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BACKGROUND: Preventing progression to moderate or severe opioid use disorder (OUD) among people who exhibit risky opioid use behavior that does not meet criteria for treatment with opioid agonists or antagonists (subthreshold OUD) is poorly understood. The Subthreshold Opioid Use Disorder Prevention (STOP) Trial is designed to study the efficacy of a collaborative care intervention to reduce risky opioid use and to prevent progression to moderate or severe OUD in adult primary care patients with subthreshold OUD. METHODS: The STOP trial is a cluster randomized controlled trial, randomized at the PCP level, conducted in 5 distinct geographic sites. STOP tests the efficacy of the STOP intervention in comparison to enhanced usual care (EUC) in adult primary care patients with risky opioid use that does not meet criteria for moderate-severe OUD. The STOP intervention consists of (1) a practice-embedded nurse care manager (NCM) who provides patient participant education and supports primary care providers (PCPs) in engaging and monitoring patient-participants; (2) brief advice, delivered to patient participants by their PCP and/or prerecorded video message, about health risks of opioid misuse; and (3) up to 6 sessions of telephone health coaching to motivate and support behavior change. EUC consists of primary care treatment as usual, plus printed overdose prevention educational materials and an educational video on cancer screening. The primary outcome measure is self-reported number of days of risky (illicit or nonmedical) opioid use over 180 days, assessed monthly via text message using items from the Addiction Severity Index and the Current Opioid Misuse Measure. Secondary outcomes assess other substance use, mental health, quality of life, and healthcare utilization as well as PCP prescribing and monitoring behaviors. A mixed effects negative binomial model with a log link will be fit to estimate the difference in means between treatment and control groups using an intent-to-treat population. DISCUSSION: Given a growing interest in interventions for the management of patients with risky opioid use, and the need for primary care-based interventions, this study potentially offers a blueprint for a feasible and effective approach to improving outcomes in this population. TRIAL REGISTRATION: Clinicaltrials.gov, identifier NCT04218201, January 6, 2020.

Teaching organic chemistry requires supporting learning strategies that meaningfully engage students with the challenging concepts and advanced problem-solving skills needed to be successful. Such meaningful learning experiences should encourage students to actively choose to incorporate new concepts into their existing knowledge frameworks by appealing to the cognitive, affective, and psychomotor domains of learning. This study provides a qualitative analysis of students' meaningful learning experiences after completing three Writing-to-Learn (WTL) assignments in an organic chemistry laboratory course. The assignments were designed to appeal to the three domains necessary for a meaningful learning experience, and this research seeks to understand if and how the WTL assignments promoted students' meaningful learning. The primary data collected were the students' responses to open-ended feedback surveys conducted after each assignment. These responses were qualitatively analyzed to identify themes across students' experiences about their meaningful learning. The feedback survey analysis was triangulated with interviews conducted after each assignment. The results identify how the assignments connected to students' existing knowledge from other courses and indicate that assignment components such as authentic contexts, clear expectations, and peer review supported students' meaningful learning experiences. These results inform how assignment design can influence students' learning experiences and suggest implications for how to support students' meaningful learning of organic chemistry through writing.

Learning to reason through organic reaction mechanisms is challenging for students because of the volume of reactions covered in introductory organic chemistry and the complexity of conceptual knowledge and reasoning skills required to develop meaningful understanding. However, understanding reaction mechanisms is valuable for students because they are useful for predicting and explaining reaction outcomes. To identify the features students find pertinent when explaining reaction mechanisms, we have collected students' written descriptions of an acid-catalysed amide hydrolysis reaction. Students' writing was produced during the implementation of Writing-to-Learn assignments in a second semester organic chemistry laboratory course. We analysed students' written responses using an analytical framework for recognizing students' mechanistic reasoning, originally developed with attention to the philosophy of science literature. The analysis sought to identify the presence of specific features necessary for mechanistic reasoning belonging to four broad categories: (1) describing an overview of the reaction; (2) detailing the setup conditions required for the mechanism to occur; (3) describing the changes that take place over the course of the mechanism; and (4) identifying the properties of reacting species. This work provides a qualitative description of the variety of ways in which students included these features necessary for mechanistic reasoning in their writing. We additionally analysed instances of co-occurrence for these features in students' writing to make inferences about students' mechanistic reasoning, defined here as the use of chemical properties to justify how electrons, atoms, and molecules are reorganized over the course of a reaction. Feature co-occurrences were quantified using the lift metric to measure the degree of their mutual dependence. The quantitative lift results provide empirical support for the hierarchical nature of students' mechanistic descriptions and indicate the variation in students' descriptions of mechanistic change in conjunction with appeals to chemistry concepts. This research applies a framework for identifying the features present in students' written mechanistic descriptions, and illustrates the use of an association metric to make inferences about students' mechanistic reasoning. The findings reveal the capacity of implementing and analysing writing to make inferences about students' mechanistic reasoning.

Assessment, including course exams, clearly indicates to students what learning goals they are expected to master in a certain course. However, most of these assessments tend to focus on generating a correct answer rather than on the type of reasoning or skills used to arrive at the answer. If educators value skills in addition to the correctness of an answer, it is important that they assess them. As part of the ANA-POGIL (analytical process oriented guided inquiry learning) project, the ANA-POGIL team developed a set of process-rich or guided-inquiry-type assessment questions to be used on exams. These questions were designed to mirror the structure of the POGIL activities, where students were provided data in the form of a table, graph, or set of information with the intention of eliciting evidence of process skills such as information processing, problem solving, and critical thinking in the students' written responses. This study presents an analysis of student responses gathered from multiple institutions over several semesters to determine characteristics of questions that are likely to elicit evidence of process skills. Results of this project can provide some insight and recommendations to instructors about how to construct questions to elicit evidence of desired skills.

