Anti-PfGARP activates programmed cell death of parasites and reduces severe malaria.

Malaria caused by Plasmodium falciparum remains the leading single-agent cause of mortality in children1, yet the promise of an effective vaccine has not been fulfilled. Here, using our previously described differential screening method to analyse the proteome of blood-stage P. falciparum parasites2, we identify P. falciparum glutamic-acid-rich protein (PfGARP) as a parasite antigen that is recognized by antibodies in the plasma of children who are relatively resistant-but not those who are susceptible-to malaria caused by P. falciparum. PfGARP is a parasite antigen of 80 kDa that is expressed on the exofacial surface of erythrocytes infected by early-to-late-trophozoite-stage parasites. We demonstrate that antibodies against PfGARP kill trophozoite-infected erythrocytes in culture by inducing programmed cell death in the parasites, and that vaccinating non-human primates with PfGARP partially protects against a challenge with P. falciparum. Furthermore, our longitudinal cohort studies showed that, compared to individuals who had naturally occurring anti-PfGARP antibodies, Tanzanian children without anti-PfGARP antibodies had a 2.5-fold-higher risk of severe malaria and Kenyan adolescents and adults without these antibodies had a twofold-higher parasite density. By killing trophozoite-infected erythrocytes, PfGARP could synergize with other vaccines that target parasite invasion of hepatocytes or the invasion of and egress from erythrocytes.

Elaboration Models with Symmetric Information Divergence.

Various statistical methodologies embed a probability distribution in a more flexible family of distributions. The latter is called elaboration model, which is constructed by choice or a formal procedure and evaluated by asymmetric measures such as the likelihood ratio and Kullback-Leibler information. The use of asymmetric measures can be problematic for this purpose. This paper introduces two formal procedures, referred to as link functions, that embed any baseline distribution with a continuous density on the real line into model elaborations. Conditions are given for the link functions to render symmetric Kullback-Leibler divergence, Rényi divergence, and phi-divergence family. The first link function elaborates quantiles of the baseline probability distribution. This approach produces continuous counterparts of the binary probability models. Examples include the Cauchy, probit, logit, Laplace, and Student-t links. The second link function elaborates the baseline survival function. Examples include the proportional odds and change point links. The logistic distribution is characterized as the one that satisfies the conditions for both links. An application demonstrates advantages of symmetric divergence measures for assessing the efficacy of covariates.

Unified methods for feature selection in large-scale genomic studies with censored survival outcomes.

MOTIVATION: One of the major goals in large-scale genomic studies is to identify genes with a prognostic impact on time-to-event outcomes which provide insight into the disease process. With rapid developments in high-throughput genomic technologies in the past two decades, the scientific community is able to monitor the expression levels of tens of thousands of genes and proteins resulting in enormous datasets where the number of genomic features is far greater than the number of subjects. Methods based on univariate Cox regression are often used to select genomic features related to survival outcome; however, the Cox model assumes proportional hazards (PH), which is unlikely to hold for each feature. When applied to genomic features exhibiting some form of non-proportional hazards (NPH), these methods could lead to an under- or over-estimation of the effects. We propose a broad array of marginal screening techniques that aid in feature ranking and selection by accommodating various forms of NPH. First, we develop an approach based on Kullback-Leibler information divergence and the Yang-Prentice model that includes methods for the PH and proportional odds (PO) models as special cases. Next, we propose R2 measures for the PH and PO models that can be interpreted in terms of explained randomness. Lastly, we propose a generalized pseudo-R2 index that includes PH, PO, crossing hazards and crossing odds models as special cases and can be interpreted as the percentage of separability between subjects experiencing the event and not experiencing the event according to feature measurements. RESULTS: We evaluate the performance of our measures using extensive simulation studies and publicly available datasets in cancer genomics. We demonstrate that the proposed methods successfully address the issue of NPH in genomic feature selection and outperform existing methods. AVAILABILITY AND IMPLEMENTATION: R code for the proposed methods is available at github.com/lburns27/Feature-Selection. CONTACT: karthik.devarajan@fccc.edu. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Temperature, emergence phenology and consumption drive seasonal shifts in fish growth and production across riverscapes.

