North Idaho College

Management of refractory chronic low back pain (CLBP) includes a range of treatments (eg, physical therapy, injections, ablations, neurostimulation, surgery) with varying utilization and effectiveness. This pragmatic randomized controlled trial (RCT) evaluated the effectiveness of one treatment option, percutaneous 60-day peripheral nerve stimulation (PNS), compared to usual care with standard interventional management for CLBP. Two hundred thirty patients with CLBP were randomized in a 1:1 ratio to Group 1 (percutaneous 60-day PNS) or Group 2 (physician-directed usual care with standard interventional management). The Primary Clinical Endpoint evaluated the proportion of participants with ≥50% reductions in CLBP at 3 months post-treatment compared to baseline. At the Primary Endpoint, a greater proportion of participants receiving percutaneous 60-day PNS (55%; n = 112; 95% confidence interval [CI] = 45-65) experienced ≥50% pain relief compared to usual care with standard interventional management (26%; n = 110; 95% CI = 17-34; P < .001). Concordant with the Primary Endpoint, percutaneous 60-day PNS also produced greater improvements in patient-centric secondary endpoints, including disability, pain interference, health-related quality of life, and analgesic consumption. Reductions in pain and resulting improvements in function were sustained through 6 months with percutaneous 60-day PNS. This prospective multicenter pragmatic RCT met its Primary Clinical Endpoint and found that more participants with CLBP reported pain relief at 3 months after receiving percutaneous 60-day PNS as compared to usual care with standard interventional management. Participants treated with 60-day PNS showed greater reductions in pain and more substantial improvements in functional outcomes through 6 months. NCT04246281; Primary funding: Department of Defense (DoD), with additional funding needed to complete the study provided by the study's sponsor, SPR.The protocol is available on ClinicalTrials.gov. The statistical analysis plan and results will be made available within 12 months of the study's completion.

Teaching Programmable Logic Controllers (PLCs) requires both theory and hands-on practice, yet traditional training setups are often costly and unengaging. This paper presents a novel, cost-effective approach using a PLC-controlled pinball machine. A BRX PLC handles game logic, sensors, and flippers via ladder logic, while Python integration through Modbus enables real-time data analysis. A self-playing AI mode further enhances learning. The system design bridges PLC theory and application, exposing students to automation, data analytics, and Industry 4.0 practices.

Smoke from wildland fires contains viable microbes and cell concentrations higher than typical ambient air, yet little is known about the sources and sinks of smoke-borne microorganisms. Data from molecular-based surveys suggest smoke-borne microorganisms originate from material associated with the vegetation and underlying soils that becomes aerosolized during combustion, however, the sources of microbes in smoke have not yet been experimentally assessed. To elucidate this link, we studied high-intensity forest fires in the Fishlake National Forest, Utah, USA and applied source-sink modeling to assemblages of 16S rRNA gene sequences recovered from samples of smoke, vegetation, and soil. Our results imply that 70% of the bacteria in smoke originated from the local aspen (Populus tremuloides)(33%) and soil (37%) communities. In comparison, 42% of bacteria in air sampled prior to the fires could be attributed to these terrestrial sources. When the bacterial assemblages in smoke were modeled as sources to the local communities, they contributed an average of 25% to the terrestrial sinks versus an estimated contribution of <4% from ambient air. Our results provide support for the role of wildland fire in bacterial dispersal and the working hypothesis that smoke is an environmental reservoir of microbial inocula for receiving ecosystems.

