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This study assesses adults' perceptions of and predictors of intention to use prescription drug take-back boxes. This mixed methods study utilized focus groups and an online survey to examine factors related to intention to use a prescription drug take-back box. This study was conducted in [State] during the spring and summer of 2018. Themes identified in focus group data included the importance of take-back box location, benefits of take-back box use (such as reducing opportunities for medication misuse), and barriers to take-back box use (such as lack of awareness, stigma associated with law enforcement). Survey results indicate that pharmacies are the most preferred take-back box location and that attitudes, subjective norms, and perceived behavioral control are statistically significant predictors of intention to use a take-back box. Results suggest that individuals are open to using take-back boxes in secure, convenient locations, but many arsoe unaware of take-back boxes as an option for safe disposal. These findings have implications for health communication and policy efforts designed to increase the use of take-back boxes for prescription drug disposal.

BACKGROUND: Refeeding syndrome is the gravest possible medical complication in malnourished patients undergoing refeeding in the hospital. We previously reported that males with malnutrition secondary to eating disorders required more calories and had longer hospital stays than females; however, sex differences in electrolyte abnormalities indicating refeeding syndrome risk remain unknown. The objective of this study was to assess differences in electrolyte abnormalities indicating refeeding syndrome risk among male and female adolescents and young adults with eating disorders hospitalized for medical instability. METHODS: We retrospectively reviewed the electronic medical records of 558 patients aged 9-25 years admitted to the University of California, San Francisco Eating Disorders Program for medical instability between May 2012 and August 2020. Serum was drawn per standard of care between 5 and 7 am each morning and electrolyte abnormalities indicating refeeding syndrome risk were defined as: hypophosphatemia (

Objective: The aim of this study was to investigate the perceptions of university students who served as outside facilitators for evidence-based nutrition education for elementary-age children. Design: Qualitative case study. Methods: Thirteen undergraduate university students facilitated four nutrition education sessions for elementary-age students in an after-school programme using the Choice, Control, Change model as part of service learning curriculum. University students completed pre- and post-participation surveys. Elementary-age participants completed surveys after each session. Results: University students saw the benefit of this type of experiential learning with the following themes: knowledge application, learning about diverse perspectives and having a positive impact. Before the first nutrition education session, the university students felt excited, nervous and/or enthusiastic, and during and immediately after the sessions reported they felt confident. Participant engagement was low/mixed and classroom management was challenging, which may be linked to the university students' perceptions that they were underprepared to work in a distracting social environment, and with behaviour typical to elementary-age children. The education session recipients reported they gained knowledge about healthy behaviours and believed that eating healthy foods is important. Conclusion: There are gaps in nutrition education programme theory and implementation by outside facilitators. These findings are relevant to those who provide health education services for surrounding communities. This study provides information about implementation barriers when outside facilitators lead nutrition education, alongside recommendations to improve these types of programmes in the future.

In this paper, I draw together myriad theoretical and philosophical sources to think through the intensification of emotion amid and emerging from the COVID-19 pandemic. I begin with three narratives from my own teaching and learning, which ground the subsequent conversation. I then characterize the current movement in educational theorizing known as the affective turn. The affective turn, I suggest, attunes educational inquiry to small, yet vital, moments of classroom interaction often taken for granted in public education. Toward considering those vital moments in more nuance, I discuss psychoanalyst Wilfred R. Bion's notion of the alpha function -- a nonconscious digestion of emotion we perform for others when they are overwhelmed. When coupled with Nel Noddings' evocation of the ethics of care in education, the alpha function offers an understanding of the hidden emotional labour in teaching. This hidden dimension of the teacher's task, the portion of the job that deals in regulating our own emotions and in helping students make sense of theirs, I suggest, is becoming more difficult amid the affective situation of the COVID-19 pandemic. I conclude the paper by gesturing toward a threefold response to be taken up more fully elsewhere: humility before the task of teaching, a reverence for the work of feeling, and a willingness to organize toward a more caring school system.

