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Background Pre-existing cardiovascular disease (CVD) or cardiovascular risk factors have been associated with an increased risk of complications following hospitalisation with COVID-19, but their impact on the rate of recovery following discharge is not known.Objectives To determine whether the rate of patient-perceived recovery following hospitalisation with COVID-19 was affected by the presence of CVD or cardiovascular risk factors.Methods In a multicentre prospective cohort study, patients were recruited following discharge from the hospital with COVID-19 undertaking two comprehensive assessments at 5 months and 12 months. Patients were stratified by the presence of either CVD or cardiovascular risk factors prior to hospitalisation with COVID-19 and compared with controls with neither. Full recovery was determined by the response to a patient-perceived evaluation of full recovery from COVID-19 in the context of physical, physiological and cognitive determinants of health.Results From a total population of 2545 patients (38.8% women), 472 (18.5%) and 1355 (53.2%) had CVD or cardiovascular risk factors, respectively. Compared with controls (n=718), patients with CVD and cardiovascular risk factors were older and more likely to have had severe COVID-19. Full recovery was significantly lower at 12 months in patients with CVD (adjusted OR (aOR) 0.62, 95% CI 0.43 to 0.89) and cardiovascular risk factors (aOR 0.66, 95% CI 0.50 to 0.86).Conclusion Patients with CVD or cardiovascular risk factors had a delayed recovery at 12 months following hospitalisation with COVID-19. Targeted interventions to reduce the impact of COVID-19 in patients with cardiovascular disease remain an unmet need.Trail registration number ISRCTN10980107.

BackgroundEvidence regarding differences in survival associated with the site of metastasis in triple-negative breast cancer (TNBC) remains limited. Our aim was to analyze the overall survival (OS), distant relapse free survival (DRFS), and survival since the diagnosis of the relapse (MS), according to the side of metastasis.MethodsThis was a retrospective study of TNBC patients with distant metastases at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru) from 2000 to 2014. Prognostic factors were determined by multivariate Cox regression analysis.ResultsIn total, 309 patients were included. Regarding the type of metastasis, visceral metastasis accounted for 41% and the lung was the most frequent first site of metastasis (33.3%). With a median follow-up of 10.2 years, the 5-year DRFS and OS were 10% and 26%, respectively. N staging (N2-N3 vs. N0, HR = 1.49, 95%CI: 1.04-2.14), metastasis in visceral sites (vs. bone; HR = 1.55, 95%CI: 0.94-2.56), the central nervous system (vs. bone; HR = 1.88, 95% CI: 1.10-3.22), and multiple sites (vs. bone; HR = 2.55, 95%CI:1.53-4.25) were prognostic factors of OS whereas multiple metastasis (HR = 2.30, 95% CI: 1.42-3.72) was a predictor of MS. In terms of DRFS, there were no differences according to metastasis type or solid organ.ConclusionTNBC patients with multiple metastasis and CNS metastasis have an increased risk of death compared to those with bone metastasis in terms of OS and MS.

Abstract Background Optimal infant and young child feeding practices (IYCFP) reduce childhood stunting and are associated with additional health benefits. In Tanzania, IYCFP are far from optimal where 32% of children under the age of 5 years are stunted. The purpose of this study was to examine whether behavior change communication focused on reducing child undernutrition was associated with improved IYCFP in Tanzania. Methods A cross-sectional survey was administered to approximately 10,000 households with children under the age of 2 at baseline and endline. Bivariate analyses and logistic regression was used to examine the relationship between exposure to behavior change communication and timely initiation of breastfeeding, exclusive breastfeeding, continued breastfeeding at one year, timely complementary feeding (CF), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). Results Mothers who heard a radio spot about IYCFP were more likely than mothers who had not heard a radio spot about IYCFP to begin complementary foods at six months. Their children were also more likely to achieve MMF, MDD, and MAD with odds ratios of 2.227 (p = 0.0061), 1.222 (p = 0.0454), 1.618 (p =

Background. Up to a quarter of inpatients in high-income countries (HICs) self-report beta-lactam allergy (BLA), which if incorrect,increases the use of alternative antibiotics, worsening individual health outcomes and driving bacterial resistance. In HICs, up to 95% ofself-reported BLAs are incorrect. The epidemiology of BLA in low- and middle-income African countries is unknown.Objectives. To describe the epidemiology and de-labelling outcomes of self-reported BLA in hospitalised South African (SA) patients.Methods. Point-prevalence surveys were conducted at seven hospitals (adult, paediatric, government and privately funded, district andtertiary level) in Cape Town, SA, between April 2019 and June 2021. Ward prescription records and in-person interviews were conductedto identify and risk-stratify BLA patients using the validated PEN-FAST tool. De-labelling was attempted at the tertiary allergy clinic atGroote Schuur Hospital.Results. A total of 1 486 hospital inpatients were surveyed (1 166 adults and 320 children). Only 48 patients (3.2%) self-reported a BLA,with a higher rate in private than in government-funded hospitals (6.3% v. 2.8%; p=0.014). Using the PEN-FAST tool, only 10.4% (n=5/48)of self-reported BLA patients were classified as high risk for true penicillin hypersensitivity. Antibiotics were prescribed to 70.8% (n=34/48)of self-reported BLA patients, with 64.7% (n=22/34) receiving a beta-lactam. Despite three attempts to contact patients for de-labelling atthe allergy clinic, only 3/36 underwent in vivo testing, with no positive results, and 1 patient proceeded to a negative oral challenge.Conclusion. Unlike HICs, self-reported BLA is low among inpatients in SA. The majority of those who self-reported BLA were low risk fortype 1 hypersensitivity, but outpatient de-labelling efforts were largely unsuccessful.

