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Background: Hospice and palliative medicine (HPM) is a board-certified subspecialty within emergency medicine (EM), but prior studies have shown that EM residents do not receive sufficient training in HPM. Experts in HPM-EM created a consensus list of competencies for HPM training in EM residency. We evaluated how the HPM competencies integrate within the American Board of Emergency Medicine Milestones, which include the Model of the Clinical Practice of Emergency Medicine (EM Model) and the knowledge, skills, and abilities (KSA) list.Methods: Three emergency physicians independently mapped the HPM-EM competencies onto the 2019 EM Model items and the 2021 KSAs. Discrepancies were resolved by a fourth independent reviewer, and the final mapping was reviewed by all team members.Results: The EM Model included 78% (18/23) of the HPM competencies as a direct match, and we identified recommended areas for incorporating the other five. The KSAs included 43% (10/23). Most HPM competencies included in the KSAs mapped onto at least one level B (minimal necessary for competency) KSA. Three HPM competencies were not clearly included in the EM Model or in the KSAs (treating end-of-life symptoms, caring for the imminently dying, and caring for patients under hospice care).Conclusion: The majority of HPM-EM competencies are included in the current EM Model and KSAs and correspond to knowledge needed to be competent in EM. Programs relying on the EM Milestones to plan their curriculums may miss training in symptom management and care for patients at the end of life or who are on hospice.

Despite the known higher risk of cardiovascular disease in individuals with type 2 diabetes, the pathophysiology and optimal management of diabetic foot ulcers (DFUs), a leading complication associated with diabetes, is complex and continues to evolve. Complications of type 2 diabetes, such as DFUs, are a major cause of morbidity and mortality and the leading cause of major lower extremity amputation in the United States. There has recently been a strong focus on the prevention and early treatment of DFUs, leading to the development of multidisciplinary diabetic wound and amputation prevention clinics across the country. Mounting evidence has shown that, despite these efforts, amputations associated with DFUs continue to increase. Furthermore, due to increasing patient complexity of management secondary to comorbid conditions, such as cardiovascular disease, the management of peripheral artery disease associated with DFUs has become increasingly difficult, and care delivery is often episodic and fragmented. Although structured, process-specific approaches exist at individual institutions for the management of DFUs in the cardiovascular patient population, there is insufficient awareness of these principles in the general medicine communities. Furthermore, there is growing interest in better understanding the mechanistic underpinnings of DFUs to better define personalized medicine to improve outcomes. The goals of this scientific statement are to provide salient background information on the complex pathogenesis and current management of DFUs in cardiovascular patients, to guide therapeutic and preventive strategies and future research directions, and to inform public policy makers on health disparities and other barriers to improving and advancing care in this expanding patient population.

Background: Emergency medicine (EM) resident training is guided by the American Board of Emergency Medicine Model of the Clinical Practice of Emergency Medicine (EM Model) and the EM Milestones as developed based on the knowledge, skills, and abilities (KSA) list. These are consensus documents developed by a collaborative working group of seven national EM organizations. External experts in geriatric EM also developed competency recommendations for EM residency education in geriatrics, but these are not being taught in many residency programs. Our objective was to evaluate how the geriatric EM competencies integrate/overlap with the EM Model and KSAs to help residency programs include them in their educational curricula.Methods: Trained emergency physicians independently mapped the geriatric resident competencies onto the 2019 EM Model items and the 2021 KSAs using Excel spreadsheets. Discrepancies were resolved by an independent reviewer with experience with the EM Model development and resident education, and the final mapping was reviewed by all team members.Results: The EM Model included 77% (20/26) of the geriatric competencies. The KSAs included most of the geriatric competencies (81%, 21/26). All but one of the geriatric competencies mapped onto either the EM Model or the KSAs. Within the KSAs, most of the geriatric competencies mapped onto necessary level skills (ranked B, C, D, or E) with only five (8%) also mapping onto advanced skills (ranked A).Conclusion: All but one of the geriatric EM competencies mapped to the current EM Model and KSAs. The geriatric competencies correspond to knowledge at all levels of training within the KSAs, from beginner to expert in EM. Educators in EM can use this mapping to integrate the geriatric competencies within their curriculums.