In 2022, Dr. Robin Wall Kimmerer (Potawatomi; State University of New York, College of Environmental Science and Forestry) was named a MacArthur Foundation Fellow for her work on Indigenous knowledge, ecology, and environmental stewardship. Her work is widely read and widely cited; the concept of "braiding" Indigenous and Western knowledge systems has led to the increasing validity and visibility of Indigenous worldviews and viewpoints in science and knowledge production. In this essay, we, two Indigenous scholars working in "Western" universities, speak on the ways in which Robin and her work has inspired us in our work, and share a bit on our hopes for future generations of Indigenous scholars. I never believed I would see an Indigenous scholar win the MacArthur "Genius Grant." Most certainly, not in this lifetime. It was not because there was a lack of deserving candidates; it is because I did not see Indigenous knowledges and perspectives valued in the academy. I am an enrolled member of the Coeur d'Alene Tribe and grew up with a strong affinity for science. There was a time when I thought I would pursue a career in medicine. So, I gained ecological research experience at the University of Wisconsin–Madison, while majoring in Zoology and Environmental Studies, in order to diversify my application to medical school. I then sought summer internships and came across several research experience for undergraduates (REU) programs. I applied for/to many internships for the summer of 2000 and received two offers from vastly different REU programs. I chose the Rocky Mountain Biological Laboratory (RMBL) summer REU program near Crested Butte, Colorado, USA. This experience had such a profound impact on my life that it changed the trajectory of my career. Instead of medicine, I knew I needed to research the impacts of climate change on ecosystem health and biodiversity. I also knew my research needed to focus on plants. This awakening occurred 13 years prior to the publication of Dr. Robin Wall Kimmerer's "Braiding Sweetgrass: Indigenous Wisdom, Scientific Knowledge and the Teaching of Plants." I often wonder how this transformative writing would have changed my perspectives on ecology. I knew about the Three Sisters (corn, squash, and beans) crops that are culturally significant for many Indigenous communities. But, my relationships with these crops did not include thinking about the stages of germination or how three human sisters could be an analogy to ecological concepts as eloquently described in Kimmerer's writing. The chapter, People of Corn, People of Light, Kimmerer asks "What if Western scientists saw plants as their teachers rather than their subjects? What if they told stories with that lens?" Surely, if I was well acquainted with these kinds of questions early in my education, they would have guided my work. When I finished my REU experience at RMBL in 2000 I had the opportunity to attend the Ecological Society of America (ESA) Annual Meeting in Snowbird, Utah, USA. I had enjoyed a summer in the mountains, newly determined to pursue a career in ecology. I felt like, at least scientifically, ESA was where I belonged. So, with a renewed sense of purpose, I went back home to my family and felt the connection to Indigenous knowledge and perspectives. However, once I left for graduate school I immersed myself in the Western science world. I assimilated. I fit in. Thus, keeping my Indigenous self separate from the work I was doing. I had no idea on how to bring Indigenous perspective's to my research. There were no Indigenous scholars in my department and I certainly did not see any Indigenous scholars doing the research that I was interested in. It left me with a sense of emptiness and the feeling that I could not bring my whole self to the work that I was so drawn to. My first ever ESA meeting was in 2000. The Traditional Ecological Knowledge (TEK) section of ESA came into existence in 2001, which meant that without a symposium, workshop, or oral session, I was left rudderless in a sea of thousands of ecologists. I wondered: Where are the other Indigenous scholars? Nearly two decades and many ESA meetings later, I found myself at a crossroads in my career. In 2019, I almost left academia. I could not continue to bring only part of myself to the work I was doing and I also did not feel Indigenous knowledges and perspectives were given equal value or significance relative to Western science. I began my detachment from conferences and academia. 