The purpose of this paper is to describe a state-wide process used to determine which Teaching Works High Leverage Practices (Ball, 2016) pre-service teachers could be expected to implement at a proficient level by the completion of their preparation program (Initial HLPs), followed by two sets of high leverage practices novice teachers could master during their induction years (Induction and Expert HLPs) (Ball & Forzani, 2011; McLeskey & Brownell, 2015). Data were collected from a wide variety of stakeholders, including K-12 teachers, administrators, and educator preparation program faculty from across the state (N=203). Findings identified five High Leverage Practices that the majority of stakeholders indicated should be a priority for educator preparation programs in the state.

BackgroundClinical trials using psilocybin therapy to treat anorexia nervosa (AN) are currently underway. The safety and tolerability of psilocybin is of utmost importance in individuals with AN who may present unique medical vulnerabilities. The purpose of this review is to describe how the common physiologic adverse effects of psilocybin may impact medical complications experienced by individuals with AN in clinical trials of psilocybin therapy.Main bodyThe physiologic underpinnings of common adverse effects following psilocybin administration are described, including tachycardia, hypertension, electrocardiogram changes, nausea, headache, and lightheadedness. These anticipated physiologic changes are described in relation to the common medical correlates seen in individuals with AN. Risk mitigation strategies for each adverse effect are proposed.ConclusionEarly evidence suggests that psilocybin therapy is well-tolerated in individuals with AN. Understanding the unique medical complications of AN, and how they may be impacted by common physiologic adverse effects of psilocybin administration, leads to tailored risk mitigation strategies to enhance safety and tolerability of this novel intervention.

This paper revisits the well-known and often-taught novel "The Chrysalids" toward a reconsideration of the novel's place within curriculum and the pedagogies it may offer. Framed as a mourning ceremony, a way of revisioning what the novel could mean in the present by saying goodbye to what it has meant in the past, the paper progresses in two major moments. The first looks at the novel in the author's lived experience and discusses personal mourning. The second engages affect theory toward a (re)reading of the material resistances and erasures within one copy of the text. The author concludes by expressing the need for a (re)visioning of what curricular fixtures such as "The Chrysalids" could mean today.

Recent decades have seen a global shift in educational policy and practice towards various forms of "joining-up," through partnerships and networks. These networks have differing aims but are broadly geared towards increasing quality and/or innovation in educational provision, although many prove messy and problematic. Policy makers in England have encouraged schools to collaborate, although parallel market pressures can also drive competition, leading to an argument that schools must engage in "coopetition." More recently, policy has encouraged schools to form or join a multi-academy trust (MAT) and the government's stated aim is that all 21,000 schools in England will be part of a MAT by 2030. A MAT is a formal legal entity with a board and Chief Executive which oversees multiple schools. The headline question we address is whether pre-existing partnerships between schools predict eventual membership of multi-academy trusts? We do this through an analysis of ego network and case study interview data collected from 20 schools across two local areas. We track these networks over a seven-year period, identifying which schools join which MATs. We find that schools do not form or join MATs with other local schools they have collaborated with in the past. We assess this somewhat counter-intuitive finding through the lens of socio-spatial theory, presenting a framework for assessing the interactions between place, scale and networks and considering the implications for policy, practice and research.

Knowledge exchange (KE) is increasingly important in higher education internationally, yet relatively little attention has been paid to it as a pedagogic opportunity for students. This paper draws on 26 interviews with stakeholders within and outside HE to develop a model of student-led knowledge exchange as a guide for learning through KE. The model includes the following elements: Preconditions, Prior Knowledge, Planning and Place, Pedagogic Context and Product, and offers an analysis of different forms of KE which occur between individuals in a learning triad consisting of student, facilitator and external participant. The research foregrounds a social view of learning where valid knowledge comes from diverse participants in the exchange, including students themselves. Students act as a catalyst for multi-directional KE -- a finding which challenges the implied hierarchies evident in much of the literature on this topic. The model is offered as a starting point for developing a pedagogy of KE in higher education.

