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ProblemOur nation faces an urgent need for more primary care (PC) physicians, yet interest in PC careers is dwindling. Students from underrepresented in medicine (UIM) backgrounds are more likely to choose PC and practice in underserved areas yet their representation has declined. Accelerated PC programs have the potential to address workforce needs, lower educational debt, and diversify the physician workforce to advance health equity.ApproachWith support from Kaiser Permanente Northern California (KPNC) and the American Medical Association's Accelerating Change in Medical Education initiative, University of California School of Medicine (UC Davis) implemented the Accelerated Competency-based Education in Primary Care (ACE-PC) program - a six-year pathway from medical school to residency for students committed to health equity and careers in family medicine or PC-internal medicine. ACE-PC accepts 6-10 students per year using the same holistic admissions process as the 4-year MD program with an additional panel interview that includes affiliated residency program faculty from UC Davis and KPNC. The undergraduate curriculum features: PC continuity clinic with a single preceptor throughout medical school; a 9-month longitudinal integrated clerkship; supportive PC faculty and culture; markedly reduced student debt with full-tuition scholarships; weekly PC didactics; and clinical rotations in affiliated residency programs with the opportunity to match into specific ACE-PC residency tracks.OutcomesSince 2014, 70 students have matriculated to ACE-PC, 71% from UIM groups, 64% are first-generation college students. Of the graduates, 48% have entered residency in family medicine and 52% in PC-internal medicine. In 2020, the first graduates entered the PC workforce; all are practicing in California, including 66% at federally qualified health centers, key providers of underserved care.

Lifelong, guideline-based monitoring for late effects is recommended for childhood cancer survivors (CCS). We examined rates of receiving surveillance tests among at-risk young adult CCS in a population-based study (n = 253; 50% Hispanic/Latino; mean post-treatment interval 14.5 years, range: 5-22). Adherence rates were 36.1%, 31.9%, and 36.4% among those indicated for cardiac (n = 119), thyroid (n = 68), and breast (n = 66) surveillance, respectively, indicating that poor surveillance among long-term CCS is widespread. Receipt of any of these surveillance tests was positively associated with being in follow-up care, having any health insurance (vs. none), and receiving education about need for follow-up with surveillance (all p-values less than .05).

BackgroundObesity rates among children and adults continue to accelerate in the U.S., particularly among marginalized and low-income populations. Obesity prevention and reduction policies can significantly impact population health by improving environmental conditions and increasing access to health-promoting resources. Limited research has been conducted to examine state obesity policy change over time. The primary aim of this study is to examine legislative approaches used to prevent and reduce obesity in the state of California (U.S.).MethodsWe used quantitative policy surveillance methods to develop a state database of obesity-related legislation (bills, resolutions) introduced in California's legislature between 1999 and 2020. Descriptive statistics were used to examine trends of introduced and enacted policy by legislative and policy characteristics. Chi-square tests were used to determine differences in characteristics between enacted and non-enacted legislation. Legislative session and policy characteristics found to be associated with enactment were used to predict adoption in a logistic regression.ResultsA total of 284 obesity-related bills and resolutions were introduced in California's legislature between 1999 and 2020 with a peak of 43 in 2005-2006. On average, 25.8 bills and resolutions were introduced each 2-year legislative cycle. Findings indicate that (a) children and schools were the most frequently specified population and setting; (b) the most common policy topics were nutrition (45%) and physical activity (33%); and (c) only 15% of legislation mentioned race/ethnicity. Overall, 24.9% of bills were enacted compared to 82.1% of resolutions adopted. Legislation to raise awareness about obesity had 5.4 times the odds of being passed compared to other topics. Yet this difference was not statistically significant in a sensitivity analysis when we excluded resolutions.ConclusionsThis database can be leveraged to advance our knowledge of effective and equitable policy instruments to prevent and reduce obesity. Results reveal important policy elements that may impact legislative success, including policy topic, and contribute to a nascent evidence base for public health law research, legal epidemiology, and practice. Future work should investigate the role of policy effectiveness research and evidence on legislative policymaking.

IntroductionFew studies have examined the relationship between education and cognition among the oldest-old.MethodsCognitive assessments were conducted biannually for 803 participants (62.6% women) of LifeAfter90, a longitudinal study of individuals ≥ 90 years old. Gender differences in associations between education (

AAPM Task Group Report 135.B covers new technology components that have been added to an established radiosurgery platform and updates the components that were not well covered in the previous report. Considering the current state of the platform, this task group (TG) is a combination of a foundational task group to establish the basis for new processes/technology and an educational task group updating guidelines on the established components of the platform. Because the technology discussed in this document has a relatively small user base compared to C-arm isocentric linacs, the authors chose to emphasize the educational components to assist medical physicists who are new to the technology and have not had the opportunity to receive in-depth vendor training at the time of reading this report. The TG has developed codes of practice, introduced QA, and developed guidelines which are generally expected to become enduring practice. This report makes prescriptive recommendations as there has not been enough longitudinal experience with some of the new technical components to develop a data-based risk analysis.

Abstract: State and local government decisions about how school funding is raised and allocated have profound impacts on American public education, and in recent years, experts have documented large increases in one type of spending in particular: public pensions. Because most data on school district pension expenditures are at the state level, it has so far been difficult to assess what changes local school districts have made in response. In this paper, I analyze a new dataset of the annual pension expenditures of approximately 200 unified school districts across the United States from 2005 to 2016. Consistent with findings in the literature, I find that pension expenditures rose in real terms in most of them, but also that there has been significant variation in that growth. Moreover, in a descriptive analysis, I find that larger within-district pension expenditure growth is associated with (1) greater revenue growth in the subsequent year and (2) reductions in school district employment, mainly through reductions in the number of non-teaching staff. Finally, there is evidence that districts’ responses to rising pension expenditures may depend on state political institutions, in particular whether the states have mandatory collective bargaining for teachers.

