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Health data access and sharing in the U.S. have been hindered by complex privacy and security conditions, limiting research and improvement of health outcomes. This challenge is even greater in minority and sensitive populations - who would benefit most from integrative research. The All of Us Research Program is a National Institutes of Health funded initiative aiming to enhance health research through the analysis of lifestyle, environment, and genetics data from over one million participants, with a focus on communities historically underrepresented in biomedical research. The program is enhancing the utility of data by incorporating passive data streams, such as claims, electronic health records (EHRs), environmental, geocodes, mortality, and residential history. Further, through the use of national health information exchange standards, All of Us also aims to address technical challenges in linking EHRs from health information networks to deliver a more complete longitudinal participant record. However, such an initiative necessitates a thoughtful approach through data awareness, advancing data access in ways that preserve individual privacy while increasing scientific utility. Here, we describe our privacy-preserving record linkage (PPRL) and data privacy risk disclosure control strategy, emphasizing fit-for-purpose data provisioning. Our knowledge-driven data ecosystem architecture leverages a combination of PPRL, data provenance, and geocoding at multiple levels to support context-aware data sharing granular access control.

Abstract Background Research conducted in urban areas has highlighted the impact of housing instability on people who inject drugs (PWID), revealing that it exacerbates vulnerability to drug-related harms and impedes syringe service program (SSP) use. However, few studies have explored the effects of houselessness on SSP use among rural PWID. This study examines the relationship between houselessness and SSP utilization among PWID in eight rural areas across 10 states. Methods PWID were recruited using respondent-driven sampling for a cross-sectional survey that queried self-reported drug use and SSP utilization in the prior 30 days, houselessness in the prior 6 months and sociodemographic characteristics. Using binomial logistic regression, we examined the relationship between experiencing houselessness and any SSP use. To assess the relationship between houselessness and the frequency of SSP use, we conducted multinomial logistic regression analyses among participants reporting any past 30-day SSP use. Results Among 2394 rural PWID, 56.5% had experienced houselessness in the prior 6 months, and 43.5% reported past 30-day SSP use. PWID who had experienced houselessness were more likely to report using an SSP compared to their housed counterparts (adjusted odds ratio [aOR] = 1.24 [95% confidence intervals [CI] 1.01, 1.52]). Among those who had used an SSP at least once (n = 972), those who experienced houselessness were just as likely to report SSP use two (aOR = 0.90 [95% CI 0.60, 1.36]) and three times (aOR = 1.18 [95% CI 0.77, 1.98]) compared to once. However, they were less likely to visit an SSP four or more times compared to once in the prior 30 days (aOR = 0.59 [95% CI 0.40, 0.85]). Conclusion This study provides evidence that rural PWID who experience houselessness utilize SSPs at similar or higher rates as their housed counterparts. However, housing instability may pose barriers to more frequent SSP use. These findings are significant as people who experience houselessness are at increased risk for drug-related harms and encounter additional challenges when attempting to access SSPs.

Abstract Background Research on causal reasoning often uses group-level data analyses that downplay individual differences and simple reasoning problems that are unrepresentative of everyday reasoning. In three empirical studies, we used an individual differences approach to investigate the cognitive processes people used in fault diagnosis, which is a complex diagnostic reasoning task. After first showing how high-level fault diagnosis strategies can be composed of simpler causal inferences, we discussed how two of these strategies—elimination and inference to the best explanation (IBE)—allow normative performance, which minimizes the number of diagnostic tests, whereas backtracking strategies are less efficient. We then investigated whether the use of normative strategies was infrequent and associated with greater fluid intelligence and positive thinking dispositions and whether normative strategies used slow, analytic processing while non-normative strategies used fast, heuristic processing. Results Across three studies and 279 participants, uses of elimination and IBE were infrequent, and most participants used inefficient backtracking strategies. Fluid intelligence positively predicted elimination and IBE use but not backtracking use. Positive thinking dispositions predicted avoidance of backtracking. After classifying participants into groups that consistently used elimination, IBE, and backtracking, we found that participants who used elimination and IBE made fewer, but slower, diagnostic tests compared to backtracking users. Conclusions Participants’ fault diagnosis performance showed wide individual differences. Use of normative strategies was predicted by greater fluid intelligence and more open-minded and engaged thinking dispositions. Elimination and IBE users made the slow, efficient responses typical of analytic processing. Backtracking users made the fast, inefficient responses suggestive of heuristic processing.

Focal brain injury in the form of a needlestick (NS) results in cell death and induces a self-protective response flanking the lesion. Myo/Nog cells are identified by their expression of bone morphogenetic protein inhibitor Noggin, brain-specific angiogenesis inhibitor 1 (BAI1) and the skeletal muscle specific transcription factor MyoD. Myo/Nog cells limit cell death in two forms of retinopathy. In this study, we examined the acute response of Myo/Nog cells to a NS lesion that extended from the rat posterior parietal cortex to the hippocampus. Myo/Nog cells were identified with antibodies to Noggin and BAI1. These cells were the primary source of both molecules in the uninjured and injured brain. One day after the NS, the normally small population of Myo/Nog cells expanded approximately eightfold within a 1 mm area surrounding the lesion. Myo/Nog cells were reduced by approximately 50% along the lesion with an injection of the BAI1 monoclonal antibody and complement. The number of dying cells, identified by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL), was unchanged at this early time point in response to the decrease in Myo/Nog cells. However, increasing the number of Myo/Nog cells within the lesion by injecting BAI1-positive (+) cells isolated from the brains of other animals, significantly reduced cell death and increased the number of NeuN+ neurons compared to brains injected with phosphate buffered saline or exogenous BAI1-negative cells. These findings demonstrate that Myo/Nog cells rapidly react to injury within the brain and increasing their number within the lesion is neuroprotective.

