Adjusting content to individual student needs: Further evidence from an in-service teacher training program

Adapting instruction to the specific needs of each student is a promising strategy to improve overall academic achievement. In this article, I study the impact of an intensive in-service teacher training program on reading skills offered to kindergarten teachers in France. The program modifies the lesson content and encourages teachers to adapt instruction to student needs by dividing the class according to initial achievement. While assessing impact is usually difficult due to the presence of ability bias and teacher selection, I show that in this context, a value-added model that controls for school and teacher characteristics constitutes a legitimate strategy to estimate the treatment effect. Results show that all students benefiting from the program progressed in reading skills at the end of the year. Besides, weaker students progressed faster on less-advanced competences (such as letter recognition), while stronger students improved their reading skills. This suggests that teachers adjusted content to students' needs. Finally, a cost-effectiveness analysis reveals that the program is approximately three times more cost-effective than reducing class size in France

Parent's Participation, Involvement and Impact on Student Achievment: Evidence from a Randomized Evaluation in South Africa

This article investigates the role of parents by looking at the effect of a parental involvement program implemented in poor primary school in South Africa. Based on a random variation of the program assignment and on a partial population design, it allows to rigorously identify impacts on parental involvement, on the relationship between parents and teachers and on student outcomes. We find mixed results suggesting that parents who volunteer to attend the meetings changed their behavior toward more involvement at home and at school. Such behavioral change appears stronger for a subgroup of parents whose children is enrolled in the facilitating teacher's class, suggesting positive interactions between parents and teachers. Yet, no cognitive or non cognitive impact on students can be detected. We interpret these disappointing results as evidence that in a developing country context, parents face constraints that makes such program unable to have significant effects on student performance

Preschool and Parental Response in a Second Best World: Evidence from a School Construction Experiment

Interventions targeting early childhood development hold promise for increasing human capital and reducing the intergenerational transmission of poverty. This paper presents results from a randomized evaluation of a preschool construction program in Cambodia, and suggests caution. The overall impact of the program on early childhood outcomes was small and statistically insignificant. For the cohort with highest program exposure, the impact on cognitive indicators was negative; with the largest negative effects among children of poorer and less educated parents. The results are consistent with frequent underage enrollment in primary school in the absence of preschools, stricter enforcement of the minimum age for primary school entry after the intervention, substitution between primary and preschool following intervention, and difference in demand responses to the new preschools between more and less educated parents. The results show that contextual and program specifics, and behavioral responses, can potentially lead to perverse effects of programs

Crohn's disease: is there any link between anal and luminal phenotypes?

International audiencePURPOSE: Perianal Crohn's disease (CD) encompasses a variety of lesion similar to luminal disease, which are usually not distinctly assessed. Links between luminal and perianal CD phenotype remains therefore underreported, and we aimed to describe both luminal and perianal phenotype and their relationships. METHODS: From January 2007, clinical data of all consecutive patients with CD seen in a referral center were prospectively recorded. Data recorded until October 2011 were extracted and reviewed for study proposal. RESULTS: A total of 282 patients (M/F, 108/174; aged 37.8 ± 16.2 years) were assessed that included 154 cases (54.6 %) with anal ulceration, 118 cases (41.8 %) with fistula, 49 cases (17.4 %) with stricture, and 94 cases without anal lesion (33.3 %). Anal ulcerations were associated with fistulas (N = 87/154) in more than half of patients (56.5 %) and were isolated in 55 patients (35.7 %). Most of strictures (94 %) were associated with other lesions (N = 46/49). Harvey-Bradshaw score was significantly higher in patients with ulcerations (p \textless 0.001) as compared to those with perianal fistulas (p = 0.15) or with anal strictures (p = 0.16). Proportions of complicated behavior (fistulizing or stricturing) of luminal CD were similar according to anal lesions: anal fistulas were not significantly associated to penetrating Montreal phenotype (N = 4/31 p = 0.13) as well as anal stricture and stricturing Montreal phenotype (N = 3/49, p = 0.53). CONCLUSIONS: The phenotype of luminal disease does not link with the occurrence and the phenotype of perianal Crohn's disease. Anal ulcerations denote a more severe disease on both luminal and perianal locations and should consequently be taking into account in physician decision-makin

