Inclusion: a view from students and teachers

The purpose of this study is to examine students\u27 and teachers\u27 opinions on the inclusion model and its implementation in classrooms today. This study was conducted in an elementary school (grades one through five) in a K-12 public school district in Roosevelt Township, New Jersey. The participants were 27 second and third grade multiage students as well as 7 second and third grade teachers with varied teaching experiences and certifications. Teacher participants completed open-ended questionnaires while student participants completed surveys in which they used a rating scale to assign their comfort level with varied example situations. Data from the surveys was recorded in percentages. Students\u27 written narratives and oral commentary were also analyzed to obtain more information about students\u27 points of view. A significant finding of the study was that both teachers and students find value and success in the implementation of inclusion, although teachers indicated that some improvements could be made. Implications for future research include examining inclusion in other multiage classroom settings to determine the success of inclusion in multiage classrooms

Within‑marsh and Landscape Features Structure Ribbed Mussel Distribution in Georgia, USA, Marshes

Ribbed mussels, Geukensia demissa, are marsh fauna that are used in coastal management and restoration due to the ecosystem services they provide. Ribbed mussel restoration efforts may be improved with a greater understanding of the environmental drivers of ribbed mussel distribution at multiple spatial scales to predict areas where restoration could be successful. This study sought to estimate the effects of within-marsh (4 m) and landscape (500 m) factors on ribbed mussel distribution. Ribbed mussel densities were surveyed at 11 sites along the coast of Georgia, USA, and overlaid with spatial data for within-marsh factors (elevation, distance to marsh features, slope) as well as landscape factors (percent cover by subtidal creek, forest, and development within a 500-m radius). The distribution model was then validated using three previously unsurveyed marshes and explained 55% of the variance in ribbed mussel abundance. Ribbed mussel abundances and occupancy were most sensitive to changes in within-marsh factors (elevation and distance to subtidal creeks, bodies of water inundated during the full tidal cycle) but were also sensitive to landscape features (percent landcover of forests and development). The highest ribbed mussel densities were found in mid-elevation areas (~ 0.7 m NAVD88), far from subtidal creeks, and in marshes surrounded with forest and development. These results contrast with distributions in the northeastern USA, where ribbed mussels are distributed along subtidal creek banks. This work suggests that restoration may be most effective when focused on appropriate elevations and at locations away from the marsh-creek ecotone

After Constantine\u27s Sword: The Past, Present, and Future of Jewish-Christian Relations

An Interfaith Conversation with award-winning author: James Carroll. With responses by: Dr. Ellen M. Umansky, Carl and Dorothy Bennett Professor of Judaic Studies and Dr. Elizabeth A. Dreyer, Professor of Religious Studies. Also participating: Bill Huselman \u2798; M.T.S. Harvard Divinity School, \u2701.https://digitalcommons.fairfield.edu/bennettcenter-posters/1216/thumbnail.jp

Access to Emergency Contraception After Removal of Age Restrictions

BACKGROUND: Levonorgestrel emergency contraception (EC) is safe and effective for postcoital pregnancy prevention. Starting in 2013, the US Food and Drug Administration removed age restrictions, enabling EC to be sold over the counter to all consumers. We sought to compare the availability and access for female adolescents with the 2012 study, using the same study design. METHODS: Female mystery callers posing as 17-year-old adolescents in need of EC used standardized scripts to telephone 979 pharmacies in 5 US cities. Using 2015 estimated census data and the federal poverty level, we characterized income levels of pharmacy neighborhoods. RESULTS: Of 979 pharmacies, 827 (83%) indicated that EC was available. This proportion did not vary by pharmacy neighborhood income level, nor was significantly different from the 2012 study (P = .78). When examining access, 8.3% of the pharmacies reported it was impossible to obtain EC under any circumstances, which occurred more often in low-income neighborhoods (10.3% vs 6.3%, adjusted odds ratio 1.5; 95% confidence interval 1.20-1.94). This was not significantly different from 2012 (P = .66). Correct information regarding over-the-counter access was conveyed only 51.6% of the time; accuracy did not differ by pharmacy's neighborhood income (47.9% vs 55.3%, adjusted odds ratio 0.89; 95% confidence interval 0.71-1.11) and was not significantly different from 2012 (P = .37). CONCLUSIONS: A majority of pharmacies have EC available; however, barriers to and disparities in access for adolescents persist and have not changed since the previous study despite regulatory changes that were designed to improve access to EC

Evaluating Loss to Follow-Up in Newborn Hearing Screening in a Southern State

Objective: The aim of this study was to examine loss to follow-up on the usage of diagnostic or intervention services for South Carolina infants screened or diagnosed with hearing loss and the risk factors associated with loss to follow up. Design: A cross sectional analysis of data from South Carolina was used to examine loss to follow-up on the use of audiologic evaluation services after initial newborn hearing screening and receipt of intervention services after confirmation of hearing loss. Results: Three percent (3.1%) of all children screened in the state of South Carolina did not pass their newborn hearing screening test in 2013 with less than half (49.1%) of those children not reported to have used audiologic diagnostic services within one month of their initial screening test. Factors significant with receipt of services include birth weight, mother’s education, insurance type, and rurality. The degree of hearing loss was a significant determinant of receiving intervention at some point in time. Conclusions: The highest risk children are “lost follow-up” for both the initial diagnostic services and follow-up intervention services in South Carolina. Interventions targeted at specific groups are needed to improve the delivery of hearing services and prevent a public health shortfall

Biomarkers of aging associated with past treatments in breast cancer survivors.

