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BackgroundImproving access to end-of-life symptom control interventions among cancer patients is a public health priority in Tanzania, and innovative community-based solutions are needed. Mobile health technology holds promise; however, existing resources are limited, and outpatient access to palliative care specialists is poor. A mobile platform that extends palliative care specialist access via shared care with community-based local health workers (LHWs) and provides remote support for pain and other symptom management can address this care gap. ObjectiveThe aim of this study is to design and develop mobile-Palliative Care Link (mPCL), a web and mobile app to support outpatient symptom assessment and care coordination and control, with a focus on pain. MethodsA human-centered iterative design framework was used to develop the mPCL prototype for use by Tanzanian palliative care specialists (physicians and nurses trained in palliative care), poor-prognosis cancer patients and their lay caregivers (patients and caregivers), and LHWs. Central to mPCL is the validated African Palliative Care Outcome Scale (POS), which was adapted for automated, twice-weekly collection of quality of life–focused patient and caregiver responses and timely review, reaction, and tracking by specialists and LHWs. Prototype usability testing sessions were conducted in person with 21 key informants representing target end users. Sessions consisted of direct observations and qualitative and quantitative feedback on app ease of use and recommendations for improvement. Results were applied to optimize the prototype for subsequent real-world testing. Early pilot testing was conducted by deploying the app among 10 patients and caregivers, randomized to mPCL use versus phone-contact POS collection, and then gathering specialist and study team feedback to further optimize the prototype for a broader randomized field study to examine the app’s effectiveness in symptom control among cancer patients. ResultsmPCL functionalities include the ability to create and update a synoptic clinical record, regular real-time symptom assessment, patient or caregiver and care team communication and care coordination, symptom-focused educational resources, and ready access to emergency phone contact with a care team member. Results from the usability and pilot testing demonstrated that all users were able to successfully navigate the app, and feedback suggests that mPCL has clinical utility. User-informed recommendations included further improvement in app navigation, simplification of patient and caregiver components and language, and delineation of user roles. ConclusionsWe designed, built, and tested a usable, functional mobile app prototype that supports outpatient palliative care for Tanzanian patients with cancer. mPCL is expressly designed to facilitate coordinated care via customized interfaces supporting core users—patients or caregivers, LHWs, and members of the palliative care team—and their respective roles. Future work is needed to demonstrate the effectiveness and sustainability of mPCL to remotely support the symptom control needs of Tanzanian cancer patients, particularly in harder-to-reach areas.

Purpose: In this study, the authors evaluated the contribution made by dialect shifting to reading achievement test scores of African American English (AAE)-speaking students when controlling for the effects of socioeconomic status (SES), general oral language abilities, and writing skills. Method: Participants were 165 typically developing African American 1st through 5th graders. Half were male and half were female, one third were from low-SES homes, and two-thirds were from middle-SES homes. Dialect shifting away from AAE toward Standard American English (SAE) was determined by comparing AAE production rates during oral and written narratives. Structural equation modeling evaluated the relative contributions of AAE rates, SES, and general oral language and writing skills on standardized reading achievement scores. Results: AAE production rates were inversely related to reading achievement scores and decreased significantly between the oral and written narratives. Lower rates in writing predicted a substantial amount of the variance in reading scores, showing a significant direct effect and a significant indirect effect mediated by measures of oral language comprehension. Conclusion: The findings support a dialect shifting-reading achievement hypothesis, which proposes that AAE-speaking students who learn to use SAE in literacy tasks will outperform their peers who do not make this linguistic adaptation. (Contains 8 tables, 2 figures and 2 footnotes.)

Purpose: In this study, the authors evaluated the contribution made by dialect shifting to reading achievement test scores of African American English (AAE)-speaking students when controlling for the effects of socioeconomic status (SES), general oral language abilities, and writing skills. Method: Participants were 165 typically developing African American 1st through 5th graders. Half were male and half were female, one third were from low-SES homes, and two-thirds were from middle-SES homes. Dialect shifting away from AAE toward Standard American English (SAE) was determined by comparing AAE production rates during oral and written narratives. Structural equation modeling evaluated the relative contributions of AAE rates, SES, and general oral language and writing skills on standardized reading achievement scores. Results: AAE production rates were inversely related to reading achievement scores and decreased significantly between the oral and written narratives. Lower rates in writing predicted a substantial amount of the variance in reading scores, showing a significant direct effect and a significant indirect effect mediated by measures of oral language comprehension. Conclusion: The findings support a dialect shifting-reading achievement hypothesis, which proposes that AAE-speaking students who learn to use SAE in literacy tasks will outperform their peers who do not make this linguistic adaptation. KEY WORDS: African American English, literacy, code switching, dialect shifting, reading achievement, Learning to read is one of the most important academic tasks faced by elementary-grade students. Not only does learning to read provide students with entry into a wealth of fictional [...]

Interview with artist Ilka List describes her research: collecting 1872 drawings from rural and urban second- and third-grade children to determine the impact of environmental experiences on children's art, sense of self, and cognitive and emotional abilities. Children with a broad range of outdoor, nature-oriented experiences had greater spatial abilities and enhanced memory of natural history details. (SAS)