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BackgroundChronic pain is a common problem in adolescents that can negatively impact all aspects of their health-related quality of life. The developmental period of adolescence represents a critical window of opportunity to optimize and solidify positive health behaviors and minimize future pain-related disability and impaired work productivity. This research focuses on the development and evaluation of a smartphone-based pain self-management app for adolescents with chronic pain. ObjectiveThe objectives of this study were to characterize (1) the feasibility of deploying a mobile health (mHealth) app (iCanCope) to the personal smartphones of adolescent research participants; (2) adherence to daily symptom tracking over 55 consecutive days; (3) participant interaction with their symptom history; and (4) daily pain-related experiences of adolescents with chronic pain. MethodsWe recruited adolescents aged 15-18 years from 3 Canadian pediatric tertiary care chronic pain clinics. Participants received standardized instructions to download the iCanCope app and use it once a day for 55 days. Detailed app analytics were captured at the user level. Adherence was operationally defined as per the relative proportion of completed symptom reports. Linear mixed models were used to examine the trajectories of daily symptom reporting. ResultsWe recruited 60 participants between March 2017 and April 2018. The mean age of the participants was 16.4 (SD 0.9) years, and 88% (53/60) of them were female. The app was deployed to 98% (59/60) devices. Among the 59 participants, adherence was as follows: low (4, 7%), low-moderate (14, 24%), high-moderate (16, 27%), and high (25, 42%). Most (49/59, 83%) participants chose to view their historical symptom trends. Participants reported pain intensity and pain-related symptoms of moderate severity, and these ratings tended to be stable over time. ConclusionsThis study indicates that (1) the iCanCope app can be deployed to adolescents’ personal smartphones with high feasibility; (2) adolescents demonstrated moderate-to-high adherence over 55 days; (3) most participants chose to view their symptom history; and (4) adolescents with chronic pain experience stable symptomology of moderate severity. Trial RegistrationClinicalTrials.gov NCT02601755; https://clinicaltrials.gov/ct2/show/NCT02601755 (Archived by WebCite at http://www.webcitation.org/74F4SLnmc)

BackgroundThe current landscape of a rapidly aging population accompanied by multiple chronic conditions presents numerous challenges to optimally support the complex needs of this group. Mobile health (mHealth) technologies have shown promise in supporting older persons to manage chronic conditions; however, there remains a dearth of evidence-informed guidance to develop such innovations. ObjectivesThe purpose of this study was to conduct a scoping review of current practices and recommendations for designing, implementing, and evaluating mHealth technologies to support the management of chronic conditions in community-dwelling older adults. MethodsA 5-stage scoping review methodology was used to map the relevant literature published between January 2005 and March 2015 as follows: (1) identified the research question, (2) identified relevant studies, (3) selected relevant studies for review, (4) charted data from selected literature, and (5) summarized and reported results. Electronic searches were conducted in 5 databases. In addition, hand searches of reference lists and a key journal were completed. Inclusion criteria were research and nonresearch papers focused on mHealth technologies designed for use by community-living older adults with at least one chronic condition, or health care providers or informal caregivers providing care in the home and community setting. Two reviewers independently identified articles for review and extracted data. ResultsWe identified 42 articles that met the inclusion criteria. Of these, described innovations focused on older adults with specific chronic conditions (n=17), chronic conditions in general (n=6), or older adults in general or those receiving homecare services (n=18). Most of the mHealth solutions described were designed for use by both patients and health care providers or health care providers only. Thematic categories identified included the following: (1) practices and considerations when designing mHealth technologies; (2) factors that support/hinder feasibility, acceptability, and usability of mHealth technologies; and (3) approaches or methods for evaluating mHealth technologies. ConclusionsThere is limited yet increasing use of mHealth technologies in home health care for older adults. A user-centered, collaborative, interdisciplinary approach to enhance feasibility, acceptability, and usability of mHealth innovations is imperative. Creating teams with the required pools of expertise and insight regarding needs is critical. The cyclical, iterative process of developing mHealth innovations needs to be viewed as a whole with supportive theoretical frameworks. Many barriers to implementation and sustainability have limited the number of successful, evidence-based mHealth solutions beyond the pilot or feasibility stage. The science of implementation of mHealth technologies in home-based care for older adults and self-management of chronic conditions are important areas for further research. Additionally, changing needs as cohorts and technologies advance are important considerations. Lessons learned from the data and important implications for practice, policy, and research are discussed to inform the future development of innovations.

