Rural-Urban Disparities in Video Telehealth Use During Rapid Mental Health Care Virtualization Among American Indian/Alaska Native Veterans.

Importance: American Indian/Alaska Native veterans experience a high risk for health inequities, including mental health (MH) care access. Rapid virtualization of MH care in response to the COVID-19 pandemic facilitated care continuity across the Veterans Health Administration (VHA), but the association between virtualization of care and health inequities among American Indian/Alaska Native veterans is unknown. Objective: To examine differences in video telehealth (VTH) use for MH care between American Indian/Alaska Native and non-American Indian/Alaska Native veterans by rurality and urbanicity. Design, Setting, and Participants: In this cohort study, VHA administrative data on VTH use among a veteran cohort that received MH care from October 1, 2019, to February 29, 2020 (prepandemic), and April 1 to December 31, 2020 (early pandemic), were examined. Exposures: At least 1 outpatient MH encounter during the study period. Main Outcomes and Measures: The main outcome was use of VTH among all study groups (ie, American Indian/Alaska Native, non-American Indian/Alaska Native, rural, or urban) before and during the early pandemic. American Indian/Alaska Native veteran status and rurality were examined as factors associated with VTH utilization through mixed models. Results: Of 1 754 311 veterans (mean [SD] age, 54.89 [16.23] years; 85.21% male), 0.48% were rural American Indian/Alaska Native; 29.04%, rural non-American Indian/Alaska Native; 0.77%, urban American Indian/Alaska Native; and 69.71%, urban non-American Indian/Alaska Native. Before the pandemic, a lower percentage of urban (b = -0.91; SE, 0.02; 95% CI, -0.95 to -0.87; P < .001) and non-American Indian/Alaska Native (b = -0.29; SE, 0.09; 95% CI, -0.47 to -0.11; P < .001) veterans used VTH. During the early pandemic period, a greater percentage of urban (b = 1.37; SE, 0.05; 95% CI, 1.27-1.47; P < .001) and non-American Indian/Alaska Native (b = 0.55; SE, 0.19; 95% CI, 0.18-0.92; P = .003) veterans used VTH. There was a significant interaction between rurality and American Indian/Alaska Native status during the early pandemic (b = -1.49; SE, 0.39; 95% CI, -2.25 to -0.73; P < .001). Urban veterans used VTH more than rural veterans, especially American Indian/Alaska Native veterans (non-American Indian/Alaska Native: rurality b = 1.35 [SE, 0.05; 95% CI, 1.25-1.45; P < .001]; American Indian/Alaska Native: rurality b = 2.91 [SE, 0.38; 95% CI, 2.17-3.65; P < .001]). The mean (SE) increase in VTH was 20.34 (0.38) and 15.35 (0.49) percentage points for American Indian/Alaska Native urban and rural veterans, respectively (difference in differences [DID], 4.99 percentage points; SE, 0.62; 95% CI, 3.77-6.21; t = -7.999; df, 11 000; P < .001), and 12.97 (0.24) and 11.31 (0.44) percentage points for non-American Indian/Alaska Native urban and rural veterans, respectively (DID, 1.66; SE, 0.50; 95% CI, 0.68-2.64; t = -3.32; df, 15 000; P < .001). Conclusions and Relevance: In this cohort study, although rapid virtualization of MH care was associated with greater VTH use in all veteran groups studied, a significant difference in VTH use was seen between rural and urban populations, especially among American Indian/Alaska Native veterans. The findings suggest that American Indian/Alaska Native veterans in rural areas may be at risk for VTH access disparities.

High variation across E. coli hybrid isolates identified in metabolism-related biological pathways co-expressed with virulent genes.

Virulent genes present in Escherichia coli (E. coli) can cause significant human diseases. These enteropathogenic E. coli (EPEC) and enterotoxigenic E. coli (ETEC) isolates with virulent genes show different expression levels when grown under diverse laboratory conditions. In this research, we have performed differential gene expression analysis using publicly available RNA-seq data on three pathogenic E. coli hybrid isolates in an attempt to characterize the variation in gene interactions that are altered by the presence or absence of virulent factors within the genome. Almost 26.7% of the common genes across these strains were found to be differentially expressed. Out of the 88 differentially expressed genes with virulent factors identified from PATRIC, nine were common in all these strains. A combination of Weighted Gene Co-Expression Network Analysis and Gene Ontology Enrichment Analysis reveals significant differences in gene co-expression involving virulent genes common among the three investigated strains. The co-expression pattern is observed to be especially variable among biological pathways involving metabolism-related genes. This suggests a potential difference in resource allocation or energy generation across the three isolates based on genomic variation.

