Touro University California

ABSTRACT The COVID-19 pandemic exposed significant gaps in teacher preparation for online instruction, highlighting the persistent disconnect between the growth of K-12 digital learning and inadequate teacher education programs. Despite over fifteen years of research indicating this deficiency, few teacher preparation programs offer coursework or field experiences in online teaching. This study presents findings from the seventh cycle of an ongoing action research project examining a graduate instructional technology course to improve the preparation of teachers to teach online. Using constant comparative analysis, researchers analyzed blog posts, discussions, and assignments to explore how in-service teachers view K-12 online education and how these perspectives influence curriculum development. The study examines these findings through the lens of Hybrid-Flexible (HyFlex) instructional design, which allows students to choose their participation mode while maintaining equivalent learning opportunities. While HyFlex may not be directly applicable to K-12 settings due to logistical constraints, its principles of mode neutrality could address time constraints in teacher preparation programs.The research suggests incorporating HyFlex concepts into teacher education through comparative lesson development across multiple modalities, micro field experiences in virtual schools, and preparing educators for emergency remote teaching situations rather than creating separate online-specific coursework.

Distinguishing postoperative ileus (POI) from early mechanical small bowel obstruction (SBO) remains a challenging clinical dilemma after abdominal surgery, especially among elderly, frail patients with baseline gastrointestinal dysfunction. We describe an 83-year-old man with multiple comorbidities who underwent a robotic umbilical hernia repair converted to open due to incarcerated omentum and small-bowel dilation. The postoperative course was notable for persistent abdominal distention, high nasogastric output, alternating imaging interpretations of jejunal obstruction versus ileus, severe malnutrition requiring total parenteral nutrition, multidrug-resistant urinary infection, and progressive debility. Despite partial return of bowel function, the patient remained debilitated and elected hospice care. This case underscores the diagnostic ambiguity between persistent POI and partial SBO, emphasizes multidisciplinary management, and highlights the importance of aligning treatment with patient-centered goals in frail postoperative patients.

Most adult mental health conditions begin in early childhood and adolescence, the most common being anxiety and behavioral disorders. Early intervention can improve outcomes and may reduce the risk of developing a clinical disorder in the future. However, children may not have the communication or understanding to share their symptoms with those around them, leaving pediatric primary care providers responsible for identifying concerning signs. This paper reviews both general symptoms that suggest possible mental health conditions as well as specific correlations between symptoms and psychiatric diagnoses. A literature search utilizing PubMed identified nine relevant articles that were supplemented with additional sources. The findings found that impaired coordination or balance, weakness, paralysis or loss of sensation, seizure-like activity, blindness, double vision, deafness, or one severe symptom, typically pain, were general signs that may indicate a psychiatric illness. More specific associations were also identified. For instance, children who report somatic complaints and school refusal have been linked to anxiety; in addition, reported stress, anger, and worries about family alcohol and drug use have been linked to depression, among many others. Awareness of the somatic and social concerns presented by children to primary care can reduce the delay from the onset of symptoms to diagnosis, leading to earlier identification, treatment, and improved outcomes. Early intervention may delay or prevent symptoms from developing into a diagnosable psychiatric disorder and/or may reduce the severity of symptoms in a child who already has a psychiatric condition.

Metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH) are associated with adverse clinical outcomes, impaired health-related quality of life, and significant economic burden. The growing burden of MASLD and MASH has led to the publication of a large number of MASLD/MASH guidelines by national and international societies. However, important differences among the recommendations have created confusion, contributing to a low implementation rate and suboptimal management of MASLD and MASH. Creating a consensus recommendation has become more important since the approval of a selective agonist of thyroid hormone β receptor (resmetirom) for MASH treatment in the United States. We built a consensus among the most recently published recommendations for MASLD/MASH. A comprehensive search for MASLD and MASH guidelines, guidance documents, or similar publications from January 2018 to January 2025 using PubMed, Embase, Web of Science, and society websites was conducted. Each selected document was assessed across 8 specific domains with 145 variables. Variables with <50% concordance were used for the Delphi statement development. A supermajority threshold of 67% was set for statement acceptance. There were 61 documents published from 2018 through January 2025. Four rounds of Delphi were conducted: 46 statements were generated for Round 1, 32 statements for Round 2, 16 statements for Round 3, and 8 statements for Round 4, whereby 100% of statements achieved a greater than 90% agreement. All final consensus recommendations were summarized in tables and algorithms. Our study provides an extensive set of recommendations generated based on a comprehensive review of the most recent MASLD/MASH guidelines and a consensus-building process.