Changes in biophysical conditions through time generate spatial and temporal variability in habitat quality across landscapes. For river ecosystems, researchers are increasingly able to characterize spatial and temporal patterns in habitat conditions, referred to as shifting habitat mosaics, yet rarely demonstrate how this translates into corresponding biological processes such as organism growth and production. We assessed spatial patterns and processes determining seasonal changes in juvenile Chinook Salmon Oncorhynchus tshawytscha size, growth and production over 30-40 km in two NE Oregon subbasins. We quantified seasonal patterns of growth by combining estimated emergence dates and body size distributions in July and September. We then used analysis of bioenergetics, empirical fish diets and spatial models incorporating temperature, habitat and population density to evaluate mechanisms driving spatiotemporal patterns of growth. Lastly, we quantified seasonal contributions to individual fish growth and to total production as a function of position within the stream network. Spatial heterogeneity in incubation temperatures corresponded to later estimated emergence timing with distance upstream in both subbasins. During spring, estimated growth rates decreased with distance upstream, and coupled with emergence patterns, resulted in pronounced longitudinal gradients in body size by July. During summer, spatial patterns of growth reversed, with greater diet ration sizes and growth efficiencies upstream than downstream. These opposing spatiotemporal patterns of emergence timing and seasonal growth rates produced longitudinal gradients in the proportion of fish growth achieved in spring versus summer, with up to 80% of an individual's growth occurring in spring at downstream sites but as low as 10% at upstream sites. Coupling longitudinal patterns of fish density and growth revealed that in one subbasin the majority (65%) of total production occurred in spring, while in the other, in which fish were concentrated in headwaters, the majority (60%) of production occurred in summer. While recent work has emphasized inter-annual shifts in fish production across large spatial scales, this study demonstrates that longitudinal gradients of fish growth and production can reverse across seasons, and reveals important contributions of warmer, downstream habitats to overall production that occurred during cooler times of the year.

Impact of Web-Based Sharing and Viewing of Self-Harm-Related Videos and Photographs on Young People: Systematic Review.

BACKGROUND: Given recent moves to remove or blur self-harm imagery or content on the web, it is important to understand the impact of posting, viewing, and reposting self-harm images on young people. OBJECTIVE: The aim of this study is to systematically review research related to the emotional and behavioral impact on children and young people who view or share web-based self-harm-related videos or images. METHODS: We searched databases (including Embase, PsychINFO, and MEDLINE) from January 1991 to February 2019. Search terms were categorized into internet use, images nonspecific and specific to the internet, and self-harm and suicide. Stepwise screening against specified criteria and data extraction were completed by two independent reviewers. Eligible articles were quality assessed, and a narrative synthesis was conducted. RESULTS: A total of 19 independent studies (20 articles) were included. Of these, 4 studies focused on images, 10 (11 articles) on videos, and 5 on both. There were 4 quantitative, 9 qualitative, and 7 mixed methods articles. In total, 11 articles were rated as high quality. There has been an increase in graphic self-harm imagery over time. Potentially harmful content congregated on platforms with little moderation, anonymity, and easy search functions for images. A range of reactions and intentions were reported in relation to posting or viewing images of self-harm: from empathy, a sense of solidarity, and the use of images to give or receive help to potentially harmful ones suggesting new methods, normalization, and exacerbation of self-harm. Viewing images as an alternative to self-harm or a creative outlet were regarded in 2 studies as positive impacts. Reactions of anger, hostility, and ambivalence have been reported. There was some evidence of the role of imitation and reinforcement, driven partly by the number of comments and wound severity, but this was not supported by time series analyses. CONCLUSIONS: Although the results of this review support concern related to safety and exacerbation of self-harm through viewing images of self-harm, there may be potential for positive impacts in some of those exposed. Future research should evaluate the effectiveness and potential harms of current posting restrictions, incorporate user perspectives, and develop recovery-oriented content. Clinicians assessing distressed young people should ask about internet use, including access to self-harm images, as part of their assessment.

Shared decision-making preferences in mental health: does age matter? A systematic review.

BACKGROUND: Research to date suggests older adults prefer a passive involvement in the clinical decision-making process; however, the empirical evidence underlying this claim in the mental health context is yet to be reviewed systematically. AIMS: To understand whether older adults desire involvement in mental health-related clinical decisions. METHOD: A systematic review was conducted to identify primary research that explored mental-health decision-making preferences of people with a mean age of over 55 from January 1990 through to December 2018. RESULTS: Three independent studies of varying design and quality were included. Study settings were in the USA, Germany, and the UK. A preference for shared decision-making was seen in two studies, while a preference for active decision-making was identified in one. CONCLUSIONS: In contrast to other reviews on clinical decision-making, this review focused on mental health-related decisions of older adults. The evidence suggests older adults desire involvement in mental health-related clinical decisions. Given the political drive to empower patients and the need to ensure evidence-based clinical practice, more high-quality research regarding the shared decision-making preferences and outcomes of older adults with mental ill-health is needed. Systematic Review Registration PROSPERO: CRD42018102009.