The purpose of this qualitative study was to understand, from the perspective of students with disabilities, what special education leaders and their respective classroom educators should consider in the integration of artificial intelligence (AI) features and tools to support individualized instruction. This study utilized an immersive and interactive personalized learning environment, virtual reality, to engage students with disabilities as they consider AI tools, features, and supports that are currently needed to enhance their learning experience. The five primary themes for AI integration that building and instructional special education leaders should consider included: (1) response options; (2) content; (3) learning environment and virtual characters; (4) visuals; and (5) sound or auditory supports. As special education leaders seek to determine how best to navigate growing AI tools and how and when to implement, this study, coming from the voice of students with disabilities, offers some immediate and pertinent suggestions within the context of current personalized learning efforts.

With the introduction of artificial intelligence (AI), specifically generative AI and large language models (e.g., ChatGPT, Google Gemini), into education, there is a conversation regarding what knowledge teachers still need and will need moving forward. In this article, we describe how AI can, and should, be aligned to the Technological Knowledge, Pedagogical Knowledge, and Content Knowledge (TPACK) framework, as a part of special education teacher preparation. Additionally, we explore the implications of AI on the TPACK framework, specifically how AI can be integrated within each of the three components, specific tools that support each aspect, and guiding questions that teacher-educators and pre-service teachers should be using when considering AI. We will provide teacher-educators with example activities they can use with their pre-service teachers to introduce AI and integrate its use within their curriculum, framed within the TPACK.

This study employed a critical inquiry paradigm to explore the significance of equity and social justice in teaching qualitative methodologies and methods to graduate students. Graduate students of multiple minoritized identities and a faculty member conducted a two-year inquiry into the research apprenticeship experience, including the stages of student-led conceptualization, data collection, analysis, international conference presentation, and publication. The study investigated the experiences of the faculty and students as well as the responsibilities of the institution against the backdrop of historical and contemporary pandemics. Consequently, we problematized hidden curriculum and unconscious assumptions to suggest research course design sequencing improvements. The findings emphasize the impact of these experiences on qualitative research teaching and learning practices and institutional responsibility to graduate student research apprenticeships. The Graduate Research Apprenticeship Nested Design Pathway is presented as a tool that institutions worldwide can adapt and implement to serve the complex needs of their students.

Objective Determine the pharmacokinetics (PK) and exposure–response of hydroxychloroquine (HCQ) and desethylhydroxychloroquine (DHCQ) in paediatric SLE (pSLE).Methods We conducted an exploratory phase 2, direct-to-family trial. Children enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry with a diagnosis of pSLE were eligible if they were receiving HCQ as standard of care for ≥3 months. Biological samples were collected at up to four visits over a 6-month period. At each visit, plasma was obtained to measure the concentrations of HCQ and DHCQ, as well as cytokines. HCQ and DHCQ plasma PK data were analysed using a population PK modelling approach.Results Twenty-five subjects provided a total of 88 plasma concentrations for PK analysis. There was a poor linear fit between HCQ concentrations and total body weight (R2=0.03). There was a decline in both interferon (IFN)-alpha and IFN-gamma with higher concentrations of HCQ and DHCQ. Volume of distribution for HCQ in plasma was higher in children compared with published values in adults (73 000 L vs 44 000 L), but clearance values in children were similar to adults.Conclusions We report the first population PK model for HCQ and DHCQ in children using data from a novel direct-to-family clinical trial. We observed high interindividual variability in HCQ PK and found that weight-based dosing for HCQ is poorly correlated with drug concentrations, suggesting the need to use therapeutic drug monitoring to individualise dosing. Furthermore, our results suggest that the current weight-based dosing paradigm for HCQ may result in suboptimal drug exposures, particularly for children with obesity. Accordingly, additional studies of HCQ are needed in pSLE to determine the optimal drug concentration and dosing to reduce disease activity and improve outcomes.Trial registration number NCT04358302.