In Spring 2020, colleges across the nation swiftly transitioned their operations—including both classes and student support services—to remote delivery on an emergency basis in response to the crisis posed by the COVID-19 pandemic. While prior research has documented that the transition was associated with decrements in student outcomes, there remains limited understanding of the organizational factors that might have mitigated these negative associations during the pandemic. Drawing on administrative data from the California Community College system, along with a novel survey conducted among distance education leaders, our study reveals that the degree of declines in course completion and course passing rates varied based on pre-COVID online education resources (such as the ratio of distance education personnel to students and the availability of pre-COVID professional development programs in online learning): Colleges with greater pre-COVID online resources experienced more modest declines in student performance. To a lesser extent, we also found that declines in student performance during the onset of the pandemic varied depending on the responses implemented in reaction to the pandemic, such as the extent of technology delivery to students. The implications of our findings extend to the realm of planning for the continuity of operations in potential future crises.

Learning structures that effectively abstract decision policies is key to the flexibility of human intelligence. Previous work has shown that humans use hierarchically structured policies to efficiently navigate complex and dynamic environments. However, the computational processes that support the learning and construction of such policies remain insufficiently understood. To address this question, we tested 1026 human participants, who made over 1 million choices combined, in a decision-making task where they could learn, transfer, and recompose multiple sets of hierarchical policies. We propose a novel algorithmic account for the learning processes underlying observed human behavior. We show that humans rely on compressed policies over states in early learning, which gradually unfold into hierarchical representations via meta-learning and Bayesian inference. Our modeling evidence suggests that these hierarchical policies are structured in a temporally backward, rather than forward, fashion. Taken together, these algorithmic architectures characterize how the interplay between reinforcement learning, policy compression, meta-learning, and working memory supports structured decision-making and compositionality in a resource-rational way.

We combine design-based implementation research with a pre-registered RCT to address a long-standing challenge in psychological science: How to use psychological principles to address real-world problems while designing and implementing interventions in the field. We posit this as a design methodology for optimizing the translation between psychological science and real-world applications. We tested the efficacy of an extensively co-designed version of a game-based rational number intervention, Fraction Ball, versus “business-as-usual” math instruction and physical education in a sample of 4th/5th grade Latine students (N = 360). Insights from nine co-design sessions with 20 teachers informed revisions and additions to a previous version of Fraction Ball, strengthening impacts across 10 of 12 rational number subtests. This methodology provides insights for translating psychological science research and scaling it to address real-world educational needs, such as play-based interventions that improve rational number understanding in authentic contexts.

PURPOSE: This practice parameter for the performance of proton beam radiation therapy was revised collaboratively by the American College of Radiology (ACR) and the American Radium Society (ARS). This practice parameter was developed to serve as a tool in the appropriate application of proton therapy in the care of cancer patients or other patients with conditions in which radiation therapy is indicated. It addresses clinical implementation of proton radiation therapy, including personnel qualifications, quality assurance (QA) standards, indications, and suggested documentation. MATERIALS AND METHODS: This practice parameter for the performance of proton beam radiation therapy was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters - Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ARS. RESULTS: The qualifications and responsibilities of personnel, such as the proton center Chief Medical Officer or Medical Director, Radiation Oncologist, Radiation Physicist, Dosimetrist and Therapist, are outlined, including the necessity for continuing medical education. Proton therapy standard clinical indications and methodologies of treatment management are outlined by disease site and treatment group (e.g. pediatrics) including documentation and the process of proton therapy workflow and equipment specifications. Additionally, this proton therapy practice parameter updates policies and procedures related to a quality assurance and performance improvement program (QAPI), patient education, infection control, and safety. CONCLUSION: As proton therapy becomes more accessible to cancer patients, policies and procedures as outlined in this practice parameter will help ensure quality and safety programs are effectively implemented to optimize clinical care.

Preliminary evidence from the Childhood Joint Attention Rating Scale (C-JARS; Mundy et al., 2017) suggests symptoms related to diminished joint attention and the spontaneous sharing of experience with others can be assessed with a parent-report measure in children and adolescents with autism. This study was designed to expand on the previous study by examining the validity of both a Social Symptom (SS) and a Prosocial (PS) scale of the C-JARS in a study of school-aged autistic children (n  = 89) with and without co-occurring intellectual disability (ID), as well as an age matched neurotypical sample (n  = 62). Results indicated that both C-JARS scales were sensitive and specific with respect to identifying the diagnostic status of the children. In addition, the PS scale was sensitive to differences in cognitive abilities (IQ) and sex differences in the autism group. These results are consistent with the hypothesis that joint attention and spontaneous sharing of experience symptoms are not only characteristic of preschool children with autism but may also constitute a developmentally continuous dimension of the social phenotype of autism that can be measured in school-aged children.

BackgroundIndividuals with intellectual disabilities experience barriers to quality healthcare. To reduce this disparity, equipping medical trainees with the knowledge and skills required for treating this patient population is critical. Our aim is to describe the breadth of instructional interventions and identify gaps in intellectual disability medical education curricula.MethodUsing scoping review methods, the intellectual disability programmes described in 27 articles were evaluated and their coverage of the six core competencies on disability for health care education was examined.ResultsThe most frequently represented core competencies were disability conceptual frameworks, professionalism and communication, and clinical assessment, which were, in most programmes, fulfilled by activities involving individuals with intellectual disabilities. Uneven competency coverage warrants consideration.ConclusionsConsiderable variabilities exist in medical school curricula on intellectual disabilities. Using core competencies on disability for health care education for curricular design and evaluation would provide a coherent training experience in this important area.

