What should an index of school segregation measure?

The article aims to make a methodological contribution to the education segregation literature, providing a critique of previous measures of segregation used in the literature, as well as suggesting an alternative approach to measuring segregation. Specifically, the paper examines Gorard, Fitz and Taylor's finding that social segregation between schools, as measured by free school meals (FSM) entitlement, fell significantly in the years following the 1988 Education Reform Act. Using Annual Schools Census data from 1989 to 2004, the paper challenges the magnitude of their findings, suggesting that the method used by Gorard et al. seriously overstates the size of the fall in segregation. We make the case for a segregation curve approach to measuring segregation, where comparisons of the level of segregation are possible regardless of the percentage FSM eligibility. Using this approach, we develop a new method for describing both the level and the location of school segregation

Internet Use for Health Information among American Indians: Facilitators and Inhibitors

Our research team explored Internet use among a heterogeneous American Indian (AI) population to determine Internet use in relation to health information seeking behaviors. Participants examined an AI culturally-tailored tobacco website as an example to explain what they wanted in an AI Internet health site. Using community-based participatory research, we conducted 10 focus groups with non-college AI men and women (N=96), stratified by age (18-29, 30-49, and 50 and over) to better understand their perceptions of Internet use and health information needs. We found that Internet use varied greatly among all strata. Participants referenced WebMD© more than any other website, but participants were not pleased with the design and navigation. When examining the sample website, participants across strata stressed that recreational and traditional tobacco use should be discussed. Participants in all strata desired a simple website design with easy to read text accompanied by images. In order to gain and maintain cultural respect, participants stated that web designers should be aware that some images hold cultural meaning, particularly tobacco. Baseline data are needed for AI’s use of the Internet to obtain health information; this research is helpful to address health inequalities among AI, particularly access to web-based health information

A Survey of Language Diversity and Communication in Indian Academic Emergency Departments

Background Communication in the Emergency Department (ED) is particularly important given the acuity of patients and lack of prior medical history. In India, patient care is further complicated by the many spoken languages, the regional differentiation in language and the fact that medical training is primarily delivered in English. Our objective was to document language diversity among clinicians in Indian EDs linked to an international training program and explore issues related to clinician-clinician and clinician-patient communication. Methodology A cross-sectional survey of ED clinicians was conducted from May to July 2017. Survey participants were recruited via convenience sampling by a researcher at 6 ED training sites in Kerala and Karnataka. Doctors were also sent an email link to the survey. ANOVA and binary logistic regression were used to perform subgroup analysis. Results 106 clinicians completed the survey including 42 doctors (9 consultants and 33 residents), 45 nurses and 19 paramedics. On average, clinicians spoke 3. 75 languages. Fluency in the majority language at the hospital was reported by 93% of doctors, 84% of nurses and 95% of paramedics. Fluency in English was reported by 100% of doctors, 71% of nurses and 63% of paramedics. Type of clinician, age, gender, and time in clinical practice did not predict number of languages spoken or fluency in the majority language. Doctors were more likely to report fluency in English, compared to other providers (p \u3c 0. 003). 70% of clinicians reported that they used a non-English language to speak to their fellow providers most of the time. 64% felt that information was lost or changed when English medical knowledge was explained in a different language. 53% reported at least one critical incident over the last year where poor communication played a part. Time constraints, language and differences in medical knowledge were the most frequently identified barriers in these incidents. Conclusions Our study is the first to document language diversity in Indian EDs. Important findings include the common use of non-English language in clinician-clinician communication and the frequent perceived loss of information in clinician-patient communication. The reported rates of critical incidents linked to poor communication are higher than reported in comparable studies and warrant further research and action

