Two-Buck Chuck and Wine Quality: Hedonic Price Analysis of Cool Climate Wines

Demand and Price Analysis,

Addressing the Wicked Problem of English Learner Disproportionality by Examining Speech-Language Pathologists’ Beliefs: Applying Q Methodology to Special Education

The attribution of academic failure to an educational disability instead of a lack of English proficiency is one factor contributing to the disproportionate representation of English learners (ELs) in special education. As gatekeepers to special education, speech-language pathologists (SLPs) must ensure that ELs found eligible for special education under the category of Speech and Language Impairment are truly those with an impairment due to Developmental Language Disorder (DLD) or another developmental disability, not children exhibiting differences from standard English use due to cultural or linguistic differences or lack of English proficiency. However, many SLPs’ ongoing reliance on invalid procedures to make a determination about an EL’s language learning ability makes their ability to make appropriate determinations of special education eligibility problematic. This exploratory study hypothesized that factor(s) besides the lack of knowledge or resources as previously documented may be presenting a barrier to the fidelity with which SLPs perform bilingual assessments. This study utilized Q methodology, a unique gestalt procedure whose aim is to reveal how configurations of themes are interconnected among a group of participants. A set of California school-based SLPs sorted a set of subjective statements about linguistic diversity, bilingualism, ELs’ learning potential, and the use of EL language assessment best practices. Sorts were intercorrelated and revealed 4 distinct profiles defined by their beliefs and attitudes. While areas of consensus among the 4 profiles were discovered, the profiles diverged in their beliefs about the importance and value of using EL assessment best practices, their perceptions of social pressure to utilize these best practices, their perceptions of ELs situated in either strengths-based or deficit thinking, and their perceptions of the degree of control they have over using EL assessment best practices. Results shed new light on the association of SLPs’ assessment practices with the issue of EL disproportionality and suggest ways to enhance the ability of pre-service educators, professional development providers, and school administrators to create targeted remedies for the “wicked” problem of EL disproportionality in special education

Dressings and securements for the prevention of peripheral intravenous catheter failure in adults (SAVE): a pragmatic, randomised controlled, superiority trial

Background: Two billion peripheral intravenous catheters (PIVCs) are used globally each year, but optimal dressing and securement methods are not well established. We aimed to compare the efficacy and costs of three alternative approaches to standard non-bordered polyurethane dressings. Methods: We did a pragmatic, randomised controlled, parallel-group superiority trial at two hospitals in Queensland, Australia. Eligible patients were aged 18 years or older and required PIVC insertion for clinical treatment, which was expected to be required for longer than 24 h. Patients were randomly assigned (1:1:1:1) via a centralised web-based randomisation service using random block sizes, stratified by hospital, to receive tissue adhesive with polyurethane dressing, bordered polyurethane dressing, a securement device with polyurethane dressing, or polyurethane dressing (control). Randomisation was concealed before allocation. Patients, clinicians, and research staff were not masked because of the nature of the intervention, but infections were adjudicated by a physician who was masked to treatment allocation. The primary outcome was all-cause PIVC failure (as a composite of complete dislodgement, occlusion, phlebitis, and infection [primary bloodstream infection or local infection]). Analysis was by modified intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000769987. Findings: Between March 18, 2013, and Sept 9, 2014, we randomly assigned 1807 patients to receive tissue adhesive with polyurethane (n=446), bordered polyurethane (n=454), securement device with polyurethane (n=453), or polyurethane (n=454); 1697 patients comprised the modified intention-to-treat population. 163 (38%) of 427 patients in the tissue adhesive with polyurethane group (absolute risk difference −4·5% [95% CI −11·1 to 2·1%], p=0·19), 169 (40%) of 423 of patients in the bordered polyurethane group (–2·7% [–9·3 to 3·9%] p=0·44), 176 (41%) of 425 patients in the securement device with poplyurethane group (–1·2% [–7·9% to 5·4%], p=0·73), and 180 (43%) of 422 patients in the polyurethane group had PIVC failure. 17 patients in the tissue adhesive with polyurethane group, two patients in the bordered polyurethane group, eight patients in the securement device with polyurethane group, and seven patients in the polyurethane group had skin adverse events. Total costs of the trial interventions did not differ significantly between groups. Interpretation: Current dressing and securement methods are commonly associated with PIVC failure and poor durability, with simultaneous use of multiple products commonly required. Cost is currently the main factor that determines product choice. Innovations to achieve effective, durable dressings and securements, and randomised controlled trials assessing their effectiveness are urgently needed

Scaling up a surgical residency program in Rwanda

Background: Beginning in 2012, the Government of Rwanda implemented the Human Resources for Health (HRH) program to enhance capacity building in the Rwandan health education sector. Through this program, surgical training at University of Rwanda (UR) has expanded. The aim of this presentation is to describe the scaling up of the UR surgical residency programMethods: We performed a descriptive analysis of the UR surgical residency program after initiation of the Rwanda HRH Program.Results: Through the HRH Program, faculty from US institutions supplements the existing Rwandan educational infrastructure to increase the teaching capacity in Rwanda. Intake of surgical trainees more than doubled within the first year of the program. Service-based surgical training has changed to competency-based training through curriculum development, dedicated academic days and surgical education within firms. Lectures remain a dominant feature of the educational program, but more focus is placed on bedside teaching and peer-education. Shortage of operative space and a tremendous number of emergency patients overwhelm public teaching hospitals posing a challenge towards providing residents with a broad spectrum of operative experiences, especially elective surgical cases.Conclusion: Through this program, the ursurgical residency program has greatly expanded. Over time, the quantity and quality of surgical residents is expected to increase