ABSTRACT: A framework for a 2-wk summer research course is presented, with a mindset of discovery and self-advocacy that is interdisciplinary and inclusive. The foundations of the course are built upon 2 pillars: (a) a well-defined educational plan focused on cellular engineering, with a goal to instill an engineering mindset into the cell biology field; and (b) a tailored Dimensions of Mentoring policy, which uses a structured feedback system to define and strengthen mentor attributes and provide multiple opportunities for mentorship and mentorship training. Undergraduate and master’s student participants work with PhD students or postdoctoral/professor team leaders in small teams in discovery-based research projects. Multiple teams work in parallel during the 2-wk period and convene in course-wide meetings to share findings and give feedback. Working in small teams with multiple levels of peer and team lead mentoring, students experience advancement in research and technical skills. Participants also experience gains in their understanding of the overarching educational goals in cellular engineering and science communication skills through course-wide activities. The principles from the Dimensions of Mentoring were also effective, with mentors at different levels building strong inclusive teams, coaching practical skills, and promoting individual advocacy. Meeting basic needs, providing relatable role models, and prioritizing enjoyable team-building activities were found to be critical factors in providing inclusive and productive environments. Overall, participants report high satisfaction with a discovery-based interdisciplinary research experience because of a supported environment. This creation of a strong community benefits individual career development and contributes to sustainable research productivity.

ObjectiveNon-suicidal self-directed violence (NSSDV) is a significant and growing youth public health crisis. Girls with ADHD are at increased risk of engaging in NSSDV, yet qualitative studies with this population-to better understand manifestations, motivations, and developmental course-are lacking.MethodWe conducted semi-structured, qualitative interviews with a sub-sample of 57 young women (32 with childhood ADHD, 25 neurotypical comparisons; mean age of 27 years, part of a larger prospective longitudinal study) regarding histories and manifestations of NSSDV.ResultsInductive and deductive analysis revealed several key themes, including self-perceived reasons for engaging in NSSDV (affect regulation, attention seeking, self-punishment, asserting control), impulsivity, secretiveness, and in some cases motivations for desistance.ConclusionFindings underscore the importance of early education and screening, especially among high-risk clinical populations. Increased resources and supports for professionals, parents, and peers are indicated, along with countering the persistent stigma associated with ADHD and NSSDV.

Background and objectiveReadability of patient education materials is of utmost importance to ensure understandability and dissemination of health care information in uro-oncology. We aimed to investigate the readability of the official patient education materials of the European Association of Urology (EAU) and American Urology Association (AUA).MethodsPatient education materials for prostate, bladder, kidney, testicular, penile, and urethral cancers were retrieved from the respective organizations. Readability was assessed via the WebFX online tool for Flesch Kincaid Reading Ease Score (FRES) and for reading grade levels by Flesch Kincaid Grade Level (FKGL), Gunning Fog Score (GFS), Smog Index (SI), Coleman Liau Index (CLI), and Automated Readability Index (ARI). Layperson readability was defined as a FRES of ≥70 and with the other readability indexes

SignificanceA majority of visually impaired older adults were able to learn to proficiently use visual-assistive iPhone applications (apps) following a median 1 hour and/or multiple training sessions, which should be considered when planning vision rehabilitation service delivery, including the option for remote telerehabilitation for those who prefer that modality.PurposeOlder adults with low vision are increasingly using technology to improve their visual functioning. We examined whether age-related comorbidities were potential barriers to success in learning to use visual-assistive apps on a smartphone.MethodsA clinical trial assessed visual-assistive apps in 116 older adults aged 55+ years (mean [standard deviation], 72 [10] years). Subjects were randomized to use an app (SuperVision+, Seeing AI, or Aira) preloaded to a loaner iPhone and completed one-on-one training. App proficiency was measured by the participant's ability to use the iPhone/app without cueing at the end of training sessions. Training time was recorded for the initial session and totaled after subsequent sessions. Multiple regression models explored significant factors associated with training time and proficiency.ResultsMedian initial and total training times were 45 and 60 minutes, respectively. Increased initial and total training times were both significantly related to increased age (p

Abstract: How do teachers develop and use political knowledge to create equitable and inclusive conditions for and with disabled students, particularly disabled students of color? In this essay, we build on concepts of political teacher knowledge in mathematics education, critical inclusive mathematics education and disability studies to explore teacher knowledges that support disabled students’ mathematical learning. We focus on four aspects of political knowledge for teaching mathematics: (1) knowledge as relational and unfolding over time, (2) understanding and negotiating the political contexts in which we teach mathematics, (3) deconstructing deficit discourses about marginalized students, and (4) learning to creatively resist the systems for and with our students. To develop our theoretical analysis, we use a counterstory of a middle school Latino student named Luis and his Latina mathematics teacher, Ms. Marquez. Our aim is to open up discussions in mathematics teacher educational research about the politics at play in teaching inclusive mathematics.

Following the Supreme Court's decision in Dobbs v Jackson Women's Health in June 2022, many states restricted or banned abortion. Medical educators have focused on how this change impacts abortion training for residents, but schools must also adapt undergraduate medical education. Medical schools provide the foundation for future physicians' knowledge and attitudes on abortion. Comprehensive, high-quality abortion education for all medical students is essential for the future of abortion care. Here, we present how education champions can lead curricular improvements in abortion education in the preclinical, clerkship, and postclerkship phases of undergraduate medical education.

Abstract: With the growing recognition of the prevalence and impact of adverse childhood experiences, building trauma-informed service systems is critical. Although there are many online resources to help school systems become more trauma informed, how much they meet the needs of educators is not well understood. To help schools implement trauma-informed practices (TIPS) to support both educators (all school-based certificated staff) and students, a partnership among a California research university, a local foundation, and three school districts was developed at the start of the COVID-19 pandemic. The partnership envisioned a three-phase study to determine the feasibility, acceptability, and outcomes of an intervention supporting TIPS. First, two local districts were engaged in a mixed method needs assessment to explore educators’ wellbeing and use of trauma-informed resources. Input from district-level advisory committees guided a needs assessment that informed the development of trainings to (1) help administrators best support their staff, and (2) teach educators how to best support themselves and their students with traumatic stress and related symptoms. Second, researchers curated freely available resources to develop a 3-module administrator training and an 8-module teacher training. Finally, university-based psychologists and teacher educators delivered the curricula in two school districts and the university’s teacher education program. Researchers implemented a pretest–posttest evaluation design and gathered in-session feedback after each module. Results indicated that participants found the sessions helpful and relevant and they had greater knowledge of TIPS. Future directions include scaling up implementation, understanding outcomes from multiple perspectives, and integrating follow-up activities to help with skill retention.