Lifestyles and mindsets of Olympic, Paralympic and world champions: is an integrated approach the key to elite performance?

OBJECTIVES: The holy grail of any nation in the global sporting race is to better understand, replicate and sustain podium winning performances on the world stage. International sporting bodies advocate a holistic approach to the athletic profile and environmental and system-level factors required for world-class sporting performance, yet key lifestyle, relational, training and performance practices are commonly overlooked. We aimed to explore the contribution, interplay, and impact of lifestyle and psychological factors among a sample of world-class, champion athletes. METHODS: Open-ended, semistructured face-to-face interviews were conducted with 10 World, Olympic and Paralympic Champion athletes that covered their sporting development and athletic profile including their mindset, training and competition practices, along with lifestyle and other key factors to which they attributed their success. A thematic approach guided by grounded theory principles, was employed to source and analyse their perspectives and experiences and determine common themes. RESULTS: Four dominant and overlapping themes emerged: psychological attributes, interpersonal relationships, performance strategies and lifestyle practices. All athletes attributed their success to psychological rather than physical factors, and the vast majority relied on mental rehearsal skills and recovery practices. CONCLUSION: The athletic profile and support required to reach and sustain podium-level performance is multidimensional, integrated and individualised and psychological factors are paramount. Championship performance is likely to occur at the intersection of psychological prowess, interpersonal support, effective performance strategies and lifestyle. An integrated approach inclusive of these dimensions can be used to guide athlete development and support at both an individual level and a collective level.

Factors influencing speech perception in noise for 5-year-old children using hearing aids or cochlear implants.

OBJECTIVE: We investigated the factors influencing speech perception in babble for 5-year-old children with hearing loss who were using hearing aids (HAs) or cochlear implants (CIs). DESIGN: Speech reception thresholds (SRTs) for 50% correct identification were measured in two conditions - speech collocated with babble, and speech with spatially separated babble. The difference in SRTs between the two conditions give a measure of binaural unmasking, commonly known as spatial release from masking (SRM). Multiple linear regression analyses were conducted to examine the influence of a range of demographic factors on outcomes. STUDY SAMPLE: Participants were 252 children enrolled in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. RESULTS: Children using HAs or CIs required a better signal-to-noise ratio to achieve the same level of performance as their normal-hearing peers but demonstrated SRM of a similar magnitude. For children using HAs, speech perception was significantly influenced by cognitive and language abilities. For children using CIs, age at CI activation and language ability were significant predictors of speech perception outcomes. CONCLUSIONS: Speech perception in children with hearing loss can be enhanced by improving their language abilities. Early age at cochlear implantation was also associated with better outcomes.

Hearing aid fitting and developmental outcomes of children fit according to either the NAL or DSL prescription: fit-to-target, audibility, speech and language abilities.

OBJECTIVE: This study examined the influence of prescription on hearing aid (HA) fitting characteristics and 5-year developmental outcomes of children. DESIGN: A randomised controlled trial implemented as part of a population-based study on Longitudinal Outcomes of Children with Hearing Impairment (LOCHI). STUDY SAMPLE: Two-hundred and thirty-two children that were fit according to either the National Acoustic Laboratories (NAL) or Desired Sensation Level (DSL) prescription. RESULTS: Deviation from targets and root-mean-square error in HA fitting revealed no significant difference between fitting prescriptions. Aided audibility quantified by using the Speech Intelligibility Index (SII) model showed that DSL provided higher audibility than NAL at low and medium input levels but not at high input level. After allowing for hearing loss desensitisation, differences in audibility between prescription groups were significant only at low input level. The randomised trial of prescription that was implemented for 163 children revealed no significant between-group differences in speech production, perception, and language; but parent-rated functional performance was higher for the DSL than for the NAL group. CONCLUSIONS: Proximity to prescriptive targets was similar between fitting prescriptions. The randomised trial revealed differences in aided audibility at low input level between prescription groups, but no significant differences in speech and language abilities.

Outcomes of early- and late-identified children at 3 years of age: findings from a prospective population-based study.