BACKGROUND: Recently enacted environmental justice policies in the United States at the state and federal level emphasize addressing place-based inequities, including persistent disparities in air pollution exposure and associated health impacts. Advances in air quality measurement, models, and analytic methods have demonstrated the importance of finer-scale data and analysis in accurately quantifying the extent of inequity in intraurban pollution exposure, although the necessary degree of spatial resolution remains a complex and context-dependent question. OBJECTIVE: The objectives of this commentary were to a) discuss ways to maximize and evaluate the effectiveness of efforts to reduce air pollution disparities, and b) argue that environmental regulators must employ improved methods to project, measure, and track the distributional impacts of new policies at finer geographic and temporal scales. DISCUSSION: The historic federal investments from the Inflation Reduction Act, the Infrastructure Investment and Jobs Act, and the Biden Administrations commitment to Justice40 present an unprecedented opportunity to advance climate and energy policies that deliver real reductions in pollution-related health inequities. In our opinion, scientists, advocates, policymakers, and implementing agencies must work together to harness critical advances in air quality measurements, models, and analytic methods to ensure success. https://doi.org/10.1289/EHP13063.

Ambient fine particulate matter (PM2.5) is the worlds leading environmental health risk factor. Quantification is needed of regional contributions to changes in global PM2.5 exposure. Here we interpret satellite-derived PM2.5 estimates over 1998-2019 and find a reversal of previous growth in global PM2.5 air pollution, which is quantitatively attributed to contributions from 13 regions. Global population-weighted (PW) PM2.5 exposure, related to both pollution levels and population size, increased from 1998 (28.3 μg/m3) to a peak in 2011 (38.9 μg/m3) and decreased steadily afterwards (34.7 μg/m3 in 2019). Post-2011 change was related to exposure reduction in China and slowed exposure growth in other regions (especially South Asia, the Middle East and Africa). The post-2011 exposure reduction contributes to stagnation of growth in global PM2.5-attributable mortality and increasing health benefits per µg/m3 marginal reduction in exposure, implying increasing urgency and benefits of PM2.5 mitigation with aging population and cleaner air.

Assessments of scientific reasoning that capture the intertwining aspects of conceptual, procedural and epistemic knowledge are often associated with intensive qualitative analyses of student responses to open-ended questions, work products, interviews, discourse and classroom observations. While such analyses provide evaluations of students' reasoning skills, they are not scalable. The purpose of this study is to develop a three-tiered multiple-choice assessment to measure students' reasoning about biological phenomena and to understand the affordances and limitations of such an assessment. To validate the assessment and to understand what the assessment measures, qualitative and quantitative data were collected and analyzed, including read-aloud, focus group interviews and analysis of large sample data sets. These data served to validate our three-tiered assessment called the Assessment of Biological Reasoning (ABR) consisting of 10 question sets focused on core biological concepts. Further examination of our data suggests that students' reasoning is intertwined in such a way that procedural and epistemic knowledge is reliant on and given meaning by conceptual knowledge, an idea that pushes against the conceptualization that the latter forms of knowledge construction are more broadly applicable across disciplines.

In light of recent efforts to increase the diversity of the physics workforce, the need to counter the long-term marginalisation of students of colour from physics has received more attention. Culturally relevant pedagogy (CRP) is a multicultural approach to teaching and learning designed to attend to students' culture as starting points toward learning canonical disciplinary knowledge (Ladson-Billings, 1995). This research explored physics teachers' dispositions regarding implementing culturally relevant practices in their classrooms. The study participants were a select group of physics teachers expressing interest in culturally relevant instruction (n = 6). The teachers participated in interviews using a semi-structured protocol. Interviews were transcribed and analysed using inductive coding. Interview analysis showed four categories of teacher dispositions about CRP: (1) recognition of CRP as a need for various approaches to teaching, (2) use of culture as a pedagogical reference, (3) recognition of systemic inequities, and (4) recognition of the role of socio-political factors in CRP. Despite the productive beginning identified, the results also suggest that these physics teachers had difficulty identifying precisely how to enact culturally relevant practices in their physics instruction. This result indicates the need for further research into physics teachers' thinking about and using culturally relevant pedagogy.