This paper describes a Human-Centred Learning Analytics (HCLA) design approach for developing learning analytics (LA) dashboards for K-12 classrooms that maintain both contextual relevance and scalability—two goals that are often in competition. Using mixed methods, we collected observational and interview data from teacher partners and assessment data from their students' engagement with the lesson materials. This DBR-based, human-centred design process resulted in a dashboard that supported teachers in addressing their students' learning needs. To develop the dashboard features that could support teachers, we found that a design refinement process that drew on the insights of teachers with varying teaching experience, philosophies and teaching contexts strengthened the resulting outcome. The versatile nature of the approach, in terms of student learning outcomes, makes it useful for HCLA design efforts across diverse K-12 educational contexts. Practitioner notes What is already known about this topic Learning analytics that are aligned to both a learning theory and learning design support student learning. LA dashboards that support users to understand the associated learning analytics data provide actionable insight. Design-based research is a promising methodology for Human-Centred Learning Analytics design, particularly in the K-12 educational context. What this paper adds Leveraging a longstanding, yet fluid, research-practice partnership is an effective design-based research adaptation for addressing the high variation in instructional practices that characterize K-12 education. Using both quantitative and qualitative data that reflects students' developing knowledge effectively supports teachers' inquiry into student learning. Teachers' use of learning analytics dashboards is heavily influenced by their perspectives on teaching and learning. Implications for practice and/or policy Impact on student learning outcomes, alongside usability and feasibility, should be included as a necessary metric for the effectiveness of LA design. LA dashboard developers should both leverage learning data that reflect students' developing knowledge and position teachers to take responsive pedagogical action to support student learning. LA researchers and developers should utilize a long-term, yet fluid, research-practice partnership to form a multi-stakeholder, multidisciplinary design team for Human-Centred Learning Analytics design.

Climate change is a major global concern. Greenhouse gas emissions that cause global climate change are directly or indirectly affected by human activities. Individual low-carbon behaviors are crucial in reducing CO2 emissions and improving environmental and ecological health. To effectively promote individual low-carbon behavior, this study designed a questionnaire on the factors influencing individual low-carbon intentions and behavior based on theoretical models of environmental behavior. A total of 2430 valid questionnaires were collected in China. This study focuses on analyzing the impact of demographic characteristics, internal and external factors on individual low-carbon behaviors and their interrelationships. The research shows correlations between internal and external factors in determining low-carbon intention or behaviors. Internal factors-related low-carbon behavior is not closely linked with demographic variables, whereas the external factors-related low-carbon behavior vary significantly by age, residence, education, marital status, occupation, and income. The findings have important implications for designing effective policies to promote low-carbon behaviors, such as creating a more favorable external environment and increasing the use of policy tools for reducing CO2 emission.

Working in a stem cell laboratory necessitates a thorough understanding of complex cell culture protocols, the operation of sensitive scientific equipment, adherence to safety standards, and general laboratory etiquette. For novice student researchers, acquiring the necessary specialized knowledge before their initial laboratory experience can be a formidable task. Similarly, for experienced laboratory personnel, efficiently and uniformly training new trainees to a rigorous standard presents a significant challenge. In response to these issues, we have developed an educational and interactive virtual cell culture environment. This interactive virtual lab aims to equip students with foundational knowledge in maintaining cortical brain organoids and to instill an understanding of pertinent safety procedures and laboratory etiquette. The gamification of this training process seeks to provide laboratory supervisors in highly specialized fields with an effective tool to integrate students into their work environments more rapidly and safely.

IntroductionHPTN 083 demonstrated the superiority of long-acting cabotegravir (CAB-LA) versus daily oral emtricitabine/tenofovir disoproxil fumarate (TDF/FTC) as pre-exposure prophylaxis (PrEP) among cisgender men and transgender women who have sex with men (MSM/TGW). HPTN 083 provided the first opportunity to understand experiences with injectable PrEP in a clinical trial.MethodsParticipants from two US sites (Chicago, IL and Atlanta, GA) and one international site (Rio de Janeiro, Brazil) were purposively sampled for individual qualitative interviews (N = 40), between November 2019 and March 2020, to explore trial experiences, barriers to adherence and other factors that may have impacted study implementation or outcomes. The blinded phase ended early due to efficacy; this analysis includes interviews conducted prior to unblinding with three groups defined by adherence (i.e. injection visit attendance): adherent (n = 27), non-adherent (n = 12) and early discontinuers (n = 1). Data were organized using NVivo software and analysed using content analysis.ResultsParticipants (mean age: 27) were primarily cisgender MSM (90%) and Black/African American (60%). Reasons for trial enrolment and PrEP use included a preference for using HIV prevention medication versus treatment in the event of HIV acquisition; the ability to enhance health via study-related education and services; access to a novel, convenient HIV prevention product at no cost; and contributing to MSM/TGW communities through research. Participants contrasted positive experiences with study staff with their routine clinical care, and emphasized increased scheduling flexibility, thorough communication, non-judgemental counselling and open, affirming environments (e.g. compassion, less stigma) as adherence facilitators. Injection experiences were positive overall; some described early injection-related anxiety, which abated with time and when given some measure of control (e.g. pre-injection countdown), and minimal injection site discomfort. Some concerns and misperceptions about injectable PrEP were reported. Barriers to adherence, across all adherence categories, included structural factors (e.g. financial constraints, travel) and competing demands (e.g. work schedules).ConclusionsRespondents viewed injectable PrEP trial participation as a positive experience and a means of enhancing wellbeing. Study site flexibility and affirming clinic environments, inclusive of non-judgemental counselling, were key facilitators of adherence. To support injection persistence, interventions that address structural barriers and promote flexible means of injection delivery may be most effective.

