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In response to the demand for more STEM-certified teachers, identity has emerged as a theoretical lens for examining how candidates can be recruited into and retained in the teaching profession. This study explores the intersection between teaching identity and disciplinary identity as they relate to the development of a disciplinary teaching identity. Survey responses were collected from students in a teaching recruitment class for STEM majors, and regression models were developed to predict disciplinary teaching identity and program persistence. Findings from both models indicated that teaching identity is a strong predictor of both disciplinary teaching identity and program persistence, but disciplinary identity plays less of a role. These findings align with previous qualitative research on teacher identity development. Additionally, these findings highlight a need to engage STEM faculty in efforts to recruit students who strongly identify with STEM into the teaching profession.

Research Goes to School (RGS) is a professional development program that focuses on high school teachers of science, technology, engineering, and mathematics (STEM) subjects. This collective case study examines RGS participants and their use of project-based learning (PBL) as they implemented curricular units that they developed at the RGS summer workshop. Based on the analysis of the data from the observations, the RGS participants exhibited partial fidelity of implementation to the features of PBL. Analysis of the data from the interviews indicated that participants were aware of features of PBL that they were not able to fully implement. Participants also identified several supports, particularly from the RGS program such as being able to order materials to implement their units, as well as supports that were specific to their teaching contexts. The findings suggested that the professional development program had some positive if limited influence on teachers' instructional practices. This study highlights the need for professional development to enhance teachers' content knowledge as well as their knowledge of pedagogy and to promote collaboration between teachers and professional development providers, particularly once teachers are in their classroom contexts.

Purpose: Understanding variation in multimorbidity across sociodemographics and social drivers of health is critical to reducing health inequities. Methods: From the multi-state OCHIN network of community-based health centers (CBHCs), we identified a cross-sectional cohort of adult (> 25 years old) patients who had a visit between 2019-2021. We used generalized linear models to examine the relationship between the Multimorbidity Weighted Index (MWI) and sociodemographics and social drivers of health (Area Deprivation Index [ADI] and social risks [e.g., food insecurity]). Each model included an interaction term between the primary predictor and age to examine if certain groups had a higher MWI at younger ages. Results: Among 642,730 patients, 28.2% were Hispanic/Latino, 42.8% were male, and the median age was 48. The median MWI was 2.05 (IQR: 0.34, 4.87) and was higher for adults over the age of 40 and American Indians and Alaska Natives. The regression model revealed a higher MWI at younger ages for patients living in areas of higher deprivation. Additionally, patients with social risks had a higher MWI (3.16; IQR: 1.33, 6.65) than those without (2.13; IQR: 0.34, 4.89) and the interaction between age and social risk suggested a higher MWI at younger ages. Conclusions: Greater multimorbidity at younger ages and among those with social risks and living in areas of deprivation shows possible mechanisms for the premature aging and disability often seen in community-based health centers and highlights the need for comprehensive approaches to improving the health of vulnerable populations. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Limited research has assessed how virtual care (VC) affects cardiovascular disease (CVD) risk management, especially in community clinic settings. This study assessed change in community clinic patients' CVD risk management during the COVID-19 pandemic and CVD risk factor control among patients who had primarily in-person or primarily VC visits. STUDY DESIGN: Retrospective interrupted time-series analysis. METHODS: Data came from an electronic health record shared by 52 community clinics for index (March 1, 2019, to February 29, 2020) and follow-up (July 1, 2020, to February 28, 2022) periods. Analyses compared follow-up period changes in slope and level of population monthly means of 10-year reversible CVD risk score, blood pressure (BP), and hemoglobin A1c (HbA1c) among patients whose completed follow-up period visits were primarily in person vs primarily VC. Propensity score weighting minimized confounding. RESULTS: There were 10,028 in-person and 6593 VC patients in CVD risk analyses, 9874 in-person and 5390 VC patients in BP analyses, and 8221 in-person and 4937 VC patients in HbA1c analyses. The VC group was more commonly younger, female, White, and urban. Mean reversible CVD risk, mean systolic BP, and percentage of BP measurements that were 140/90 mm Hg or higher increased significantly from index to follow-up periods in both groups. Rate of change between these periods was the same for all outcomes in both groups, regardless of care modality. CONCLUSIONS: Among community clinic patients with CVD risk, receiving a majority of care in person vs a majority of care via VC was not significantly associated with longitudinal trends in reversible CVD risk score or key CVD risk factors. [ABSTRACT FROM AUTHOR]