Hall Sensors for Extreme Temperatures

We report on the preparation of the first complete extreme temperature Hall sensor. This means that the extreme-temperature magnetic sensitive semiconductor structure is built-in an extreme-temperature package especially designed for that purpose. The working temperature range of the sensor extends from −270 °C to +300 °C. The extreme-temperature Hall-sensor active element is a heavily n-doped InSb layer epitaxially grown on GaAs. The magnetic sensitivity of the sensor is ca. 100 mV/T and its temperature coefficient is less than 0.04 %/K. This sensor may find applications in the car, aircraft, spacecraft, military and oil and gas industries

Anti-glomerular basement membrane disease, ulcerative colitis, and primary sclerosing cholangitis: link or co-incidence?

International audienceUlcerative colitis, primary sclerosing cholangitis, and anti-glomerular basement membrane disease (anti-GBM) are three rare immune diseases with incompletely under-stood pathogenic mechanisms. We describe here the case of a 29-year-old man with ulcer-ative colitis and primary sclerosing cholang -itis who, eight years later, developed anti-GBM disease with destruction of all glomeruli leading to end-stage kidney disease. Association of these three immune diseases in the same patient has never been described. Because HLA-mediated susceptibility cannot be incriminated completely in our case, we hypothesize that environmental factors or previous immunosuppressive treatment used might be the link

Treat to Target: A Proposed New Paradigm for the Management of Crohn's Disease.

International audience: The traditional management of CD, based on progressive, step-wise treatment intensification with re-evaluation of response according to symptoms, does not improve long-term outcomes of CD and places patients at risk for bowel damage. The introduction of novel therapies and the development of new approaches to treatment in rheumatoid arthritis led to better outcomes for patients. Prominent among these is a "treat to target" strategy that is based on regular assessment of disease activity using objective clinical and biological outcome measures and the subsequent adjustment of treatments. This approach is complementary to the concept of early intervention in high risk patients. This review evaluates current literature on this topic and proposes a definition for the concept treating to targets for Crohn's disease

Safety and efficacy of granulocyte/monocyte apheresis in steroid-dependent active ulcerative colitis with insufficient response or intolerance to immunosuppressants and/or biologics (ART trial): 12-week interim results

International audienceBACKGROUND AND AIMS: Patients with active, steroid-dependent ulcerative colitis with insufficient response or intolerance to immunosuppressants and/or biologic therapies have limited treatment options. Adacolumn, a granulocyte/monocyte adsorptive apheresis device, has shown clinical benefit in these patients. This study aimed to provide additional clinical data regarding the safety and efficacy of Adacolumn in this patient subgroup.METHODS: This single arm, open-label, multicentre trial (ART) was conducted at 18 centres across the UK, France and Germany. Eligible patients were 18-75 years old with moderate-to-severe, steroid-dependent active ulcerative colitis with insufficient response or intolerance to immunosuppressants and/or biologics. Patients received ≥5 weekly apheresis sessions with Adacolumn. The primary endpoint was clinical remission rate (clinical activity index ≤4) at Week 12.RESULTS: Eighty-six patients were enrolled. At Week 12, 33/84 (39.3%) of patients in the intention-to-treat population achieved clinical remission, with 47/84 (56.0%) achieving a clinical response (clinical activity index reduction of ≥3). Clinical remission was achieved in 30.0% of patients with prior immunosuppressant and biologic failure; steroid-free clinical remission and response were observed in 22.6% and 35.7% of these patients, respectively. Quality of life (Short Health Scale) significantly improved at Week 12 (p\textless0.0001). The majority of adverse events were of mild/moderate intensity.CONCLUSIONS: At Week 12, Adacolumn provided significant clinical benefit in a large cohort of steroid-dependent ulcerative colitis patients with previous failure to immunosuppressant and/or biologic treatment, with a favourable safety profile. These results are consistent with previous studies and support Adacolumn use in this difficult-to-treat patient subgrou

Placebo response rate in clinical trials of fistulizing crohn's disease: systematic review and meta-analysis