Abstract Background Aortic stenosis (AS) is the most common degenerative valve disease in high income countries. While hemodynamic metrics are commonly used to assess severity of stenosis, they are impacted by loading conditions and stroke volume and are often discordant. Anatomic valve assessments such as aortic valve calcification (AVC) and valve motion (VM) during transthoracic echocardiography (TTE) can offer clues to disease severity. The reliability of these semi-quantitatively assessed anatomic imaging parameters is unknown. Methods This is a retrospective study of semi-quantitative assessment of AVC and valve VM on TTE. TTEs representing a range of AS severities were identified. The degree of calcification of the aortic valve and the degree of restricted VM were assessed in standard fashion. AVC scores and valve motion were assessed by readers with varied training levels blinded to the severity of AS. Correlation and inter-reader reliability between readers were assessed. Results 420 assessments (210 each for AVC and VM) were collected for 35 TTEs. Correlation of AVC for imaging trainees (fellows and students, respectively), ranged from 0.49 (95% CI 0.18–0.70) to 0.62 (95% CI 0.36–0.79) and 0.58 (95% CI 0.30–0.76) to 0.54 (95% CI 0.25–0.74) for VM. Correlation of anatomic assessments between echocardiographer-assigned AVC grades was r = 0.76 (95% CI 0.57–0.87)). The correlation between echocardiographer-assigned assessment of VM was r = 0.73 (95% CI 0.53–0.86), p

Abstract Background Refeeding syndrome is the gravest possible medical complication in malnourished patients undergoing refeeding in the hospital. We previously reported that males with malnutrition secondary to eating disorders required more calories and had longer hospital stays than females; however, sex differences in electrolyte abnormalities indicating refeeding syndrome risk remain unknown. The objective of this study was to assess differences in electrolyte abnormalities indicating refeeding syndrome risk among male and female adolescents and young adults with eating disorders hospitalized for medical instability. Methods We retrospectively reviewed the electronic medical records of 558 patients aged 9–25 years admitted to the University of California, San Francisco Eating Disorders Program for medical instability between May 2012 and August 2020. Serum was drawn per standard of care between 5 and 7 am each morning and electrolyte abnormalities indicating refeeding syndrome risk were defined as: hypophosphatemia (

Abstract The term ‘perspective’ in the context of economic evaluations and costing studies in healthcare refers to the viewpoint that an analyst has adopted to define the types of costs and outcomes to consider in their studies. However, there are currently notable variations in terms of methodological recommendations, definitions, and applications of different perspectives, depending on the objective or intended user of the study. This can make it a complex area for stakeholders when interpreting these studies. Consequently, there is a need for a comprehensive overview regarding the different types of perspectives employed in such analyses, along with the corresponding implications of their use. This is particularly important, in the context of low-and-middle-income countries (LMICs), where practical guidelines may be less well-established and infrastructure for conducting economic evaluations may be more limited. This article addresses this gap by summarising the main types of perspectives commonly found in the literature to a broad audience (namely the patient, payer, health care providers, healthcare sector, health system, and societal perspectives), providing their most established definitions and outlining the corresponding implications of their uses in health economic studies, with examples particularly from LMIC settings. We then discuss important considerations when selecting the perspective and present key arguments to consider when deciding whether the societal perspective should be used. We conclude that there is no one-size-fits-all answer to what perspective should be used and the perspective chosen will be influenced by the context, policymakers'/stakeholders’ viewpoints, resource/data availability, and intended use of the analysis. Moving forward, considering the ongoing issues regarding the variation in terminology and practice in this area, we urge that more standardised definitions of the different perspectives and the boundaries between them are further developed to support future studies and guidelines, as well as to improve the interpretation and comparison of health economic evidence.

Given the persistence of health inequities in the United States, scholars and health professionals alike have turned to the social determinants of health (SDH) framework to understand the overlapping factors that produce and shape these inequities. However, there is scant empirical literature on how frontline health and social service workers perceive and apply the SDH framework, or related movements such as the right to health, in their daily practice. Our study seeks to bridge this gap by applying constructs from the sociological imagination and structural competency (an emerging paradigm in health professions' education) to understand the perspectives and experiences of social work case managers, community health workers, legal advocates, and mental health counselors at a maternal and child health center in a large US city. This frontline workforce displayed strong sociological imagination, elements of structural competency, and engagement with the principles of the right to health. Workers shared reflections on the SDH framework in ways that signaled promising opportunities for frontline workers to link with the global movement for the right to health. We offer a novel approach to understanding the relationships between frontline worker perspectives on and experiences with the SDH, sociological imagination, structural competency, and the right to health.