Recent instructional reforms in science education aim to change the way students engage in learning in the discipline, as they describe that students are to engage with disciplinary core ideas, crosscutting concepts, and the practices of science to make sense of phenomena (NRC, 2012). For such sensemaking to become a reality, there is a need to understand the ways in which students' thinking can be maintained throughout the trajectory of science lessons. Past research in this area tends to foreground either the curriculum or teachers' practices. We propose a more comprehensive view of science instruction, one that requires attention to teachers' practice, the instructional task, and students' engagement. In this study, by examining the implementation of the same lesson across three different classrooms, our analysis of classroom videos and artifacts of students' work revealed how the interaction of teachers' practices, students' intellectual engagement, and a cognitively demanding task together support rigorous instruction. Our analyses shed light on their interaction that shapes opportunities for students' thinking and sensemaking throughout the trajectory of a science lesson. The findings provide implications for ways to promote rigorous opportunities for students' learning in science classrooms.

LGBTQIA+ choruses in the United States play an important role in the development of queer movement culture by providing safe spaces other than bars and clubs, by emotionally supporting queer people through extended political struggles and the AIDS crisis, and by presenting public counternarratives to anti-gay propaganda. Jon Sims, a music teacher from Kansas, inspired to action by queer activists like Harvey Milk and the anti-gay countermovement of Anita Bryant, founded the world's first publicly identifying gay music ensembles in San Francisco in the late 1970s. By the 1990s, hundreds of queer music ensembles had organized across five continents. At the start of the 21st century, LGBTQIA+ choruses in the United States are beginning to dismantle the structural and social inequities inherited from mid-20th century queer organizing, in an attempt to better reflect the diverse intersectional identities that comprise the queer community and to collaborate more effectively with activists from other historically marginalized groups. The historical development of the LGBTQIA+ choral movement in the United States demonstrates how processes of cultural institutionalization reproduce social inequalities enacted by systemic prejudices like racism, sexism, ablism, and transphobia, even in marginalized communities. A critical musicological analysis of this community's history may help music educators recognize and interrogate discrepancies between the benevolent intent and the complicated, sometimes inverted, impacts that music institutions have on participants, communities, and culture.

Eighty-one percent of persons living with cancer have an emergency department (ED) visit within the last 6 months of life. Many cancer patients in the ED are at an advanced stage with high symptom burden and complex needs, and over half is admitted to an inpatient setting. Innovative models of care have been developed to provide high quality, ambulatory, and home-based care to persons living with serious, life-limiting illness, such as advanced cancer. New care models can be divided into a number of categories based on either prognosis (e.g., greater than or less than 6 months), or level of care (e.g., lower versus higher intensity needs, such as intravenous pain/nausea medication or frequent monitoring), and goals of care (e.g., cancer-directed treatment versus symptom-focused care only). We performed a narrative review to (1) compare models of care for seriously ill cancer patients in the ED and (2) examine factors that may hasten or impede wider dissemination of these models.

Medical students need to understand core neuroscience principles as a foundation for their required clinical experiences in neurology. In fact, they need a solid neuroscience foundation for their clinical experiences in all other medical disciplines also, because the nervous system plays such a critical role in the function of every organ system. Due to the rapid pace of neuroscience discoveries, it is unrealistic to expect students to master the entire field. It is also unnecessary, as students can expect to have ready access to electronic reference sources no matter where they practice. In the pre-clerkship phase of medical school, the focus should be on providing students with the foundational knowledge to use those resources effectively and interpret them correctly. This article describes an organizational framework for teaching the essential neuroscience background needed by all physicians. This is particularly germane at a time when many medical schools are re-assessing traditional practices and instituting curricular changes such as competency-based approaches, earlier clinical immersion, and increased emphasis on active learning. This article reviews factors that should be considered when developing the pre-clerkship neuroscience curriculum, including goals and objectives for the curriculum, the general topics to include, teaching and assessment methodology, who should direct the course, and the areas of expertise of faculty who might be enlisted as teachers or content experts. These guidelines were developed by a work group of experienced educators appointed by the Undergraduate Education Subcommittee (UES) of the American Academy of Neurology (AAN). They were then successively reviewed, edited, and approved by the entire UES, the AAN Education Committee, and the AAN Board of Directors.