Use of telehealth assessments for toddlers at increased likelihood of autism spectrum disorder (ASD) began prior to the global COVID-19 pandemic; however, the value of telehealth assessments as an alternative to in-person assessment (IPA) became clearer during the pandemic. The Naturalistic Observation Diagnosis Assessment (NODA™), previously demonstrated as a valid and reliable tool to evaluate asynchronous behaviors for early diagnosis, was enhanced to add synchronous collection of behaviors to assist clinicians in making a differential diagnosis of ASD. This study was conducted to validate the information gathered through NODA-Enhanced (NODA-E™) as compared to a gold standard IPA. Forty-nine toddlers aged 16.0-32.1 months of age, recruited through community pediatric offices and a tertiary ASD clinic, participated in both NODA-E and IPA assessments. There was high agreement between the two assessment protocols for overall diagnosis (46 of 49 cases; 93.6%; [kappa] = 0.878), specific diagnostic criteria for social communication and social interaction (SCI; range 95.9-98%; [kappa] = 0.918-0.959), and for two of four criteria specified for restricted and repetitive behaviors (RRB; range 87.8-98%; [kappa] = 0.755 and 0.959). There was lower agreement for two subcategories of RRBs (range 65.3-67.3%; [kappa] = 0.306 and 0.347). NODA-E is a tool that can assist clinicians in making reliable and valid early ASD diagnoses using both asynchronous and synchronous information gathered via telehealth and offers an additional tool within a clinician's assessment toolbox.

This study investigated the predictive effect of 11th grade Taiwanese students' (N = 878) self-assessed critical thinking, group participation self-efficacy, and active learning on their genuine learning interest (GLI) in socio-scientific issues (SSI). Results showed that active learning had a direct effect on GLI, while critical thinking and group participation self-efficacy had indirect effects on GLI as mediated by active learning. Critical thinking showed a significant direct effect on active learning, and a significant indirect effect on active learning that was mediated by group participation self-efficacy.

There is a nationwide shortage of special education teachers (SETs) due, in part, to unmanageable workload expectations, which has reached crisis level. SETs are expected to modify, adapt, and accommodate general education curriculum to meet the needs of their students, communicate and collaborate with parents and general education teachers, and progress monitor on IEP goals, to name a few. SETs, especially those in more restrictive self-contained settings, report spending almost half of their time completing non-teaching tasks. One emerging and innovative solution to help SETs accomplish these tasks is using Artificial Intelligence (AI). AI powers many popular educational tools, such as predictive text, adaptive learning platforms, and digital assistants. The launch of ChatGPT, Bard, and other generative pre-trained transformers (GPTs), provides an opportunity to support SETs with some of the paperwork requirements. This is due to the GPTs ability to craft human-like responses via drafting essays, emails, lists, and the like. In this article, we provide step-by-step directions to use ChatGPT. Additionally, we illustrate how GPTs can be used to operationalize, automate, and streamline many of the SET's non-teaching tasks through specific examples of its use in (1) collaboration; (2) adapting readings; and (3) developing progress monitoring assessments.

The purpose of this descriptive review of nine research studies was to explore the types of educational technologies used with SWDs to support written expression (WE), the implementation of the educational technology for WE, and the methods and domains WE outcomes are measured. This review focused on: (1) the technologies utilized in combination with WE outcomes; (2) student demographics, background experience and knowledge of technology, and the training they received for the educational technology in the intervention; (3) strategy use for WE and the accompanying student training; and (4) the instrumentation and WE criteria assessed. Based on the results of this review, we provide recommendations for future research around educational technologies to support WE.

Editing and revising is a necessary, yet complex, stage of the writing process that is challenging for students with and without disabilities. One solution to improve overall writing outcomes is with strategy instruction, such as the Strategic Instruction Model for writing. More specifically, strategies such as the Error Monitoring Strategy, that support editing and revising. Additionally, with the increase in access to devices, and the continued development of tools that support writing, these strategies should be aligned to technologies to further support students with learning disabilities and other struggling writers. Simply providing teaching strategies to students and providing them with devices is not enough to improve writing outcomes. Rather, explicit instruction in the strategy and the tool, along with how to use them together, is necessary. The purpose of this article is to offer an example of how educators can combine effective writing strategy instruction with readily and easily available technology tools to support the needs of students who struggle with writing.

Objectives COVIDTrach is a UK multicentre prospective cohort study project that aims to evaluate the outcomes of tracheostomy in patients with COVID-19 receiving mechanical ventilation and record the incidence of SARS-CoV-2 infection among healthcare workers involved in the procedure.Design Data on patient demographic, clinical history and outcomes were entered prospectively and updated over time via an online database (REDCap). Clinical variables were compared with outcomes, with logistic regression used to develop a model for mortality. Participants recorded whether any operators tested positive for SARS-CoV-2 within 2 weeks of the procedure.Setting UK National Health Service departments involved in treating patients with COVID-19 receiving mechanical ventilation.Participants The cohort comprised 1605 tracheostomy cases from 126 UK hospitals collected between 6 April and 26 August 2020.Main outcome measures Mortality following tracheostomy, successful wean from mechanical ventilation and length of time from tracheostomy to wean, discharge from hospital, complications from tracheostomy, reported SARS-CoV-2 infection among operators.Results The median time from intubation to tracheostomy was 15 days (IQR 11, 21). 285 (18%) patients died following the procedure. 1229 (93%) of the survivors had been successfully weaned from mechanical ventilation at censoring and 1049 (81%) had been discharged from hospital. Age, inspired oxygen concentration, positive end-expiratory pressure setting, fever, number of days of ventilation before tracheostomy, C reactive protein and the use of anticoagulation and inotropic support independently predicted mortality. Six reports were received of operators testing positive for SARS-CoV-2 within 2 weeks of the procedure.Conclusions Tracheostomy appears to be safe in mechanically ventilated patients with COVID-19 and to operators performing the procedure and we identified clinical parameters that are predictive of mortality.Trial registration number The study is registered with ClinicalTrials.Gov (NCT04572438).

