had a major complication, 81 (19%) were readmitted, and 31 (7.2%) were discharged to a facility. Of the patients who died within 90 days, 19 had a major complication, yielding a failure-to-rescue rate of 13%. The risk of 30-day major complications (OR, 1.24 [95% CI, 1.09–1.41]; p = 0.001), readmissions (OR, 1.31 [95% CI, 1.13–1.52]; p < 0.001), and discharge to a facility (OR, 1.86 [95% CI, 1.49–2.37]; p < 0.001) increased with increasing frailty. Frailty and 90-day mortality were not associated. Conclusions: Frailty assessment during surgery decision-making can identify patients with a high risk of morbidity.

Abstract Background Air pollution poses a significant threat to global public health. While broad mitigation policies exist, an understanding of the economic consequences, both in terms of health benefits and mitigation costs, remains lacking. This study systematically reviewed the existing economic implications of air pollution control strategies worldwide. Methods A predefined search strategy, without limitations on region or study design, was employed to search the PubMed, Scopus, Cochrane Library, Embase, Web of Science, and CEA registry databases for studies from their inception to November 2023 using keywords such as “cost–benefit analyses”, “air pollution”, and “particulate matter”. Focus was placed on studies that specifically considered the health benefits of air pollution control strategies. The evidence was summarized by pollution control strategy and reported using principle economic evaluation measurements such as net benefits and benefit–cost ratios. Results The search yielded 104 studies that met the inclusion criteria. A total of 75, 21, and 8 studies assessed the costs and benefits of outdoor, indoor, and mixed control strategies, respectively, of which 54, 15, and 3 reported that the benefits of the control strategy exceeded the mitigation costs. Source reduction (n = 42) and end-of-pipe treatments (n = 15) were the most commonly employed pollution control methodologies. The association between particulate matter (PM) and mortality was the most widely assessed exposure-effect relationship and had the largest health gains (n = 42). A total of 32 studies employed a broader benefits framework, examining the impacts of air pollution control strategies on the environment, ecology, and society. Of these, 31 studies reported partially or entirely positive economic evidence. However, despite overwhelming evidence in support of these strategies, the studies also highlighted some policy flaws concerning equity, optimization, and uncertainty characterization. Conclusions Nearly 70% of the reviewed studies reported that the economic benefits of implementing air pollution control strategies outweighed the relative costs. This was primarily due to the improved mortality and morbidity rates associated with lowering PM levels. In addition to health benefits, air pollution control strategies were also associated with other environmental and social benefits, strengthening the economic case for implementation. However, future air pollution control strategy designs will need to address some of the existing policy limitations.

Abstract Background In the U.S. there are significant racial and gender disparities in the uptake of pre-exposure prophylaxis (PrEP). Black Americans represented 14% of PrEP users in 2022, but accounted for 42% of new HIV diagnoses in 2021 and in the South, Black people represented 48% of new HIV diagnoses in 2021 but only 21% of PrEP users in 2022. Women who use drugs may be even less likely than women who do not use drugs have initiated PrEP. Moreover, women involved in community supervision programs (CSP) are less likely to initiate or use PrEP, More PrEP interventions that focus on Black women with recent history of drug use in CSPs are needed to reduce inequities in PrEP uptake. Methods We conducted a secondary analysis from a randomized clinical trial with a sub-sample (n = 336) of the total (N = 352) participants from the parent study (E-WORTH), who tested HIV negative at baseline were considered PrEP-eligible. Black women were recruited from CSPs in New York City (NYC), with recent substance use. Participants were randomized to either E-WORTH (n = 172) an HIV testing plus, receive a 5-session, culturally-tailored, group-based HIV prevention intervention, versus an HIV testing control group (n = 180). The 5 sessions included an introduction to PrEP and access. This paper reports outcomes on improved awareness of PrEP, willingness to use PrEP, and PrEP uptake over the 12-month follow-up period. HIV outcomes are reported in a previous paper. Results Compared to control participants, participants in this study assigned to E-WORTH had significantly greater odds of being aware of PrEP as a biomedical HIV prevention strategy (OR = 3.25, 95% CI = 1.64–6.46, p = 0.001), and indicated a greater willingness to use PrEP as an HIV prevention method (b = 0.19, 95% CI = 0.06–0.32, p = 0.004) over the entire 12-month follow-up period. Conclusions These findings underscore the effectiveness of a culturally-tailored intervention for Black women in CSP settings in increasing awareness, and intention to initiate PrEP. Low uptake of PrEP in both arms highlight the need for providing more robust PrEP-on-demand strategies that are integrated into other services such as substance abuse treatment. Trial Registration ClinicalTrials.gov Identifier: NCT02391233 .

Abstract Sex and gender are inadequately considered in health and medical research, policy and practice, leading to preventable disparities in health and wellbeing. Several global institutions, journals, and funding bodies have developed policies and guidelines to improve the inclusion of diverse participants and consideration of sex and gender in research design and reporting and the delivery of clinical care. However, according to recent evaluations, these policies have had limited impact on the inclusion of diverse research participants, adequate reporting of sex and gender data and reducing preventable inequities in access to, and quality provision of, healthcare. In Australia, the Sex and Gender Policies in Medical Research (SGPMR) project aims to address sex and gender bias in health and medical research by (i) examining how sex and gender are currently considered in Australian research policy and practice; (ii) working with stakeholders to develop policy interventions; and (iii) understanding the wider impacts, including economic, of improved sex and gender consideration in Australian health and medical research. In this paper we describe the development of a theory of change (ToC) for the SGPMR project. The ToC evolved from a two-stage process consisting of key stakeholder interviews and a consultation event. The ToC aims to identify the pathways to impact from improved consideration of sex and gender in health and medical research, policy and practice, and highlight how key activities and policy levers can lead to improvements in clinical practice and health outcomes. In describing the development of the ToC, we present an entirely novel framework for outlining how sex and gender can be appropriately considered within the confines of health and medical research, policy and practice.

Abstract Background Aortic stenosis (AS) is the most common degenerative valve disease in high income countries. While hemodynamic metrics are commonly used to assess severity of stenosis, they are impacted by loading conditions and stroke volume and are often discordant. Anatomic valve assessments such as aortic valve calcification (AVC) and valve motion (VM) during transthoracic echocardiography (TTE) can offer clues to disease severity. The reliability of these semi-quantitatively assessed anatomic imaging parameters is unknown. Methods This is a retrospective study of semi-quantitative assessment of AVC and valve VM on TTE. TTEs representing a range of AS severities were identified. The degree of calcification of the aortic valve and the degree of restricted VM were assessed in standard fashion. AVC scores and valve motion were assessed by readers with varied training levels blinded to the severity of AS. Correlation and inter-reader reliability between readers were assessed. Results 420 assessments (210 each for AVC and VM) were collected for 35 TTEs. Correlation of AVC for imaging trainees (fellows and students, respectively), ranged from 0.49 (95% CI 0.18–0.70) to 0.62 (95% CI 0.36–0.79) and 0.58 (95% CI 0.30–0.76) to 0.54 (95% CI 0.25–0.74) for VM. Correlation of anatomic assessments between echocardiographer-assigned AVC grades was r = 0.76 (95% CI 0.57–0.87)). The correlation between echocardiographer-assigned assessment of VM was r = 0.73 (95% CI 0.53–0.86), p