Meeting the needs of gifted students through teacher inservicing

Inservicing classroom teachers in compacting, independent study, and mentoring may help them become more effective in meeting the instructional needs of talented and gifted students. It is easier for teachers to apply learning if it is easily applicable to their own classroom instruction, and if the learning seems manageable for the teacher. This project includes an inservice model that contains applicable teaching strategies and an inservice plan for teachers. Teaching talented and gifted students through appropriate teaching strategies and becoming aware of these students\u27 needs in the classroom can assure that students are challenged to realize their full learning potential. This project presents research to support examples of inservice teaching strategies for the instruction of the talented and gifted. It also offers suggestions for conducting effective teacher inservices on meeting the special needs of the talented and gifted student in the regular classroom

The Influence of Justice Thurgood Marshall on the Development of Title VII Jurisprudence

This Article highlights Justice Marshall’s influence on the development of Title VII jurisprudence. Part I presents a brief overview of Justice Marshall’s personal and professional life before becoming a Justice to show how his experience influenced the development of his judicial philosophy. Part II summarizes the Court’s approach to some of the issues left unresolved by Congress in the initial passage of Title VII. Specifically, it explores how the Court determined what would constitute a violation of Title VII and standards of pleading and proof. Part III examines the changes in the Court’s jurisprudence before Justice Marshall retired from the bench. As the majority of Justices became less sympathetic to the protection of African Americans in the workplace, Justice Marshall’s voice of dissent emerged. Part IV concludes with a discussion of the Civil Rights Act of 1991, which vindicated Justice Marshall’s choice to dissent by adopting many of the positions taken in his departure from the majority view

Assessing Readiness of Community Pharmacists to Perform and Document Medically Billed Clinical Services

Objectives: To assess the readiness of community pharmacists in documenting and performing medically billed clinical services.  Additionally, the preferred training method of community pharmacists was evaluated.  Methods:  This study surveyed practicing pharmacists in a chain community pharmacy in Washington State via a voluntary, anonymous online survey through Qualtrics.  Data collected in the survey measured each pharmacist’s self-perceived ability to perform examinations and to gather and document patient subjective and objective information compliant with medical billing requirements. In addition, questions evaluated the training methods pharmacists preferred in the community setting. The data was aggregated and analyzed utilizing descriptive statistics to assess pharmacists’ self-perceived baseline understanding regarding documenting and performing medically billed clinical services as well training preferences of the pharmacists surveyed. Results: Pharmacists in the study had a generally higher perceived ability in performing past medical history, medical decision-making and clinical documentation of a medical visit. In contrast, pharmacists in the community setting had a lower perceived ability performing physical assessment criteria in a medically billed clinical visit. This study indicated that pharmacists in the community setting preferred live small-group training on future medical billing. Conclusion: Pharmacists have some of the skills necessary to perform and bill clinical visits; however, there is room for improvement in particular areas where pharmacists have a lack of training and experience.   Article Type: Original Researc

Pharmacists’ Role in Chronic Disease Management from Physicians’ Perspective

Objective: The objective of this research was to gather physicians’ perception of pharmacists providing chronic disease management and identify trends in physicians’ characteristics that could potentially impact their comfort level collaborating with pharmacists. Method: Physicians practicing in the outpatient setting in the state of Washington were invited to participate in a voluntary, anonymous survey. Physicians practicing in a large multidisciplinary outpatient clinic in the Southwest Washington and Seattle areas were included. For Likert scale questions, median values were reported. Physicians’ characteristics were also correlated with their willingness to collaborate with pharmacists in the provision of clinical services.   Results: Results were analyzed using descriptive statistics to summarize the data collected to determine which pharmacist provided clinical services physicians would like to collaborate on. Physicians were most comfortable with pharmacists reviewing patients’ medications followed by pharmacist provision of disease state education and least comfortable with pharmacists initiating therapy. Physicians that have worked with pharmacists in the past were more likely to collaborate with pharmacists compared to physicians that have never worked with a pharmacist. Furthermore, pharmacists’ ability to bill patients’ medical insurance did not influence physicians’ likelihood to collaborate with pharmacists. Conclusion: This information will be used to aid in the determination of future directions for the implementation of additional clinical services within the community pharmacy setting.  Additionally, it is anticipated that pharmacists will be able to utilize this information to initiate conversations with physicians in an effort to collaborate on new pharmacist provided clinical services as well as improve patient outcomes by increasing access to healthcare providers, including pharmacists.   Article Type: Original Researc