The Indiana Science Initiative (ISI) is a systemic effort to reform K-8 science education. The program provides teachers with professional development, reform-oriented science modules, and materials support. To examine the impact of the initiative's professional development, a participant observation study was conducted in the program's pilot year. Five teachers in grades 3-6 were observed and interviewed as they implemented the ISI-provided modules. Analysis of the observation data revealed that the teachers incorporated each of the features of inquiry science instruction. However, they did not consistently teach in a way that was aligned with the intent of the ISI. Examination of interview data provided insight into influences on teachers' use of inquiry with the ISI-provided modules. These data revealed that teachers were aware of the intent of the ISI and attempted to align their instruction. However, teachers were influenced by their perceptions of students' behavior and abilities as well as timing and the appropriate level of teacher control needed to facilitate science instruction. The research suggests that professional development activities should prepare teachers to help learners evaluate explanations against alternatives, connect explanations to scientific knowledge, and provide strategies to address teachers' perceptions of students, timing, and teacher control.

In response to the demand for more STEM-certified teachers, identity has emerged as a theoretical lens for examining how candidates can be recruited into and retained in the teaching profession. This study explores the intersection between teaching identity and disciplinary identity as they relate to the development of a disciplinary teaching identity. Survey responses were collected from students in a teaching recruitment class for STEM majors, and regression models were developed to predict disciplinary teaching identity and program persistence. Findings from both models indicated that teaching identity is a strong predictor of both disciplinary teaching identity and program persistence, but disciplinary identity plays less of a role. These findings align with previous qualitative research on teacher identity development. Additionally, these findings highlight a need to engage STEM faculty in efforts to recruit students who strongly identify with STEM into the teaching profession. [ABSTRACT FROM AUTHOR]

Abstract Behavioral interventions for children with ASD typically target disability specific behaviors such as social skills and communication. There is a particular need for age-appropriate interventions/programs for school-aged children with [...]

Abstract Community-based physical activity, provided by the community sector, allows for a safe and effective delivery of physical activity for children with disabilities (USDHHS, 2008). To assist community-based health professionals [...]