Current visions of science education advocate that students should engage with science in the classroom in ways that mirror the work of scientists in order to develop science proficiency. For this goal, teachers are tasked with the complex responsibility of supporting students in understanding not only the conceptual knowledge of science, but also its disciplinary practices, norms, and epistemologies. In order for teachers to teach in such ways, they must be afforded opportunities to develop and reflect on their own disciplinary understandings about science. Research Experiences for Teachers' (RETs) programs, in which teachers engage in research with scientists, may be fertile contexts for the development of teachers' robust understandings about science. As such, the purpose of this naturalistic single-case study is to explore the ways in which one elementary teacher (Ava) describes shifts in her disciplinary understandings about science after participating in a 6-week summer Research Experience for Teachers' program. Through examination of interviews and observations, this study takes a critical event narrative analysis approach to unpack the ways in which Ava interprets certain disciplinary understandings about science in light of events during her research experience that to her had lasting and important impact on her understandings of science. We conclude by discussing the implications of this work for research and professional development design.

In this paper, we describe the work of a teacher (Sarah) as she attempted to use culturally relevant pedagogy in her physics classroom. Culturally relevant pedagogy (CRP) is an approach to teaching developed by Gloria Ladson-Billings, with the goal of encouraging learning through drawing on students' cultural capital as a centerpiece of their instruction. CRP meets the academic and cultural needs of diverse students through recognizing and building upon their cultural backgrounds, experiences, and interests in instruction. We describe how our experience working with Sarah broadened and honed our original understanding of CRP as we documented Sarah's instructional successes, as well as the challenges, she encountered in her physics teaching. Based on our work with Sarah, we provide recommendations to inform other physics teachers as they attempt to employ CRP.

Science reforms in national K-12 science education standards position engineering as a discipline that can be productively integrated into science curricula. This integrated approach presents science as foundational to engineering and engineering as a tool to contextualize and reinforce science ideas such that students come to develop understandings about the natural and engineered worlds. To better understand if integrating engineering into science classrooms achieves the promise described in national reforms, we explored how elementary school students came to understand what is expected of them when asked to engage in an integrated science and engineering unit and whether their understandings represent epistemologically productive ways of integrating the doing of science and engineering. For this purpose, we examined video recordings, transcripts, and classroom artifacts of tasks from a 9-week unit contextualized in an engineering challenge in which students engaged in activities to explore, design, and build simple circuits devices to develop explanations of energy movement in a circuit. Our findings suggest that an integrated approach may be more problematic than promising; while at times students took up integrated tasks as opportunities to wonder about, question, and explore materials that sparked their interest, their framing of the tasks did not align with the vision for integration called for in current reform documents.

Research calls for teachers to integrate students' funds of knowledge to bridge the gap between students' lived experiences with that of learning science -- that is, to make science relevant for students. Based on this critical practice, this exploratory study focuses on how pre-service science teachers integrate relevance, specifically students' funds of knowledge, within the lessons they intend to implement. Drawing on the literature, this study developed a coding scheme to identify the ways in which pre-service teachers (PSTs) attempted to make science relevant to students. We distinguished between constructed relevance (i.e. relevance that does not consider students' funds of knowledge) and relevance that drew on students' funds of knowledge. Findings indicated that 48% of lessons contained some aspect of attending to students' funds of knowledge highlighting that pre-service science teachers understand the need to make science relevant to students beyond constructed relevance. However, lessons that did attend to funds of knowledge, were most often done through attending to how students understand how knowledge is constructed. Across PSTs, there was a significant difference in the use of relevance over time during the semester. Findings indicated productive beginnings in PSTs' orientations to funds of knowledge without explicit instruction in this area.