OBJECTIVE: To address the question of whether, on a population level, early detection and amplification improve outcomes of children with hearing impairment. DESIGN: All families of children who were born between 2002 and 2007, and who presented for hearing services below 3 years of age at Australian Hearing pediatric centers in New South Wales, Victoria, and Southern Queensland were invited to participate in a prospective study on outcomes. Children's speech, language, functional, and social outcomes were assessed at 3 years of age, using a battery of age-appropriate tests. Demographic information relating to the child, family, and educational intervention was solicited through the use of custom-designed questionnaires. Audiological data were collected from the national database of Australian Hearing and records held at educational intervention agencies for children. Regression analysis was used to investigate the effects of each of 15 predictor variables, including age of amplification, on outcomes. RESULTS: Four hundred and fifty-one children enrolled in the study, 56% of whom received their first hearing aid fitting before 6 months of age. On the basis of clinical records, 44 children (10%) were diagnosed with auditory neuropathy spectrum disorder. There were 107 children (24%) reported to have additional disabilities. At 3 years of age, 317 children (70%) were hearing aid users and 134 children (30%) used cochlear implants. On the basis of parent reports, about 71% used an aural/oral mode of communication, and about 79% used English as the spoken language at home. Children's performance scores on standardized tests administered at 3 years of age were used in a factor analysis to derive a global development factor score. On average, the global score of hearing-impaired children was more than 1 SD below the mean of normal-hearing children at the same age. Regression analysis revealed that five factors, including female gender, absence of additional disabilities, less severe hearing loss, higher maternal education, and (for children with cochlear implants) earlier age of switch-on were associated with better outcomes at the 5% significance level. Whereas the effect of age of hearing aid fitting on child outcomes was weak, a younger age at cochlear implant switch-on was significantly associated with better outcomes for children with cochlear implants at 3 years of age. CONCLUSIONS: Fifty-six percent of the 451 children were fitted with hearing aids before 6 months of age. At 3 years of age, 134 children used cochlear implants and the remaining children used hearing aids. On average, outcomes were well below population norms. Significant predictors of child outcomes include: presence/absence of additional disabilities, severity of hearing loss, gender, maternal education, together with age of switch-on for children with cochlear implants.

A comparison of NAL and DSL prescriptive methods for paediatric hearing-aid fitting: predicted speech intelligibility and loudness.

OBJECTIVE: To examine the impact of prescription on predicted speech intelligibility and loudness for children. DESIGN: A between-group comparison of speech intelligibility index (SII) and loudness, based on hearing aids fitted according to NAL-NL1, DSL v4.1, or DSL m[i/o] prescriptions. A within-group comparison of gains prescribed by DSL m[i/o] and NAL-NL2 for children in terms of SII and loudness. STUDY SAMPLE: Participants were 200 children, who were randomly assigned to first hearing-aid fitting with either NAL-NL1, DSL v4.1, or DSL m[i/o]. Audiometric data and hearing-aid data at 3 years of age were used. RESULTS: On average, SII calculated on the basis of hearing-aid gains were higher for DSL than for NAL-NL1 at low input level, equivalent at medium input level, and higher for NAL-NL1 than DSL at high input level. Greater loudness was associated with DSL than with NAL-NL1, across a range of input levels. Comparing NAL-NL2 and DSL m[i/o] target gains revealed higher SII for the latter at low input level. SII was higher for NAL-NL2 than for DSL m[i/o] at medium- and high-input levels despite greater loudness for gains prescribed by DSL m[i/o] than by NAL-NL2. CONCLUSION: The choice of prescription has minimal effects on speech intelligibility predictions but marked effects on loudness predictions.

A randomized controlled trial of nonlinear frequency compression versus conventional processing in hearing aids: speech and language of children at three years of age.

OBJECTIVE: To determine the effect of nonlinear frequency compression (NLFC) on children's development of speech and language at three years of age. DESIGN: A randomized controlled trial was conducted as part of the population-based longitudinal study on outcomes of children with hearing impairment (LOCHI). Participants were randomly assigned to fitting with NLFC (Phonak Naida V SP or UP) or with conventional processing in hearing aids, prescribed by using either the NAL or the DSL formula. Standardized tests of speech production, receptive and expressive language were administered, and parent ratings were collected. All assessments were double-blinded. STUDY SAMPLE: Participants were 44 of the 450 children in the LOCHI cohort. RESULTS: Compared to children using conventional processing, receptive and expressive language was higher but receptive vocabulary and consonant articulation scores were lower for children who use NLFC. There was increased substitution of affricates by fricatives for children using NLFC, compared to children using conventional amplification. After allowing for the effect of multiple demographic variables, the difference in global language scores between groups was not significant (effect: 0.8 [95% confidence interval: - 6.7, 8.3]). CONCLUSIONS: There is insufficient evidence to indicate a difference in language ability between children using NLFC and those using conventional amplification.