Black, Indigenous, and Persons of Color (BIPOC) autistic transition-aged youth (TAY) report lower rates of competitive employment compared to White autistic TAY and even greater deficits with social skills associated with positive job interviewing. A virtual job interviewing program was adapted to support and improve the job interviewing skills of autistic TAY. The current study evaluates the effectiveness of an efficacious virtual interview training program on the job interview skills, interview anxiety, and likeliness to be hired, for a subsample of 32 BIPOC autistic TAY, ages 17-26 years old from a previous randomized control trial of the program. Bivariate analyses were used to evaluate between-group differences at pre-test related to background characteristics, and whether Virtual Interview Training for Transition-Age Youth (VIT-TAY) was associated with changes between pre-test and post-test measures of job interview skills. Additionally, a Firth logistic regression was conducted to examine the relationship between VIT-TAY and competitive integrative employment at 6 months, covarying for fluid cognition, having ever had a job interview, and baseline employment status. Participants receiving pre-employment services (Pre-ETS) and virtual interview training had better job interview skills (F = 12.7, [rho] < 0.01; [partial eta-squared] =0.32, lower job interview anxiety (F = 0.3.96, [rho] < 0.05; [partial eta-squared] = 0.12), and a higher likeliness of receiving employment (F = 4.34, [rho] < 0.05; [partial eta-squared] =0.13 at the 6-month follow up compared to participants that only had Pre-ETS. Findings from this study suggest that virtual interview training for TAY is effective for BIPOC autistic TAY in improving their interview skills to gain competitive employment and lower their job interview anxiety.

Existing literature attests to the importance of assessing the learning enjoyment and learning interest of students toward socio-scientific issues (SSI). However, there are few existing studies that examine how ecological stimuli, which are crucial to young learners' perceptual development and the shaping of ethical judgment, predict their learning enjoyment and learning interest in SSI. This investigation addresses this gap in the available literature by investigating and assessing the effects of self-perceived influences of three ecological stimuli constructs--textbooks, family/classmates, and news media--on a learning interest in SSI construct and a learning enjoyment from SSI construct among Taiwanese high school students. A structural equation model consisting of these five constructs was fitted to data collected from 966 students. Results show that influence on students' ethical judgments from textbooks and news media directly predict learning interest in SSI, with effects partially mediated by learning enjoyment from SSI. The influence of family/classmates on students' learning interest was fully mediated by learning enjoyment. The role of enjoyment and learning interest as predictors of these outcomes is discussed within the context of genuine interest in learning SSI content. The value and implications of these results for science education specialists and interest researchers are forwarded and suggested directions of future investigation submitted.

Few studies have examined differences in autism spectrum disorder (ASD) phenotype between children from multiplex and simplex families at the time of diagnosis. The present study used an age- and gender-matched, community-based sample (n = 105) from the southwestern United States to examine differences in ASD symptom severity, cognitive development, and adaptive functioning. No significant differences between children from multiplex and simplex families were observed. Exploratory analysis revealed that parents underreported receptive and expressive language and fine motor skills compared to professional observation, especially among children from multiplex families. These findings suggest that diagnosticians may need to consider family structure when choosing and interpreting assessments of receptive language, expressive language, and fine motor skills.

School absenteeism among children and adolescents has been associated with a myriad of adverse outcomes. Despite a substantial amount of research on school attendance, our understanding of absenteeism in elementary-aged children with mental health difficulties is limited. The current study used a mixed-method sequential explanatory design to gain a better understanding of the links between children's mental health symptoms, age, gender and school absenteeism. The study included two phases: Phase I presented a quantitative investigation of the links between absenteeism and mental health symptoms in a large sample (N = 750) of primarily White (74%) clinic-referred children aged 5-12 years. Phase II used a participant selection model and chart review design to garner a deeper understanding of how school absenteeism presents in children with mental health problems in the elementary years. Results suggested that internalizing symptoms were significantly related to school attendance problems, and this association worsens as children age and as internalizing symptoms increase in severity. Externalizing symptoms were associated with absenteeism as well, but these findings showed that school attendance problems were worse for younger children with low to moderate levels of externalizing symptoms. The qualitative chart review illustrates the complex interplay of school absenteeism and child mental health, particularly for children experiencing co-occurring internalizing and externalizing problems. Children often struggled academically and socially, with some exhibiting increasing levels of school refusal and truancy and others displaying aggressive behaviors resulting in suspensions. Future studies that examine additional contextual factors, such as school and family variables, with longitudinal cross-lagged models and diverse families are needed to develop a comprehensive understanding of causal associations and their impact on children's school attendance across children's development.

Introduction Tourniquets are routinely used during total knee replacement (TKR) surgery. They could increase the risk of thromboembolic events including cerebral emboli, cognitive decline, pain and other adverse events (AEs). A randomised controlled trial to assess whether tourniquet use might safely be avoided is therefore warranted but it is unclear whether such a trial would be feasible.Methods In a single-site feasibility study and pilot randomised controlled trial, adults having a TKR were randomised to surgery with an inflated tourniquet versus a non-inflated tourniquet. Participants underwent brain MRI preoperatively and within 2 days postoperatively. We assessed cognition using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Oxford Cognitive Screen (OCS) and thigh pain using a Visual Analogue Scale at baseline and days 1 and 2, and 1 week postsurgery. AEs related to surgery were recorded up to 12 months.Results We randomised 53 participants (27 tourniquet inflated and 26 tourniquet not inflated). Fifty-one participants received care per-protocol (96%) and 48 (91%) were followed up at 12 months. One new ischaemic brain lesion was detected. Of the cognitive tests, MoCA was easy to summarise, sensitive to change with lower ceiling effects compared with OCS and MMSE. There was a trend towards more thigh pain (mean 49.6 SD 30.4 vs 36.2 SD 28 at day 1) and more AEs related to surgery (21 vs 9) in participants with an inflated tourniquet compared with those with a tourniquet not inflated.Conclusion A full trial is feasible, but using MRI as a primary outcome is unlikely to be appropriate or feasible. Suitable primary outcomes would be cognition measured using MoCA, pain and AEs, all of which warrant investigation in a large multicentre trial.Trial registration number ISRCTN20873088.

Wheat rusts are the key biological constraint to wheat production in Ethiopia-one of Africa's largest wheat producing countries. The fungal diseases cause economic losses and threaten livelihoods of smallholder farmers. While it is known that wheat rust epidemics have occurred in Ethiopia, to date no systematic long-term analysis of past outbreaks has been available. We present results from one of the most comprehensive surveillance campaigns of wheat rusts in Africa. More than 13,000 fields have been surveyed during the last 13 years. Using a combination of spatial data-analysis and visualization, statistical tools, and empirical modelling, we identify trends in the distribution of wheat stem rust (Sr), stripe rust (Yr) and leaf rust (Lr). Results show very high infection levels (mean incidence for Yr: 44%; Sr: 34%; Lr: 18%). These recurrent rust outbreaks lead to substantial economic losses, which we estimate to be of the order of 10s of millions of US-D annually. On the widely adopted wheat variety, Digalu, there is a marked increase in disease prevalence following the incursion of new rust races into Ethiopia, which indicates a pronounced boom-and-bust cycle of major gene resistance. Using spatial analyses, we identify hotspots of disease risk for all three rusts, show a linear correlation between altitude and disease prevalence, and find a pronounced north-south trend in stem rust prevalence. Temporal analyses show a sigmoidal increase in disease levels during the wheat season and strong inter-annual variations. While a simple logistic curve performs satisfactorily in predicting stem rust in some years, it cannot account for the complex outbreak patterns in other years and fails to predict the occurrence of stripe and leaf rust. The empirical insights into wheat rust epidemiology in Ethiopia presented here provide a basis for improving future surveillance and to inform the development of mechanistic models to predict disease spread.

Objectives Informing research participants of the results of studies in which they took part is viewed as an ethical imperative. However, there is little guidance in the literature about how to do this. The Fluoxetine Or Control Under Supervision trial randomised 3127 patients with a recent acute stroke to 6 months of fluoxetine or placebo and was published in the Lancet on 5 December 2018. The trial team decided to inform the participants of the results at exactly the same time as the Lancet publication, and also whether they had been allocated fluoxetine or placebo. In this report, we describe how we informed participants of the results.Design In the 6-month and 12-month follow-up questionnaires, we invited participants to provide an email address if they wished to be informed of the results of the trial. We re-opened our trial telephone helpline between 5 December 2018 and 31 March 2019.Setting UK stroke services.Participants 3127 participants were randomised. 2847 returned 6-month follow-up forms and 2703 returned 12-month follow-up forms; the remaining participants had died (380), withdrawn consent or did not respond.Results Of those returning follow-up questionnaires, a total of 1845 email addresses were provided and a further 50 people requested results to be sent by post. Results were sent to all email and postal addresses provided; 309 emails were returned unrecognised. Seventeen people replied, of whom three called the helpline and the rest responded by email.Conclusion It is feasible to disseminate results of large trials to research participants, though only around 60% of those randomised wanted to receive the results. The system we developed was efficient and required very little resource, and could be replicated by trialists in the future.Trial registration number ISRCTN83290762; Post-results.

