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Background: Innovative technology can enhance patient access to healthcare but must be successfully implemented to be effective. Objective: We evaluated Department of Veterans Affairs' (VA's) implementation of My VA Images, a direct-to-patient asynchronous teledermatology mobile application enabling established dermatology patients to receive follow-up care remotely instead of in-person. Design /Participants/Approach: Following pilot testing at 3 facilities, the app was introduced to 28 facilities (4 groups of 7) every 3 months using a stepped-wedge cluster-randomized design. Using the Organizational Theory of Implementation Effectiveness, we examined the app's implementation using qualitative and quantitative data consisting of encounter data from VA's corporate data warehouse; app usage from VA's Mobile Health database; bi-monthly reports from facility representatives; phone interviews with clinicians; and documented communications between the operational partner and facility staff. Key Results: Implementation policies and practices included VA's vision to expand home telehealth and marketing/communication strategies. The COVID-19 pandemic dominated the implementation climate by stressing staffing, introducing competing demands, and influencing stakeholder attitudes to the app, including its fit to their values. These factors were associated with mixed implementation effectiveness, defined as high quality consistent use. Nineteen of 31 exposed facilities prepared to use the app; 10 facilities used it for actual patient care, 7 as originally intended. Residents, nurse practitioners, and physician assistants were more likely than attendings to use the app. Facilities exposed to the app pre-pandemic were more likely to use and sustain the new process. Conclusions: Considerable heterogeneity existed in implementing mobile teledermatology, despite VA's common mission, integrated healthcare system, and stakeholders' broad interest. Identifying opportunities to target favorable facilities and user groups (such as teaching facilities and physician extenders, respectively) while addressing internal implementation barriers including incomplete integration with the electronic health record as well as inadequate staffing may help optimize the initial impact of direct-to-patient telehealth. The COVID pandemic was a notable extrinsic barrier. Clinical Trials Registration: NCT03241589 [ABSTRACT FROM AUTHOR]

This manuscript reflects on the affordances and limitations of methodological approaches commonly adopted by science education researchers examining learner identities. Our aims are to unpack the relative strengths and weaknesses of such approaches and note their respective prevalence. In so doing, we identify and critique studies which we consider exemplify the different approaches and, in turn, note the direction of fruitful developments and the nature of key challenges. From our review of the field, we suggest that three discrete methodological approaches can be identified: macro-studies within a psychological tradition; macro-studies within a sociological tradition; and micro-studies within an interpretive tradition. Our review comprised a critical analysis of papers included in the Web of Science databases published between 1998 and 2018. A total of 198 papers examining aspects of learner identity relating to science were identified. Of these, the majority (146) were categorised as micro-studies within an interpretive tradition. We discuss the implications of methodological choices for the advancement of understanding and further note ambiguities in the field particularly in relation to the ways in which learner identity research is conceived. We also raise questions for the field relating to the ways in which findings may be scaled, and how the field might develop to allow stronger theoretical and conceptual coherence. [ABSTRACT FROM AUTHOR]

Programming and creative thinking are important skills for the twenty-first century. A large body of evidence suggests that a playful approach to learning helps children engage deeply with programming, improves their creative thinking skills, and shapes a positive attitude towards programming. However, such research has rarely considered how differences in socioeconomic background impact the way children experience such programming activities. The theoretical perspective of science capital suggests that children from high income families will hold more positive attitudes towards science and technology and will perform better in programming than children from lower income families based on their generally higher exposure to experiences involving computing technology. To examine this assumption, we designed and implemented single-occasion programming workshops lasting two hours that followed the Lifelong Kindergarten Approach and investigated differences in children's attitudes, their learning outcomes (measured by a pre-post-test, perceived learning, and task-based performance), and the fun they experienced during the workshops. We collected data from three primary schools in three distinct socioeconomic neighborhoods (i.e., high-, middle-, and low-income areas), involving, in total, 138 children. Findings indicate that the workshops had a positive effect on the children's attitude towards programming in the middle- and low-income schools only. The self-reported learning was similar in the three schools, but children from the low-income school significantly outperformed children from the high-income school in their task-based performance. Children from the middle-income school had the most fun, however, the experience of fun only significantly affected the low-income school children's perceived learning scores. We conclude that children from the middle- and low-income schools profited the most from the playful programming workshop and call on future research to investigate further underlying factors of perception, acceptance, and enjoyment of out-of-school programming activities in relation to participants' socioeconomic background when studying children's participation of programming in school. [ABSTRACT FROM AUTHOR]

