An Assessment of an Experimental Surgery Scheme in General Practice

A study of aspects of the work and of the opinions of patients and staff was made at times over a period of two years before and one year after the opening of an experimental surgery tmit specially designed for a particular way of organising the doctor/nurse team in general practice. The investigation took place in a busy group practice of three doctors caring between them for over 9000 patients living in a London borough

IMLS Sparks Ignite IL Framework Cooperative Project Pre-Test

This is a pdf file of the pre-test that was administered to students before they received any information literacy instruction. The pre-test contains all the questions that were in the post-test, plus several extra that were only asked on the pre-test

Providing Access for Students with Moderate Disabilities: An Evaluation of a Professional Development Program at a Catholic Elementary School

After a significant policy change led to the admittance of students with moderate disabilities, St. Agnes School (SAS; pseudonym)—a Catholic PK-8 school in Southern California—implemented an 18-month professional development (PD) program to improve teachers’ inclusive classroom practices. Grounded in the theoretical framework of Universal Design for Learning (UDL; Center for Applied Special Technology, 2015b), the PD program included cyclical, one-on-one instructional coaching sessions that were led by trained UDL coaches and consisted of lesson demonstrations and personalized feedback. While SAS teachers held state credentials, most had very little training to work with students with special needs prior to this PD; the purpose of this study was to evaluate the UDL PD program at SAS in terms of its impact on teachers’ instructional practices and students’ engagement in the classroom. Data from one-on-one interviews and classroom observations were analyzed using evaluation coding (Patton, 2002, 2008; Rallis & Rossman, 2003; Saldana, 2013) and findings revealed improvements in classroom instruction and student engagement for teachers who embraced the framework. Administrative and programmatic challenges that emerged over the course of the program and teachers’ hope for a long term shift toward professional learning communities among faculty and staff are discussed. Acceso a estudiantes con discapacidades moderadas: evaluación de un programa de desarrollo profesional en una escuela elemental católica Después de que un cambio normativo significativo permitiera la admisión de estudiantes con discapacidades moderadas, St. Agnes School (SAS), una escuela católica de pre-kínder a 8o del sur de California, implementó un programa de desarrollo profesional (DP) de 18 meses para mejorar las prácticas inclusivas en el aula de los profesores. Basados en el marco teórico del Diseño Universal de Aprendizaje (UDL, Universal Design for Learning, Center for Applied Special Technology, 2015b), el programa DP incluyó sesiones cíclicas de instrucción personal, lideradas por especialistas en formación UDL que consistían en demostraciones de lecciones y comentarios personalizados. Aunque los profesores de SAS tenían credenciales estatales, la mayoría no había recibido formación para trabajar con estudiantes con necesidades especiales antes de este DP. El objetivo de este estudio fue evaluar el programa de DP de UDL en SAS en cuanto a su impacto en las prácticas de instrucción del profesorado y la participación de los estudiantes en el aula. Se analizó la información de las entrevistas personalizadas y las observaciones de clase utilizando la codificación de la evaluación (Patton, 2002, 2008, Rallis & Rossman, 2003, Salana, 2013). Los resultados revelaron mejoras en la instrucción en el aula y en la participación de los estudiantes para aquellos profesores que adoptaron el marco. Se discuten los retos administrativos y programáticos que emergieron en el transcurso del programa, así como el deseo de los profesores de un cambio a largo plazo hacia comunidades de aprendizaje profesionales entre profesores y personal administrativo. Palabras clave: desarrollo profesional, inclusión, diseño universal del aprendizaje, educación católica Donner accès aux élèves moyennement handicapés : une évaluation d\u27un programme de développement professionnel dans une école catholique primaire Après l\u27admission d\u27élèves moyennement handicapés à la suite d\u27un important changement de politique, l\u27école Sainte Agnès (dont le pseudonyme est SAS), une école catholique de la maternelle à la 3e dans le sud de la Californie, a mis en œuvre un programme de développement professionnel de 18 mois pour que les enseignants améliorent leurs pratiques d\u27inclusion en classe. Ce programme, ancré dans le cadre théorique de l\u27Universal Design for Learning (concept universel d\u27apprentissage), (UDL ; Centre de technologies appliquée, 2015b), comprenait des séances de formation pédagogique en tête à tête, dirigées par des animateurs formés à l\u27UDL, constituées de démonstrations de cours et d\u27un feedback personnalisé. Alors que les enseignants de SAS étaient titulaires de diplômes d\u27État, la plupart étaient peu formés à travailler avec des élèves présentant des besoins particuliers avant ce programme. Cette étude visait à évaluer le programme de développement professionnel de l\u27UDL à SAS par rapport à son impact sur les pratiques pédagogiques des enseignants et la participation des élèves en classe. Des données tirées des entretiens en tête à tête et des observations en classe ont été analysées à l\u27aide d\u27un codage d\u27évaluation (Patton, 2002, 2008; Rallis & Rossman, 2003 ; Saldana, 2013) et les conclusions ont montré des améliorations dans l\u27enseignement dispensé en classe et la participation des élèves pour les enseignants qui ont appliqué le cadre. Les difficultés administratives et programmatiques qui sont apparues pendant le programme et l\u27espoir des enseignants de voir s’opérer un changement à long terme parmi le corps enseignant et le personnel y sont exposés. Mots-clés : développement professionnel, Universal Design for Learning, éducation catholiqu