Impact of teaching breathing techniques on patient health outcomes: A systematic review

The United States has some of the most expensive health care world wide, with an increase in chronic illness, poorer outcomes, and fragmentation of care. Patients seek integrative or alternative methods of care in order to participate and improve their own health outcomes. Promoting cost effective, useful, and safe tools for patients to learn during an office visit allows patients to participate in their own care for improved health. The clinical question for this systematic review is: What is the evidence for teaching breathing techniques in primary care to improve health outcomes? Evidence in the literature shows that while breath is vital for life, trained breathing techniques improve health care outcomes such as GERD, anxiety, diabetes, autonomic nervous system disorders, hypertension, pain, immune function, and oxidative stress as evidenced in this review. This systematic review uses the PRISMA approach, analyzing integrity and value of each article based on seven criteria: title, abstract, introduction, methods, results, discussion, and findings. Opportunities for further research are discussed regarding breathing techniques and improved health outcomes. Key words: breath, breath work, breathing exercises, breath* technique* AND health*, diaphragmatic, yoga, pranayama, autonomic nervous system, GERD, hypertension, anxiety, diabetes, pain, immunity, oxidative stress

Utilizing the American Board of Surgery in-training exam in a Rwandan surgical residency program: Alignment of exam topics with the University of Rwanda general surgery curriculum

Background: University of Rwanda (UR) increased postgraduate surgery training and assessment strategies are needed. We compared American Board of Surgery In-Training Exam (ABSITE) topics with UR surgery curriculum to determine the applicability of ABSITE in Rwanda.Methods: Topics are outlined in the Surgical Council on Resident Education (SCORE) curriculum whereas the UR utilizes a modular system. Diseases and conditions in SCORE were compared with UR surgery module content. Operation and procedures in SCORE were compared with operative procedures in UR surgery curriculum.Results: Overall, 72% of diseases and conditions from SCORE were covered in UR curriculum. Of this, 76% of medical knowledge and 71% of patient care content was covered in UR curriculum. 41% of operations and procedures from SCORE were identified in UR curriculum. 55% of core operations and 16% of advanced operations from SCORE were included in UR general surgery curriculum. Content identified in UR curriculum and not SCORE included infectious and tropical diseases, orthopedics, urology and neurosurgery.Conclusions: There is alignment between ABSITE topics and UR general surgery curriculum suggesting that the ABSITE can be used as an in-training examination for Rwandan residents. Understanding the limitations of the ABSITE exam can help utilization of this examination.Keywords: internship and residency, curriculum, Rwanda, global healt

Epidemiological study of peritonitis among children and factors predicting mortality at a tertiary referral hospital in Rwanda

Background: Peritonitis is a commonly encountered paediatric surgical emergency. We conducted this study to identify common causes of peritonitis among Rwandan children and factors affecting morbidity and mortality.Methods: The study sample consisted of children with peritonitis who underwent surgical treatment at a tertiary referral hospital in Rwanda from 1 September 2015 to 28 February 2016. Collected data included sociodemographic, clinical, paraclinical, management, and outcome information. The analysis included Pearson's chi-square test and multivariate logistic regression to determine factors associated with morbidity and mortality.Results: Of 63 patients, 28 were female. Ages ranged from 4 months to 15 years, with a mean of 8.8 years. Seventy-three percent of patients presented within the first week of symptom onset. Appendicular perforation (25.4%) and gangrenous intussusception (23.8%) were the most common causes of peritonitis. Fourteen patients (22.2%) died. On multivariate analysis, factors associated with mortality included sepsis (odds ratio [OR] = 11.60; 95% confidence interval [CI] = 2.15 to 62.5; P = 0.004) and intensive care unit (ICU) admission (OR = 7.38; 95% CI = 1.20 to 45.3; P = 0.031).Conclusions: Peritonitis among children is common and bears significant morbidity and mortality at our centre. Training of healthcare providers in district hospitals for early recognition of peritonitis, and improved ICU care availability may reduce mortality secondary to peritonitis in children.Keywords: epidemiology; peritonitis; paediatric surgery; Rwand

A note on comonotonicity and positivity of the control components of decoupled quadratic FBSDE

In this small note we are concerned with the solution of Forward-Backward Stochastic Differential Equations (FBSDE) with drivers that grow quadratically in the control component (quadratic growth FBSDE or qgFBSDE). The main theorem is a comparison result that allows comparing componentwise the signs of the control processes of two different qgFBSDE. As a byproduct one obtains conditions that allow establishing the positivity of the control process.Comment: accepted for publicatio

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication