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Background: In rural areas with health professional workforce shortages, telehealth offers an opportunity to address service gaps and meet the health needs of students. Few studies have examined telehealth implementation in rural schools. This study explores facilitators and barriers to the implementation of telehealth programs in rural schools and identifies strategies for successful implementation to inform future school-based telehealth initiatives. Methods: We conducted semi-structured qualitative interviews with 50 key informants involved in the implementation of telehealth programs funded through the School-Based Telehealth Network Grant Program. Researchers completed a thematic analysis of interview transcripts. Results: The most commonly cited barriers were technology, reimbursement for services, and facilitating acceptance of the telehealth among school staff, clinicians, parents, and students. Key informants identified strategies for facilitating program implementation, including technology training and support, marketing efforts, and integration into existing school processes. Conclusions: School-based telehealth can augment clinical capacity in areas with clinician shortages. Entities interested in such an approach to care must engage with their school community to ensure successful implementation. For rural, school-based telehealth to gain greater adoption and be sustained, these services must be reimbursable by Medicaid and private insurers.

In September 2013, the Queen's University Accelerated Route to Medical School (QuARMS), an innovative 2-year premedical curriculum which combines coursework, seminars, fieldwork, and faculty mentorship, was developed. After successful completion of the program, students are eligible to enter medical school. A key aspect of this learning stream is the integrated service-learning aspect which is scaffolded across both years of study and includes in class sessions, community projects, mentoring, and assessment. This paper provides the results of a mixed-methods program evaluation designed to examine students' QuARMS service learning experiences. Overall, students were happy with the service learning component of the program, and indicated that the in-class and experiential service-learning sessions were beneficial. However, students also indicated that they wanted more structure and feedback while working on their projects.

Interpretation of variants of uncertain significance, especially chromosomal rearrangements in non-coding regions of the human genome, remains one of the biggest challenges in modern molecular diagnosis. To improve our understanding and interpretation of such variants, we used high-resolution three-dimensional chromosomal structural data and transcriptional regulatory information to predict position effects and their association with pathogenic phenotypes in 17 subjects with apparently balanced chromosomal abnormalities. We found that the rearrangements predict disruption of long-range chromatin interactions between several enhancers and genes whose annotated clinical features are strongly associated with the subjects' phenotypes. We confirm gene-expression changes for a couple of candidate genes to exemplify the utility of our analysis of position effect. These results highlight the important interplay between chromosomal structure and disease and demonstrate the need to utilize chromatin conformational data for the prediction of position effects in the clinical interpretation of non-coding chromosomal rearrangements.

The 1998 publication of Carla Benedetti’s Pasolini contro Calvino: Per una letteratura impura provoked a series of attacks in the Italian press, mostly aimed at its so-called “banalissima contrapposizione” between authors. Debates in Italy today about the legacy of the Novecento, the state of Italian postmodernism, and the future of Italian literary culture are still haunted by this authorial contraposition, and are often compounded by the perceived opposition, in the field of criticism, between Benedetti’s supporters and her critics. The aim of this essay is to frame these debates by comparing Benedetti’s provocative call for an impure literature in Pasolini contro Calvino with Francesco De Sanctis’ foundational Storia della letteratura italiana. Through this comparison, I argue that Benedetti and De Sanctis are “Machiavellian” literary critics whose future-oriented strategies of expression represent one of multiple ways that the unprecedented challenges Italian culture faces today are being confronted with tools from its past.

This paper examines indirect discrimination in Australian universities that tends to obstruct and delay women's academic careers. The topic is defined and contextualised via a 1998 speech by the Australian Human Rights Commission's Sex Discrimination Commissioner, juxtaposed with a brief contemporaneous exemplar. The paper discusses the prevalence of women among casual and fixed-term academic workers, and the contrasting low numbers of women in senior academic positions. It is argued that the neo-liberal "marketisation" of higher education, which still prevails, has fostered a number of indirectly discriminatory practices and conditions that substantially disadvantage women. A selection of studies of the problem are critiqued. It is argued that a broad statistical methodology is inadequate due to its tendency to "homogenise" the academy and its component individuals, in the process giving scope for unjustified optimism among university policy-makers. A particulate approach is advocated, acknowledging the wide variation between and within universities, and the range of hidden difficulties individual women academics can face. It is concluded that despite apparent reforms over the past decade, the situation of women has improved little in practical terms.