Virtual visits are a telehealth service where patients and providers communicate in real-time using audio and/or video technology. Setting up a virtual visit is complex and may pose challenges for some autistic adults. We conducted semi-structured interviews with autistic adults (n = 7), family members of autistic adults (n = 12), and clinic personnel (n = 6) from one US-based clinic and used thematic analysis to identify factors affecting usability of virtual visits. We found virtual visit preparation involves multiple contacts between clinic personnel and patients or family members via a variety of channels and usability was affected by technology considerations, logistical considerations, and expectations for visits. Participants said technological experience and using the patient portal enhanced usability, but technological issues could increase anxiety. Clinic personnel reported time constraints created logistical barriers to virtual visits; streamlining the process before the visit via the patient portal may improve the usability of virtual visits for autistic adults, family members, and clinic personnel. Participants also reported unclear expectations for virtual visits reduced usability and recommended reminders, instructional videos, and estimated wait-times to clarify expectations. While our findings are based on a single clinic, they may help inform usability improvement efforts in other clinics offering virtual visits for autistic adults.

Online educational marketplaces have seen remarkable growth, but have had little empirical investigation of the quality of materials, particularly in social studies. This exploratory study examined characteristics and quality of secondary U.S. history resources on TeachersPayTeachers.com. Findings show that activities were esthetically well-designed, but 70% were of "moderate" or "low" overall quality according to our rubric that assessed areas such as higher order thinking, connections to student experiences, and representations of multiple perspectives. Thirty percent of the activities were found to be potentially harmful to students. We discuss implications for teachers and online marketplace accountability.

Online educational marketplaces such as TeachersPayTeachers.com (TPT) have become popular among teachers, but the quality of materials offered is inconsistent. This descriptive study explored quality indicators for site materials. Examining a sample of TPT's 100 best-selling 11th-grade U.S. history activities, we compared overall quality scores (as evaluated by three experts) with user review metrics and store characteristics. Expert ratings were not correlated with average user ratings, the number of user ratings, qualitative user feedback, the resource's popularity rank, or marketing appeal. However, price and the seller's number of followers were positively correlated with expert ratings, albeit weakly. These findings highlight how for-profit educational marketplaces constrain teachers' ability to access and evaluate curricular materials. Ways forward for teachers, teacher educators, and the for-profit platforms are discussed.

Autistic adults experience barriers to primary care, including distant/inaccessible clinics, sensory stressors, and communication barriers with providers. Synchronous telehealth visits, termed "virtual visits," may be a way to minimize these barriers. We investigated the advantages and disadvantages of primary care virtual visits using a phenomenological approach. We interviewed autistic adults (n = 7) and caregivers of autistic adults (n = 12) from one primary care clinic. Using thematic analysis, we identified three advantages to virtual visits: (1) increased patient comfort from avoiding travel to the clinic, crowded waiting rooms, and other sensory stressors; (2) increased safety by avoiding physical contact with others who may be sick; and (3) similar or better patient--provider communication than in-person visits. Disadvantages included the following: (1) Internet instability and other technological issues, (2) the inability to receive hands-on care from the provider, and (3) reduced patient engagement due to environmental distractions. Virtual visits may minimize barriers to care for autistic adults by reducing travel time, exposure to sensory stressors, and barriers to communication with the provider. While we recognize that virtual visits may not be appropriate for all patients or in all situations, they may be a promising model of health care delivery for autistic adults.

In this research, we explore the potential for computational thinking (CT) to benefit the spatial reasoning abilities of thirty-three middle-school students (aged 11-13) in grades 6 and 7. There is an increasing focus on the explicit development of spatial reasoning throughout the mathematics curriculum, such as geometry, as students' success in mathematics is largely tied to their spatial reasoning abilities. CT provides a method through which numerous mathematics concepts can be taught or explored, but also offers an avenue through which spatial reasoning skill can be developed. We used the block programming website Scratch and programmable robotics in weekly 'coding clubs' run in two different elementary school classrooms for 10 weeks each. Lessons were structured to develop students' CT abilities and mathematical reasoning, as well as being tied to their mathematics units such as geometry and number sense. Pre- and post-test data measured student spatial reasoning. Qualitative data in the form of student journal responses and teacher and researcher observations further illustrate incidents of learning which benefitted students' spatial reasoning abilities. Our results found improvement over time. Implications for classroom instruction and further research will be discussed.