Background: Nonadherence to direct-acting agents (DAAs) for hepatitis C (HCV) decreases viral response. To measure nonadherence to DAAs, a reliable, valid, and easily implemented method is needed.Aims: The goals of this study were to refine a previously validated (in patients with hypertension) self-report measure of extent of nonadherence and reasons for nonadherence in the context of DAAs and to obtain initial evidence of content validity and reliability.Methods: Phase I involved two focus groups with patients with HCV (n = 12) and one focus group with prescribers of HCV medications (n = 6) to establish content validity of reasons for nonadherence. Subsequent cognitive interviews with patients (n = 11) were conducted to refine items. Phase II was a prospective cohort study involving weekly administration of the refined measure by telephone to patients (n = 75) who are prescribed DAAs to evaluate reliability and consistency with viral response.Results: In the cohort study, internal consistency ranged from acceptable (α = .69) to very high (α = 1.00) across time points and was quite high on average (α = .91). Across the 75 participants, there were 895 measurement occasions; of those, nonadherence was reported on only 27 occasions (3%), all of which occurred in the first 12 weeks. These 27 occasions represented 19 (26%) different individuals. At 12 weeks, 1 (1%) of patients had a detectable HCV viral load; at 12-24 weeks posttreatment, 4 (5%) had a sustained viral response. Nonadherent patients reported an average of 1.41 reasons for nonadherence.Conclusions: This multi-method study established content validity of reasons for nonadherence and reliability of extent of nonadherence. High rates of adherence and viral response were consistent with previous studies using other nonadherence measurement methods. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of Helping Invested Families Improve Veterans' Experiences Study (HI-FIVES), a skills training program for caregivers of persons with functional or cognitive impairments.Design: A two-arm RCT.Setting: Single Veterans Affairs Medical Center.Participants: Patients and their primary caregivers referred in the past 6 months to home and community-based services or geriatrics clinic.Intervention: All caregivers received usual care. Caregivers in HI-FIVES also received five training calls and four group training sessions.Main Measures: Cumulative patient days at home 12 months post-randomization, defined as days not in an emergency department, inpatient hospital, or post-acute facility. Secondary outcomes included patients' total VA health care costs, caregiver and patient rating of the patient's experience of VA health care, and caregiver depressive symptoms.Results: Of 241 dyads, caregivers' (patients') mean age was 61 (73) years, 54% (53%) Black and 89% (4%) female. HI-FIVES was associated with a not statistically significant 9% increase in the rate of days at home (95% CI 0.72, 1.65; mean difference 1 day over 12 months). No significant differences were observed in health care costs or caregiver depressive symptoms. Model-estimated mean baseline patient experience of VA care (scale of 0-10) was 8.43 (95% CI 8.16, 8.70); the modeled mean difference between HI-FIVES and controls at 3 months was 0.29 (p = .27), 0.31 (p = 0.26) at 6 months, and 0.48 (p = 0.03) at 12 months. For caregivers, it was 8.34 (95% CI 8.10, 8.57); the modeled mean difference at 3 months was 0.28 (p = .18), 0.53 (p < .01) at 6 months, and 0.46 (p = 0.054) at 12 months.Conclusions: HI-FIVES did not increase patients' days at home; it showed sustained improvements in caregivers' and patients' experience of VA care at clinically significant levels, nearly 0.5 points. The training holds promise in increasing an important metric of care quality-reported experience with care. [ABSTRACT FROM AUTHOR]

This paper draws on Judith Butler's concepts of intelligibility and identity as performance to make sense of enactments of 'subaltern' (that is, subordinated) urban students within secondary school science. Understanding classrooms as constituted by complex power struggles for voice, authenticity and recognition, the paper offers an in-depth exploration of a particular dominant performance of science that was enacted across classes by some students—and which curtailed the possibilities for other students in terms of who can, and cannot, be intelligible in school science. Analysing data from 9 months of observations conducted with nine teachers and c. 200 students aged 11–15 from six London schools and 13 discussion groups with 59 of these students, a dominant performance was identified across the classrooms of 'talking science through muscular intellect'. This was predominantly enacted by a small group of working-class boys from a range of ethnic backgrounds and was generally recognised as an authentic and legitimate performance of science by both teachers and other students. These performances comprised three main elements: competition; dominating and controlling class science talk; and policing the science talk of others. However, such performances were experienced ambiguously by teachers and were viewed negatively by Other students, notably girls and 'quiet' boys, due to silencing their contributions and limiting the range of ways that Others might be recognised as intelligible science students. The paper concludes by reflecting on the implications of the dominance of performances of 'talking science through muscular intellect' for students, teachers and social justice approaches to science education. [ABSTRACT FROM AUTHOR]