Objective: We evaluated the extent to which providing training and technical assistance to early childcare centre (ECC) directors, faculty and staff in the implementation of evidence-based nutrition strategies improved the nutrition contexts, policies and practices of ECC serving racially and ethnically diverse, low-income children in Broward County, Florida, USA. The nutrition strategies targeted snack and beverage policies and practices, consistent with Caring for Our Children National Standards.Design: We used the nutrition observation and document review portions of the Environment and Policy Assessment and Observation (EPAO) instrument to observe ECC as part of a one-group pre-test/post-test evaluation design.Setting: ECC located within areas of high rates of poverty, diabetes, minority representation and unhealthy food index in Broward County, Florida, USA.Subjects: Eighteen ECC enrolled, mean 112·9 (sd 53·4) children aged 2-5 years; 12·3 (sd 7·2) staff members; and 10·2 (sd 4·6) children per staff member at each centre.Results: We found significant improvements in centres' overall nutrition contexts, as measured by total EPAO nutrition scores (P=0·01). ECC made specific significant gains within written nutrition policies (P=0·03) and nutrition training and education (P=0·01).Conclusions: Our findings support training ECC directors, faculty and staff in evidence-based nutrition strategies to improve the nutrition policies and practices of ECC serving racially and ethnically diverse children from low-income families. The intervention resulted in improvements in some nutrition policies and practices, but not others. There remains a need to further develop the evaluation base involving the effectiveness of policy and practice interventions within ECC serving children in high-need areas. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance is a growing, global public health crisis, due in large part to the overuse and misuse of antibiotics. Understanding medication allergy data and allergy reactions that are documented in electronic health records (EHRs) can help to identify opportunities to improve the quality of documentation of beta-lactam allergies, thus potentially reducing the prescribing of alternative antibiotics.Methods: Medication allergies and allergy reactions recorded in the EHR for 319 051 patients seen across 32 community health centers were reviewed. Patients with a beta-lactam allergy recorded in their EHR were identified. Free text, as well as standardized allergy and allergy reaction fields, were analyzed.Results: Among patients, 9.1% (n = 29 095) had evidence of a beta-lactam allergy recorded in their EHR. Women, white, and non-Hispanic patients were more likely to have a documented allergy compared to men, black, and Hispanic patients. Among all patients with a documented beta-lactam allergy, 36.2% had an empty or missing allergy reaction description in their EHR.Conclusions: Findings suggest that current EHR documentation practices among the health centers reviewed do not provide enough information on allergic reactions to allow providers to discern between true allergies and common, but anticipated, drug side effects. Improved EHR documentation guidance, training that reinforces the use of standardized data and more detailed recording of allergic reactions, combined with initiatives to address patient barriers including health literacy, may help to improve the accuracy of drug allergies in patients' records. These initiatives, combined with antimicrobial stewardship programs, can help to reduce inappropriate prescribing of alternative antibiotics when beta-lactam antibiotics are first-line and can be tolerated. [ABSTRACT FROM AUTHOR]

The Indiana Science Initiative ( ISI) is a systemic effort to reform K-8 science education. The program provides teachers with professional development, reform-oriented science modules, and materials support. To examine the impact of the initiative's professional development, a participant observation study was conducted in the program's pilot year. Five teachers in grades 3-6 were observed and interviewed as they implemented the ISI-provided modules. Analysis of the observation data revealed that the teachers incorporated each of the features of inquiry science instruction. However, they did not consistently teach in a way that was aligned with the intent of the ISI. Examination of interview data provided insight into influences on teachers' use of inquiry with the ISI-provided modules. These data revealed that teachers were aware of the intent of the ISI and attempted to align their instruction. However, teachers were influenced by their perceptions of students' behavior and abilities as well as timing and the appropriate level of teacher control needed to facilitate science instruction. The research suggests that professional development activities should prepare teachers to help learners evaluate explanations against alternatives, connect explanations to scientific knowledge, and provide strategies to address teachers' perceptions of students, timing, and teacher control. [ABSTRACT FROM AUTHOR]

Research Goes to School (RGS) is a professional development program that focuses on high school teachers of science, technology, engineering, and mathematics (STEM) subjects. This collective case study examines RGS participants and their use of project-based learning (PBL) as they implemented curricular units that they developed at the RGS summer workshop. Based on the analysis of the data from the observations, the RGS participants exhibited partial fidelity of implementation to the features of PBL. Analysis of the data from the interviews indicated that participants were aware of features of PBL that they were not able to fully implement. Participants also identified several supports, particularly from the RGS program such as being able to order materials to implement their units, as well as supports that were specific to their teaching contexts. The findings suggested that the professional development program had some positive if limited influence on teachers' instructional practices. This study highlights the need for professional development to enhance teachers' content knowledge as well as their knowledge of pedagogy and to promote collaboration between teachers and professional development providers, particularly once teachers are in their classroom contexts. [ABSTRACT FROM AUTHOR]