A Definition of “Regular Meals” Driven by Dietary Quality Supports a Pragmatic Schedule

Public health guidelines advise eating regular meals without defining “regular.” This study constructed a meaning for “regular” meals congruent with dietary quality. Parents of 4th grade youth in a school-based intervention (Clinicaltrials.gov NCT02491294) completed three, ASA24 online 24-h dietary recalls. Differences in time of intake across days for breakfasts, lunches, dinners were categorized with consistency denoted as always, often/sometimes or rarely/never and assigned values of 3, 2 or 1, respectively. Meal-specific values were summed to form mealtime regularity scores (mReg) ranging from 3 (low) to 9. Healthy eating index (HEI) scores were compared to mReg controlling for weekday/weekend recall pattern. Linear regression predicted HEI scores from mReg. Parents (n = 142) were non-Hispanic white (92%), female (88%) and educated (73%). One mReg version, mReg1 was significantly associated with total HEI, total fruit, whole fruit, tended to correlate with total protein, seafood/plant protein subcomponents. mReg1 predicted total HEI (p = 0.001) and was inversely related to BMI (p = 0.04). A score of three (always) was awarded to breakfasts, lunches or dinners with day-to-day differences of 0–60 min; also, lunches/dinners with one interval of 60–120 min when two meals were ≤60 min apart. More rigid mReg versions were not associated with dietary quality

Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED).

BackgroundRecurrent strokes are preventable through awareness and control of risk factors such as hypertension, and through lifestyle changes such as healthier diets, greater physical activity, and smoking cessation. However, vascular risk factor control is frequently poor among stroke survivors, particularly among socio-economically disadvantaged blacks, Latinos and other people of color. The Chronic Care Model (CCM) is an effective framework for multi-component interventions aimed at improving care processes and outcomes for individuals with chronic disease. In addition, community health workers (CHWs) have played an integral role in reducing health disparities; however, their effectiveness in reducing vascular risk among stroke survivors remains unknown. Our objectives are to develop, test, and assess the economic value of a CCM-based intervention using an Advanced Practice Clinician (APC)-CHW team to improve risk factor control after stroke in an under-resourced, racially/ethnically diverse population.Methods/designIn this single-blind randomized controlled trial, 516 adults (≥40 years) with an ischemic stroke, transient ischemic attack or intracerebral hemorrhage within the prior 90 days are being enrolled at five sites within the Los Angeles County safety-net setting and randomized 1:1 to intervention vs usual care. Participants are excluded if they do not speak English, Spanish, Cantonese, Mandarin, or Korean or if they are unable to consent. The intervention includes a minimum of three clinic visits in the healthcare setting, three home visits, and Chronic Disease Self-Management Program group workshops in community venues. The primary outcome is blood pressure (BP) control (systolic BP <130 mmHg) at 1 year. Secondary outcomes include: (1) mean change in systolic BP; (2) control of other vascular risk factors including lipids and hemoglobin A1c, (3) inflammation (C reactive protein [CRP]), (4) medication adherence, (5) lifestyle factors (smoking, diet, and physical activity), (6) estimated relative reduction in risk for recurrent stroke or myocardial infarction (MI), and (7) cost-effectiveness of the intervention versus usual care.DiscussionIf this multi-component interdisciplinary intervention is shown to be effective in improving risk factor control after stroke, it may serve as a model that can be used internationally to reduce race/ethnic and socioeconomic disparities in stroke in resource-constrained settings.Trial registrationClinicalTrials.gov Identifier NCT01763203

Calcium phosphate particles stimulate interleukin-1β release from human vascular smooth muscle cells: A role for spleen tyrosine kinase and exosome release