Student engagement with science is a long-standing, central interest within science education research. In this article, we examine student engagement with science using a Bourdiusian lens, placing a particular emphasis on the notion of field. Over the course of one academic year, we collected data in an inner London secondary science classroom through lesson observations, interviews and discussion groups with students, and interviews with the teacher. We argue that applying Bourdieusian theory can help better understand differential patterns of student engagement by directing attention to the alignment between students’ habitus and capital, and the field. Student behaviours that did not meet the requirements of the wider field were not recognised and valued as constituting engagement. Even when the ‘rules of the game’ of the science classroom were understood by the students, the tensions they experienced within the field made engaging with science impossible and undesirable. We discuss how a greater focus on the field can be useful for planning future interventions aimed at making science education more equitable. [ABSTRACT FROM AUTHOR]

Fundamental knowledge of natural history is lacking in many western societies, as demonstrated by its absence in school science curricula. And yet, to meet local and global challenges such as environmental degradation, biodiversity loss and climate change, we need to better understand the living and non-living parts of the natural world. Many have argued passionately for an increased understanding of natural history; others have developed successful pedagogical programmes for applying knowledge of natural history in environmental initiatives. In joining wider calls, we choose here to focus on the educational value afforded by understanding the epistemological bases of natural history and its particular forms of reasoning. We also briefly discuss the ways in which an education in natural history provides the foundation for environmental and social justice efforts that directly affect the lives of young people and their communities. We end by highlighting the ease by which natural history may be incorporated in learning opportunities both in and outside of the classroom. [ABSTRACT FROM AUTHOR]

Background: Inclusive STEM (traditionally known to stand for 'Science, Technology, Engineering, and Math') high schools are emerging across the country as a mechanism for improving STEM education and getting more and diverse students into STEM majors and careers. However, there is no consensus on what these schools are or should be, making it difficult to both evaluate their effectiveness and scale successful models. We addressed this problem by working with inclusive STEM high school leaders and stakeholders to articulate and understand their intended school models. This 'bottom-up' approach is in contrast with other studies that have taken a 'top-down,' literature-based approach to defining STEM schools. Results: Through this process, we identified 76 critical components of STEM schools and derived a theoretical framework of eight elements that represent the common goals and strategies employed by inclusive STEM high schools across the country: Personalization of Learning; Problem-Based Learning; Rigorous Learning; Career, Technology, and Life Skills; School Community and Belonging; External Community; Staff Foundations; and External Factors. This framework offers a clear picture of what exactly inclusive STEM schools are and common language for both researchers and practitioners. Interestingly, STEM disciplinary content did not emerge as a defining component across school models. Conclusions: Findings suggest that STEM school leaders and stakeholders view their STEM school identity as rooted in pedagogy, transferrable skills, school culture, and rigorous instruction across all subjects, including, but not restricted to, STEM. This raises questions about the goals of inclusive STEM high schools and the STEM discipline outcomes that we should reasonably expect to see from STEM schools. [ABSTRACT FROM AUTHOR]

Rationale: Exogenous brain-derived neurotrophic factor (BDNF) in the insular cortex (IC) is known to influence conditioned taste avoidance (CTA) learning, but little is known of its endogenous role in the phenomenon. Preexposure to many abusable compounds attenuates their ability to induce CTA, thus providing a possible platform from which to further elucidate the endogenous role of IC BDNF in CTA. Objectives: The role of IC BDNF in CTA learning was examined by assessing the effect of preexposure to methylphenidate (MPH) on MPH-induced CTA, followed by expression between preexposure groups of BDNF in the IC, central nucleus of the amygdala (CeA), and the nucleus accumbens (NAc). Methods: Following preexposure to MPH (18 mg/kg), CTAs induced by MPH (0, 10, 18, and 32 mg/kg) were assessed in adult male Sprague-Dawley rats ( n = 64). In separate groups ( n = 31), differences in BDNF and tropomyosin-related kinase receptor-B (TrkB) were assessed using Western blots following similar preexposure and conditioning procedures. Results: Preexposure to MPH significantly blunted MPH-CTA compared to preexposure to vehicle. Unexpectedly, there were no significant effects of MPH on BDNF activity following CTA, but animals preexposed to MPH exhibited decreased activity in the CeA and enhanced activity in the IC and NAc. Conclusions: Preexposure to MPH attenuates its aversive effects on subsequent presentations, and BDNF's impact on CTA learning may be dependent upon its temporal relation to other CTA-related intracellular cascades. [ABSTRACT FROM AUTHOR]