Culturally Centered Implementation of Video Telehealth for Rural Native Veterans.

Introduction: Native American Veterans are the most rural and experience heightened risk for mental health (MH) challenges while facing significant health care inequities and access barriers. Rural Native Veterans (RNVs) have experienced historical loss and racial discrimination, contributing to mistrust of Veterans Health Administration (VHA) and other Federal systems. Telemedicine, including video telehealth (VTH), can improve access to MH care for RNVs by addressing barriers. Understanding the cultural context and existing community resources can improve engagement and implementation efforts with RNVs. Objective: This article describes a model of culturally centered MH care and a flexible implementation approach, Personalized Implementation of Virtual Treatments for Rural Native Veterans (PIVOT-RNV), used to disseminate the model. Methods: Participants included four VHA sites serving large RNV populations where PIVOT-RNV was applied to expand the availability of virtual solutions, including VTH, for RNVs. A mixed methods formative evaluation tracked VTH utilization and used provider and RNV feedback to inform iterative process improvements. Results: Where PIVOT-RNV was used, number of providers using VTH with RNVs, number of unique RNVs receiving MH care through VTH, and number of VTH encounters with RNVs grew annually. Provider and RNV feedback highlighted the importance of addressing the unique barriers and cultural context of RNVs. Conclusions: PIVOT-RNV demonstrates promise for improving implementation of virtual treatments and access to MH care for RNVs. The integration of implementation science within a cultural safety framework helps address specific barriers to adoption of virtual treatments for RNVs. Next steps include expanding PIVOT-RNV efforts at additional sites.

Feasibility of Group-Based Implementation Facilitation for Video Telemental Health.

Video telehealth experienced rapid growth throughout the COVID-19 pandemic in many healthcare sectors, including mental health. The Veterans Health Administration's video telehealth platform, VA Video Connect, has been widely used to reach veterans who may have experienced difficulty accessing care, such as those living in rural areas or other barriers (e.g., transportation). Implementing VVC requires a multifaceted approach, including training providers on technical skills, increasing access to equipment for providers and veterans, and integrating VVC within the culture and processes of the clinic unit. Prior successful VVC implementation efforts in rural areas have focused on simultaneous one-on-one provider and leadership engagement using implementation facilitation (IF). However, given the rapid need for VVC expansion in light of limits and dangers associated with in-person care during the pandemic, our team developed group facilitation to increase the reach of VVC implementation through IF. Group facilitation combined training in technical and policy elements of VVC with IF with groups of providers from clinic units. This approach was designed to rapidly disseminate the necessary knowledge to conduct VVC combined with collaborative problem solving as a team to improve the ability of the clinical team to sustain VVC. Attendees were asked for feedback on the session through multiple choice and open-ended questions. Participants (N = 26) reported being highly satisfied with the training and reported a high degree of confidence in their ability to use VVC. Based on evaluation data and interview feedback, providers and clinic leaders were satisfied with group facilitation. Group facilitation may be a helpful tool in rapidly training clinical teams to implement and sustain video telemental health.

Getting Connected: a Retrospective Cohort Investigation of Video-to-Home Telehealth for Mental Health Care Utilization Among Women Veterans.

BACKGROUND: Increasingly, women are serving in the military and seeking care at the Veterans Health Administration (VHA). Women veterans face unique challenges and barriers in seeking mental health (MH) care within VHA. VA Video Connect (VVC), which facilitates video-based teleconferencing between patients and providers, can reduce barriers while maintaining clinical effectiveness. OBJECTIVE: Primary aims were to examine gender differences in VVC use, describe changes in VVC use over time (including pre-COVID and 6 months following the beginning of COVID), and determine whether changes over time differed by gender. DESIGN: A retrospective cohort investigation of video-to-home telehealth for MH care utilization among veterans having at least 1 MH visit from October 2019 to September 2020. PARTICIPANTS: Veterans (236,268 women; 1,318,024 men). INTERVENTIONS (IF APPLICABLE): VVC involves face-to-face, synchronous, video-based teleconferencing between patients and providers, enabling care at home or another private location. MAIN MEASURES: Percentage of MH encounters delivered via VA Video Connect. KEY RESULTS: Women veterans were more likely than men to have at least 1 VVC encounter and had a greater percentage of MH care delivered via VVC in FY20. There was an increase in the percentage of MH encounters that were VVC over FY20, and this increase was greater for women than men. Women veterans who were younger than 55 (compared to those 55 and older), lived in urban areas (compared to those in rural areas), or were Asian (compared to other races) had a greater percentage of MH encounters that were VVC since the start of the pandemic, controlling for the mean percentage of VVC MH encounters in the 6 months pre-pandemic. CONCLUSIONS: VVC use for MH care is greater in women veterans compared to male veterans and may reduce gender-specific access barriers. Future research and VVC implementation efforts should emphasize maximizing patient choice and satisfaction.