BackgroundThe aim of this study was to determine the utility of the neutrophil-to-lymphocyte ratio (NLR) as a biomarker for predicting early-mortality (MethodsWe reviewed 118 medical records of females with mTNBC. The cut-off value for the NLR (ResultsThe median follow-up was 24 months. Females with NLR ≥2.5 had a poor overall survival compared to females with NLR ConclusionThe NLR is an accessible and reliable biomarker that predicts early mortality among females with mTNBC. Our results suggest that females with high NLR values have poor prognosis despite receiving standard chemotherapy. Health providers should evaluate the possibility to enroll these patients in novel immunotherapy trials.

Some university students face barriers to learning in physical classrooms, while others are reluctant to return to in-person learning environments because of COVID-19. Hybrid-flexible (HyFlex) learning environments give students the option to participate in-person or virtually, but there are concerns about student engagement and success. In this pre-pandemic study, we conducted a program-wide survey to explore student perceptions of and experiences with a HyFlex teaching and learning platform (n=238). Our survey data revealed that 86.17% of students find features of this platform helpful when accessing, engaging with, and learning course content. This was particularly true among students who reported having a flexible learning need. We also compared engagement with the HyFlex teaching and learning platform (calculated as a score out of 100 based on attendance and participation in interactive slides) and final grades between students who chose to participate predominantly in-person or online in two HyFlex offerings during the 2019/20 academic year. We found no significant difference in engagement or final grade between in-person dominant and online dominant learners in either course. We found a moderate correlation between engagement and final grade in both courses, such that highly engaged students achieved high grades regardless of their preferred mode of attendance. Our findings suggest that giving students the option to learn in-person or virtually from class to class does not negatively affect engagement or success and may in fact support success among students with flexible learning needs. As Canadian universities emerge from the pandemic, our findings remind us to retain the flexibility that virtual teaching and learning affords to support our diverse student bodies.

While there has been significant research on both how academic struggles impact college students, as well as factors that impact the sense of belonging for college students, there has been little research examining how a significant academic struggle impacts a students' perception of sense of belonging at that institution. This qualitative study explores how an academic struggle impacts students' sense of belonging at that institution, as well as other findings from this study.

Background. The concept of occupational justice was derived from a social justice perspective in response to a renewed commitment by the occupational therapy profession to address the occupational needs of individuals, groups and communities who experience social injustice. Accordingly, it is acknowledged that education with regard to occupational justice has the deliberate intention of preparing graduates, who would be change agents as critical practitioners. Nonetheless, while occupational therapy education programmes may seek to instil broader professional values, theory covered in the curriculum may not always assure congruent practice.Objective. To explore how occupational therapy graduates’ conceptualisations of occupational justice, as instilled by the occupational therapy curriculum of the University of the Western Cape, South Africa, manifested in their practice while undergoing community service.Methods. Seven occupational therapy graduates were selected to participate in the study through purposive sampling. A descriptive case study of their practice was generated through qualitative methods. Semi-structured interviews, document review and participant observation were used as data collection methods, analysed through a process of inductive thematic analysis.Results. The findings revealed that while the participants conceptualised occupational justice as broader social change through occupational enablement, they encountered several constraints related to structural and systemic power issues in their practice contexts.Conclusion. The study supports the utilisation of transformative learning and inter-professional education in developing critical competencies such as agency and political proficiency to assist graduates in dealing with the complexities of practice during community service.

Background: Research is needed to better understand the specific challenges for autistic learners in informal STEM learning settings. This study aimed to increase inclusion in STEM museums, with a larger goal of increasing the impact (i.e., learning and application of knowledge during and after visits) of informal STEM learning settings for autistic youth. We conducted an online parent attitudes survey with 93 parents of autistic adolescents and 53 parents of adolescents in the general population to better understand the experiences of autistic adolescents when visiting STEM-related museums. Parent responses informed professional development training for museum staff at four partner museums, which taught strategies to better support autistic learners. Then, autistic adolescents (n = 20) and their parents were randomly assigned to visit one partner and one control museum. They were asked to report their experiences through an online survey and semi-structured interviews. Results: Participants who completed the parent attitudes survey indicated significantly lower inclusion, engagement, and general impact of STEM museum visits among autistic adolescents compared to the general population comparison group. Parents of adolescents who visited partner and control museums reported higher STEM impact during visits to partner museums; however, parent-reported inclusion, engagement, and general impact did not differ significantly between partner and control museums. Qualitative analysis identified four themes (Spectrum of Museum Impact; Adolescent-Environment Fit; Barriers to Engagement, and Barrier Breakers), providing context for quantitative findings. Conclusions: Findings underscore the need for increased inclusion for autistic individuals in informal STEM learning environments like museums. This project demonstrated feasibility of professional development training of forward-facing staff and identified several themes that should inform future efforts to improve inclusion in informal STEM learning settings.

Virtual reality (VR) has evolved to include non-immersive to fully-immersive experiences for the classroom. This study seeks to understand the potential effects VR may offer, specifically characteristics associated with how a student experiences a VR intervention and the effects of using a VR device for learning. A group experimental design was used to compare a fully-immersive VR intervention and an identical non-immersive VR intervention for a group of middle school participants with ASD (N = 22). Participants were randomly assigned a screen-based VR experience or a head-mounted display VR experience through rolling randomization. Results indicate that while the more immersive condition did not produce higher acquisition than the non-immersive condition, both device conditions did produce significant increases in learning.