This study evaluated spouse health behavior outcomes from a randomized controlled trial of a spouse-assisted lifestyle intervention to reduce patient low-density lipoprotein cholesterol and improve patient health behaviors. Participants were 251 spouses of patients from the Durham Veterans Affairs Medical Center randomized to intervention or usual care. The intervention comprised 9 monthly telephone calls to patients and spouses. Outcomes were assessed at baseline, 6 and 11 months. At 11 months, there were no differences in spouse outcomes between intervention and usual care groups for moderate intensity physical activity (i.e., frequency, duration) or dietary intake (i.e., total calories, total fat, percentage of calories from total fat, saturated fat, percentage of calories from saturated fat, cholesterol, fiber). To improve spouse outcomes, couple interventions may need to include spouse behavior change goals and reciprocal support between patients and spouses and consider the need for improvement in spouse outcomes. [ABSTRACT FROM AUTHOR]

Collaboration between policy, research, and clinical partners is crucial to achieving proven quality care. The Veterans Health Administration has expended great efforts towards fostering such collaborations. Through this, we have learned that an ideal collaboration involves partnership from the very beginning of a new clinical program, so that the program is designed in a way that ensures quality, validity, and puts into place the infrastructure necessary for a reliable evaluation. This paper will give an example of one such project, the Lung Cancer Screening Demonstration Project (LCSDP). We will outline the ways that clinical, policy, and research partners collaborated in design, planning, and implementation in order to create a sustainable model that could be rigorously evaluated for efficacy and fidelity. We will describe the use of the Donabedian quality matrix to determine the necessary characteristics of a quality program and the importance of the linkage with engineering, information technology, and clinical paradigms to connect the development of an on-the-ground clinical program with the evaluation goal of a learning healthcare organization. While the LCSDP is the example given here, these partnerships and suggestions are salient to any healthcare organization seeking to implement new scientifically proven care in a useful and reliable way. [ABSTRACT FROM AUTHOR]

Drugs of abuse have both rewarding and aversive effects, as indexed by the fact that they support place preferences and taste aversions, respectively. In the present study, we explored whether having a history with the aversive effects of morphine (via taste aversion conditioning) impacted the subsequent rewarding effects of morphine, as measured in the place preference design. In Experiment 1, rats were exposed to a taste aversion procedure in which saccharin was followed by morphine. Place preference conditioning was then initiated in which animals were injected with morphine and placed on one side of a two-chambered apparatus. Animals with a taste aversion history acquired place preferences to the same degree as controls without such a history, suggesting that morphine’s affective properties condition multiple effects, dependent on the specific stimuli present during conditioning. To determine whether these results were a reflection of processes operating in traditional associative conditioning, in a modified blocking procedure, place preference conditioning was attempted in the presence of a taste previously associated with morphine (Exp. 2). Under these conditions, animals still acquired morphine-induced place preferences comparable to those of animals without a morphine or conditioning history. These results are consistent with the position that drugs of abuse have multiple stimulus effects (positive and negative) that are differentially associated with specific stimuli (environmental and taste) that drive different behavioral responses (approach and avoidance). [ABSTRACT FROM AUTHOR]

Many transcription factors regulate specific temporal-spatial events during cardiac differentiation; however, the mechanisms that regulate such events are largely unknown. Using a modified subtractive hybridization method to identify specific genes that influence early cardiac development, we found that Bop is expressed specifically in cardiac and skeletal muscle precursors before differentiation of these lineages. Bop encodes a protein containing MYND and SET domains, which have been shown to regulate transcription by mediating distinct chromatin modifications. We show that m-Bop is a histone deacetylase-dependent transcriptional repressor. Targeted deletion of Bop in mice disrupted maturation of ventricular cardiomyocytes and interfered with formation of the right ventricle. Normal expression of Hand2, a transcription factor essential for right ventricular development, in cardiomyocyte precursors is dependent upon m-Bop. These results indicate that m-Bop is essential for cardiomyocyte differentiation and cardiac morphogenesis. [ABSTRACT FROM AUTHOR]

According to the empty chair doctrine, lawyers may comment on the absence of a prospective opposing witness and judges may invite the jury to draw adverse inferences from that lack of evidence. A mock jury study was conducted to determine how people react to absent witnesses and evaluate the effects of empty chair comments on decision making. Fifty subjects read a trial transcript in which a central or peripheral defense witness did not testify, and in which the prosecuting attorney did or did not suggest making an adverse inference. Pre- and postdeliberation results indicated that subjects who were in the comment condition were less favorable to the defense when the missing witness was central, but they were more favorable when that witness was peripheral. These results are discussed for their practical implications. [ABSTRACT FROM AUTHOR]