Aims: Calcium phosphate (CaP) particle deposits are found in several inflammatory diseases including atherosclerosis and osteoarthritis. CaP, and other forms of crystals and particles, can promote inflammasome formation in macrophages leading to caspase-1 activation and secretion of mature interleukin-1β (IL-1β). Given the close association of small CaP particles with vascular smooth muscle cells (VSMCs) in atherosclerotic fibrous caps, we aimed to determine if CaP particles affected pro-inflammatory signalling in human VSMCs. Methods and results: Using ELISA to measure IL-1β release from VSMCs, we demonstrated that CaP particles stimulated IL-1β release from proliferating and senescent human VSMCs, but with substantially greater IL-1β release from senescent cells; this required caspase-1 activity but not LPS-priming of cells. Potential inflammasome agonists including ATP, nigericin and monosodium urate crystals did not stimulate IL-1β release from VSMCs. Western blot analysis demonstrated that CaP particles induced rapid activation of spleen tyrosine kinase (SYK) (increased phospho-Y525/526). The SYK inhibitor R406 reduced IL-1β release and caspase-1 activation in CaP particle-treated VSMCs, indicating that SYK activation occurs upstream of and is required for caspase-1 activation. In addition, IL-1β and caspase-1 colocalised in intracellular endosome-like vesicles and we detected IL-1β in exosomes isolated from VSMC media. Furthermore, CaP particle treatment stimulated exosome secretion by VSMCs in a SYK-dependent manner, while the exosome-release inhibitor spiroepoxide reduced IL-1β release. Conclusions: CaP particles stimulate SYK and caspase-1 activation in VSMCs, leading to the release of IL-1β, at least in part via exosomes. These novel findings in human VSMCs highlight the pro-inflammatory and procalcific potential of microcalcification

The SEC\u27s Misguided Climate Disclosure Rule Proposal

The following article adapts and consolidates two comment letters submitted last spring by a group of twenty-two professors of finance and law on the SEC’s proposed climate change disclosure rules. The professors reiterate their recommendation that the SEC withdraw its proposal as legally misguided, while outlining some of the issues that the proposal will face when challenged in court

Innovation in Diabetes - Ideas and Initiatives

A collection of multiple reports on MyDiabetesMyWay (MDMW). Included reports are: MyDiabetesMyWay Patient Portal; MyDiabetesMyWay e-learning hub (Moodle) ; SCI-diabetes/ MDMW Communication Portal- Tools for Remote Communication/ Consultation; Risk Modelling for Care Planning- integration into Informatics Dashboard for Clinical Use; Access to Chronic Medication Service (CMS) and Pharmaceutical Care Planning Medication and Lifestyle Coaching; Multi-media Diabetes Resources; Promoting Diabetes Education; Tele-Pharmacy; Understanding my diabetes medication; Pharmaceutical Industry and Medical Technology (PIMTs); An on-line and interactive education system for young people with type 1 diabetes to understand self-management for their lifestyle; Proof of Concept study to deliver personalised use of information to support diabetes management and behaviour change; right information; right time; right way; Virtual promotion of physical activity for people with type 2 diabetes; Remote foot ulcer management: RAPID (Reducing Amputation in People with Diabetes); Diabetic foot screening – development of technology; Portable capillary HbA1c testing for diagnosis and self-monitoring of diabetes; Possibility of mobile phone adaption for testing; Web app for decision support for patients with type 1 diabetes undertaking sport or exercise; Online level 3 structured education for type 1 diabetes; My Diabetes My Way electronic personal health record – uptake at scale; TeleClinics for diabetes; Develop a diabetes sim / game in which the main character has diabetes. Young people need to keep the sim / character alive as they face the various challenges of life or the game; Development of meaningful automated glucose data to in-patient clinical areas; In-patient Care: Integrated eHealth solutions to improve patient care, safety and outcomes; Innovative model of care to address the 'process of care' in managing people with long term conditions; Young Persons Remote Clinic Consultation; Maximise use of the data to support self-management of patients with co-morbidities; Virtual practice outreach and education in primary care

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

P-Element Homing Is Facilitated by engrailed Polycomb-Group Response Elements in Drosophila melanogaster

P-element vectors are commonly used to make transgenic Drosophila and generally insert in the genome in a nonselective manner. However, when specific fragments of regulatory DNA from a few Drosophila genes are incorporated into P-transposons, they cause the vectors to be inserted near the gene from which the DNA fragment was derived. This is called P-element homing. We mapped the minimal DNA fragment that could mediate homing to the engrailed/invected region of the genome. A 1.6 kb fragment of engrailed regulatory DNA that contains two Polycomb-group response elements (PREs) was sufficient for homing. We made flies that contain a 1.5kb deletion of engrailed DNA (enΔ1.5) in situ, including the PREs and the majority of the fragment that mediates homing. Remarkably, homing still occurs onto the enΔ1. 5 chromosome. In addition to homing to en, P[en] inserts near Polycomb group target genes at an increased frequency compared to P[EPgy2], a vector used to generate 18,214 insertions for the Drosophila gene disruption project. We suggest that homing is mediated by interactions between multiple proteins bound to the homing fragment and proteins bound to multiple areas of the engrailed/invected chromatin domain. Chromatin structure may also play a role in homing