Epilepsy, a prevalent chronic neurological disorder, presents numerous challenges for people with epilepsy (PWEs) and their caregivers. They experience difficulties in receiving proper care and support due to stigma and misconceptions. Promoting public awareness in early education would be critical to reduce the stigma and to properly support them. We conducted 145 surveys and 21 interviews with teachers, school nurses, and parents of elementary and middle school students. While the participants exhibited slightly positive attitudes towards PWEs, we identified obstacles that hinder learning about epilepsy and seizure first aid: inadequate education and limited information sharing among school stakeholders. Moreover, there is a pressing need for age-appropriate education that considers the students' ages and perceptual levels. Considering the current limitations and needs, we propose potential implications for future information and communication technologies (ICTs) designs, including knowledge-sharing systems and an educational game aimed at enhancing epilepsy awareness and fostering collaborative care in elementary and middle school environments.

The human body represents a collection of interacting systems that range in scale from nanometers to meters. Investigations from a systems perspective focus on how the parts work together to enact changes across spatial scales, and further our understanding of how systems function and fail. Here, we highlight systems approaches presented at the 2022 Summer Biomechanics, Bio-engineering, and Biotransport Conference in the areas of solid mechanics; fluid mechanics; tissue and cellular engineering; biotransport; and design, dynamics, and rehabilitation; and biomechanics education. Systems approaches are yielding new insights into human biology by leveraging state-of-the-art tools, which could ultimately lead to more informed design of therapies and medical devices for preventing and treating disease as well as rehabilitating patients using strategies that are uniquely optimized for each patient. Educational approaches can also be designed to foster a foundation of systems-level thinking.

ObjectivesIndividuals increasingly experience delays or interruptions in schooling; we evaluate the association between these non-traditional education trajectories and mental health.MethodsUsing year-by-year education data for 7,501 National Longitudinal Survey of Youth 1979 participants, ages 14-48 (262,535 person-years of education data), we applied sequence analysis and a clustering algorithm to identify educational trajectory groups, incorporating both type and timing to credential. Linear regression models, adjusted for early-life confounders, evaluated relationships between educational trajectories and mental health component scores (MCS) from the 12-item short form instrument at age 50. We evaluated effect modification by race, gender, and race by gender.ResultsWe identified 24 distinct educational trajectories based on highest credential and educational timing. Compared to high school (HS) diplomas, < HS (beta=-3.41, 95%CI:-4.74,-2.07) and general educational development credentials (GEDs) predicted poorer MCS (beta=-2.07,95%CI:-3.16,-0.98). The following educational trajectories predicted better MCS: some college immediately after High School (beta=1.52, 95%CI:0.68,2.37), Associate degrees after long interruptions (beta=1.73, 95%CI:0.27,3.19), and graduate school soon after Bachelor's completion (beta=1.13, 95%CI:0.21,2.06). Compared to White men, Black women especially benefited from educational credentials higher than HS in predicting MCS.ConclusionsBoth type and timing of educational credential predicted mental health. Black women's mental higher especially benefited from higher educational credentials.

This study investigated how heritage Spanish–English bilinguals integrate their cue hierarchies to process simple sentences in both Spanish and English. Sentence interpretation is achieved by weighing the various cues that are present in the sentence against that language's cue hierarchy. The Unified Competition Model (UCM) suggests that bilinguals show a variety of patterns in sentence interpretation strategies depending on language proficiency. Previous research on heritage Spanish–English bilinguals and late bilinguals has demonstrated differences in cue utilization and sentence interpretation compared to monolinguals. However, good-enough processing suggests that when a sentence does not meet certain heuristics, like the first-noun agent heuristic, a semantic representation of the sentence will be processed instead of a syntactic one. Even with reliable sentential-level cues such as word order, a plausible semantic representation of the sentence is favored. This is especially the case with inanimate–inanimate (IA-IA) sentences, like in the present study, in which there is less reversibility of thematic roles without competing with semantic plausibility. For this study, participants (n = 32) read a total of 80 inanimate sentences in English and Spanish with subject–verb–object and object–verb–subject (OVS) word orders, indicated the subject of the sentences, and completed language proficiency and dominance tasks. When reading Spanish sentences, participants read the OVS word order faster. English proficiency was a significant predictor of sentence reading time and choice selection time but did not predict word choice. The results suggest that IA-IA sentences pose challenges for cue utilization and thematic role assignment due to semantic limitations. This study found that participants may prioritize semantic plausibility over syntactic representations in sentence processing, supporting a good-enough processing model.

BackgroundAchilles tendinopathy can be a devastating condition in ballet dancers. Initial medical evaluation is frequently conducted by generalist physicians, who may lack the perspective of dance and sports medicine focused training and often prescribe complete rest for chronic overuse injuries. In order to provide targeted information about Achilles tendinopathy and the unique needs of elite athletes, such as ballet dancers, we designed an educational intervention that covers relevant anatomy, physiology, biomechanics, clinical presentation and evaluation, and recommendations for initial treatment and sub-specialty referral. The objectives of this study were to determine baseline understanding of Achilles tendinopathy by generalist physicians and to evaluate the efficacy of an educational intervention on their knowledge.MethodsThis was a prospective pre- post-test study, to measure improvement in knowledge about Achilles tendinopathy. Emergency Medicine and Primary Care physicians participated in an educational intervention with didactic and hands-on components. Data were analyzed using a two-tailed t-test.ResultsTwenty generalist physicians participated. There was significant improvement in their knowledge of Achilles tendinopathy for all our educational objectives (Pre-test: 59% correct answers; post-test: 79% correct answers; P

Abstract: Instructional practices in science education often create dichotomies of “expert” and “outsider” that produce distinct power differences in classrooms. Building upon the idea of “making present practice” to disrupt these binaries, this paper presents select findings from a year-long study investigating two urban teachers' use of community-based science (CBS) instructional practices to create relational shifts that reframe expert and expertise in science instruction. By examining how CBS instructional practices reframe power through co-learning experiences, our findings demonstrated that teachers positioned youth as knowledge constructors through three instructional practices: (a) creating space for students to share their knowledge and experiences, (b) positioning students’ lives and experiences as assets to/within science, and (c) being responsive to assets in future lessons. We use these findings to demonstrate how CBS instructional practices support shifts in relational dynamics by creating spaces of rightful presence, where students are viewed as legitimate classroom members who contribute scientific knowledge in practice and have power in the classroom space. By relinquishing traditional boundaries in science teaching to deconstruct ideas of who holds power, we position CBS instructional practices as a means to expand educational equity by legitimizing students’ diverse sensemaking and re-mediating hierarchical structures in classroom spaces.