Bringing Assessment-to-Instruction (A2i) Technology to Scale: Exploring the Process from Development to Implementation.

Bringing effective, research-based literacy interventions into the classroom is challenging, especially given the cultural and linguistic diversity of today's classrooms. We examined the promise of Assessment-to-Instruction (A2i) technology redesigned to be used at scale to support teachers' implementation of the individualized student instruction (ISI) intervention from kindergarten through third grade. In seven randomized controlled trials, A2i and ISI have demonstrated efficacy. However, the research version of A2i was not scalable. In order to bring A2i to scale in schools serving linguistically diverse students, we carried out the current study across two phases. This study represents both an exploration of what it takes to bring an educational intervention to scale (Phase 1) and a quasi-experiment on the literacy outcomes of learners whose teachers used the technology (Phase 2). We integrated assessments of vocabulary, word decoding, and reading comprehension; revised the A2i algorithms to account for the constellation of skills English learners (ELs) bring to the classroom; updated the user interfaces and added new graphic features; and improved bandwidth and stability of the technology. Findings were mixed, including several non-significant results, a marginally significant intent-to-treat effect on word reading in kindergarten and first grade for English monolingual students and ELs, and one significant interaction effect, which suggested ELs and students with less developed reading skills in second and third grade benefitted most from the intervention. With some caution, we conclude that A2i demonstrates potential to be used at scale and promise of effectiveness for improving code-focused skills for diverse learners.

DrosoPhyla: Resources for Drosophilid Phylogeny and Systematics.

The vinegar fly Drosophila melanogaster is a pivotal model for invertebrate development, genetics, physiology, neuroscience, and disease. The whole family Drosophilidae, which contains over 4,400 species, offers a plethora of cases for comparative and evolutionary studies. Despite a long history of phylogenetic inference, many relationships remain unresolved among the genera, subgenera, and species groups in the Drosophilidae. To clarify these relationships, we first developed a set of new genomic markers and assembled a multilocus data set of 17 genes from 704 species of Drosophilidae. We then inferred a species tree with highly supported groups for this family. Additionally, we were able to determine the phylogenetic position of some previously unplaced species. These results establish a new framework for investigating the evolution of traits in fruit flies, as well as valuable resources for systematics.

Exploring Adolescents' (Non-)Use of Modern Contraceptives in Ghana Through the Lens of the Theory of Gender and Power.

Despite the benefits of modern contraceptives, its usage is low among adolescents in sub-Saharan Africa. Based on the theory of gender and power, this study explored adolescents' (non-)use of contraceptives in the context of their sexual and reproductive health. Data were collected from adolescents (15-19 years) through focus group discussions as well as through interviews with five key informants. The collected data were investigated through thematic analysis. The study revealed that gender and power influenced adolescents sexual behavior. Both young men and young women engaged in risky sexual behavior, which exposed them to unintended pregnancy. Whereas some young women engaged in risky sexual behaviors due to financial reasons, young men engaged in such behaviors for pleasure. Lack of knowledge about the correct use of modern contraceptives, type of sexual relationship, and cultural norms of adolescent girls' appropriate sexual behavior influenced the use of contraceptives by adolescent girls. Avoiding pregnancy could be easier for adolescent girls if only they could have easy access to more long-term and reliable contraceptive methods. Education on the need to use condoms during sexual intercourse should be intensified to create awareness about using condoms to avoid sexually transmitted infections in addition to unwanted pregnancy.

Personalized implementation of video telehealth for rural veterans (PIVOT-R).