A randomized controlled comparison of NAL and DSL prescriptions for young children: hearing-aid characteristics and performance outcomes at three years of age.

OBJECTIVE: To determine the influence of choice of prescription and other child-, family- and intervention-related factors on speech, language, and functional performance of hearing-impaired children by three years of age. DESIGN AND STUDY SAMPLE: A randomized controlled design was implemented as part of a population-based, longitudinal study on outcomes of children with hearing impairment (LOCHI) in Australia. Two hundred and eighteen children were randomly assigned to either the NAL or the DSL prescription for first fitting of hearing aids. Their performance outcomes were evaluated. RESULTS: Prescriptive targets were closely matched in children's hearing aids. There were no significant differences in children's language, speech production, or functional performance between prescriptions. Parents' ratings of children's device usage and loudness discomfort were not significantly different between prescription groups. Functional performance within the first year of fitting together with degree of hearing loss, presence of additional disabilities, and maternal education explained 44% of variation in language ability of children by three years of age. CONCLUSIONS: There was no significant association between choice of hearing-aid prescription and variance in children's outcomes at three years of age. In contrast, additional disability, maternal educational level, and early functional performance were significant predictive factors of children's outcomes.

Utilizing 3D Printing Technology to Create Prosthetic Irises: Proof of Concept and Workflow.

PURPOSE: There are currently limited treatment options for aniridia. In this context, 3D printed iris implants may provide a cost-effective, cosmetically acceptable alternative for patients with aniridia. The purpose of this study was to develop a proof-of-concept workflow for manufacturing 3D printed iris implants using a silicone ink palette that aesthetically matches iris shades, identified in slit lamp images. METHODS: Slit lamp iris photos from 11 healthy volunteers (3 green; 4 blue; 4 brown) were processed using k-means binning analyses to identify two or three prominent colors each. Candidate silicone inks were created by precisely combining pigments. A crowdsourcing survey software was used to determine color matches between the silicone ink swatches and three prominent iris color swatches in 2 qualifying and 11 experimental workflows. RESULTS: In total, 54 candidate silicone inks (20 brown; 16 green; 18 blue) were developed and analyzed. Survey answers from 29 individuals that had passed the qualifying workflow were invited to identify "best matches" between the prominent iris colors and the silicone inks. From this color-match data, brown, blue, and green prototype artificial irises were printed with the silicone ink that aesthetically matched the three prominent colors. The iris was printed using a simplified three-layer five-branch starburst design at scale (12.8 mm base disc, with 3.5 mm pupil). CONCLUSIONS: This proof-of-concept workflow produced color-matched silicone prosthetic irises at scale from a panel of silicone inks using prominent iris colors extracted from slit lamp images. Future work will include printing a more intricate iris crypt design and testing for biocompatibility.

A survey of elite and pre-elite athletes' perceptions of key support, lifestyle and performance factors.

BACKGROUND: Success at the elite level in sport is often attributed to physical prowess, technical skill, and mental attitude. However, underpinning these factors are various lifestyle, support and social factors that may contribute to successful performance, but which may be absent from athlete development programs. METHODS: An online survey was used to investigate athlete perceptions of lifestyle practices and support services amongst 135 Australian Olympic, Paralympic, National, and state-level athletes across 25 Olympic sports. RESULTS: International athletes perceived psychological skills and attributes, along with strong interpersonal relationships as vital to their success, and they also rated 'Recovery practices' as very important and made extensive use of available support services. These athletes also indicated that they would have liked access to these services earlier in their careers, a wish that was reiterated by the sub-elite athletes. Furthermore, athletes wanted greater knowledge, mentoring, and autonomy earlier in their careers, and the importance of 'athlete wellbeing' as well as 'athletic performance' was evident in a number of contexts. CONCLUSIONS: An athlete development system into which these are included may assist in generating an environment that facilitates athlete success, repeated podium performances, retain athletes in high-performance sport for longer, encourage human-flourishing, wellbeing and smooth transitions for retiring athletes.

Test-Retest Reliability of Self-Reported Substance Use and Sexual Risk Behavior Among at-Risk Adolescents.