We study how human capital and economic conditions causally affect the choice of religious denomination. We utilize a longitudinal dataset monitoring the religious history of more than 5,000 Kenyans over twenty years, in tandem with a randomized experiment (deworming) that has exogenously boosted education and living standards. The main finding is that the program reduces the likelihood of membership in a Pentecostal denomination up to 20 years later when respondents are in their mid-thirties, while there is a comparable increase in membership in traditional Christian denominations. The effect is concentrated and statistically significant among a sub-group of participants who benefited most from the program in terms of increased education and income. The effects are unlikely due to increased secularization, because the program does not reduce measures of religiosity. The results help explain why the global growth of the Pentecostal movement, sometimes described a "New Reformation", is centered in low-income communities.

ABO blood group antigens are critical determinants of immunologic self and non-self and are ubiquitously expressed on all cellular tissues. Antibodies against non-self ABO antigens are naturally present and can mediate pathologic reactions against incompatible transfused blood cells and transplanted tissues. Laboratory testing for ABO antigens and isoagglutinins is essential for safe and effective transfusion and transplantation. Testing for ABO antigens has traditionally depended on serologic testing. However, there is increasing need for evaluation of genetic analysis of ABO antigens, to enable evaluation of ABO blood group in cases where serologic testing may be ambiguous or impossible to accurately perform. The clinical need for ABO genotyping is being addressed by the development of multiple molecular diagnostic approaches. Recent data have clearly demonstrated the potential utility of ABO genotyping in solid organ transplantation, yet widespread implementation has been slow. We propose that this lag is related to practical considerations in laboratory testing, including limited regulatory guidance on the performance and reporting of these assays and the absence of widely available external proficiency testing programs for quality assurance. Here we describe approaches to ABO genotyping, current initiatives in developing ABO genotyping proficiency testing programs, and laboratory quality assurance considerations for ABO genotyping.

BackgroundPrior research suggests that physicians' personal experience with breastfeeding may influence their attitudes toward breastfeeding. This phenomenon has not been explored in well-newborn care physician leaders, whose administrative responsibilities often include drafting and approval of hospital breastfeeding and formula supplementation policies.MethodsWe conducted a mixed-methods study, surveying physicians in the Better Outcomes through Research for Newborns (BORN) network. We examined physician attitudes toward recommending breastfeeding and their breastfeeding experience. Qualitative analysis was conducted on responses to the question: "How do you think your breastfeeding experience influences your clinical practice?"ResultsOf 71 participants, most (92%) had a very positive attitude toward breastfeeding with 75% of respondents reporting personal experience with breastfeeding. Of these, 68% had a very positive experience, 25% had a somewhat positive experience, and 6% had a neutral experience. Four themes emerged with respect to the effect of breastfeeding experience on practice: (1) empathy with breastfeeding struggles, (2) increased knowledge and skills, (3) passion for breastfeeding benefits, and (4) application of personal experience in lieu of evidence-based medicine, particularly among those who struggled with breastfeeding.ConclusionsWell-newborn care physician leaders reported positive attitudes about breastfeeding, increased support toward breastfeeding persons, and a perception of improved clinical lactation skills. Those who struggled with breastfeeding reported increased comfort with recommending formula supplementation to their own patients. Medical education about evidence-based breastfeeding support practices and provision of lactation support to physicians has the potential to affect public health through improved care for the patients they serve.

BackgroundResearch and clinical practice rely heavily on caregiver-report measures, such as the Child Behavior Checklist 1.5-5 (CBCL/1.5-5), to gather information about early childhood behavior problems and to screen for child psychopathology. While studies have shown that demographic variables influence caregiver ratings of behavior problems, the extent to which the CBCL/1.5-5 functions equivalently at the item level across diverse samples is unknown.MethodsItem-level data of CBCL/1.5-5 from a large sample of young children (N = 9087) were drawn from 26 cohorts in the Environmental influences on Child Health Outcomes program. Factor analyses and the alignment method were applied to examine measurement invariance (MI) and differential item functioning (DIF) across child (age, sex, bilingual status, and neurodevelopmental disorders), and caregiver (sex, education level, household income level, depression, and language version administered) characteristics. Child race was examined in sensitivity analyses.ResultsItems with the most impactful DIF across child and caregiver groupings were identified for Internalizing, Externalizing, and Total Problems. The robust item sets, excluding the high DIF items, showed good reliability and high correlation with the original Internalizing and Total Problems scales, with lower reliability for Externalizing. Language version of CBCL administration, education level and sex of the caregiver respondent showed the most significant impact on MI, followed by child age. Sensitivity analyses revealed that child race has a unique impact on DIF over and above socioeconomic status.ConclusionsThe CBCL/1.5-5, a caregiver-report measure of early childhood behavior problems, showed bias across demographic groups. Robust item sets with less DIF can measure Internalizing and Total Problems equally as well as the full item sets, with slightly lower reliability for Externalizing, and can be crosswalked to the metric of the full item set, enabling calculation of normed T scores based on more robust item sets.

Abstract: Language proficiency is a critically important factor in research on bilingualism, but researchers disagree on its measurement. Validated objective measures exist, but investigators often rely exclusively on subjective measures. We investigated if combining multiple self-report measures improves prediction of objective naming test scores in 36 English-dominant versus 32 Spanish-dominant older bilinguals (Experiment 1), and in 41 older Spanish–English bilinguals versus 41 proficiency-matched young bilinguals (Experiment 2). Self-rated proficiency was a powerful but sometimes inaccurate predictor and better predicted naming accuracy when combined with years of immersion, while percent use explained little or no unique variance. Spanish-dominant bilinguals rated themselves more strictly than English-dominant bilinguals at the same objectively measured proficiency level. Immersion affected young more than older bilinguals, and non-immersed (English-dominant) more than immersed (Spanish-dominant) bilinguals. Self-reported proficiency ratings can produce spurious results, but predictive power improves when combined with self-report questions that might be less affected by subjective judgements.

“Neurophobia” is a phenomenon in human medical education where students develop negative attitudes towards neurology, impeding student learning and future clinical practice. While suspected to exist in veterinary medical education, it remains unstudied. The main objectives of this study were to examine North American veterinary student attitudes towards neurology and neurology education and explore elements that might contribute to neurophobia. Additional objectives were to evaluate veterinary educators’ perceptions of student neurophobia and to develop and validate a scoring tool (VetNeuroQ) to quantify veterinary neurophobia. Veterinary students and faculty at North American veterinary schools were surveyed. A scoring tool was developed from a subset of questions and validated using confirmatory factor analysis. Six hundred six anonymous responses were collected from students at all stages of veterinary education. Neurology training was reported as insufficient by 35.9% and most respondents perceived neurology to not be easy to learn. Neuroanatomy/physiology and neurolocalization were considered difficult concepts. Students rated low confidence in neurology (vs. other topics), and low interest in the Neurology/Neurosurgery specialty. 61.7% of educators reported neurophobia amongst their students. The proposed VetNeuroQ scale showed high reliability (Cronbach's alpha >0.7) and validity ( p < .05; CFI >0.9, RMSEA

As AI increasingly enters classrooms, educational designers have begun investigating students' learning processes vis-à-vis simultaneous feedback from active sources—AI and the teacher. Nevertheless, there is a need to delve into a more comprehensive understanding of the orchestration of interactions between teachers and AI systems in educational settings. The research objective of this paper is to identify the challenges and opportunities when AI intertwines with instruction and examine how this hybrid teaching intelligence is being perceived by the students. The insights of this paper are extracted by analysing a case study that utilizes an AI-driven system (MOVES-NL) in the context of learning integer arithmetic. MOVES-NL is an advanced interactive tool that deploys whole-body movement and immediate formative feedback in a room-scale environment designed to enhance students' learning of integer arithmetic. In this paper, we present an in-situ study where 29 students in grades 6–8 interacted individually with MOVES-NL for approximately 1 hour each with the support of a facilitator/instructor. Mixed-methods analyses of multimodal data sources enabled a systematic multifaceted account of students' cognitive–affective experiences as they engaged with MOVES-NL while receiving human support (eg, by asking students to elaborate on their digital actions/decisions). Finally, we propose design insights for instructional and technology design in support of student hybrid learning. The findings of this research contribute to the ongoing discourse on the role of hybrid intelligence in supporting education by offering practical insights and recommendations for educators and designers seeking to optimize the integration of technology in classrooms. Practitioner notes What is already known about this topic Students and teachers develop different relations with and through AI, beyond just interacting with it. AI can support and augment the teachers' capabilities. Hybrid intelligence (HI) has already demonstrated promising potential to advance current educational theories and practices. What this paper adds This research identifies the important learning opportunities and adversities emerging when AI intertwines with instruction and examines how learners perceive those moments. The results show that the system and the facilitator's feedback were complementary to the success of the learning experience. AI-enabled students to reflect upon and test their previous knowledge and guided teachers to work with students to consolidate challenging topics. Findings provide insights into how the teacher–AI collaboration could engage and motivate students to reflect conceptually upon mathematical rules. Implications for practice and/or policy This study encourages practitioners and scholars to consider hybrid teaching intelligence when designing student-centred AI learning tools, focusing on supporting the development of effective teacher–AI collaborative technologies.

BackgroundDespite the need to increase engagement of underrepresented groups (URG) in Alzheimer's disease and related dementias (ADRD) studies, enrollment remains low.ObjectiveCompare referral sources across racial and ethnic groups among participants enrolled in ADRC studies.MethodsData for this cross-sectional secondary analysis were extracted from the National Alzheimer's Coordinating Center Uniform Data Set. We performed mixed effects logistic regression models using generalized estimating equations for professional referral versus non-professional referral by racial and ethnic group, adjusted for age, gender, education, visit year, and Clinical Dementia Rating scale (CDR) with a random effect for study site.ResultsIncluded in the analysis were 48,330 participants across 46 ADRCs (mean [SD] age, 71.3 [10.5] years; 20,767 female [57%]; 4,138 Hispanic [8.6%]; 1,392 non-Hispanic Asian [2.9%]; 6,766 non-Hispanic Black [14%] individuals; and 676 individuals [1.4%] of other races. Non-Hispanic Black and Asian participants had lower odds of being referred by a professional contact compared to non-Hispanic White participants (Black: adjusted OR = 0.61, 95% CI = 0.44-0.86, p = 0.005; Asian: adjusted OR = 0.65, 95% CI, p = 0.004). In participants who had completed an MRI, there was no significant difference in referral source across ethnic and racial groups.ConclusionsFurther studies are needed to better understand the systemic and structural factors that contribute to differences in referral sources and disparities in recruitment of URG into ADRD studies.