Radiation and chemotherapy are effective treatments for cancer, but are also toxic to healthy cells. Little is known about whether prior exposure to these treatments is related to markers of cellular aging years later in breast cancer survivors. We examined whether past exposure to chemotherapy and/or radiation treatment was associated with DNA damage, telomerase activity, and telomere length 3-6 years after completion of primary treatments in breast cancer survivors (stage 0-IIIA breast cancer at diagnosis). We also examined the relationship of these cellular aging markers with plasma levels of Interleukin (IL)-6, soluble TNF-receptor-II (sTNF-RII), and C-reactive protein (CRP). Ninety-four women (36.4-69.5 years; 80% white) were evaluated. Analyses adjusting for age, race, BMI, and years from last treatment found that women who had prior exposure to chemotherapy and/or radiation compared to women who had previously received surgery alone were more likely to have higher levels of DNA damage (P = .02) and lower telomerase activity (P = .02), but did not have differences in telomere length. More DNA damage and lower telomerase were each associated with higher levels of sTNF-RII (P's < .05). We found that exposure to chemotherapy and/or radiation 3-6 years prior was associated with markers of cellular aging, including higher DNA damage and lower telomerase activity, in post-treatment breast cancer survivors. Furthermore, these measures were associated with elevated inflammatory activation, as indexed by sTNF-RII. Given that these differences were observed many years after the treatment, the findings suggest a long lasting effect of chemotherapy and/or radiation exposure

Extracting information from the text of electronic medical records to improve case detection: a systematic review

Background: Electronic medical records (EMRs) are revolutionizing health-related research. One key issue for study quality is the accurate identification of patients with the condition of interest. Information in EMRs can be entered as structured codes or unstructured free text. The majority of research studies have used only coded parts of EMRs for case-detection, which may bias findings, miss cases, and reduce study quality. This review examines whether incorporating information from text into case-detection algorithms can improve research quality. Methods: A systematic search returned 9659 papers, 67 of which reported on the extraction of information from free text of EMRs with the stated purpose of detecting cases of a named clinical condition. Methods for extracting information from text and the technical accuracy of case-detection algorithms were reviewed. Results: Studies mainly used US hospital-based EMRs, and extracted information from text for 41 conditions using keyword searches, rule-based algorithms, and machine learning methods. There was no clear difference in case-detection algorithm accuracy between rule-based and machine learning methods of extraction. Inclusion of information from text resulted in a significant improvement in algorithm sensitivity and area under the receiver operating characteristic in comparison to codes alone (median sensitivity 78% (codes + text) vs 62% (codes), P = .03; median area under the receiver operating characteristic 95% (codes + text) vs 88% (codes), P = .025). Conclusions: Text in EMRs is accessible, especially with open source information extraction algorithms, and significantly improves case detection when combined with codes. More harmonization of reporting within EMR studies is needed, particularly standardized reporting of algorithm accuracy metrics like positive predictive value (precision) and sensitivity (recall)

Continuous subcutaneous insulin infusion alters microRNA expression and glycaemic variability in children with type 1 diabetes

To determine whether continuous subcutaneous insulin infusion (CSII) vs. multiple daily injections (MDI) therapy from near-diagnosis of type 1 diabetes is associated with reduced glycaemic variability (GV) and altered microRNA (miRNAs) expression. Adolescents (74% male) within 3-months of diabetes diagnosis (n = 27) were randomized to CSII (n = 12) or MDI. HbA1c, 1-5-Anhydroglucitol (1,5-AG), high sensitivity C-peptide and a custom TaqMan qPCR panel of 52 miRNAs were measured at baseline and follow-up (median (LQ-UQ); 535 (519-563) days). There were no significant differences between groups in baseline or follow-up HbA1c or C-peptide, nor baseline miRNAs. Mean +/- SD 1,5-AG improved with CSII vs. MDI (3.1 +/- 4.1 vs. - 2.2 +/- - 7.0 mg/ml respectively, P = 0.029). On follow-up 11 miRNAs associated with diabetes vascular complications had altered expression in CSII-users. Early CSII vs. MDI use is associated with lower GV and less adverse vascular-related miRNAs. Relationships with future complications are of interest

Optimising use of electronic health records to describe the presentation of rheumatoid arthritis in primary care: a strategy for developing code lists

Background Research using electronic health records (EHRs) relies heavily on coded clinical data. Due to variation in coding practices, it can be difficult to aggregate the codes for a condition in order to define cases. This paper describes a methodology to develop ‘indicator markers’ found in patients with early rheumatoid arthritis (RA); these are a broader range of codes which may allow a probabilistic case definition to use in cases where no diagnostic code is yet recorded. Methods We examined EHRs of 5,843 patients in the General Practice Research Database, aged ≥30y, with a first coded diagnosis of RA between 2005 and 2008. Lists of indicator markers for RA were developed initially by panels of clinicians drawing up code-lists and then modified based on scrutiny of available data. The prevalence of indicator markers, and their temporal relationship to RA codes, was examined in patients from 3y before to 14d after recorded RA diagnosis. Findings Indicator markers were common throughout EHRs of RA patients, with 83.5% having 2 or more markers. 34% of patients received a disease-specific prescription before RA was coded; 42% had a referral to rheumatology, and 63% had a test for rheumatoid factor. 65% had at least one joint symptom or sign recorded and in 44% this was at least 6-months before recorded RA diagnosis. Conclusion Indicator markers of RA may be valuable for case definition in cases which do not yet have a diagnostic code. The clinical diagnosis of RA is likely to occur some months before it is coded, shown by markers frequently occurring ≥6 months before recorded diagnosis. It is difficult to differentiate delay in diagnosis from delay in recording. Information concealed in free text may be required for the accurate identification of patients and to assess the quality of care in general practice