2019 was the same year in which Robin Wall Kimmerer gave ESA's Recent Advances Lecture "P-values and cultural values: Creating symbiosis among Indigenous and Western knowledges to advance ecological justice" at the annual meeting in Louisville, Kentucky. What if I had been there to see her presentation? Would I have felt the same way? During the pandemic, Kimmerer's work was everywhere. Ecologists were referencing and including excerpts from "Braiding Sweetgrass." I never thought I would see such broad appreciation for Indigenous knowledge in ecology. At least, not in this lifetime. It was part of a dramatic shift in the re-evaluation of curriculum, policies, and research. It still is. The socio-economic inequalities and injustices started to become major dialogues. The shift was so seismic in 2020 that I was finally asked for my Indigenous perspective in the climate change dialogue. I never thought anyone would ask, but I knew that the timing was right and that I could excitedly and finally bring my whole self to the ecological work I was doing. At the 2023 ESA annual meeting in Montreal, Canada, I could see Indigenous People in the sea of thousands of students and scholars. The TEK section grew, there were significantly more Indigenous-led and Indigenous-centered presentations. There was standing room only and ecologists lining out the door for the TEK sessions. There were powerful discussions focused on shared experiences and perspectives from many Indigenous scholars. Undergraduates can now attend the ESA meetings and see themselves in ecology and are now empowered to bring their whole selves to their work. That was always my goal. None of this is about or for awards. We still have a long journey for Indigenous knowledges and perspectives to be viewed as viable and valid as Western science in ecology. But we can see the path now and we can dare to hope that we may see another Indigenous scholar win the MacArthur "Genius Award," in this lifetime. Thank you Dr. Robin Wall Kimmerer, for showing us what is possible. Fig. 1. Copy of Braiding Sweetgrass held in front of an office window, with a tribal flag covering the window. Photo credit: Niiyokamigaabaw Deondre Smiles. Until fairly recently, I had gotten used to being told I was not good enough or smart enough to achieve my dreams. It is something that seemed to always be hovering in the background throughout my life, whether it was societal discourse about what young Native children like me, raised by a single mother, could accomplish, or my undergraduate professors dismissing my academic talent as I struggled through an undergraduate degree, to my peers in graduate school telling me that Indigenous worldviews had no place in the academy. I very clearly remember a departmental happy hour during my Ph.D. program at Ohio State, where a fellow grad student said between sips of a beer, "Why do you do Indigenous geographies? Didn't colonialism win?" I also remember being "advised" in no uncertain terms that I might be better off leaving my program, as it would be a "very tough road" to do a degree focusing on Indigenous geographies and worldviews. I had to fight to ensure the visibility of Indigenous thought in graduate seminars; it was clearly communicated that there was no room for them among the multitudes of white, European, male thinkers that dominated these spaces. I felt demoralized, I felt alone, and I felt ready to leave the academy and abandon my dreams of being an Indigenous professor. However, there were a number of events that soon occurred that helped me keep my faith. The first was the solid advising and care shown by my Ph.D. advisor. The second was beginning my dissertation fieldwork and building relationships with community members in several Indigenous nations. The third came when I applied to, and was accepted to, a workshop at Haskell Indian Nations University in September 2018; the workshop, organized, and convened via an NSF grant, focused on the ways in which young Native scholars and scientists (such as myself) could be best mentored in order to help open up the academy and its associated structures. I remember meeting Dr. Robin Kimmerer at this workshop, and I was in awe; here was a published Native scholar, sitting across from me as the workshop participants discussed important issues related to Indigenous science. It was a wonderful few days, as Robin, along with other amazing Native scholars, spoke about the importance of Indigenous science and the ways in which Indigenous science was not only worthy of being mentioned in the same breath as "Western" science, but was vitally important to tackle many of the issues facing the world around us today. I emerged from the workshop feeling energized and feeling inspired; I remember returning to Ohio and downloading as many articles as I could find from the scholars I would heard from, as well as purchasing a copy of Braiding Sweetgrass. This was yet another step in me learning to become comfortable with myself and comfortable with taking up space as an Indigenous scholar in colonial education, as well as being comfortable bringing my own Indigenous worldviews into how I did work. Kimmerer's words on Indigenous worldviews in scientific knowledge production and the ways in which our more-than-human kin played important roles in creating and maintaining this knowledge resonated, and still resonates with me in a deeply validating way. It led me on a different track in my intellectual development and career path. Rather than trying to fit myself into narrowly defined academic boxes that did not fully encapsulate who I was as a scholar and as a person, I felt better prepared to bring my full self into my work and to