Adolescents often engage in behaviors such as substance use and risky sexual activity that can lead to negative health and psychological consequences for themselves and others. Accurate measurement of these behaviors in surveys is challenging given that the behaviors are often viewed as undesirable and/or are illegal, so it is important to test the psychometric properties of instruments used to assess adolescent risk behaviors. The current study aimed to assess the test-retest reliability of a widely used measure of youth risk-taking behavior, the Youth Risk Behavior Survey (YRBS). A sample of 156 at-risk adolescents aged 16-18 years (81% male; 61% White) completed the YRBS retrospectively across intervals ranging from 3 to 12 days during their stay in a residential program at which they were under close supervision and had limited ability to engage in new risk behaviors. Participants were asked to complete the YRBS based on their "typical" (pre-program) behavior at both administrations, which were 10-14 weeks into their stay. The reliability of responses was assessed using kappa and weighted kappa analyses. Findings indicate moderate to substantial reliability for nearly all items, suggesting that at-risk youth reliably reported their engagement in health risk behaviors across multiple administrations and supporting the psychometric strength of the YRBS measure for use with this population.

Supervised Dimension Reduction for Large-Scale "Omics" Data With Censored Survival Outcomes Under Possible Non-Proportional Hazards.

The past two decades have witnessed significant advances in high-throughput "omics" technologies such as genomics, proteomics, metabolomics, transcriptomics and radiomics. These technologies have enabled simultaneous measurement of the expression levels of tens of thousands of features from individual patient samples and have generated enormous amounts of data that require analysis and interpretation. One specific area of interest has been in studying the relationship between these features and patient outcomes, such as overall and recurrence-free survival, with the goal of developing a predictive "omics" profile. Large-scale studies often suffer from the presence of a large fraction of censored observations and potential time-varying effects of features, and methods for handling them have been lacking. In this paper, we propose supervised methods for feature selection and survival prediction that simultaneously deal with both issues. Our approach utilizes continuum power regression (CPR) - a framework that includes a variety of regression methods - in conjunction with the parametric or semi-parametric accelerated failure time (AFT) model. Both CPR and AFT fall within the linear models framework and, unlike black-box models, the proposed prognostic index has a simple yet useful interpretation. We demonstrate the utility of our methods using simulated and publicly available cancer genomics data.

Increased mood disorder symptoms, perceived stress, and alcohol use among college students during the COVID-19 pandemic.

The COVID-19 pandemic caused significant disruption during the spring of 2020. Many college students were told to leave campus at spring break and to complete the semester remotely. This study evaluates effects of this disruption on student well-being. Measures of psychological symptoms, perceived stress, and alcohol use during the pandemic were completed by 148 students in spring 2020 and 352 students in fall 2020 at a university in the southeastern U.S. Results from both cohorts were compared to 240 students who completed the same measures in the fall 2019 semester. Participants in spring 2020 reported more mood disorder symptoms, perceived stress, and alcohol use than did pre-pandemic participants and worry about COVID-19 was negatively associated with well-being. By fall 2020 symptoms had largely returned to pre-pandemic levels. In general, White students reported a greater effect of the pandemic on well-being than did African American students. Young adults appear to be less vulnerable to the most serious medical complications associated with COVID-19, but nonetheless experience psychological effects from the pandemic. Universities and practitioners who work with college students can help young adults manage their symptoms and avoid behaviors like risky alcohol use when confronted with stressors such as the COVID-19 pandemic.

Leveraging Online Learning to Promote Systems Thinking for Sustainable Food Systems Training in Dietetics Education.

Educating and training a multisectoral food systems workforce is a critical part of developing sustainable, resilient, and healthy food and water systems. This paper shares perspectives from a working group of educators, learners, and food systems subject matter experts that collaborated over the course of a year to develop, pilot test, and evaluate two interactive webinar series with a multi-site cohort of dietetics interns and graduate students. The three-part webinar series format included a training webinar, a practice activity, and a synthesis webinar. In reflecting on the effectiveness of this format, we provide direct assessments of student learning from subject matter experts alongside indirect assessments from pre- and post-surveys fielded with learners. Learners who participated in an interactive webinar series demonstrated skills in several dimensions of systems thinking and gained confidence in food systems learning outcomes. Learners also shared valuable feedback on the opportunities and challenges of using online platforms for this experience. As online learning opportunities become more common, it will become increasingly important for educators to prioritize strategies that effectively equip students with the higher-order thinking skills, such as systems thinking, needed to address the complexities of sustainable food systems. The interactive webinar series format described here provides an opportunity to leverage didactic webinars in combination with interactive experiences that enable learners to deepen their knowledge through practice with peers and subject matter experts. Though this format was piloted within dietetics education programs, many of the lessons learned are transferable to other food systems educational contexts.