Introduction: The NSW Integrated Care Strategy involves implementing innovative, locally led models of integrated care across the State to transform the NSW healthcare system. The Agency for Clinical Innovation's Patient Reported Measures (PRMs) Program is an important enabler of this strategy. The PRMs Program aims to enable patients to provide direct, timely feedback in order to drive improvement and integration of health care across NSW. Short description of practice change implemented: The PRMs Program enables the collection and use of Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs). The program has used a collaborative co-design approach working with a range of consumers and clinicians throughout each phase. The program is currently working with 11 proof of concept sites (geographical areas) from rural, regional and metropolitan NSW and has facilitated the development of strong partnerships between the acute, community and primary health care services. The program has significantly built capability and capacity of the health care system to transform how care is delivered and how people think about patient outcomes using a range of resources. Aim and theory of change: A formative evaluation of the program was completed to assess the short-term and intermediate outcomes and identify the barriers and enablers of embedding PRMs into routine clinical practice. Targeted population and stakeholders: The targeted population for the program was people living with complex and long term conditions. The PRMs Program has worked with a variety of consumers, clinicians and managers from the proof of concept sites across a range of different settings. Timeline: The Integrated care strategy commenced in 2014 and will run over six years. The PRMs Program commenced late 2014 initially with four proof of concept sites and, due to heavy demand for support and broadening of the program, the program has expanded to 11 proof of concept areas which comprises 81 sites. Highlights (innovation, Impact and outcomes): The PRMs Program formative evaluation identified that having a genuine co-design approach (working from the start with consumers and clinicians) of the program was identified as a key strength of the program as was the co mmitment to travelling out to visit the sites to localise implementation and the education and training was well received. There was early evidence that care planning changed following completion of PROMs and that PRM data has been used to monitor quality and refine service delivery. There was also early evidence that care was more patient-centred, more responsible to patient's needs, clinical practices improved, service delivery more effective and added to reduction in unplanned hospital admissions. Conclusions (comprising key findings): PRMs Program demonstrates how the use of co-design and technology can be used to improve the integration of care and change the way care is delivered to ensure that we really hear what matters most to patients. The results of the program evaluation will be shared and will highlight the enablers and barriers to embedding PRMs into routine clinical practice. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Understanding how the COVID-19 pandemic affected cardiovascular disease (CVD) risk monitoring in primary care may inform new approaches for addressing modifiable CVD risks. This study examined how pandemic-driven changes in primary care delivery affected CVD risk management processes. STUDY DESIGN: This retrospective study used electronic health record data from patients at 70 primary care community clinics with scheduled appointments from September 1, 2018, to September 30, 2021. METHODS: Analyses examined associations between appointment type and select care process measures: appointment completion rates, time to appointment, and up-to-date documentation for blood pressure (BP) and hemoglobin A1c (HbA1c). RESULTS: Of 1,179,542 eligible scheduled primary care appointments, completion rates were higher for virtual care (VC) vs in-person appointments (10.7 percentage points [PP]; 95% CI, 10.5-11.0; P < .001). Time to appointment was shorter for VC vs in-person appointments (--3.9 days; 95% CI, --4.1 to --3.7; P < .001). BP documentation was higher for appointments completed pre-- vs post pandemic onset (16.2 PP; 95% CI, 16.0-16.5; P < .001) and for appointments completed in person vs VC (54.9 PP; 95% CI, 54.6-55.2; P < .001). HbA1c documentation was higher for completed appointments after pandemic onset vs before (5.9 PP; 95% CI, 5.1-6.7; P < .001) and for completed VC appointments vs in-person appointments (3.9 PP; 95% CI, 3.0-4.7; P < .001). CONCLUSIONS: After pandemic onset, appointment completion rates were higher, time to appointment was shorter, HbA1c documentation increased, and BP documentation decreased. Future research should explore the advantages of using VC for CVD risk management while continuing to monitor for unintended consequences. [ABSTRACT FROM AUTHOR]