loudly and proudly declare Ojibwe worldviews related to space to have a valid and vital place in the academy. My encounter with Kimmerer also has led me to embrace the interconnectedness of different schools of thought and study via interdisciplinarity. In recent years, I have found myself pursuing connections and collaborations with scholars in many different fields, including political sciences, public affairs, history, communication, rhetoric, biology, and ecology. In August 2022, I attended the ESA's Annual Meeting in Montreal, along with an NSF-funded symposium on traditional ecological knowledge. I spent nearly a week with a group of amazing Indigenous thinkers and allies, and similarly to my time at the workshop in Kansas, USA 4 years prior, it was yet another moment where I found myself surrounded by people with whom I felt an immediate intellectual connection to. Now I find myself pursuing connections with Indigenous ecologists, and working with them to do good work in a variety of spheres and via a variety of media, such as this very essay. It is validating, and heartwarming work. I never would have called myself an Indigenous ecologist before…now it is a title I wear proudly, if still something I am getting used to wearing. All of this has led me to a place of increased confidence as an Indigenous academic. Much of my current work focuses on Indigenous responses to climate change via modes of adaptation and mitigation, with a particular interest in how communities in my homelands (Minnesota, USA and the broader Great Lakes region) tackle these issues through conservation and preservation of cultural resources, including the environment. I often broach these perspectives to my students through introducing them to Ojibwe concepts of kinship and connection to our more-than-human kin. A decade ago, I would have probably tried to come up with a cutting-edge, Western-based theory, as I did not feel that my own worldviews would be respected. Now, I go forward fearlessly in sharing my own worldviews, and move with confidence that they have been or will be validated, and I have people such as Robin to thank for it. The fact that Dr. Robin Wall Kimmerer has won the MacArthur Genius Grant is deeply exciting and satisfying for me to see, but it is not surprising. If anything, I find myself saying, "It's about damn time that someone realized the amazing work that Indigenous peoples, particularly, Indigenous women, are doing in the world today." I echo my co-author, Dr. Ignace, in saying that the path has been shown in how Indigenous thinkers can gain acclaim and validation in knowledge structures, but I will take it a bit further; I imagine Kimmerer will not be the last Indigenous person to win a Genius Grant, but she will definitely be one of the most important, in opening the door to future generations to step through and do great work. Miigwech, Robin, and congratulations. It is clear that Robyn is more than deserving of her award; in fact, we wonder why it has taken so long for her to get it! The stories we have shared are our own, but we imagine that many Indigenous scholars, particularly young scholars such as students, have similar stories to us in the ways that they have moved (or struggled to move) within Western, colonial educational structures. Similarly, we hope that they have found spaces of belonging within these structures, thanks to the work of Indigenous scholars such as Robyn opening up doors for them to walk through. Our hope is that our stories not only recognize the important work that Dr. Robin Wall Kimmerer has done for Indigenous science and in our own careers, but also can serve as inspiration for a whole new generation of Indigenous scientists as they work toward making important contributions, not only for themselves, but also for their communities/nations. Who knows…perhaps the next Indigenous MacArthur Fellow will read this article.

This study compares two parent reports, the Mental Synthesis Evaluation Checklist (MSEC) and the Autism Treatment Evaluation Checklist (ATEC), with the Childhood Autism Rating Scale (CARS). The ATEC consists of four subscales, as follows: (1) expressive language, (2) sociability, (3) sensory awareness, and (4) health. The MSEC is complementary to the ATEC in measuring complex language comprehension. The parents of 143 autistic children, from 2 to 22 years of age (mean 6.7 ± 5.1 years), completed the MSEC and the ATEC questionnaires and a clinician assessed their CARS score. The CARS score correlated strongly with all parent reports, the complex language comprehension MSEC (r = 0.60, p < 0.0001), expressive language (r = 0.66, p < 0.0001), sociability (r = 0.58, p < 0.0001), sensory awareness (r = 0.71, p < 0.0001), and health (r = 0.53, p < 0.0001), as well as the total ATEC score (r = 0.75, p < 0.0001). The strongest correlation was between the CARS score and the composite of all five parent-reported scores (total ATEC + MSEC, r = 0.77, p < 0.0001). These results suggest a high fidelity of the MSEC and ATEC parent reports and especially of their composite score, total ATEC + MSEC.