A critical component to disciplinary engagement in science is that of epistemic affect--learning how to "feel" as scientists do when engaged in their work. The emotional responses, feelings, and dispositions that emerge as one participates in the construction of knowledge are part and parcel to the experiences of scientists and, we argue, should be integral to the experiences of science learners--and their teachers--as well. As such, this study takes the position that teachers must have opportunities to encounter, understand, and appreciate the epistemic affect in science to support students in navigating their affect in the science classroom. Through analysis of field observations and semistructured interviews conducted during a 6-week Research Experience for Teachers program, this study examines how four elementary teachers experience an epistemic affect over the course of their engagement in scientific research. The findings of the study highlight that engaging in science research afforded teachers rich opportunities to experience epistemic affect, ranging from frustration, perseverance, and ultimately pride in their work. We argue such firsthand affective experiences within professional development programs featuring participation in science research hold important implications for teachers' instructional practice and orientations to their students as thinkers, doers, and learners of science.

Vocational psychologists have predicted the utilization of telepsychology in career interventions, yet vocational research have not capitalized on this modality. The purpose of this article is to describe how telepsychology could be used effectively in vocational psychology research to expand the reach and application of the field's scholarship to real-world practice. We discuss challenges and ethical issues of this modality and the limitations of vocational psychology scholarship. We argue that telepsychology can overcome current challenges in the field by allowing vocational psychology research to extend to underserved populations, to produce scholarship that might better fill the research to practice gap, and to have practical application to better meet the challenges of the rapidly transforming world of work. In this article, each of these research areas is explored and potential research questions are highlighted.

BackgroundThe effect of procalcitonin-guided use of antibiotics on treatment for suspected lower respiratory tract infection is unclear.MethodsIn 14 U.S. hospitals with high adherence to quality measures for the treatment of pneumonia, we provided guidance for clinicians about national clinical practice recommendations for the treatment of lower respiratory tract infections and the interpretation of procalcitonin assays. We then randomly assigned patients who presented to the emergency department with a suspected lower respiratory tract infection and for whom the treating physician was uncertain whether antibiotic therapy was indicated to one of two groups: the procalcitonin group, in which the treating clinicians were provided with real-time initial (and serial, if the patient was hospitalized) procalcitonin assay results and an antibiotic use guideline with graded recommendations based on four tiers of procalcitonin levels, or the usual-care group. We hypothesized that within 30 days after enrollment the total antibiotic-days would be lower - and the percentage of patients with adverse outcomes would not be more than 4.5 percentage points higher - in the procalcitonin group than in the usual-care group.ResultsA total of 1656 patients were included in the final analysis cohort (826 randomly assigned to the procalcitonin group and 830 to the usual-care group), of whom 782 (47.2%) were hospitalized and 984 (59.4%) received antibiotics within 30 days. The treating clinician received procalcitonin assay results for 792 of 826 patients (95.9%) in the procalcitonin group (median time from sample collection to assay result, 77 minutes) and for 18 of 830 patients (2.2%) in the usual-care group. In both groups, the procalcitonin-level tier was associated with the decision to prescribe antibiotics in the emergency department. There was no significant difference between the procalcitonin group and the usual-care group in antibiotic-days (mean, 4.2 and 4.3 days, respectively; difference, -0.05 day; 95% confidence interval [CI], -0.6 to 0.5; P=0.87) or the proportion of patients with adverse outcomes (11.7% [96 patients] and 13.1% [109 patients]; difference, -1.5 percentage points; 95% CI, -4.6 to 1.7; P

Current reform efforts in science place a premium on student sense making and participation in the practices of science. Given the disparity between these activities and current teaching practices, effective means of professional development around such practices must be identified. We use a close examination of 106 science teachers participating in Research Experiences for Teachers (RET) to identify, through structural equation modeling, the essential features in supporting teacher learning from these experiences. Findings suggest that participation in RET shape science teacher practice and beliefs, which in turn influence practice. Essential features of RET include engaging teachers socially in the research context and in research projects that are personally relevant to them. The model suggests ways to maximize the professional development potential of RET intended to support engagement in disciplinary practices.

