Inter-relações entre as intenções dos decisores políticos e as interpretações da política de responsabilização dos agentes escolares em Israel

The study examined the interrelations between policymakers’ intentions for test-based accountability policy, and school agents’ perceptions and actions with regard to this policy. Mixed-methods were used and encompassed 24 policymakers, 80 school principals, 168 teachers and case studies of four schools. New institutional theory, including the concept of “environmental shift” (Powell Di Maggio, 1991) and the metaphor of “coupling” (Weick, 1976), served as the conceptual framework. Findings indicate that the interrelations between intentions, perceptions and actions are mainly tightly coupled. These are discussed by invoking three types of institutional isomorphism (DiMaggio Powell, 1983): coercive, mimetic and normative. The study examined the interrelations between policymakers’ intentions for test-based accountability policy, and school agents’ perceptions and actions with regard to this policy. Mixed-methods were used and encompassed 24 policymakers, 80 school principals, 168 teachers and case studies of four schools. New institutional theory, including the concept of “environmental shift” (Powell Di Maggio, 1991) and the metaphor of “coupling” (Weick, 1976), served as the conceptual framework. Findings indicate that the interrelations between intentions, perceptions and actions are mainly tightly coupled. These are discussed by invoking three types of institutional isomorphism (DiMaggio Powell, 1983): coercive, mimetic and normative.O estudo examinou as inter-relações entre as intenções dos formuladores de políticas para a política de responsabilidade baseada em testes e as percepções e ações dos agentes escolares em relação a essa política. Métodos mistos foram utilizados e englobavam 24 formuladores de políticas, 80 diretores de escolas, 168 professores e estudos de caso de quatro escolas. A nova teoria institucional, incluindo o conceito de “mudança ambiental” (Powell Di Maggio, 1991) e a metáfora do “acoplamento” (Weick, 1976), serviu de quadro conceitual. Os achados indicam que as inter-relações entre intenções, percepções e ações estão bem “acopladas”. Estes são discutidos invocando três tipos de isomorfismo institucional (DiMaggio Powell, 1983): coercivo, mimético e normativo

Improving Specialty Care Access via Telemedicine

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Chikungunya Arthritis Mechanisms in the Americas

ObjectiveTo determine if chikungunya virus persists in synovial fluid after infection, potentially acting as a causative mechanism of persistent arthritis.MethodsWe conducted a cross-sectional study of 38 Colombian participants with clinical chikungunya virus infection during the 2014-2015 epidemic who reported chronic arthritis and 10 location-matched controls without chikungunya virus or arthritis. Prior chikungunya virus infection status was serologically confirmed, and the presence of synovial fluid chikungunya virus, viral RNA, and viral proteins was determined by viral culture, quantitative reverse transcription-polymerase chain reaction (qRT-PCR), and mass spectrometry, respectively. Biomarkers were assessed by multiplex analysis.ResultsPatients with serologically confirmed chikungunya arthritis (33 of 38 [87%]) were predominantly female (82%) and African Colombian (55%) or white Colombian (33%), with moderate disease activity (mean ± SD Disease Activity Score in 28 joints 4.52 ± 0.77) a median of 22 months after infection (interquartile range 21-23 months). Initial symptoms of chikungunya virus infection included joint pain (97%), swelling (97%), stiffness (91%), and fever (91%). The most commonly affected joints were the knees (87%), elbows (76%), wrists (75%), ankles (56%), fingers (56%), and toes (56%). Synovial fluid samples from all patients with chikungunya arthritis were negative for chikungunya virus on qRT-PCR, showed no viral proteins on mass spectrometry, and cultures were negative. Case and control plasma cytokine and chemokine concentrations did not differ significantly.ConclusionThis is one of the largest observational studies involving analysis of the synovial fluid of chikungunya arthritis patients. Synovial fluid analysis revealed no detectable chikungunya virus. This finding suggests that chikungunya virus may cause arthritis through induction of potential host autoimmunity, suggesting a role for immunomodulating agents in the treatment of chikungunya arthritis, or that low-level viral persistence exists in synovial tissue only and is undetectable in synovial fluid

Polygenic Dissection of Diagnosis and Clinical Dimensions of Bipolar Disorder and Schizophrenia

Bipolar disorder and schizophrenia are two often severe disorders with high heritabilities. Recent studies have demonstrated a large overlap of genetic risk loci between these disorders but diagnostic and molecular distinctions still remain. Here, we perform a combined genome-wide association study (GWAS) of 19 779 bipolar disorder (BP) and schizophrenia (SCZ) cases versus 19 423 controls, in addition to a direct comparison GWAS of 7129 SCZ cases versus 9252 BP cases. In our case–control analysis, we identify five previously identified regions reaching genome-wide significance (CACNA1C, IFI44L, MHC, TRANK1 and MAD1L1) and a novel locus near PIK3C2A. We create a polygenic risk score that is significantly different between BP and SCZ and show a significant correlation between a BP polygenic risk score and the clinical dimension of mania in SCZ patients. Our results indicate that first, combining diseases with similar genetic risk profiles improves power to detect shared risk loci and second, that future direct comparisons of BP and SCZ are likely to identify loci with significant differential effects. Identifying these loci should aid in the fundamental understanding of how these diseases differ biologically. These findings also indicate that combining clinical symptom dimensions and polygenic signatures could provide additional information that may someday be used clinically