BACKGROUND: A national shortage of mental health (MH) professionals leaves more than 90% of rural individuals without adequate access to services each year, troubling because 33% of Veterans Health Administration (VHA) enrollees live in rural areas and rural Veterans have a greater risk of suicide than urban Veterans. Additional barriers such as travel distance and cost, stigma and extreme weather or geography add to challenges of rural Veterans seeking treatment. Although the VHA has addressed this disparity by providing telemental health services, provision of services via traditional hub-and-spoke and/or establishment of regional centers has not fully addressed barriers or resource limitations. Video telehealth to home (VTH) has assisted in better addressing geographic, attitudinal and systematic barriers to in-person care; however, its uptake and implementation have been problematic. This article describes the Personalized Implementation of Video Telehealth for Rural Veterans (PIVOT-R) approach, developed in response to the unique needs of rural veterans. METHODS: We developed PIVOT, a flexible implementation strategy that is adaptive to site-specific contexts and different digital innovations and relies on a collaborative relationship between external facilitators, internal facilitators and clinical champions. We used formative evaluation (FE) to gather ongoing information about our quality improvement (QI) implementation approach of VTH. Our FE of PIVOT at rural sites provided insight into adaptations to improve rural implementation. This led to development of PIVOT-R, which explicitly focuses on rural implementation. PIVOT-R, developed from provider and patient feedback plus lessons learned during implementation, focuses on rurality as an important diversity factor and addresses relationship building, engaging the site, assessing context and infrastructure and balancing national expectations with site-level goals. During fiscal year 2018 we partnered with a VHA healthcare system in a Western mountain state to pilot the PIVOT-R approach, again using FE which included quantitative and qualitative data collection to evaluate its impact. RESULTS: PIVOT-R effectively increased uptake of VTH for MH care at the healthcare system evaluated. In fiscal year 2019 the percentage of Veterans receiving MH care via VTH at the site was 10 times greater than in fiscal year 2018, matching the mean VHA nationwide percentage and increasing by 43.24% by the end of 2019. Veteran feedback supported a positive experience by users. CONCLUSIONS: Inclusion of a comprehensive assessment of the rural system, including infrastructure and resources, greatly improves understanding of a system's specific needs and enables a tailored approach targeting relevant barriers. Our FE suggests the potential of PIVOT-R to increase VTH uptake at other rural locations and reinforces the value of telehealth technology as an important resource for rural sites.

Simulation of fluvial sediment dynamics through strategic assessment of stream gaging data: A targeted watershed sediment loading analysis.

Near-channel sediment loading (NCSL) is localized and episodic, making it difficult to accurately quantify its cumulative contribution to watershed sediment loading, let alone predict the effects from changes in river discharge due to climate change or land management practices. We developed a methodological framework, using commonly available stream gaging data, for estimating watershed-scale NCSL, a feature generally absent in most watershed models. The method utilizes a network of paired gages that bracket the incised river corridors of 15 tributaries to the Minnesota River, in which near-channel sources are often the dominant contributors of sediment loading. For each set of paired gages, we calculate NCSL as the difference between the upstream and downstream sediment loading minus the field contribution between the gages. NCSL generally increases with river discharge when it exceeds the observed threshold benchmark in the tributaries of Minnesota River Basin; accordingly, we developed a predictive model for quantifying NCSL using river discharge as the independent variable. This approach provides a predictive basis for evaluating the impacts on near-channel sediment supply from increases in runoff and river discharge. Application of this approach includes evaluation of watershed-scale conservation trade-offs, where benefits of landscape management practices, such as wetlands and reservoirs are measured in terms of reduction in downstream near-channel sediment loading in the incised river corridors.

An Evidence-Based Model for Disseminating-Implementing Coordinated Anxiety Learning and Management in Department of Veterans Affairs' Community-Based Outpatient Clinics.