Background:  Current research on firearm violence is largely limited to patients who received care in emergency departments or inpatient acute care settings or who died. This is because standardized disease classification codes for firearm injury only represent bodily trauma. As a result, research on pathways and health impacts of firearm violence is largely limited to people who experienced acute bodily trauma and does not include the estimated millions of individuals who were exposed to firearm violence but did not sustain acute injury. Assessing and collecting data on exposure to firearm violence in ambulatory care settings can expand research and more fully frame the public health issue., Objective: The aim of the study is to evaluate the demographic and clinical characteristics of patients who self-reported exposure to firearm violence during a behavioral health visit., Methods: This study assessed early data from an initiative implemented in 2022 across a national network of ambulatory behavioral health centers to support trauma-informed care by integrating structured data fields on trauma exposure into an electronic health record behavioral health patient assessment form (SmartForm), as such variables are generally not included in standard outpatient medical records. We calculated descriptive statistics on clinic characteristics, patient demographics, and select clinical conditions among clinics that chose to implement the SmartForm and among patients who reported an exposure to firearm violence. Data on patient counts are limited to positive reports of exposure to firearm violence, and the representativeness of firearm exposure among all patients could not be calculated due to unknown variability in the implementation of the SmartForm., Results: There were 323 of 629 (51%) clinics that implemented the SmartForm and reported at least 1 patient exposed to firearm violence. In the first 11 months of implementation, 3165 patients reported a recent or past exposure to firearm violence across the 323 clinics. Among patients reporting exposure, 52.7% (n=1669) were male, 38.8% (n=1229) were Black, 45.7% (n=1445) had posttraumatic stress disorder, 37.5% (n=1186) had a substance abuse disorder (other than nicotine), and 11.7% (n=371) had hypertension., Conclusions: Current research on firearm violence using standardized data is limited to acute care settings and death data. Early results from an initiative across a large network of behavioral health clinics demonstrate that a high number of clinics chose to implement the SmartForm, resulting in thousands of patients reporting exposure to firearm violence. This study demonstrates that collecting standardized data on firearm violence exposure in ambulatory care settings is feasible. This study further demonstrates that resultant data from ambulatory settings can be used for meaningful analysis in describing populations affected by firearm violence. The results of this study hold promise for further collection of structured data on exposure to firearm violence in ambulatory settings., (©Nicole Cook, Megan Hoopes, Frances M Biel, Natalie Cartwright, Michelle Gordon, Marion Sills. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 05.02.2024.)

Introduction: Health centers provide primary and behavioral health care to the nation's safety net population. Many health centers served on the frontlines of the COVID-19 pandemic, which brought major changes to health center care delivery., Objective: To elucidate primary care and behavioral health service delivery patterns in health centers before and during the COVID-19 public health emergency (PHE)., Methods: We compared annual and monthly patients from 2019 to 2022 for new and established patients by visit type (primary care, behavioral health) and encounter visits by modality (in-person, telehealth) across 218 health centers in 13 states., Results: There were 1581,744 unique patients in the sample, most from health disparate populations. Review of primary care data over 4 years show that health centers served fewer pediatric patients over time, while retaining the capacity to provide to patients 65+. Monthly data on encounters highlights that the initial shift in March/April 2020 to telehealth was not sustained and that in-person visits rose steadily after November/December 2020 to return as the predominant care delivery mode. With regards to behavioral health, health centers continued to provide care to established patients throughout the PHE, while serving fewer new patients over time. In contrast to primary care, after initial uptake of telehealth in March/April 2020, telehealth encounters remained the predominant care delivery mode through 2022., Conclusion: Four years of data demonstrate how COVID-19 impacted delivery of primary care and behavioral health care for patients, highlighting gaps in pediatric care delivery and trends in telehealth over time., Competing Interests: Conflict of interest:: The authors have no conflicts of interest to declare., (© Copyright by the American Board of Family Medicine.)