The Next Generation Science Standards support understanding of the nature of science as it is practiced and experienced in the real world through interconnected concepts to be imbedded within scientific practices and crosscutting concepts. This study explored how fourth and fifth grade elementary students' views of nature of science change when they engage in a technology-enhanced, scientific inquiry-oriented curriculum that takes place across formal and informal settings. Results suggest that student engagement in technology-enhanced inquiry activities that occur in informal and formal settings when supported through explicit instruction focused on metacognitive and social knowledge construction can improve elementary students' understanding of nature of science.

This research examines factors influencing elementary science teacher learning as they participate in professional development with and enactment of educative curricula in comparison with learning following limited professional development and enactment of traditional curricula. Using a randomized cluster design (125 teachers and 2,694 students in 4th-5th grades) that met the What Works Clearinghouse standards without reservations, teacher learning was conceptualized using four outcomes. Data were analyzed using standard single-level multiple regression models and possible mediation models for the teacher outcomes were considered using piecewise multiple regression and path analytic approaches. Treatment group teachers experienced greater increases in content knowledge, views of science inquiry, beliefs about reform-based teaching, and teaching self-efficacy than comparison group teachers. The findings indicate that what teachers learn from the combination of professional development and teaching with educative curriculum varies according to what their knowledge and beliefs are on entering the experience. Surprisingly, high entry-level self-efficacy was associated not only with lower learning gains for the teachers, but also for their students. Finally, teachers' space science learning and that of their students are implicated as mediators of the positive effect of the professional development and educative curriculum enactment on teacher beliefs about reform science teaching. This work refines and extends a theoretical framework of teachers' participatory relationship with curricula.

Emergency Department (ED) Observation Units (OU) can provide safe, effective care for low risk patients with intracranial hemorrhages. We compared current ED OU use for patients with subdural hematomas (SDH) to the validated Brain Injury Guidelines (BIG) to evaluate the potential impact of implementing this risk stratification tool. Retrospective cohort of patients ≥18 years old with SDH of any cause from 2014 to 2020 to evaluate for potential missed OU cases. Missed OU cases were defined as patients with an initial Glasgow Coma Score (GCS) of 15 with hospital length of stays (LOS) <2 days, who did not meet the composite outcome and were not cared for in the OU or discharged from the ED. Composite outcome included in-hospital death or transition to hospice care, neurosurgical intervention, GCS decline, and worsening SDH size. Secondary outcomes were whether application of BIG would increase ED OU use or reduce CT use. 264 patients met inclusion criteria over 5.3 year study timeframe. Mean age was 61 years (range 19–93) and 61.4% were male. SDH were traumatic in 76.9% and 60.2% of the cohort had additional injuries. The admission rate was 81.4% (n = 215). Fourteen (6.5%) missed OU cases were identified (2.6/year). Retrospective application of BIG resulted in 82.6% (n = 217) at BIG 3, 10.2% (n = 27) at BIG 2 and 7.6% (n = 20) at BIG 1. Application of BIG would not have decreased admission rates (82.6% BIG 3) and BIG 1 and 2 admissions were often for medical co-morbidities. The composite outcome was met in 50% of BIG 3, 22% of BIG 2, and no BIG 1 patients. In a level 1 trauma center with an established observation unit, current clinical care processes missed very few patients who could be discharged or placed in ED OU for SDH. Hospital admissions in BIG 1/2 were driven by co-morbidities and/or injuries, limiting applicability of BIG to this population. • The Brain Injury Guidelines (BIG) are validated recommendations for admission risk stratification for intracranial bleeds. • BIG does not consider medical comorbidities. In this BIG low risk cohort, comorbidities often necessitated admissions. • Current care resulted in higher levels of patients being discharged or placed in ED Observation than BIG recommendations. • BIG may not apply as well to a population with high acuity and a high comorbidity burden. [ABSTRACT FROM AUTHOR]