The present study investigates the correlation between teachers' implementation of Universal or Learning (UDL) in Mathematics and English/language arts (ELA) instruction and students' performance as measured by the state-wide standardised tests. Teacher participants included ELA and Mathematics teachers in grades 3-8 from a district in the United States in which the UDL framework had been adopted as a system-wide initiative. Student participants included all students in grades 3-8, including students identified with a disability, who took the state's standardised tests. In correlational analyses, findings showed a positive relationship between teachers who had higher UDL implementation scores and students who obtained higher standardised tests scores than the students of teachers who had lower UDL implementation scores.

Objective: This cross-sectional study examined the weight bias attitudes and obesity beliefs of health science (HS), nursing, and pre-medicine undergraduate students. Methods: Using snowballing and convenience sampling strategies, students (N = 139) completed an online survey, including a 24-item Antifat Attitudes Scale (AFAS) and eight-item Belief About Obese Persons (BAOP) scale. Results: HS students have higher weight bias than nursing and pre-medicine students combined (M = 43.45, SD = 10.75), t(137) = -2.45, p = 0.016). A negative correlation exists between AFAS and BAOP suggesting high weight bias influences a belief that obesity is controllable. Gender positively predicted weight bias attitudes ([beta] = -11.43, t = -4.33, p < 0.001) and obesity beliefs ([beta] = 3.75, t = 3.01, p = 0.003). Conclusions: Findings confirm that HS students have weight bias attitudes. This supports undergraduate curricular changes on obesity etiology that may improve treatment plans of individuals who are obese.

The COVID-19 pandemic caused worldwide educational disruption. This paper addresses a gap in the literature relating to the impact of the pandemic on learning experiences of children in rural communities in the Global South, particularly in earlier years of schooling. Children in these communities are at considerable disadvantage in comparison to their urban peers due to poor school infrastructure and challenges in recruitment and retention of teachers. Drawing on a mixed-methods study of primary school children, their teachers and families in rural Sierra Leone, both during and immediately after school closures, the paper highlights how primary schools and their communities responded to the pandemic and how this influenced children's engagement with their learning. While national planning focused on pandemic control measures and provision of some remote learning support, findings highlight challenges for poor rural communities in accessing basic learning supports and the consequent disruption to children's education.

Virtual Reality Job Interview Training (VR-JIT) and Virtual Interview Training for Transition Age Youth (VIT-TAY) demonstrated initial effectiveness at increasing employment among transition-age youth with disabilities engaged in pre-employment transition services. We characterized activities and estimated the labor and non-labor costs required to prepare schools to implement VR-JIT or VIT-TAY. Implementation preparation and support teams reported labor hours throughout the implementation preparation process. Implementation preparation labor hours at 43 schools cost approximately $1,427 per school, while non-labor costs were $100 per trainee (student). We estimated the replication of implementation preparation labor activities would cost $1,024 per school (range: $841-$1,208). Most costs were spent in delivery planning and teacher training. Given that implementation preparation costs can be barriers to intervention adoption, our results provide critical information for contemplating future implementation of VR-JIT or VIT-TAY.

"Virtual Interview Training for Transition-Age Youth" and "Virtual Reality Job Interview Training" are job interview simulators with demonstrated effectiveness in randomized controlled trials. We evaluated their dose responses via secondary data analysis of 558 transition-age youth with disabilities in 47 schools where the simulators were implemented in quasi-experimental studies. Cut-point analyses determined dosing efficiency and efficacy to optimize competitive employment. The most efficient dose when accounting for the balance between dose and employment was completing nine virtual interviews. The most efficacious dose to maximize the likelihood of successful employment was 38, but it varied across race, IQ, Individuals with Disabilities Education Improvement Act (IDEA) categories, and employment history. This study provides a novel approach to inform implementation guidelines for virtual interview training in pre-employment transition services. Limitations and implications for research and practice are discussed.

This column shares strategies for implementing a technology-based intervention within secondary special education transition services. "Virtual Interview Training for Transition-Age Youth" is a web-based job interview training that uses educational content and virtual hiring managers to help teach job interview skills. Eight support strategies for implementing the training are described. Strategies are prepare for implementation, ensure administrative support, prioritize training and support, address logistical challenges, integrate the program into the curriculum, take advantage of the administrative center, individualize student support, and offer virtual delivery.

Misgendering and deadnaming can have a negative impact on the experiences and wellbeing of transgender, non-binary, and gender expansive (TGNB) students in higher education. As a part of a larger effort to reimagine and redesign the pursuit of TGNB student health equity, the LGBTQ + Center and Student Health Center at New York University (the team) partnered to address misgendering and deadnaming as one of many barriers to the wellbeing and thriving of TGNB students at the university. Through this partnership, the team created the Misgendering and Deadnaming Survey--a brief, weekly survey of cohorts of TGNB students conducted every semester for a two-year period. The tool enabled the institution to assess if change efforts yielded improvement and provided close-to-real-time feedback that allowed the team to identify and address root causes of misgendering and deadnaming, including biases, via the reporting of individual incidents and tracking of trends over time. In addition to an overview of the survey tool for those interested in replicating it at their institution, this report concludes by offering lessons learned in the development and implementation of this innovative, co-designed campus change project to catalyze improvement toward reducing misgendering and deadnaming and improving the campus conditions for TGNB college students to thrive.