Exceptional aggressiveness of cerebral cavernous malformation disease associated with PDCD10 mutations.

PurposeThe phenotypic manifestations of cerebral cavernous malformation disease caused by rare PDCD10 mutations have not been systematically examined, and a mechanistic link to Rho kinase-mediated hyperpermeability, a potential therapeutic target, has not been established.MethodsWe analyzed PDCD10 small interfering RNA-treated endothelial cells for stress fibers, Rho kinase activity, and permeability. Rho kinase activity was assessed in cerebral cavernous malformation lesions. Brain permeability and cerebral cavernous malformation lesion burden were quantified, and clinical manifestations were assessed in prospectively enrolled subjects with PDCD10 mutations.ResultsWe determined that PDCD10 protein suppresses endothelial stress fibers, Rho kinase activity, and permeability in vitro. Pdcd10 heterozygous mice have greater lesion burden than other Ccm genotypes. We demonstrated robust Rho kinase activity in murine and human cerebral cavernous malformation vasculature and increased brain vascular permeability in humans with PDCD10 mutation. Clinical phenotype is exceptionally aggressive compared with the more common KRIT1 and CCM2 familial and sporadic cerebral cavernous malformation, with greater lesion burden and more frequent hemorrhages earlier in life. We first report other phenotypic features, including scoliosis, cognitive disability, and skin lesions, unrelated to lesion burden or bleeding.ConclusionThese findings define a unique cerebral cavernous malformation disease with exceptional aggressiveness, and they inform preclinical therapeutic testing, clinical counseling, and the design of trials.Genet Med 17 3, 188-196

Keeping the Faith: African American Faith Leaders’ Perspectives and Recommendations for Reducing Racial Disparities in HIV/AIDS Infection

In Philadelphia, 66% of new HIV infections are among African Americans and 2% of African Americans are living with HIV. The city of Philadelphia has among the largest numbers of faith institutions of any city in the country. Although faith-based institutions play an important role in the African American community, their response to the AIDS epidemic has historically been lacking. We convened 38 of Philadelphia’s most influential African American faith leaders for in-depth interviews and focus groups examining the role of faith-based institutions in HIV prevention. Participants were asked to comment on barriers to engaging faith-based leaders in HIV prevention and were asked to provide normative recommendations for how African American faith institutions can enhance HIV/AIDS prevention and reduce racial disparities in HIV infection. Many faith leaders cited lack of knowledge about Philadelphia’s racial disparities in HIV infection as a common reason for not previously engaging in HIV programs; others noted their congregations’ existing HIV prevention and outreach programs and shared lessons learned. Barriers to engaging the faith community in HIV prevention included: concerns about tacitly endorsing extramarital sex by promoting condom use, lack of educational information appropriate for a faith-based audience, and fear of losing congregants and revenue as a result of discussing human sexuality and HIV/AIDS from the pulpit. However, many leaders expressed a moral imperative to respond to the AIDS epidemic, and believed clergy should play a greater role in HIV prevention. Many participants noted that controversy surrounding homosexuality has historically divided the faith community and prohibited an appropriate response to the epidemic; many expressed interest in balancing traditional theology with practical public health approaches to HIV prevention. Leaders suggested the faith community should: promote HIV testing, including during or after worship services and in clinical settings; integrate HIV/AIDS topics into health messaging and sermons; couch HIV/AIDS in social justice, human rights and public health language rather than in sexual risk behavior terms; embrace diverse approaches to HIV prevention in their houses of worship; conduct community outreach and host educational sessions for youth; and collaborate on a citywide, interfaith HIV testing and prevention campaign to combat stigma and raise awareness about the African American epidemic. Many African American faith-based leaders are poised to address racial disparities in HIV infection. HIV prevention campaigns should integrate leaders’ recommendations for tailoring HIV prevention for a faith-based audience