Female genital schistosomiasis (FGS) is a complication of Schistosoma haematobium infection, and imposes a health burden whose magnitude is not fully explored. It is estimated that up to 56 million women in sub-Saharan Africa have FGS, and almost 20 million more cases will occur in the next decade unless infected girls are treated. Schistosomiasis is reported throughout the year in South Africa in areas known to be endemic, but there is no control programme. We analyze five actions for both a better understanding of the burden of FGS and reducing its prevalence in Africa, namely: (1) schistosomiasis prevention by establishing a formal control programme and increasing access to treatment, (2) introducing FGS screening, (3) providing knowledge to health care workers and communities, (4) vector control, and (5) water, sanitation, and hygiene. Schistosomiasis is focal in South Africa, with most localities moderately affected (prevalence between 10% and 50%), and some pockets that are high risk (more than 50% prevalence). However, in order to progress towards elimination, the five actions are yet to be implemented in addition to the current (and only) control strategy of case-by-case treatment. The main challenge that South Africa faces is a lack of access to WHO-accredited donated medication for mass drug administration. The establishment of a formal and funded programme would address these issues and begin the implementation of the recommended actions.

Background: In an era of global health security challenges such as the COVID-19 pandemic, there is greater need for strong leadership. Over the past decades, significant investments have been made in global health leadership development programs by governments and philanthropic organizations to address this need. Evaluating the societal impact of these programs remains challenging, despite consensus on the importance of public health leadership. Objective: This article identifies the gaps and highlights the critical role of monitoring and evaluation approaches in assessing the impact of global health leadership programs. Importantly, we also propose the theory of change (TOC) as a common framework and identify a set of tools and indicators that leadership programs can adapt and use. Methods: We carried out an informal review of major global health leadership programs, including a literature review on leadership program evaluation approaches. Current practices in assessing the short- to long-term outcomes of leadership training programs were explored and synthesized. We also examined use of program theory frameworks, such as theory of change to guide the evaluation strategy. We find the TOC approach can be enhanced by integrating evaluation-specific frameworks and establishing broad stakeholder buy-in. We highlight measurement challenges, proposed outcome indicators and evaluation methodologies, and outline the future direction for such efforts. Findings: Most evaluation of current leadership programs is focused on short-term individual-level outcomes, while reports on long-term societal impact were limited. Reciprocal impacts on and benefits for the “host” organizations were not included in evaluation metrics. Most programs had program logic or result chains, but with no well-articulated program theories. Conclusion: Key stakeholders involved in leadership training programs benefit from the evidence of rigorous program evaluations to inform decisions that address barriers in fostering global health leadership and improving population health outcomes. Insight into reciprocal change in host organizations is important. Evaluation of global health leadership training must go beyond the individual trainee and encompass organizational and community-level impacts. Documentation of long-lasting organizational and societal impacts is essential for donors to appreciate the return on their investment. Key Takeaways Evaluation plays an important role in understanding how leadership development takes place and how it contributes to improving public health outcomes. Making the case for investments in leadership development programs requires robust evidence from monitoring and evaluation strategies that link investments beyond the individual-level to longer-term societal impacts. The first critical step towards a strategy for success is for leadership programs to clearly build, articulate, share, and use their program theories or theories of change. Theories of change help identify the pathways (and potential tensions) through which leadership development programs effect change at the individual, organizational and community levels. Evaluation methods that examine outcomes of leadership programs should be multi-method, multi-level, and where possible include counterfactual outcomes. Allocation of funds to evaluate on-going and long-lasting societal impact of leadership programs should be a routine practice.

The Myo/Nog cell lineage was discovered in the chick embryo and is also present in adult mammalian tissues. The cells are named for their expression of mRNA for the skeletal muscle specific transcription factor MyoD and bone morphogenetic protein inhibitor Noggin. A third marker for Myo/Nog cells is the cell surface molecule recognized by the G8 monoclonal antibody (mAb). G8 has been used to detect, track, isolate and kill Myo/Nog cells. In this study, we screened a membrane proteome array for the target of the G8 mAb. The array consisted of >5,000 molecules, each synthesized in their native confirmation with appropriate post-translational modifications in a single clone of HEK-293T cells. G8 mAb binding to the clone expressing brain-specific angiogenesis inhibitor 1 (BAI1) was detected by flow cytometry, re-verified by sequencing and validated by transfection with the plasmid construct for BAI1. Further validation of the G8 target was provided by enzyme-linked immunosorbent assay. The G8 epitope was identified by screening a high-throughput, site directed mutagenesis library designed to cover 95-100% of the 954 amino acids of the extracellular domain of the BAI1 protein. The G8 mAb binds within the third thrombospondin repeat of the extracellular domain of human BAI1. Immunofluorescence localization experiments revealed that G8 and a commercially available BAI1 mAb co-localize to the subpopulation of Myo/Nog cells in the skin, eyes and brain. Expression of the multi-functional BAI1 protein in Myo/Nog cells introduces new possibilities for the roles of Myo/Nog cells in normal and diseased tissues.