The purpose of this qualitative case study was to explore how youth's engineering identity has changed in the process of productive struggle in Making activities in the Midwestern U.S in a summer program. The researchers conducted focus-group interviews, and also administered an Engineering Identity survey as well as the Draw an Engineer Test to the students at two time points (pre/post). Additionally, the researchers observed the level of youths' interaction by video-recording each session, conducted debriefing sessions, and examined youth artifacts. The findings revealed two themes. The first theme is that the boys and girls who were engaged in the process of productive struggle showed changes in their identity with engineering. The second theme is that the boys and girls who weren't fully engaged in the process of productive struggle (i.e., demonstrated unproductive struggle) showed little or no change in their identity with engineering. This study showed that regardless of whether the students went through the process of productive struggle or not, they developed neutral or positive attitudes toward engineering. This finding also added to the existing literature on that productive struggle in Making activities has potential to enhance these youth' learning of engineering knowledge and engineering tools.

Artificial intelligence in the workplace is becoming increasingly common. These tools are sometimes used to aid users in performing their task, for example, when an artificial intelligence tool assists a radiologist in their search for abnormalities in radiographic images. The use of artificial intelligence brings a wealth of benefits, such as increasing the efficiency and efficacy of performance. However, little research has been conducted to determine how the use of artificial intelligence assistants might affect the user's cognitive skills. In this theoretical perspective, we discuss how artificial intelligence assistants might accelerate skill decay among experts and hinder skill acquisition among learners. Further, we discuss how AI assistants might also prevent experts and learners from recognizing these deleterious effects. We then discuss the types of questions: use-inspired basic cognitive researchers, applied researchers, and computer science researchers should seek to answer. We conclude that multidisciplinary research from use-inspired basic cognitive research, domain-specific applied research, and technical research (e.g., human factors research, computer science research) is needed to (a) understand these potential consequences, (b) design artificial intelligence systems to mitigate these impacts, and (c) develop training and use protocols to prevent negative impacts on users' cognitive skills. Only by answering these questions from multidisciplinary perspectives can we harness the benefits of artificial intelligence in the workplace while preventing negative impacts on users' cognitive skills.

INTRODUCTION:Motivation in medical students is positively associated with learning strategies. However, the evidence of a direct relationship between motivation and performance is vague. The objective of this study is to determine if the motivation that pushed students to choose the medical career is associated with their academic performance during their university years. METHODS:The study was conducted in 4,290 medical students from 10 countries in Latin America. The "Attribution Scale of General Achievement Motivation" was used to evaluate their general performance. The "Medical motivation Scale" test was used to measure social, altruist, economic, and prestige motivators. For statistical analyses, frequencies and percentages were described, and generalized linear models were used to establish statistical associations. RESULTS:Fifty percent of the students surveyed were females and the mean student age was 21 years old. This study showed that male students had a higher social/altruist motivation (PR:1.11,95%CI: 1.03-1.18; p

In 2014, the United States experienced an epidemic of acute flaccid myelitis (AFM) cases in children coincident with a nationwide outbreak of enterovirus D68 (EV-D68) respiratory disease. Up to half of the 2014 AFM patients had EV-D68 RNA detected by RT-PCR in their respiratory secretions, although EV-D68 was only detected in cerebrospinal fluid (CSF) from one 2014 AFM patient. Given previously described molecular and epidemiologic associations between EV-D68 and AFM, we sought to develop an animal model by screening seven EV-D68 strains for the ability to induce neurological disease in neonatal mice. We found that four EV-D68 strains from the 2014 outbreak (out of five tested) produced a paralytic disease in mice resembling human AFM. The remaining 2014 strain, as well as 1962 prototype EV-D68 strains Fermon and Rhyne, did not produce, or rarely produced, paralysis in mice. In-depth examination of the paralysis caused by a representative 2014 strain, MO/14-18947, revealed infectious virus, virion particles, and viral genome in the spinal cords of paralyzed mice. Paralysis was elicited in mice following intramuscular, intracerebral, intraperitoneal, and intranasal infection, in descending frequency, and was associated with infection and loss of motor neurons in the anterior horns of spinal cord segments corresponding to paralyzed limbs. Virus isolated from spinal cords of infected mice transmitted disease when injected into naïve mice, fulfilling Koch's postulates in this model. Finally, we found that EV-D68 immune sera, but not normal mouse sera, protected mice from development of paralysis and death when administered prior to viral challenge. These studies establish an experimental model to study EV-D68-induced myelitis and to better understand disease pathogenesis and develop potential therapies.