PURPOSE: To explore the feasibility and utility of using a workshop, and supervision-consultation plus external facilitation to disseminate and implement cognitive-behavioral therapy in Veterans Affairs (VA) community-based outpatient clinics (CBOCs). METHODS: This study occurred in the context of a randomized controlled trial aimed at comparing 2 methods for implementing Coordinated Anxiety Learning Management (CALM) in VA CBOCs. A 3-phase (workshop, supervision-consultation, external facilitation) model was used to support 32 VA CBOC mental health providers in learning and adopting CALM in their clinical practice. Qualitative data describe training activities and the feasibility and utility of each training phase in addressing challenges to adopting CALM. FINDINGS: All 3 phases of the model were feasible to use with our sample of CBOC mental health providers. Providers reported challenges learning CALM during the workshop and concerns about not having enough training post-workshop to use CALM in practice. Providers primarily utilized supervision-consultation to tailor CALM to their practice, including learning how to prioritize a target disorder, "switch" the focus of treatment to a different disorder when comorbidities were present, and modify CALM sessions to fit shorter treatment visits. Providers primarily utilized external facilitation to further tailor CALM to their practice through implementation (eg, concrete help) and support-oriented help. Key lessons for implementing CALM in CBOCs are presented and discussed. CONCLUSIONS: Findings provide initial evidence for the feasibility and utility of using each component of a facilitation-enhanced training model to promote CBOC VA providers' implementation of a computer and manual version of CALM in their practice.

Personalized Implementation of Video Telehealth.

This article describes the Personalized Implementation for Video Telehealth strategy to increase adoption of video telehealth to home (VTH) across a large, urban Veterans Health Administration medical center and applications for broader use in non-VHA settings. The authors fully integrated VTH into existing mental health clinics, resulting in (1) a significant increase in the number of patients receiving VTH, (2) a significant increase in the number of VTH visits relative to median national improvement, (3) a greater number of unique specialty mental health clinics offering VTH in Houston, and (4) a greater number of community clinics active in delivering VTH.

A rare case of hyperammonaemic encephalopathy.

A 75-year-old female patient presented to the accident and emergency department following a collapse. She was treated for a saddle pulmonary embolism and underlying urinary tract infection. However, 48 hours later she was found to have reduced consciousness with no apparent cause (Glasgow Coma Scale of 8 out of 15). Subsequent blood results revealed a highammonia level. After reflection into her medical history, it was found that she had bladder exstrophy, which was managed with urinary diversion surgery as an infant, and her presentation was a rare complication of this operation.

Building Word Knowledge, Learning Strategies, and Metacognition with the Word-Knowledge E-Book.

Many children fail to comprehend what they read because they do not monitor their understanding, which requires making accurate judgements of what they know and then employing repair strategies when comprehension fails. Relying on research from learning science and cognitive and developmental psychology, we developed the Word Knowledge e-Book (WKe-Book) to improve children's calibration of their word knowledge, strategy use, and word knowledge overall; skills which are associated with reading comprehension. The WKe-Book, which is read on a tablet computer, is a choose-your-own adventure book where choices require choosing between two rare words (e.g., cogitate vs. procrastinate). Depending on the word chosen, the story follows a different plot. There are also embedded comprehension questions where students receive immediate feedback with consequences for incorrect answers, such as being sent back to reread a few pages. In a randomized controlled trial, we tested whether students (N = 603 in 25 third through fifth grade classrooms in Arizona in the US) reading the WKe-Book would demonstrate improved word knowledge, strategy use, and word knowledge calibration. Classrooms were randomly assigned to read the WKe-Book immediately (treatment) or later (delayed-treatment control), and within classrooms, students were randomly assigned to either participate in a 15-minute weekly book club (book club treatment) or to read the WKe-Book independently with no book club (no book club control). Results revealed a significant treatment effect of the WKe-Book on students' word knowledge, word knowledge calibration, and strategy use, which predicted student performance on standardized reading comprehension and vocabulary measures. The effects were greater for students who participated in weekly book clubs compared to students in the no book club control. These findings suggest that the affordances offered by technology, which are unavailable in paper-based books, can support students' development of metacognition, including word knowledge calibration, strategy use, and word learning skills.

Profiles of Foundational Learning Components among First Graders.

School readiness includes a constellation of skills and behaviors, such as social and emotional development, language and literacy, and self-regulation that provide a basis critical for classroom participation and learning. Whereas it has been well-established that students who enter kindergarten with weaknesses in language and literacy are more likely to struggle academically, less research has focused on the variability and educational impact of other foundational learning components, including internalizing and externalizing behaviors, particularly in first grade. This study used latent profile analysis to identify the following four subgroups (profiles) of students, using foundational learning components, in a sample of first graders (n = 324): Emergent Hyperactive, Externalizing, Generally Good Students, and Internalizing. Latent class growth analysis illustrated significant differences in the average rate of growth in literacy skills from the beginning to the end of first grade across the four profiles, after controlling for gender and socioeconomic status. Findings indicated the greatest growth in literacy skills for students in the Externalizing profile and the least amount of vocabulary growth for students in the Emergent Hyperactive profile followed by the Internalizing profile. Educational implications of how researchers and educators might consider students' individual differences across profiles of foundational learning components to inform ways to support development and learning in the classroom are discussed.