Myo/Nog cells were discovered in the chick embryo epiblast. Their expression of MyoD reflects a commitment to the skeletal muscle lineage and capacity to differentiate into myofibroblasts. Release of Noggin by Myo/Nog cells is essential for normal morphogenesis. Myo/Nog cells rapidly respond to wounding in the skin and eyes. In this report, we present evidence suggesting that Myo/Nog cells phagocytose tattoo ink in tissue sections of human skin and engulf cell corpses in cultures of anterior human lens tissue and magnetic beads injected into the anterior chamber of mice in vivo. Myo/Nog cells are distinct from macrophages in the skin and eyes indicated by the absence of labeling with an antibody to ionized calcium binding adaptor molecule 1. In addition to their primary roles as regulators of BMP signaling and progenitors of myofibroblasts, Myo/Nog cells behave as nonprofessional phagocytes defined as cells whose primary functions are unrelated to phagocytosis but are capable of engulfment.

In 3 experiments, the authors examined how misalignment of egocentric and exocentric reference frames affects cardinal direction judgments. Experiments 1 and 2 demonstrated large differences in the accuracy and speed with which 104 less experienced and 7 experienced navigators made cardinal direction judgments. Reference-frame misalignment was associated with large performance decrements. The extent of these decrements diminished as ability and experience increased: however, even experienced navigators showed decrements when reference frames were misaligned. In Experiment 3, the authors used 55 college students to examine the individual subtasks of a common strategy for cardinal direction judgments and to isolate the effects of reference-frame misalignment to a particular subtask of this strategy. The tasks and strategies studied in this article can be applied in the development of navigational training and interfaces.

Compares the effects of traditional and block schedules on the academic achievement of high school students with and without disabilities. Finds no difference in academic achievement for either students with or those without disabilities whether enrolled in highs schools with traditional scheduling or those with block scheduling. (Contains 3 tables and 47 references.)(PKP)

Describes six programs: special-needs instructional support services, Lakeshore Technical College, Wisconsin; services for deaf and hard of hearing, Hinds Community College, Mississippi; program accessibility committee, Florence-Darlington Technical College, South Carolina; Project ABLE, Metropolitan Community College, Missouri; Center for Special Needs, Milwaukee Area Technical College; and Office of Disability Services, Springfield Technical Community College, Massachusetts. (SK)

Describes the Wisconsin Technical College System's special needs staff leadership in supporting transition to technical colleges, increasing funding that colleges receive from the Division of Vocational Rehabilitation, and supporting professional development activities for college special needs staff. (SK)

Traditional diagnostic intelligent tutoring systems (ITS) are usually intended to be used as standalones whereas nondiagnostic tutors are designed for collaborative learning among students and between teachers and students. This article describes diagnostic and nondiagnostic ITSs, proposes a framework for comparing features of diagnostic and nondiagnostic tutors, and presents data on the effectiveness of each type. (51 references) (PEN)

This research investigated how college students learned an efficient troubleshooting strategy, elimination. The subjects' task was to find the broken components in networks that were similar to digital circuits. With only minimal training in this task, subjects usually used a strategy of backtracking from the incorrect network outputs, instead of the more efficient elimination strategy, which involves backtracking but also eliminating (ignoring) components that lead into good network outputs. Computer simulation modeling suggested that in order for subjects to learn the eUmination strategy on their own, they needed to apply (1) certain key domain-specific knowledge about h o w the components worked, and (2) the general reductio-ad-absurdum problem-solving strategy. A n experiment showed that these two kinds of knowledge do enable students to increase their use of elimination, thus supporting the model.

Guidelines for instituting or revising an on-the-job-training program for handicapped students focus on three key considerations: program sequencing, program content, and employer involvement. (CL)

Describes the "Replicating Jobs in Business and Industry for Persons with Disabilities" project at the University of Wisconsin-Madison. The project identifies successful role models for disabled youth and employers who have made accommodations for disabled employees. Includes guidelines for advocates of the disabled. (CH)

Administrative, curricular, and instructional decisions involved in serving mainstreamed students in vocational education are listed, and considerations in modifying or adjusting equipment for the mainstreamed student are noted. (CL

Meaningful program evaluation is essential to interagency collaboration for handicapped persons. A team approach to developing an evaluation strategy must take into account factors within four stages of the evaluation process: 1) focusing, 2) planning, 3) implementing the evaluation, and 4) disseminating results and assessing the evaluation project itself. (CL)

The authors present an informal assessment strategy format to aid teachers in meeting the needs of the handicapped student. The format includes an assessment sequence, how to analyze assessment results, and how to interpret results. (CT)