BackgroundAneurysmal subarachnoid hemorrhages are frequently complicated by hypertension and neurogenic myocardial stunning. Beta blockers may be used for management of these complications. We sought to investigate sympathetic nervous system modulation by beta blockers and their effect on radiographic vasospasm, delayed cerebral infarction, discharge destination and death.MethodsRetrospective chart review of 218 adults admitted to the ICU between 8/2004 and 9/2010 was performed. Groups were identified relevant to beta blockade: 77 were never beta blocked (No/No), 123 received post-admission beta blockers (No/Yes), and 18 were continued on their home beta blockers (Yes/Yes). Records were analyzed for baseline characteristics and the development of vasospasm, delayed cerebral infarction, discharge destination and death, expressed as adjusted odds ratio.ResultsOf the 218 patients 145 patients developed vasospasm, 47 consequently infarcted, and 53 died or required care in a long-term facility. When compared to No/No patients, No/Yes patients had significantly increased vasospasm (OR 2.11 (1.06-4.16)). However, these patients also had significantly fewer deaths or need for long term care (OR 0.17 (0.05-0.64)), with decreased tendency for infarcts (OR 0.70 (0.32-1.55)). When compared to No/No patients, Yes/Yes patients demonstrated a trend toward increased vasospasm (OR 1.61 (0.50-5.29)) that led to infarction (OR 1.51 (0.44-5.13)), but with decreased mortality or need for long term care in a facility (OR 0.13 (0.01-1.30)).ConclusionPost-admission beta blockade in aneurysmal subarachnoid hemorrhage patients was associated with increased incidence of vasospasm. However, despite the increased occurrence of vasospasm, beta blockers were associated with improved discharge characteristics and fewer deaths.

ObjectivesIn this 2-center study, we assessed the technical feasibility and reliability of a low cost, tablet-based mobile telestroke option for ambulance transport and hypothesized that the NIH Stroke Scale (NIHSS) could be performed with similar reliability between remote and bedside examinations.MethodsWe piloted our mobile telemedicine system in 2 geographic regions, central Virginia and the San Francisco Bay Area, utilizing commercial cellular networks for videoconferencing transmission. Standardized patients portrayed scripted stroke scenarios during ambulance transport and were evaluated by independent raters comparing bedside to remote mobile telestroke assessments. We used a mixed-effects regression model to determine intraclass correlation of the NIHSS between bedside and remote examinations (95% confidence interval).ResultsWe conducted 27 ambulance runs at both sites and successfully completed the NIHSS for all prehospital assessments without prohibitive technical interruption. The mean difference between bedside (face-to-face) and remote (video) NIHSS scores was 0.25 (1.00 to -0.50). Overall, correlation of the NIHSS between bedside and mobile telestroke assessments was 0.96 (0.92-0.98). In the mixed-effects regression model, there were no statistically significant differences accounting for method of evaluation or differences between sites.ConclusionsUtilizing a low-cost, tablet-based platform and commercial cellular networks, we can reliably perform prehospital neurologic assessments in both rural and urban settings. Further research is needed to establish the reliability and validity of prehospital mobile telestroke assessment in live patients presenting with acute neurologic symptoms.

The ubiquity of mobile devices makes them well suited for field-based learning experiences that require students to gather data as part of the process of developing scientific inquiry practices. The usefulness of these devices, however, is strongly influenced by the nature of the applications students use to collect data in the field. To increase student success and satisfaction with these experiences, mobile learning applications must be intuitive and functional for students, and support a systematic approach to the complex process of collecting data during a scientific inquiry. This article examines how developers can take an iterative, user-centred design approach to developing mobile learning applications that scaffold the process of data collection by documenting the evolution of an iPad application called Habitat Tracker. This application was created as part of an integrated curriculum that includes online and mobile computing technologies and was designed to help students learn about the nature of science and scientific inquiry on field trips to a natural science museum. The results of this research include principles that developers can use to guide the design of future applications used to support scientific inquiry during field-based learning experiences.