Caregivers of individuals with Alzheimer's disease require support across the full disease trajectory. The aim of this study was to develop a conceptual framework of caregiving phases across the Alzheimer's disease and caregiving trajectories and the corresponding caregiver support needs. Constructivist grounded theory informed data collection and analysis. 40 spousal (n = 20) and adult children (n = 20) caregivers were interviewed. Recruitment was completed when theoretical saturation was achieved. Member-checking interviews occurred with 10 participants. Participants described five phases of caregiving related to their responsibilities to support people with Alzheimer's disease including monitoring initial symptoms, navigating their diagnosis, assisting with instrumental activities of daily living, assisting with basic activities of daily living, and preparing for the future. Support (i.e., informational, emotional, instrumental, and appraisal) needs were often specific to the phase of care. For example, during the initial symptoms phase, caregivers reported needing information to assist them to distinguish normal aging from cognitive impairment. In contrast, during the preparing for the future phase, caregivers emphasized support for accessing institutional long term-care placement. Findings highlight caregiver-identified phases of caregiving and corresponding support needs across the Alzheimer's disease trajectory. Findings can inform the development, evaluation and implementation of programs and services to meet caregivers' changing needs across the disease trajectory. Caregivers for individuals with Alzheimer's disease can experience distinct caregiving phases across the disease trajectory with corresponding support needs. Rehabilitation clinicians can use these findings to help caregivers navigate available supports at appropriate times to ensure that their needs are addressed across the disease trajectory. Occupational therapists and other rehabilitation professionals can enable caregivers with timely education and support as they progress across the disease trajectory. [ABSTRACT FROM AUTHOR]

BACKGROUND: In rural areas with health professional workforce shortages, telehealth offers an opportunity to address service gaps and meet the health needs of students. Few studies have examined telehealth implementation in rural schools. This study explores facilitators and barriers to the implementation of telehealth programs in rural schools and identifies strategies for successful implementation to inform future school‐based telehealth initiatives. METHODS: We conducted semi‐structured qualitative interviews with 50 key informants involved in the implementation of telehealth programs funded through the School‐Based Telehealth Network Grant Program. Researchers completed a thematic analysis of interview transcripts. RESULTS: The most commonly cited barriers were technology, reimbursement for services, and facilitating acceptance of the telehealth among school staff, clinicians, parents, and students. Key informants identified strategies for facilitating program implementation, including technology training and support, marketing efforts, and integration into existing school processes. CONCLUSIONS: School‐based telehealth can augment clinical capacity in areas with clinician shortages. Entities interested in such an approach to care must engage with their school community to ensure successful implementation. For rural, school‐based telehealth to gain greater adoption and be sustained, these services must be reimbursable by Medicaid and private insurers. [ABSTRACT FROM AUTHOR]

Purpose: This study assesses trends in telehealth use in Maine—a rural state with comprehensive telehealth policies—across payers, services, and rurality, and identifies barriers and facilitators to the adoption and use of telehealth services. Methods: Using a mixed‐methods approach, researchers analyzed data from Maine's All Payer Claims Database (2008‐2016) and key informant interviews with health care organization leaders to examine telehealth use and explore factors impacting telehealth adoption and implementation. Findings: Despite a 14‐fold increase in the use of telehealth over the 9‐year study period, use remains low—0.28% of individuals used telehealth services in 2016 compared with 0.02% in 2008. Services provided via telehealth varied by rurality; speech language pathology (SLP) was the most common type of service among rural residents, while psychiatric services were most common among urban residents. Medicaid was the primary payer for over 70% of telehealth claims in both rural and urban areas of the state, driving the increase of telehealth claims over time. Issues challenging organizations seeking to deploy telehealth included provider resistance, staff turnover, provider shortages, and lack of broadband. Key informants identified inadequate and inconsistent reimbursement as barriers to comprehensive, systematic billing for telehealth services, resulting in underrepresentation of telehealth services in claims data. Conclusions: Claims covered by Medicaid account for much of the observed expansion of telehealth use in Maine. Telehealth appears to be improving access to behavioral health and SLP services. Provider shortages, broadband, and Medicare and commercial coverage policies limit the use of telehealth services in rural areas. [ABSTRACT FROM AUTHOR]