Direct and Reciprocal Effects among Social Skills, Vocabulary, and Reading Comprehension in First Grade.

Social skills and vocabulary are important areas of development involved in early reading achievement, yet little attention has been given to understanding the dynamic associations among them during the elementary years. This study examined the relations among three dimensions of social skills-cooperation, assertion, and self-control-vocabulary and developing reading comprehension (RC) skills in a longitudinal sample of first graders (n = 468). Using Structural Equation Modeling, reciprocal effects were observed between vocabulary and RC as well as direct effects among social skills, vocabulary, and RC after controlling for the influence of problem behaviors. This study highlights the reciprocal nature of students' vocabulary and RC skills as well as provides preliminary evidence suggesting that social skills play a role in developing vocabulary and RC skills, and further, vocabulary and RC skills play a role in social development during middle childhood. Implications for policy and practice are discussed.

Recent Advances in Delivering Mental Health Treatment via Video to Home.

PURPOSE OF REVIEW: Telemental health has rapidly evolved as technology and policy advances have allowed new and innovative approaches, including the remote delivery of services directly to patients' homes. This review examined the literature on video to home (VTH) delivery of mental health services to synthesize information regarding (1) the comparative clinical effectiveness of VTH to in-person mental health treatment, (2) impact of VTH on treatment adherence, (3) patient and provider satisfaction with VTH, (4) cost effectiveness of VTH, and (5) clinical considerations for VTH use. RECENT FINDINGS: Clinical effectiveness, treatment adherence, and patient satisfaction outcomes are comparable for VTH and in-person delivery of psychotherapy and psychiatric consultation services. Clinical applications for VTH have expanded in an effort to provide mental health care to difficult to reach, underserved populations. VTH is less costly than in-person care when assuming that patients could employ existing personal technologies. VTH delivery offers a safe and effective option for increasing access to mental health care for patients who face logistical and stigma-related barriers to receiving in-person treatment. VTH should be routinely offered to patients as an option for receiving care, maximizing patient choice, and coordination of care.

Examining the relations between self-regulation and achievement in third grade students.

Children with stronger self-regulation skills generally demonstrate greater overall success in school both academically and socially. However, there are few valid and reliable measures of self-regulation in middle elementary school. Such a measure could help identify whether a child is truly having difficulties. Thus, the Remembering Rules and Regulation Picture Task (RRRP) was developed. The aim of this study was to develop scoring systems for the RRRP and then to examine the associations between RRRP and independent measures of self-regulation and academic achievement in mathematics and reading. Children (n = 282) from 34 third grade classrooms in Florida participated in this study. Results revealed that the RRRP captured three constructs: working memory, attentional flexibility, and inhibitory control. Hierarchical linear modeling (HLM) demonstrated that the RRRP was significantly and positively associated with other measures of self-regulation. The RRRP was significantly and positively associated with mathematics and reading as well. The RRRP appears to be a promising measure of children's self-regulation skills.

The evolutionary origination of a novel expression pattern through an extreme heterochronic shift.

The evolutionary origins of morphological structures are thought to often depend upon the redeployment of old genes into new developmental settings. Although many examples of cis-regulatory divergence have shown how pre-existing patterns of gene expression have been altered, only a small number of case studies have traced the origins of cis-regulatory elements that drive new expression domains. Here, we elucidate the evolutionary history of a novel expression pattern of the yellow gene within the Zaprionus genus of fruit flies. We observed a unique pattern of yellow transcript accumulation in the wing disc during the third larval instar, a stage that precedes its typical expression pattern associated with cuticular melanization by about a week. The region of the Zaprionus wing disc that expresses yellow subsequently develops into a portion of the thorax, a tissue for which yellow expression has been reported for several fruit fly species. Tests of GFP reporter transgenes containing the Zaprionus yellow regulatory region revealed that the wing disc pattern arose by changes in the cis-regulatory region of yellow. Moreover, the wing disc enhancer activity of yellow depends upon a short conserved sequence with ancestral thoracic functions, suggesting that the pupal thorax regulatory sequence was genetically reprogrammed to drive expression that commences much earlier during development. These results highlight how novel domains of gene expression may arise by extreme shifts in timing during the origins of novel traits.