In emergence-based leadership education, the knowledge and experiencesco-created in the classroom may violate some of the assumptions behind traditional teaching and learning assessment methods. Thus, traditional assessment, evaluation, and outcomes for courses utilizing emergence-based methods, such as intentional emergence, case-in-point, dialogic group process consultations, and group relations/dynamics, are counterintuitive and must be reconsidered. We provide recommendations regarding how to conduct assessment when utilizing emergence-based teaching methods in leadership education. We review the use of inductive forms of assessment and provide recommendations for broadening learning outcomes and engaging in learning outcomes beyond the knowledge domain.

We review analytic frameworks related to the study of noticing in mathematics and science education for the purpose of suggesting trends in research literature across both disciplines over time. We focus on highly cited articles in both mathematics and science noticing research, along with recent articles in both disciplines. We focus specifically on research articles that include an analytic framework, to understand the state of how data on noticing are analyzed. We conducted an extensive review of literature, intentionally related to population, temporality, methodology, and quality. The purpose was to provide an overview of the field of noticing, based on particular search criteria for articles including an analytic framework. To be considered an analytic framework, the article had to include a framework that could be used to analyze teacher noticing. We found frameworks in science education are frequently adapted from mathematics education and are moving toward pairing noticing with aspects of effective instruction (formative assessment, sense-making, pedagogical content knowledge), whereas the frameworks in mathematics education now consider context and equity, which was not an explicit focus in the initial noticing literature.

Social media has the potential to provide social support for rare disease communities; however, little is known about the use of social media for the expression of medical uncertainty, a common feature of rare diseases. This study aims to evaluate the expression of medical uncertainty on social media in the context of dyskeratosis congenita, a rare cancer-prone inherited bone marrow failure and telomere biology disorder (TBD). We performed a content analysis of uncertainty-related posts on Facebook and Twitter managed by Team Telomere, a patient advocacy group for this rare disease. We assessed the frequency of uncertainty-related posts, uncertainty sources, issues, and management and associations between uncertainty and social support. Across all TBD social media platforms, 45.98% (1269/2760) of posts were uncertainty related. Uncertainty-related posts authored by Team Telomere on Twitter focused on scientific (306/434, 70.5%) or personal (230/434, 53%) issues and reflected uncertainty arising from probability, ambiguity, or complexity. Uncertainty-related posts in conversations among patients and caregivers in the Facebook community group focused on scientific (429/511, 84%), personal (157/511, 30.7%), and practical (114/511, 22.3%) issues, many of which were related to prognostic unknowns. Both platforms suggested uncertainty management strategies that focused on information sharing and community building. Posts reflecting response-focused uncertainty management strategies (eg, emotional regulation) were more frequent on Twitter compared with the Facebook community group (χ21=3.9; P=.05), whereas posts reflecting uncertainty-focused management strategies (eg, ordering information) were more frequent in the Facebook community group compared with Twitter (χ21=55.1; P<.001). In the Facebook community group, only 36% (184/511) of members created posts during the study period, and those who created posts did so with a low frequency (median 3, IQR 1-7 posts). Analysis of post creator characteristics suggested that most users of TBD social media are White, female, and parents of patients with dyskeratosis congenita. Although uncertainty is a pervasive and multifactorial issue in TBDs, our findings suggest that the discussion of medical uncertainty on TBD social media is largely limited to brief exchanges about scientific, personal, or practical issues rather than ongoing supportive conversation. The nature of uncertainty-related conversations also varied by user group: patients and caregivers used social media primarily to discuss scientific uncertainties (eg, regarding prognosis), form social connections, or exchange advice on accessing and organizing medical care, whereas Team Telomere used social media to express scientific and personal issues of uncertainty and to address the emotional impact of uncertainty. The higher involvement of female parents on TBD social media suggests a potentially greater burden of uncertainty management among mothers compared with other groups. Further research is needed to understand the dynamics of social media engagement to manage medical uncertainty in the TBD community.