Surgical versus balloon therapy for aortic coarctation in infants ≤ 3 months old

AbstractObjectives. This study compared the efficacy and safety of balloon angioplasty with surgical correction of native aortic coarctation in infants ≤3 months old.Background. There is a controversy with regard to the role of balloon angioplasty in the treatment of aortic coarctation, especially in young infants.Methods. Data from 29 infants ≤3 months old undergoing therapy for aortic coarctation during the decade ending 1992 were analyzed. Fourteen infants underwent surgery, and 15 had balloon angioplasty. The sole criterion for allotment to the balloon group was the availability of an interventional cardiologist at the time of presentation of the infant.Results. The surgical and balloon groups were comparable (p > 0.1) with regard to age (27 ± 35 [mean ± SD] vs. 29 ± 27 days), weight (3.5 ± 0.9 vs. 3.8 ± 1.0 kg) and prevalence (7 of 14 vs. 8 of 15) and type of associated defects. Operative (1 of 14 vs. 1 of 15) and late (3 of 13 vs. 3 of 14) mortality, immediate gradient relief (36 ± 25 to 10 ± 9 mm Hg vs. 41 ± 14 to 6 ± 6 mm Hg) and follow-up gradient (27 ± 27 vs. 24 ± 19 mm Hg) were similar (p > 0.1). Infants with a gradient > 20 mm Hg at follow-up (6 of 13 vs. 7 of 14) and need for reintervention (6 of 13 vs. 7 of 14) were also similar (p > 0.1) in both groups. Duration of hospital stay during the first intervention was higher (p < 0.05) in the surgical (32 ± 37 days) than the balloon (7 ± 6 days) group. Similarly, duration of endotracheal intubation and mechanical ventilation was longer (p < 0.05) in the surgical (12 ± 16 days) than the balloon (2 ± 3 days) group. Complications after surgical intervention (0.86 events/patient) were higher (p < 0.01) than those seen after balloon angioplasty (0.27 events/patient). However, the lack of significant differences observed for mortality rates and residual gradients may be due to low statistical power to detect differences (16% to 49%), implying that this may be due to either actual lack of statistical difference or small sample size.Conclusions. The data indicate that the degree of relief from aortic coarctation and the frequency with which reintervention is needed are similar in both groups. However, the morbidity and complication rates are lower with balloon than with surgical therapy. These data suggest that balloon angioplasty may be an acceptable alternative to surgical correction in the treatment of symptomatic aortic coarctation in infants ≤3 months old

N,N,N′,N′-Tetra­methyl­ethylene­diammonium tetra­chloridocobaltate(II)

The asymmetric unit of the title compound, [(CH3)2NH(CH2)2NH(CH3)2][CoCl4], contains a tetra­chlorido­cobalt­ate(II) dianion and two halves of two centrosymmetric, crystallographically-independent, dications. One independent dication is disordered between two conformations in a 0.784 (13):0.216 (13) ratio. In the crystal, inter­molecular N—H⋯Cl hydrogen bonds link cations and anions into chains propagated in [01]. These hydrogen bonds contribute to the distorted tetra­hedral geometry at the CoII atom

Use of the Montreal Cognitive Assessment (MoCA) in a Rural Outreach Program for Military Veterans

The Montreal Cognitive Assessment (MoCA) is a free, easily accessible screener ideal for rural areas where resources are limited. We examined administration and scoring by Veteran Community Outreach Health Workers (VCOHWs); compared positive screening rates using two cutoff scores; and examined predictors of education-adjusted scores in N = 168 rural military Veterans from the Alabama Veteran Rural Health Initiative. Accuracy of administration (95 percent) and scoring (68 percent) was calculated and recommendations are offered. Higher than expected rates of positive screens were observed (40 percent using 24/30 cutoff) in this relatively young (M = 55 years) community-dwelling sample. Age, education, and race but not subjective health predicted differences in domain and total education-adjusted scores on multivariate and univariate tests. This study advances social science research in rural communities by being the first to: (1) examine MoCA scores in a rural, Deep South U.S. sample; and (2) report fidelity administration data for VCOHWs

Posterior cricoid region fluoroscopic findings: the posterior cricoid plication.

The region posterior to the cricoid cartilage is challenging to assess fluoroscopically. The purpose of this investigation is to critically evaluate the posterior cricoid (PC) region on fluoroscopy and describe patterns of common findings. This was a case control study. All fluoroscopic swallowing studies performed between June 16, 2009, and February 9, 2010, were reviewed for features seen in the PC region. These findings were categorized into distinct patterns and compared to fluoroscopic studies performed in a cohort of normal volunteers. Two hundred patient studies and 149 healthy volunteer studies were reviewed. The mean age of the referred patient cohort and the volunteer cohort was 57&nbsp;years (±19) and 61&nbsp;years (±16), respectively (p&nbsp;&gt;&nbsp;0.05). The patient cohort was 53% male and the control cohort was 56% female (p&nbsp;&gt;&nbsp;0.05). Four groups were identified. Pharyngoesophageal webs were seen in 7% (10/149) of controls and 14% (28/200) of patients (p&nbsp;=&nbsp;0.03). A PC arch impression was seen in 16% of patients (32/200) and controls (24/149) (p&nbsp;=&nbsp;1). A PC plication was demonstrated in 23% (34/149) of controls and 30% (60/200) of patients (p&nbsp;=&nbsp;0.13). No distinctive PC region findings were seen in 54% (81/149) of controls and 42% (84/200) of referred patients (p&nbsp;=&nbsp;0.02). Four patients (2%) had both a web and a PC plication. Four categories of PC region findings were identified (unremarkable PC region, web, PC arch impression, and PC plication). Both patients referred for swallowing studies and healthy volunteers demonstrated esophageal webs, PC arch impressions, and PC plications. Only webs were more common in patients than in control subjects (p&nbsp;=&nbsp;0.03). The PC impression and PC plication are likely to represent normal variants that may be identified on fluoroscopic swallow studies