ObjectivesThis pilot research study, conducted at a large academic healthcare facility, used mixed methodology to (1) administer a survey to a group of primary care trainees and faculty and (2) conduct key informant interviews with the program directors, or their delegates of these primary care training programs, so as to gain insight into respondents' perceptions about their training on adult obesity. To maintain confidentiality of the key informants, they were defined as "Administrators." Faculty and trainees were from family medicine and internal medicine residency programs, as well as family nurse practitioner and physician assistant training programs.MethodsThis study used a quantitative survey and four qualitative key informant (Administrator) interviews. Descriptive statistics, χ2, or Fisher exact tests were used to analyze select survey responses. Administrator interviews were analyzed with thematic analysis.ResultsSurvey respondents (n = 75) included primary care trainees (n=34), faculty (n=30), other (n=2), did not answer (n=9). Surveys indicated that additional training is needed for bariatric surgery, weight loss medications, and clinical nutrition. The three highest ranked topics in the surveys on adult obesity were basic nutrition, behavioral weight management, and a rotation on adult obesity. Most agreed on the need for interprofessional collaboration, a centralized obesity treatment center, and an introductory obesity course. Key themes from the four Administrator interviews revealed the need: for more training; to build upon current curriculum; use innovative technology; fiscal challenges; and time management.ConclusionsBoth faculty and trainees perceive that academic and clinical training on adult obesity is inadequate, and that trainees need more education on such topics as nutrition, physical activity, behavioral health, antiobesity medications, and bariatric surgery. Competency to treat varied by topic. It also showed that more interprofessional collaboration and a centralized obesity treatment center are needed. Recommendations included integrating modular units about obesity into already established primary care training programs and providing additional resources.

BackgroundImplementation science scholars have made significant progress identifying factors that enable or obstruct the implementation of evidence-based interventions, and testing strategies that may modify those factors. However, little research sheds light on how or why strategies work, in what contexts, and for whom. Studying implementation mechanisms-the processes responsible for change-is crucial for advancing the field of implementation science and enhancing its value in facilitating equitable policy and practice change. The Agency for Healthcare Research and Quality funded a conference series to achieve two aims: (1) develop a research agenda on implementation mechanisms, and (2) actively disseminate the research agenda to research, policy, and practice audiences. This article presents the resulting research agenda, including priorities and actions to encourage its execution.MethodBuilding on prior concept mapping work, in a semi-structured, 3-day, in-person working meeting, 23 US-based researchers used a modified nominal group process to generate priorities and actions for addressing challenges to studying implementation mechanisms. During each of the three 120-min sessions, small groups responded to the prompt: "What actions need to be taken to move this research forward?" The groups brainstormed actions, which were then shared with the full group and discussed with the support of facilitators trained in structured group processes. Facilitators grouped critical and novel ideas into themes. Attendees voted on six themes they prioritized to discuss in a fourth, 120-min session, during which small groups operationalized prioritized actions. Subsequently, all ideas were collated, combined, and revised for clarity by a subset of the authorship team.ResultsFrom this multistep process, 150 actions emerged across 10 priority areas, which together constitute the research agenda. Actions included discrete activities, projects, or products, and ways to shift how research is conducted to strengthen the study of implementation mechanisms.ConclusionsThis research agenda elevates actions to guide the selection, design, and evaluation of implementation mechanisms. By delineating recommended actions to address the challenges of studying implementation mechanisms, this research agenda facilitates expanding the field of implementation science, beyond studying what works to how and why strategies work, in what contexts, for whom, and with which interventions.

Research demonstrates that programming and curricula that is affirmative and inclusive of sexual and gender minority (SGM) people is potentially lifesaving for students in middle and high school. There has been little examination, however, of SGM-affirmative programming at the elementary school level. Elementary school level programming has the potential to benefit SGM youth and families, as well as lead to more affirmative attitudes in later school settings. The study reports on the factors that create and sustain an elementary after school program that has implemented SGM-affirmative programming within a social justice and arts framework for over 20 years. We conducted thematic analysis of interviews with teachers, administrators, and parents in the program and the associated elementary school to identify factors that contribute to the program’s success in affirming and including SGM people. Findings highlight affirmative policies and systems (inclusive mission statements, policies encouraging expression, and hiring diverse staff) and consistent enactment of inclusive and affirmative behaviors (affirming diversity, implementing inclusive curriculum, using inclusive language, and disrupting normativity and implementing restorative practices) as key components of an SGM-affirmative program with elementary-aged students. Results highlight that creating an SGM-affirmative elementary level program is possible and provide an exemplar of this programming in action. Implications and potential focus areas for policy and practice implementation are discussed.

Promoting science, math, engineering, and technology (STEM) skills for young children provides foundation for and interest in later STEM learning, making early childhood an important time to develop these competencies. Young children also spend increasing amounts of time with media, and thus it is important to understand if children are accessing STEM content and what factors may determine this access. The current survey study of parents of three- to seven-year olds assesses how parents’ science self-efficacy and parents’ scientific literacy relate to children’s STEM media use. Results demonstrate positive relations between parent self-efficacy and child STEM media use (aligned with self-efficacy theory), but results also demonstrate no significant relation between parent scientific literacy and child STEM media use. We conclude that parent self-efficacy is an important social susceptibility for young children’s STEM media use and that future research should continue exploring potential interventions for promoting parents’ self-efficacy related to teaching their children science.

Abstract: In this mixed methods study, we analyzed survey and interview data from 100 preservice secondary science and mathematics teachers enrolled in four teacher education programs (TEPs) to investigate their readiness to teach multilingual learners. We defined readiness as preservice teachers' sense of preparedness to teach multilingual learners and their understanding of effective multilingual learner instruction. We examined participants' self‐reported levels of preparedness, their understanding of effective multilingual learner instruction, and sources contributing to and/or limiting their readiness. We found that participants' readiness to teach multilingual learners significantly increased between the beginning and end of their TEPs. We also found that participants' understanding of effective multilingual learner instruction was significantly associated with a higher sense of preparedness. Furthermore, we found that participants enrolled in graduate TEPs reported higher levels of preparedness than participants enrolled in an undergraduate TEP. Likewise, participants whose first language was other than or in addition to English reported higher levels of preparedness. Finally, participants identified field placement experiences, personal and professional background, and coursework as factors contributing to their readiness to teach multilingual learners. We close with recommendations for teacher educators intent on helping preservice teachers better understand and implement effective instruction for multilingual learners.