ObjectivesDemonstrate the ability to encapsulate clinical-grade genomics data normalization algorithms within a FHIR Genomics reference implementation.BackgroundVariability in genomics data representation is a significant impediment to precise search, clinical decision support rule writing, variant annotation, and more. Such variability is problematic not just for genetic variants, but also applies to HLA alleles, phenotype codes, and more. Here, we provide an overview of genomic data variability and normalization algorithms, focusing on three key areas: genetic variants, HLA alleles, condition and medication variant annotations. We describe and demonstrate the strategies used in a public open source FHIR Genomics reference implementation.Materials and MethodsWe developed a set of design considerations, which we used to weigh different normalization approaches. All data (ingested patient data, ingested knowledge, query parameters) are subjected to normalization. Variant normalization leverages the biocommons/hgvs python package. HLA allele normalization leverages the py-ard python package. For variant annotation terminology variability (for conditions and medications), we leveraged FHIR-based ConceptMaps.ResultsAlgorithms for normalization of genetic variants and HLA alleles, and terminology translations, have been implemented and deployed in a public open source FHIR Genomics Operations reference implementation. All data and source code described in this report are located at https://github.com/FHIR/genomics-operations, and deployed at https://fhir-gen-ops.herokuapp.com/. Every normalization strategy examined to date has known limitations.ConclusionWhile we report on our experience successfully encapsulating genomic data normalization in FHIR Genomics Operations, the challenges and solutions identified are broadly applicable to many other contexts.

This article explores the ideal educational ecosystem for Aotearoa New Zealand, integrating distance and in-person learning within schools. Based on interviews and focus groups with distance learning leaders, we identify four essential features of this system: it must prioritise student agency and choice, ensure equity and inclusivity, be cohesive and coordinated with consistent approaches and equitable regulatory frameworks, and be innovative and future-focused. Participants highlighted critical areas for attention, including leadership and policy reform, sustainable resourcing, enhanced infrastructure, redefined teacher roles, and improved accreditation. Recognising that some recommendations were influenced by organisational self-interest, we propose a comprehensive roadmap structured around the four ideal ecosystem characteristics. This roadmap outlines immediate, implementable steps within current frameworks alongside long-term transformational goals requiring broader policy reform. Achieving a more adaptable education system demands synchronised changes in regulations, teaching, and resources, coupled with bold leadership and a willingness to challenge traditional assumptions. The COVID-19 pandemic underscored the necessity and possibility of this transformation, emphasising that integrated distance and classroom learning is the natural evolution of education in the digital age.

ABSTRACT Social isolation among older adults is a major public health concern because of the adverse impact it has on health and well-being. Reducing social isolation can improve health and decrease the use of costly healthcare services. However, there is little consensus on the critical ingredients of programming to reduce social isolation. Bay Area Older Adults® (BAO) is a nonprofit organization whose community-based Healthy Living Program (HLP) focuses on building and nourishing older adults’ social networks through transitions such as retirement, divorce and loss of loved ones. The current study was a program evaluation of the HLP using a survey to understand the changes that the HLP had on participants’ social network over a one-year period. Participants (n = 177) included adults aged 50 and older who voluntarily joined the HLP. Participants were followed six months later for a second assessment (n = 92). Two naturalistic groups were compared: those who participated in the HLP (n = 81) and those who did not (n = 96). Results indicated that the participant and nonparticipant groups did not differ on any demographic or socialization variables. In bivariate analyses, the participant group had a significantly higher social network score at six-month follow up. Regression analyses at six- and 12-month follow up indicated that HLP participation was significantly associated with social network score when controlling for income. The results of the current study indicate the HLP has the potential to be an effective, customized, community-based intervention that could be implemented by multiple types of care providers.

Abstract Mammalian inner ear sensory hair cells are highly sensitive to environmental stress and do not regenerate, making hearing loss progressive and permanent. The paucity and extreme inaccessibility of these cells hinder the development of regenerative and otoprotective strategies, Direct lineage reprogramming to generate large quantities of hair cell-like cells in vitro offers a promising approach to overcome these experimental bottlenecks. Previously, we identified four transcription factors—Six1, Atoh1, Pou4f3, and Gfi1 (SAPG)—capable of converting mouse embryonic fibroblasts, adult tail tip fibroblasts, and postnatal mouse supporting cells into induced hair cell-like cells through retroviral or lentiviral transduction (Menendez et al., 2020). Here, we developed a virus-free, inducible system using a stable human induced pluripotent stem (iPS) cell line carrying doxycycline-inducible SAPG. Our inducible system significantly increases reprogramming efficiency compared to retroviral methods, achieving a ∼19-fold greater conversion to a hair cell fate in half the time. Immunostaining, Western blot, and single-nucleus RNA-seq analyses confirm the expression of hair cell-specific markers and activation of hair cell gene networks in reprogrammed cells. The reprogrammed hair cells closely resemble developing fetal hair cells, as evidenced by comparison with a human fetal inner ear dataset. Electrophysiological analysis reveals that the induced hair cell-like cells exhibit diverse voltage-dependent ion currents, including robust, quick-activating, slowly inactivating currents characteristic of primary hair cells. This virus-free approach improves scalability, reproducibility, and the modeling of hair cell differentiation, offering significant potential for hair cell regenerative strategies and preclinical drug discovery targeting ototoxicity and otoprotection.