ZFOURGE: Using Composite Spectral Energy Distributions to Characterize Galaxy Populations at 1<z<4

We investigate the properties of galaxies as they shut off star formation over the 4 billion years surrounding peak cosmic star formation. To do this we categorize $\sim7000$ galaxies from $1<z<4$ into $90$ groups based on the shape of their spectral energy distributions (SEDs) and build composite SEDs with $R\sim 50$ resolution. These composite SEDs show a variety of spectral shapes and also show trends in parameters such as color, mass, star formation rate, and emission line equivalent width. Using emission line equivalent widths and strength of the 4000\AA\ break, $D(4000)$, we categorize the composite SEDs into five classes: extreme emission line, star-forming, transitioning, post-starburst, and quiescent galaxies. The transitioning population of galaxies show modest H$\alpha$ emission ($EW_{\rm REST}\sim40$\AA) compared to more typical star-forming composite SEDs at $\log_{10}(M/M_\odot)\sim10.5$ ($EW_{\rm REST}\sim80$\AA). Together with their smaller sizes (3 kpc vs. 4 kpc) and higher S\'ersic indices (2.7 vs. 1.5), this indicates that morphological changes initiate before the cessation of star formation. The transitional group shows a strong increase of over one dex in number density from $z\sim3$ to $z\sim1$, similar to the growth in the quiescent population, while post-starburst galaxies become rarer at $z\lesssim1.5$. We calculate average quenching timescales of 1.6 Gyr at $z\sim1.5$ and 0.9 Gyr at $z\sim2.5$ and conclude that a fast quenching mechanism producing post-starbursts dominated the quenching of galaxies at early times, while a slower process has become more common since $z\sim2$.Comment: Accepted for publication in The Astrophysical Journa

Accessory Genome Dynamics and Structural Variation of Shigella from Persistent Infections

Shigellosis is a diarrheal disease caused mainly by Shigella flexneri and Shigella sonnei Infection is thought to be largely self-limiting, with short- to medium-term and serotype-specific immunity provided following clearance. However, cases of men who have sex with men (MSM)-associated shigellosis have been reported where Shigella of the same serotype were serially sampled from individuals between 1 and 1,862 days apart, possibly due to persistent carriage or reinfection with the same serotype. Here, we investigate the accessory genome dynamics of MSM-associated S. flexneri and S. sonnei isolates serially sampled from individual patients at various days apart to shed light on the adaptation of these important pathogens during infection. We find that pairs likely associated with persistent infection/carriage and with a smaller single nucleotide polymorphism (SNP) distance, demonstrated significantly less variation in accessory genome content than pairs likely associated with reinfection, and with a greater SNP distance. We observed antimicrobial resistance acquisition during Shigella carriage, including the gain of an extended-spectrum beta-lactamase gene during carriage. Finally, we explored large chromosomal structural variations and rearrangements in seven (five chronic and two reinfection associated) pairs of S. flexneri 3a isolates from an MSM-associated epidemic sublineage, which revealed variations at several common regions across isolate pairs, mediated by insertion sequence elements and comprising a distinct predicted functional profile. This study provides insight on the variation of accessory genome dynamics and large structural genomic changes in Shigella during persistent infection/carriage. In addition, we have also created a complete reference genome and biobanked isolate of the globally important pathogen, S. flexneri 3a.IMPORTANCE Shigella spp. are Gram-negative bacteria that are the etiological agent of shigellosis, the second most common cause of diarrheal illness among children under the age of five in low-income countries. In high-income countries, shigellosis is also a sexually transmissible disease among men who have sex with men. Within the latter setting, we have captured prolonged and/or recurrent infection with shigellae of the same serotype, challenging the belief that Shigella infection is short lived and providing an early opportunity to study the evolution of the pathogen over the course of infection. Using this recently emerged transmission scenario, we comprehensively characterize the genomic changes that occur over the course of individual infection with Shigella and uncover a distinct functional profile of variable genomic regions, findings that have relevance for other Enterobacteriaceae