This study seeks to determine whether giving an explicit incentive to students in an upper-division first-semester electromagnetism course (EM1), in the form of partial credit for reworking unit exam problems, will improve their problem-solving skills as measured by performance on identical problems on the final exam. Three problems–a primarily algorithmic problem, a primarily conceptual problem, and a problem that blended conceptual with algorithmic–were selected and analyzed over the course of three consecutive sections of EM1, for which each student could freely choose whether or not to rework mistakes on each one of the given problems in exchange for the aforementioned partial credit. Regression models were chosen for quantitative analysis, with the covariate being unit exam performance and whether the student reworked the problem. Results indicate that overall, students who choose to rework problems perform better on the final exam attempt, at a level that often does not correlate strongly with unit exam performance, whereas students who decline to rework problems have a stronger correlation between unit exam and final exam performances. The results show a clear difference between the two stages of problem-solving, namely, invoking the correct principles and applying the principles, where the latter showed a more significant effect with a much larger effect size. Qualitative analysis of a sample of students interviewed about their exam solutions showed that reworking an exam problem for some students did result in more expertlike problem-solving trends; that being said, there were instances of persistent novicelike trends regardless of reworking, as well as instances of students independently reviewing unit exam problems in preparation for the final even though the partial credit incentive was declined at the time of the unit exam. Thus, while the intervention showed overall benefits insofar as exam performance is concerned, the usage of more well-defined scaffolding, e.g., tutorials, may prove a more thorough and definite benefit for improving problem-solving skills.

The purpose of this study was to evaluate the safety and efficacy of a posterior facet replacement device, the Total Posterior Spine (TOPS) System, for the treatment of one-level symptomatic lumbar stenosis with grade I degenerative spondylolisthesis. Posterior lumbar arthroplasty with facet replacement is a motion-preserving alternative to lumbar decompression and fusion. The authors report the preliminary results from the TOPS FDA investigational device exemption (IDE) trial. The study was a prospective, randomized controlled FDA IDE trial comparing the investigational TOPS device with transforaminal lumbar interbody fusion (TLIF) and pedicle screw fixation. The minimum follow-up duration was 24 months. Validated patient-reported outcome measures included the Oswestry Disability Index (ODI) and visual analog scale (VAS) for back and leg pain. The primary outcome was a composite measure of clinical success: 1) no reoperations, 2) no device breakage, 3) ODI reduction of ≥ 15 points, and 4) no new or worsening neurological deficit. Patients were considered a clinical success only if they met all four measures. Radiographic assessments were made by an independent core laboratory. A total of 249 patients were evaluated (n = 170 in the TOPS group and n = 79 in the TLIF group). There were no statistically significant differences between implanted levels (L4-5: TOPS, 95% and TLIF, 95%) or blood loss. The overall composite measure for clinical success was statistically significantly higher in the TOPS group (85%) compared with the TLIF group (64%) (p = 0.0138). The percentage of patients reporting a minimum 15-point improvement in ODI showed a statistically significant difference (p = 0.037) favoring TOPS (93%) over TLIF (81%). There was no statistically significant difference between groups in the percentage of patients reporting a minimum 20-point improvement on VAS back pain (TOPS, 87%; TLIF, 64%) and leg pain (TOPS, 90%; TLIF, 88%) scores. The rate of surgical reintervention for facet replacement in the TOPS group (5.9%) was lower than the TLIF group (8.8%). The TOPS cohort demonstrated maintenance of flexion/extension range of motion from preoperatively (3.85°) to 24 months (3.86°). This study demonstrates that posterior lumbar decompression and dynamic stabilization with the TOPS device is safe and efficacious in the treatment of lumbar stenosis with degenerative spondylolisthesis. Additionally, decompression and dynamic stabilization with the TOPS device maintains segmental motion.