In 2017, the Interagency Autism Coordinating Committee, a federal advisory panel consisting of autism researchers and community members, recommended that funders of autism research prioritize research projects on: (1) treatments/interventions, (2) evidence-based services, and (3) lifespan issues. We sought to describe research funding since this recommendation was made. We searched the databases of the three largest federal funders of autism research in the United States (National Institutes of Health, Department of Education, and Centers for Disease Control and Prevention) for grants awarded during 2017-2019. We categorized grants as follows: autism screening and diagnosis, biology, risk factors, treatments and interventions, services, lifespan issues, or infrastructure and surveillance. We found that funding patterns remained largely consistent during 2017-2019. Biological research received a relative majority of funding (32.59%), followed by treatments and interventions (22.87%). While given higher funding priority by the Interagency Autism Coordinating Committee's recent budget recommendation, fewer funds were awarded to research areas like services (5.02%) and lifespan issues (2.51%), indicating a misalignment between funding patterns and the Interagency Autism Coordinating Committee budget recommendation. These findings emphasize the need for autism research funding to align with the Interagency Autism Coordinating Committee budget recommendations to best meet the needs of the autism community, particularly autistic younger, middle-aged, and older adults.

Today, millions of teachers search online to locate ideas and activities for classroom use. While some may visit established curricular sites with vetted classroom materials, many others turn to online educational marketplaces such as TeachersPayTeachers. However, issues of quality on these sites remain in question -- particularly when it comes to the extent to which diverse perspectives are included or excluded. Leanna Archambault, Catharyn Shelton, and Lauren McArthur Harris highlight concerns surrounding the limited perspectives present in online educational marketplaces and provide research-driven guidelines for educators evaluating resources from such sites.

Introduction Due to the disproportionate impact of COVID-19 on communities of color, racial disparities in maternal mortality and morbidity are likely to increase. However, neighborhood and social support factors have yet to be discussed as potential mechanisms by which COVID-19 can exacerbate racial disparities. Methods We examined literature on the role of neighborhood factors and social support on maternal health outcomes and provided analytical perspective on the potential impacts of COVID-19 on Black birthing people. Results Even prior to the pandemic, Black individuals were disproportionately impacted by psychosocial stress. However, the compounding effect of pre-existing and current pandemic psychosocial stressors may be a mechanism by which racial disparities are exacerbated and result in higher rates of maternal mortality and morbidity in Black women. Conclusion We recommend continued monitoring of data related to racial disparities in maternal mortality and morbidity throughout the pandemic. Given that Black women may be disproportionately impacted by psychosocial stress, it is necessary for leadership structures and communities to recognize the potential for worsening disparities and intervene., Author(s): Keri Carvalho [sup.1] , Anna Kheyfets [sup.1] , Blessing Lawrence [sup.1] , Alison Moky [sup.1] , Lauren Harris [sup.1] , Siwaar Abouhala [sup.1] , Ndidiamaka Amutah-Onukagha [sup.1] Author Affiliations: [...]

In this article, the authors detail a curriculum unit used by Ms. Brown and a second English Language Arts (ELA) teacher, Ms. Smith, with their high school students. The unit centered on a comparative genocide framework developed by the Comparative Genocide Project at Arizona State University. The framework detailed seven key themes common across genocides and was designed to extend genocide study beyond investigating single genocide events. Students analyzed survivor testimonies from the Holocaust and the Rwandan Genocide for evidence of those seven themes. They also completed a "reporting form" and a graphic organizer as part of the unit. While this article identifies aspects of the comparative genocide framework that were found beneficial for the students in this study, the authors also make clear the limitations of this study and plans for future iterations of this work.

This mixed-methods study explored the factors secondary history teachers use to determine historical content for their classrooms and the degree of perceived control in decision-making. Through a survey (N = 260) and follow-up interviews (n = 23), we found that secondary history teachers in the United States ranked historical significance most highly in their curricular decision-making, but the extent to which teachers felt they were able to exert control over curricular decisions was influenced by required assessments and other contextual factors. Nevertheless, many teachers also prioritized student interest and relevance when choosing historical content. Interviews revealed complexity in teachers' thinking and additional context-specific (dis)incentives (e.g., fear of controversy) regarding curricular choices. Implications for teacher education and policy are emphasized.