To address claims of human exceptionalism, we determine where humans fit within the greater mammalian distribution of reproductive inequality. We show that humans exhibit lower reproductive skew (i.e., inequality in the number of surviving offspring) among males and smaller sex differences in reproductive skew than most other mammals, while nevertheless falling within the mammalian range. Additionally, female reproductive skew is higher in polygynous human populations than in polygynous nonhumans mammals on average. This patterning of skew can be attributed in part to the prevalence of monogamy in humans compared to the predominance of polygyny in nonhuman mammals, to the limited degree of polygyny in the human societies that practice it, and to the importance of unequally held rival resources to women's fitness. The muted reproductive inequality observed in humans appears to be linked to several unusual characteristics of our species-including high levels of cooperation among males, high dependence on unequally held rival resources, complementarities between maternal and paternal investment, as well as social and legal institutions that enforce monogamous norms.

Nontraditional grading methods have recently become more common, and as with any large pedagogical shift, there are a number of questions to consider when applying a new grading scheme to a course. This article summarizes four types of nontraditional grading and shares experiences from the authors who have applied them to a variety of courses in statistics. This article is structured as a set of questions and answers, seeking to address many of the concerns and considerations that one may face as they transition a course’s grading structure. Supplementary materials for this article are available online.

Alternative grading methods, such as standards-based grading, provide students multiple opportunities to demonstrate their understanding of the learning outcomes in a course. These grading methods allow for more flexibility and help promote a growth mindset by embracing constructive failure for students. Implementation of these alternative grading methods requires developing specific, transparent, and assessable standards. Moving away from traditional methods also requires a mindset shift for how both students and instructors approach assessment. While providing multiple opportunities is important for learning in any course, these methods are particularly relevant to an upper level mathematical statistics course where topics covered often provide an additional challenge for students as they lie at the intersection of both theory and application. By providing multiple opportunities, students have the space for constructive failure as they tackle learning both a conceptual understanding of statistics and the supporting mathematical theory. In this article we share our experiences—including both challenges and benefits for students and instructors—in implementing standards-based grading in the first semester of a mathematical statistics course (i.e., focus primarily on probability). Supplementary materials for this article are available online.

The need for evolving support interventions that can help students in a wide range of settings is an ongoing requirement for middle schools today. Token reinforcement, which is a form of extrinsic motivation and incentivization, is studied within this meta-analysis to determine if significant treatment effects exist overall and if there are studies that show more gains than others. Most studies report significant positive gains individually, but the statistical significance is lost when the studies are reviewed as a whole. Variables such as sample size requirements, treatment effect variation, and session time all influence treatment effect size. Reinforcement has been shown to be a viable strategy for differentiation, but the area of standardization has yet to be adequately addressed within past and present research. Some effect size traits reported from the literature are supported within this meta-analysis, but the sampling, analysis, and interpretation protocols exhibited by certain studies make it difficult to remove bias and confounding within reinforcement studies. Further research avenues and additional considerations are discussed.

Abstract Background Clinical trials using psilocybin therapy to treat anorexia nervosa (AN) are currently underway. The safety and tolerability of psilocybin is of utmost importance in individuals with AN who may present unique medical vulnerabilities. The purpose of this review is to describe how the common physiologic adverse effects of psilocybin may impact medical complications experienced by individuals with AN in clinical trials of psilocybin therapy. Main body The physiologic underpinnings of common adverse effects following psilocybin administration are described, including tachycardia, hypertension, electrocardiogram changes, nausea, headache, and lightheadedness. These anticipated physiologic changes are described in relation to the common medical correlates seen in individuals with AN. Risk mitigation strategies for each adverse effect are proposed. Conclusion Early evidence suggests that psilocybin therapy is well-tolerated in individuals with AN. Understanding the unique medical complications of AN, and how they may be impacted by common physiologic adverse effects of psilocybin administration, leads to tailored risk mitigation strategies to enhance safety and tolerability of this novel intervention.