Background: Loneliness, social isolation, and lack of technical literacy are associated with poorer health outcomes. To help improve social connection during the COVID-19 pandemic, Nova Southeastern University's South Florida Geriatric Workforce Enhancement Program partnered with a community-based organization to provide educational resources to promote telehealth services., Objective: This study aimed to provide educational resources to older adults with limited resources and promote the use of telehealth services in this population., Methods: Through this pilot project, we contacted 66 vulnerable older adults who expressed interest in telehealth support through wellness calls, with 44 participants moving on to participate in tablet usage. All tablets were preloaded with educational information on using the device, COVID-19 resources, and accessing telehealth services for patients, caregivers, and families., Results: Feedback from wellness assessments suggested a significant need for telehealth support. Participants used the tablets mainly for telehealth (n=6, 15%), to connect with friends and family (n=10, 26%), and to connect with faith communities (n=3, 8%)., Conclusions: The findings from the pilot project suggest that wellness calls and telehealth education are beneficial to support telehealth usage among older adults., (©Sweta Tewary, Nicole Cook, Marie Dezine, Oksana Shnayder, Naushira Pandya. Originally published in JMIR Formative Research (https://formative.jmir.org), 11.09.2023.)

Social isolation and loneliness are major health concerns for older adults, with the current prevalence of social isolation among older adults estimated to be as high as 43%. In older adults, loneliness and social isolation have both been linked with poor health outcomes including falls, re-hospitalizations, dementia, and all-cause mortality. During the coronavirus disease 2019 (COVID-19) pandemic, older adults constituted one of the most at-risk groups and were faced with some of the strictest and earliest social distancing recommendations, which were associated with increased feelings of loneliness and increased rates of depression and anxiety, upwards of 12%. The objective of this study was to identify the impact of online social connection on feelings of isolation and companionship among older adults during the COVID-19 pandemic. Following the Centers for Disease Control and Prevention (CDC) guidelines in March 2020, two South Florida social and educational programs for older adults adopted online programming utilizing the Zoom platform. A research team worked collaboratively with senior stakeholders to develop and administer a survey to understand the impact of online social connections on feelings of social isolation. One year later in 2021, the survey was reviewed, modified, and re-administered. Respondents of the survey included 211 older adults (mean age 75.5 years old). Notable findings included a strong association between frequency of online class attendance and increased feelings of connectedness (p<0.001), improved spirits (p<0.001), and decreased feelings of social isolation (p<0.001). These results underscore the importance and contribution of online programming among older adults during times of social isolation. Overall, clinical practitioners should consider the importance of initiating discussions with older adults regarding returning to activities that they enjoyed prior to the COVID-19 pandemic., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Derynda et al.)

Background: Patient-reported outcome (PRO) measures have been used widely to screen for depression, anxiety, and symptoms in cancer patients. Computer-based applications that collect patients' responses and transfer them to the treating health professional in real time have the potential to improve patient well-being and cancer outcomes., Objective: This study will test the feasibility and acceptability of a newly developed eHealth system which facilitates PRO data capture from cancer patients, data linkage and retrieval to support clinical decisions and patient self-management, and data retrieval to support ongoing evaluation and innovative research., Methods: The eHealth system is being developed in consultation with 3 overarching content-specific expert advisory groups convened for this project: the clinical advisory group, technical advisory group, and evaluation advisory group. The following work has already been completed during this phase of the study: the Patient-Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care) eHealth system was developed, patient-reported outcomes were selected (distress, symptoms, unmet needs), algorithms to inform intervention thresholds for clinical and self-management were determined, clinician PRO feedback summary and longitudinal reports were designed, and patient self-management resources were collated. PROsaiq, a custom information technology system, will transfer PRO data in real time into the hospital-based oncology information system to support clinical decision making. The PROMPT-Care system feasibility and acceptability will be assessed through patients completing PROMPT-Care assessments, participating in face-to-face cognitive interviews, and completing evaluation surveys and telephone interviews and oncology staff participating in telephone interviews., Results: Over the course of 3 months, the system will be pilot-tested with up to 50 patients receiving treatment or follow-up care and 6 oncology staff at 2 hospitals in New South Wales, Australia. Data will be collected to determine the accuracy and completeness of data transfer procedures, extent of missing data from participants' assessments, acceptability of the eHealth system and usefulness of the self-management resources (via patient evaluation surveys and interviews), and acceptability and perceived usefulness of real-time PRO reporting (via oncology staff interviews) at the completion of the pilot phase., Conclusions: This research investigates implementation of evidence into real world clinical practice through development of an efficient and user-friendly eHealth system. This study of feasibility and acceptability of the newly developed eHealth system will inform the next stage of larger scale testing and future implementation of the system as part of routine care., Clinicaltrial: Australian New Zealand Clinical Trials Registry ACTRN1261500135294; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369299&isReview=true (Archived by WebCite at http://www.webcitation.org/6lzylG5A0)., Competing Interests: Conflicts of Interest: None declared., (©Afaf Girgis, Geoff P Delaney, Anthony Arnold, Alexis Andrew Miller, Janelle V Levesque, Nasreen Kaadan, Martin G Carolan, Nicole Cook, Kenneth Masters, Thomas T Tran, Tiffany Sandell, Ivana Durcinoska, Martha Gerges, Sandra Avery, Weng Ng, Stephen Della-Fiorentina, Haryana M Dhillon, Ashley Maher. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 24.11.2016.)