A growing number of autistic students enter the school system, many with the capabilities of doing grade-level work. For these students, there seems to be a lack of focus on executive functioning, self-regulation, daily living skills (DLS), and self-determination. The Independence Curriculum (IC) is a set of units addressing identified areas of challenges and supports autistic students. The study aimed to examine the effectiveness of the IC intervention with autistic middle school students on the autism spectrum (ASD). A convenience sample of thirteen 5th-grade participants diagnosed with ASD (n = 13) in an inclusive public school program was screened using a Middle School Checklist for eligibility for the IC to be used in middle school one time a week. Outcomes measures included the AIR Self-Determination Scale (AIR-S), Goal Attainment Scaling (GAS), and the Vineland Adaptive Behavior Scales-II (VABS-2)-Daily Living Skills Domain. The results of this study demonstrate a significant improvement in student reported self-determination on the AIR-S and 70% goal attainment in executive functioning and self-regulation. The IC can be an effective curriculum for increasing functional independence while facilitating self-determination in middle school autistic students.

Little is known about the extent to which the healthcare needs of autistic older adults with intellectual disability differ from autistic older adults without intellectual disability. We conducted a cross-sectional retrospective cohort study of Medicare claims data from 2016 to 2017 to compare the prevalence of physical and mental health conditions among autistic older adults (age 65+ years) with intellectual disability (N=2054) to autistic older adults without intellectual disability (N=2631). Medicare claims data consisted of records from inpatient hospitalizations and institutional outpatient visits (i.e. visits to hospital outpatient departments, rural health clinics, renal dialysis facilities, outpatient rehabilitation facilities, Federally Qualified Health Centers, and community mental health centers). Examination of the largest between-group differences revealed that autistic older adults with intellectual disability had 350% greater odds of epilepsy (odds ratio=4.5, 95% confidence interval=3.9-5.2), 170% greater odds of osteoporosis (odds ratio=2.7, 95% confidence interval=2.3-3.2), and 100% greater odds of gastrointestinal conditions (odds ratio=2.0, 95% confidence interval=1.8-2.2) but 80% lower odds of attention deficit disorders (odds ratio=0.2, 95% confidence interval=0.1-0.3), 70% lower odds of substance use disorders (odds ratio=0.3, 95% confidence interval=0.2-0.4), and 60% lower odds of suicidal ideation or intentional self-injury (odds ratio=0.4, 95% confidence interval=0.3-0.6). These findings highlight the importance of developing tailored health management strategies for the autistic older adult population as a function of intellectual disability status.

While the medical home has proven effective at improving continuity of care among other populations, there is a paucity of literature testing the effectiveness of medical homes in serving the healthcare needs of autistic adults. We conducted a retrospective cohort study to compare the continuity of care of autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the Center for Autism Services and Transition (CAST), to propensity score matched national samples of autistic adults with private insurance or Medicare. The unadjusted median Bice-Boxerman continuity of care index was 0.6 (interquartile range = 0.4-1.0) for CAST patients, 0.5 (interquartile range = 0.3-1.0) for Medicare beneficiaries, and 0.6 (interquartile range = 0.4-1.0) for privately insured autistic adults. In multivariable models controlling for demographic characteristics, on average, CAST patients had continuity of care indices that were 10% higher than national samples of autistic adult Medicare beneficiaries (p < 0.0001). Continuity of care among CAST patients did not significantly differ from that of the national sample of privately insured autistic adults (p = 0.08). Our findings suggest that medical homes, like CAST, may be a promising solution to improve healthcare delivery for the growing population of autistic adults.

Simple Summary: The landscape for medical therapy in head and neck squamous cell carcinoma has considerably evolved in the last few decades. While early-stage disease remains primarily managed with surgery and/or radiation therapy, immunotherapy and antibody-based therapy have been transformative and practice-changing for patients with recurrent and/or metastatic disease. Unfortunately, many patients ultimately develop resistance to these approaches, with limited options for subsequent treatment. A wide breadth of novel therapies has shown promise in preclinical and early-phase clinical settings, many of which are now undergoing translation into the clinical arena. Here, we provide a review of how medical therapy is used in the management of HNSCC, with a specific focus on active clinical trials, to inform the medical oncologist treating patients with this disease. Head and neck squamous cell carcinoma (HNSCC) is a complex cancer requiring a multidisciplinary approach. For patients with locally or regionally advanced disease, surgery and/or radiation are the cornerstones of definitive treatment. Medical therapy plays an important adjunct role in this setting, typically consisting of a platinum-based regimen given as induction, concurrent, or adjuvant treatment. While relapsed/metastatic HNSCC has historically been a difficult-to-treat disease with poor outcomes, options have considerably improved with the incorporation of biologics and immune checkpoint inhibitors. Clinical trials are ongoing to investigate novel approaches, including new and combination immunotherapies, targeted therapies, therapeutic vaccines, antibody–drug conjugates, and cellular therapies. The results thus far have been mixed, highlighting the knowledge gaps that continue to challenge the medical oncologist treating HNSCC. Here, we present the most updated and broad review of the current treatment landscape in both locoregional and metastatic HNSCC and discuss the expansive future medical therapies under investigation. [ABSTRACT FROM AUTHOR]