Background & Aims: It is important to determine the magnitude and identify modifiers of the rate of response to placebo in clinical trials of fistulizing Crohn’s disease (CD), to understand disease progression, and to calculate sample size. We conducted a systematic review and meta-analysis of rates of response to placebo in trials of patients with fistulizing CD. Methods: We searched MEDLINE, EMBASE, EMBASE CLASSIC, and the Cochrane central register of controlled trials for randomized controlled trials (RCTs) comparing pharmacologic agents with placebo in adults with fistulizing CD. We identified studies that reported complete fistula closure, partial closure, or response. Data were extracted as intention-to-treat analyses and pooled by using a random-effects model. Proportions of patients who received placebo and had complete or partial fistula(e) closure were calculated, with 95% confidence intervals (CIs). The effects of trial characteristics on the magnitude of response to placebo were examined. Results: Thirteen RCTs were eligible for our analysis; these included 579 patients assigned to placebo groups. The pooled rate of response to placebo, among all RCTs, for complete fistula closure was 15.6% (95% CI, 10.9%–20.9%), with significant heterogeneity (I2 = 62.5%, P = .001). The pooled rate of response to placebo for partial fistula closure or response in 9 trials, comprising 423 patients, was 18.3% (95% CI, 14.8%–22.1%). Rates of response to placebo were significantly lower in trials with shorter durations of therapy and shorter intervals to assessment of fistula closure. Neither exposure to the pharmacologic agent during the induction phase of the same (or related) RCT nor concomitant medications had any effect. Conclusions: In a meta-analysis of rate of response to placebo in patients with fistulizing CD, we found that fistulae closed in almost 1/6 patients given placebo in RCTs of pharmacologic agents. Future research should identify characteristics of patients that predict response to placebo

Simplifying the detection of MUTYH mutations by high resolution melting analysis

<p>Abstract</p> <p>Background</p> <p><it>MUTYH</it>-associated polyposis (MAP) is a disorder caused by bi-allelic germline <it>MUTYH </it>mutation, characterized by multiple colorectal adenomas. In order to identify mutations in <it>MUTYH </it>gene we applied High Resolution Melting (HRM) genotyping. HRM analysis is extensively employed as a scanning method for the detection of heterozygous mutations. Therefore, we applied HRM to show effectiveness in detecting homozygous mutations for these clinically important and frequent patients.</p> <p>Methods</p> <p>In this study, we analyzed phenotype and genotype data from 82 patients, with multiple (>= 10) synchronous (19/82) or metachronous (63/82) adenomas and negative <it>APC </it>study (except one case). Analysis was performed by HRM-PCR and direct sequencing, in order to identify mutations in <it>MUTYH </it>exons 7, 12 and 13, where the most prevalent mutations are located. In monoallelic mutation carriers, we evaluated entire <it>MUTYH </it>gene in search of another possible alteration. HRM-PCR was performed with strict conditions in several rounds: the first one to discriminate the heteroduplex patterns and homoduplex patterns and the next ones, in order to refine and confirm parameters. The genotypes obtained were correlated to phenotypic features (number of adenomas (synchronous or metachronous), colorectal cancer (CRC) and family history).</p> <p>Results</p> <p><it>MUTYH </it>germline mutations were found in 15.8% (13/82) of patients. The hot spots, Y179C (exon 7) and G396D (exon 13), were readily identified and other mutations were also detected. Each mutation had a reproducible melting profile by HRM, both heterozygous mutations and homozygous mutations. In our study of 82 patients, biallelic mutation is associated with being a carrier of ≥10 synchronous polyps (p = 0.05) and there is no association between biallelic mutation and CRC (p = 0.39) nor family history (p = 0.63). G338H non-pathogenic polymorphism (exon 12) was found in 23.1% (19/82) of patients. In all cases there was concordance between HRM (first and subsequent rounds) and sequencing data.</p> <p>Conclusions</p> <p>Here, we describe a screening method, HRM, for the detection of both heterozygous and homozygous mutations in the gene encoding <it>MUTYH </it>in selected samples of patients with phenotype of MAP. We refine the capabilities of HRM-PCR and apply it to a gene not yet analyzed by this tool. As clinical decisions will increasingly rely on molecular medicine, the power of identifying germline mutations must be continuously evaluated and improved.</p