Evidence-Based Assessment of Congenital Heart Disease Genes to Enable Returning Results in a Genomic Study

Background: Congenital heart disease (CHD) is the most common major congenital anomaly and causes significant morbidity and mortality. Epidemiologic evidence supports a role of genetics in the development of CHD. Genetic diagnoses can inform prognosis and clinical management. However, genetic testing is not standardized among individuals with CHD. We sought to develop a list of validated CHD genes using established methods and to evaluate the process of returning genetic results to research participants in a large genomic study. Methods: Two-hundred ninety-five candidate CHD genes were evaluated using a ClinGen framework. Sequence and copy number variants involving genes in the CHD gene list were analyzed in Pediatric Cardiac Genomics Consortium participants. Pathogenic/likely pathogenic results were confirmed on a new sample in a clinical laboratory improvement amendments-certified laboratory and disclosed to eligible participants. Adult probands and parents of probands who received results were asked to complete a post-disclosure survey. Results: A total of 99 genes had a strong or definitive clinical validity classification. Diagnostic yields for copy number variants and exome sequencing were 1.8% and 3.8%, respectively. Thirty-one probands completed clinical laboratory improvement amendments-confirmation and received results. Participants who completed postdisclosure surveys reported high personal utility and no decision regret after receiving genetic results. Conclusions: The application of ClinGen criteria to CHD candidate genes yielded a list that can be used to interpret clinical genetic testing for CHD. Applying this gene list to one of the largest research cohorts of CHD participants provides a lower bound for the yield of genetic testing in CHD

Synopsis of Guidelines for the Clinical Management of Cerebral Cavernous Malformations: Consensus Recommendations based on Systematic Literature Review by the Angioma Alliance Scientific Advisory Board Clinical Experts Panel

BackgroundDespite many publications about cerebral cavernous malformations (CCMs), controversy remains regarding diagnostic and management strategies.ObjectiveTo develop guidelines for CCM management.MethodsThe Angioma Alliance ( www.angioma.org ), the patient support group in the United States advocating on behalf of patients and research in CCM, convened a multidisciplinary writing group comprising expert CCM clinicians to help summarize the existing literature related to the clinical care of CCM, focusing on 5 topics: (1) epidemiology and natural history, (2) genetic testing and counseling, (3) diagnostic criteria and radiology standards, (4) neurosurgical considerations, and (5) neurological considerations. The group reviewed literature, rated evidence, developed recommendations, and established consensus, controversies, and knowledge gaps according to a prespecified protocol.ResultsOf 1270 publications published between January 1, 1983 and September 31, 2014, we selected 98 based on methodological criteria, and identified 38 additional recent or relevant publications. Topic authors used these publications to summarize current knowledge and arrive at 23 consensus management recommendations, which we rated by class (size of effect) and level (estimate of certainty) according to the American Heart Association/American Stroke Association criteria. No recommendation was level A (because of the absence of randomized controlled trials), 11 (48%) were level B, and 12 (52%) were level C. Recommendations were class I in 8 (35%), class II in 10 (43%), and class III in 5 (22%).ConclusionCurrent evidence supports recommendations for the management of CCM, but their generally low levels and classes mandate further research to better inform clinical practice and update these recommendations. The complete recommendations document, including the criteria for selecting reference citations, a more detailed justification of the respective recommendations, and a summary of controversies and knowledge gaps, was similarly peer reviewed and is available on line www.angioma.org/CCMGuidelines