The culture wars concerning what history should be taught in U.S. schools are often played out through the release of new state or national history/social studies standards or the textbooks aligned with those standards. Despite their oft-politicized status, every state now has history standards. However, these standards take on different forms in the states, and the amount of perceived control that history teachers have over content topics to teach varies from state to state. Studies have shown that standards can play an important role for teachers in deciding how and what is taught in classrooms. However, with the rise of the standards and accountability movements over the past few decades, less is known about how history standards present choice to teachers in what content they teach. In this study, the authors use a content analysis of fifty-one secondary history state standards to advance an argument about the role that history content standards can play in history teaching and teacher education. While teachers may perceive state standards as necessary burdens to bear or obstacles to be avoided, the authors begin with the principle that they can be a tool that empowers teachers to make reasoned planning and instructional decisions that meet the needs of their students--however, as the study found, the degree to which the standards function in this way currently varies among states.

While there is emerging evidence on the prevalence of physical and mental health conditions among autistic adults, less is known about this population's needs during older adulthood (aged 65+). We conducted a cross-sectional retrospective cohort study of 2016-2017 Medicare data to compare the prevalence of physical and mental health conditions in a national sample of autistic older adults (N = 4685) to a matched population comparison (N = 46,850) cohort. Autistic older adults had significantly greater odds of nearly all physical health conditions including epilepsy (odds ratio = 18.9; 95% confidence interval = 17.2-20.7), Parkinson's disease (odds ratio = 6.1; 95% confidence interval = 5.3-7.0), and gastrointestinal conditions (odds ratio = 5.2; 95% confidence interval = 4.9-5.5). Most mental health conditions were more common among autistic older adults, including schizophrenia and psychotic disorders (odds ratio = 25.3; 95% confidence interval = 22.4-28.7), attention deficit disorders (odds ratio = 24.4; 95% confidence interval = 16.2-31.0), personality disorders (odds ratio = 24.1; 95% confidence interval = 17.8-32.5), and suicidality or self-inflicted injury (odds ratio = 11.1; 95% confidence interval = 8.9-13.8). Health conditions commonly associated with advanced age in the general population (e.g. osteoporosis, cognitive disorders, heart disease, cancer, cerebrovascular disease, osteoarthritis) were also significantly more common among autistic older adults. By highlighting the significant physical and mental health needs for which autistic older adults require care, our findings can inform healthcare systems, healthcare providers, and public health initiatives seeking to promote well-being in this growing population.

Breast cancer patients often experience adverse physical side effects of medical treatments. According to the biobehavioral model of cancer stress and disease, life stress during diagnosis and treatment may negatively influence the trajectory of women's physical health-related adjustment to breast cancer. This longitudinal study examined chronic and episodic stress as predictors of bothersome physical symptoms during the year after breast cancer diagnosis. Women diagnosed with breast cancer in the previous 4 months (N = 460) completed a life stress interview for contextual assessment of chronic and episodic stress severity at study entry and 9 months later. Physical symptom bother (e.g., pain, fatigue) was measured at study entry, every 6 weeks through 6 months, and at nine and 12 months. In multilevel structural equation modeling (MSEM) analyses, both chronic stress and episodic stress occurring shortly after diagnosis predicted greater physical symptom bother over the study period. Episodic stress reported to have occurred prior to diagnosis did not predict symptom bother in MSEM analyses, and the interaction between chronic and episodic stress on symptom bother was not significant. Results suggest that ongoing chronic stress and episodic stress occurring shortly after breast cancer diagnosis are important predictors of bothersome symptoms during and after cancer treatment. Screening for chronic stress and recent stressful life events in the months following diagnosis may help to identify breast cancer patients at risk for persistent and bothersome physical symptoms. Interventions to prevent or ameliorate treatment-related physical symptoms may confer added benefit by addressing ongoing non-cancer-related stress in women's lives.