Acid-base chemistry is a foundational topic that is taught in courses across the chemistry curriculum. Students often have difficulty distinguishing between the different theories of acid-base chemistry--Brønsted-Lowry and Lewis acid-base chemistry--and applying these two definitions correctly in unfamiliar scenarios. To help students learn these definitions and be able to apply them, an acid-base Writing-to-Learn assignment was developed and evaluated. The Writing-to-Learn assignment involved a three-step process where students constructed an initial draft in response to a writing prompt, participated in peer review, and made revisions based on peer review feedback, before submitting a final draft. This process is informed by sociocultural theory applied to writing, which states that student learning of concepts increases through engagement with their peers' work and receiving peer feedback on their own writing. To test the efficacy of the acid-base writing assignment, an external assessment, comprised of conceptual questions related to acid-base chemistry and students' confidence when responding to them, was administered in two groups; a treatment group who completed the Writing-to-Learn assignment, and a comparison group who completed a separate assignment. Additionally, students who completed the Writing-to-Learn assignment were interviewed about their experiences. Regression analysis revealed that students in the treatment group had a greater increase in their conceptual understanding and confidence as compared to the students in the comparison group. The results demonstrate the students could successfully write about the Brønsted-Lowry and Lewis acid-base models separately, but were less successful with connecting these two concepts together in their writing. These results demonstrate the efficacy of Writing-to-Learn as an approach for promoting conceptual learning of acid-base chemistry.

AimsTo examine the safety and effectiveness of buprenorphine + naloxone sublingual tablets (BUP, as Suboxone(®) ) provided after administration of extended-release injectable naltrexone (XR-NTX, as Vivitrol(®) ) to reduce cocaine use in participants who met DSM-IV criteria for cocaine dependence and past or current opioid dependence or abuse.MethodsThis multi-centered, double-blind, placebo-controlled study, conducted under the auspices of the National Drug Abuse Treatment Clinical Trials Network, randomly assigned 302 participants at sites in California, Oregon, Washington, Colorado, Texas, Georgia, Ohio, New York and Washington DC, USA to one of three conditions provided with XR-NTX: 4 mg/day BUP (BUP4, n = 100), 16 mg/day BUP (BUP16, n = 100, or no buprenorphine (placebo; PLB, n = 102). Participants received pharmacotherapy for 8 weeks, with three clinic visits per week. Cognitive behavioral therapy was provided weekly. Follow-up assessments occurred at 1 and 3 months post-intervention. The planned primary outcome was urine drug screen (UDS)-corrected, self-reported cocaine use during the last 4 weeks of treatment. Planned secondary analyses assessed cocaine use by UDS, medication adherence, retention and adverse events.ResultsNo group differences were found between groups for the primary outcome (BUP4 versus PLB, P = 0.262; BUP16 versus PLB, P = 0.185). Longitudinal analysis of UDS data during the evaluation period using generalized linear mixed equations found a statistically significant difference between BUP16 and PLB [P = 0.022, odds ratio (OR) = 1.71] but not for BUP4 (P = 0.105, OR = 1.05). No secondary outcome differences across groups were found for adherence, retention or adverse events.ConclusionsBuprenorphine + naloxone, used in combination with naltrexone, may be associated with reductions in cocaine use among people who meet DSM-IV criteria for cocaine dependence and past or current opioid dependence or abuse.

Well-designed laboratories can help students master content and science practices by successfully completing the laboratory experiments. Upper-division chemistry laboratory courses often present special challenges for instruction due to the instrument intensive nature of the experiments. To address these challenges, particularly those associated with rotation style course structures, pre-laboratory videos were generated for two upper-division laboratory courses, Analytical Measurements and Physical Measurements. Sets of videos were developed for each experiment: a pre-laboratory lecture, an experimental, and a data analysis video. We describe the theoretical principles that guided the design of the instructional videos as well as the process. To assess the impact of the videos on students' successful completion of the experiments, a mixed-methods approach to data collection was used, which included video-recorded laboratory observations, student one-on-one interviews, and the Meaningful Learning in the Laboratory Inventory (MLLI) survey. Our findings indicate that video-based resources can help alleviate some challenges associated with rotation-style labs, particularly the temporal disconnect between pre-laboratory lectures and experiment completion as well as the need for more student autonomy in upper-division laboratory courses.

Undergraduate writing fellows play an important role in administering writing assignments in writing-intensive courses. At the University of Michigan, the MWrite program was designed to support the implementation of writing-to-learn (WTL) assignments in STEM courses. Within MWrite, writing fellows are a primary instructional resource for students and help evaluate students’ writing. As such, it is important to characterize writing fellows’ beliefs about both WTL and writing more generally. In this study we interviewed writing fellows for MWrite courses in biology, chemistry, economics, and statistics about how they conceptualize WTL and writing quality. Our analysis indicates that writing fellows conceptualize WTL as supporting a range of content-focused learning outcomes and as featuring specific rhetorical elements that make WTL assignments successful. Most writing fellows discussed the importance of higher-order characteristics when evaluating the quality of students’ writing, but also placed importance on the lower-order characteristics. Our results indicate that the writing fellows are internalizing the MWrite pedagogy with respect to WTL, but that their conceptions of writing quality appear to be informed by their experiences with writing more broadly. These findings support the use of writing fellows during the implementation of WTL in STEM courses that traditionally present barriers to using writing assignments. More generally, they indicate the potential for writing fellows’ conceptions to support the aims of the writing fellows program of which they are part. [ABSTRACT FROM AUTHOR]