Abstract Background With the legalization of cannabis in Canada, consumers are presented with numerous purchase options. Licensed retailers are limited by the Cannabis Act and provincial regulations with respect to offering sales, advertising, location, maximum quantities, and information sharing in an effort to protect public health and safety. The degree these policies influence consumer purchase behavior will help inform regulatory refinement. Methods A discrete choice experiment within a cross-sectional online survey was used to explore trade-offs consumers make when deciding where to purchase cannabis. Attributes included availability of sales/discounts, proximity, product information, customer service, product variety, and provincial regulation. Participants ≥ 19 years old who lived in Canada and purchased cannabis in the previous 12 months were recruited through an online market research survey panel. A multinomial logit (MNL) model was used for the base model, and latent class analysis was used to assess preference sub-groups. Key limitations included ordering effect, hypothetical bias, and framing effect. Results The survey was completed by 1626 people, and the base model showed that customer service carried the most weight in purchase decisions, followed by proximity and availability of sales and discounts. There was considerable heterogeneity in preference patterns, with a five-group latent class model demonstrating best fit. Only one group (15% of sample) placed a high value on the store being provincially regulated, while three groups were willing to make a trade-off with regulation to access better customer service, product information, or closer proximity. One group preferred non-regulated sources (24% of sample); this group was also primarily driven by the availability of sales and discounts. Three groups (60.5% of sample) preferred online stores. Conclusion This study highlighted that there exists significant diversity with respect to the influence of consumer experiences on cannabis purchase behaviors. Modifications to cannabis retail regulations that focus on improving access to product information as well as reviewing limitations on sales and discounts could have the most impact for shifting customers to licensed retailers.

Background: Excellent short-term outcomes after reverse shoulder arthroplasty (RSA) have been reported, but longer term outcomes in the existing literature are sparse and vary widely. The purpose of this study is to systematically assess the existing literature to quantify functional outcomes and complication rates after RSA at a minimum of five years of follow-up. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-analyses-compliant systematic literature search of the PubMed and Embase databases was undertaken. Studies reporting outcomes after primary RSA for nontrauma-related indications with a minimum of 5-year follow-up were included. Results: Overall, 20 studies satisfied all inclusion criteria. This represented 1591 shoulders in 1556 patients (32.1% males), with a mean age of 70.2 ± 5.0 years and mean follow-up of 8.8 years, or 106.2 ± 30.1 months (60-243). At final follow-up, the mean reported Constant Murley score was 62.1 ± 5.0 (49.0-83.0). The mean adjusted Constant Murley score was 83.5 ± 12.5 (58-111.9). The mean American Shoulder and Elbow Surgeons score was 81.8 ± 4.6, while the mean subjective shoulder value was 74.6 ± 6.4. Overall, 88% of patients rated their satisfaction as either good or very good. The range of active forward flexion, abduction, external, and internal rotation were respectively, 126° ± 13°, 106° ± 11°, 22° ± 11°, and 6° ± 2°. The overall rate of revision surgery was 4.9% (0%-45.5%). Regarding complications, the rate of prosthetic joint infection was 4.3% (0%-26.7%), shoulder dislocation was 3.7% (0%-20.4%), and acromial fracture was 2.0% (0%-8.8%). At final follow-up, 30.9% of shoulders had some degree of scapular notching. Conclusion: This systematic review shows that RSA results in high satisfaction rates, good clinical outcomes, as well as modest complication and revision rates at minimum 5-year follow-up.

Students with intellectual and developmental disabilities (IDD) who attend inclusive postsecondary education (IPSE) programs gain many new and beneficial skills, including independent living, social, and employability skills. Another skill set that may be strengthened by attending an IPSE program is self-determination. There is limited research available identifying the impact of IPSE programs on self-determination growth. We addressed this gap by using a longitudinal study designed to examine the changes in self-determination levels of students with IDD across 3 years in an IPSE program. Data collected from 23 students with IDD at 4 points of time within 3 years showed that there was an increasing trend in students' self-determination levels at the end of each year. The difference was highly significant between the baseline and the end of the third year. This suggests that IPSE programs can play a critical role in the improvement of the self-determination levels in students with IDD. Implications and future research are discussed.