Purpose: The purpose of this paper was to investigate the participation patterns of children with Down syndrome (DS) using the construct of participation as defined by the International Classification of Functioning Disability and Health (ICF)., Methods: Sixty-two children with DS were recruited between the ages of 9 and 17 years. All participants were given an interview-administered version of the Children's Assessment of Participation and Enjoyment (CAPE) to measure participation (1)., Results: Children with DS participated the most often, based on frequency, in recreational activities ( p  < 0.001); social activity types represented the greatest extension into the community based on with whom the children participated with ( p  < 0.05); finally, physical and social activities represented the greatest extension into the community geographically ( p  < 0.001). In addition, children with DS are significantly more active in activities that are informal in nature., Conclusion: Children with DS participate in a number of activities; however, the extent of their participation within these activities differs depending on the participation pattern examined. Implications for educational and community-based programs are discussed.

Background: Virtual worlds allow users to communicate and interact across various environments, scenarios, and platforms. Virtual worlds present opportunities in health care to reduce the burden of illness and disability by supporting education, rehabilitation, self-management, and social networking. The application of virtual worlds to older adults who bear the burden and cost of health conditions associated with age has not been evaluated., Objective: The aim of this study is to explore the usability, ease of use, and enjoyment of a virtual world by older adults, the types of virtual world activities that older adults may engage in, and the perceptions of older adults regarding the application of virtual worlds in health care., Methods: This quasi-experimental pre-post design research was guided by the Technology Acceptance Model (TAM). Participants were recruited from a Lifelong Learning Institute (LLI) program at Nova Southeastern University. Participants attended four training sessions over a 5-week period in the Second Life (SL) virtual world. Subjects were surveyed before and after the training on perceived ease of use, attitudes towards technology, behavioral intention to use the system, facilitating conditions, effort expectancy, and self-efficacy., Results: Older adults (N=19) completed the informed consent and attended the first training session, and 11 participants (58%, 11/19) completed the full training and the post survey. Completers (82%, 9/11) were more likely than non-completers (37%, 3/8) to consider themselves technologically savvy (P=.048), and to express confidence in being able to use the virtual world (100%, 11/11 vs 37%, 3/8; P=.002). All completers (100%, 11/11) perceived that SL has application in health behaviors and disease and reducing social isolation among people who are homebound. Of the completers, 10 (91%, 10/11) responded that they enjoyed learning how to use SL. Completers suggested that future trainings include more assistants and smaller groups., Conclusions: This pilot study suggests that virtual worlds can be both a feasible and an applicable method to promote health among some seniors. Future research on virtual worlds with older populations should consider using state-of-the art technology including large monitors, providing a minimum of one trainer for every two to three participants, and distributing a comprehensive training manual at the start of the training to support organization and recall.