Appeals Processes for Students Who Fail Graduation Exams: How Do They Apply to Students with Disabilities? (NCEO Synthesis Report)

A report of findings about high stakes tests for students with disabilities, and the appeals processes for those who need an alternative way of demonstrating skills. High stakes tests that determine whether students earn a standard high school diploma are on the rise. They are viewed as the way to make sure that students meet high standards and graduate with the skills needed to be successful employees. At the same time that more and more states are investing in graduation exams, there are concerns about students who have met high standards, yet are unable to pass a test. To determine the extent to which there are other options for demonstrating skills, and to check the availability of these to students with disabilities, the authors studied state Web sites for information on appeals processes and the availability of waivers. They found only six states with appeals processes, and these varied considerably from locally set procedures to relatively specific requirements. In one state, the appeals process is viewed as the avenue for students with disabilities to have access to accommodations. In most states, there is no evidence that students with disabilities have been considered. Further, states do not have data on the number of students involved in appeals processes, much less disaggregated for students with disabilities. The difficulty they experienced in finding information about an appeals process is certainly encountered by students and families whose lives are affected by graduation exams. Without appeals processes, or easily found information on such processes, the likelihood that lawsuits will be viewed as the only avenue for recourse is dramatically increased.The Center is supported through a Cooperative Agreement (#H326G000001) with the Research to Practice Division, Office of Special Education Programs, U.S. Department of Education. Opinions expressed herein do not necessarily reflect those of the U.S. Department of Education or Offices within it

Evaluating nature-based solutions for water management in peri-urban areas

The term nature-based solutions (NBS) has gained traction in recent years and has been applied in many settings. There are few comprehensive assessment frameworks available that can guide NBS planning and implementation while at the same time capturing the short- and long-term impacts and benefits of the NBS. Here a recently presented framework, which builds on the theory of change and was developed to assess NBS at different phases of the project cycle, was applied to seven diverse case studies. The case studies addressed water quality and quantity issues in peri-urban areas across the global north and south. Framework indicators covering the sustainability dimensions (environmental, social and economic) were assessed at three stages of the framework: context, process and results. The work sought to investigate the following research objectives: (1) Can this framework be robust and yet flexible enough to be applied across a diverse selection of NBS projects that are at different phases of the project cycle and address different kinds of water challenges within varied ecological, social and economic contexts? (2) Is it possible to draw generalisations from a comparative analysis of the application of the framework to the case studies? Results showed that the framework was able to be applied to the case studies; however, their diversity showed that NBS projects designed in one context, for a specific purpose in a specific location, can not necessarily be transferred easily to another location. There were several process-based indicators that were universally significant for the case studies, including expertise, skills and knowledge of the involved actors, roles and responsibilities of involved actors and political support. The result-based indicators were case study-specific when environmental indicators were case study-specific, and important social indicators were environmental identity and recreational values. Overall, the use of the framework benefits the recognition of the implementation’s advances, such as the change in context, the processes in place and the results obtained.The authors would like to thank the European Commission and the Research Council of Norway (RCN-project number 300560), Swedish Research Council for Sustainable Development (FORMAS-project number 2018-02777), the Water Research Commission (WRC) in South Africa (Project: 2019/2020-00034) and Spain Ministry of Science and Innovation (MCIU/AEI/FEDER) (PCI2019- 103674,2019), for funding the research in the frame of the collaborative international consortium NATWIP financed under the 2018 Joint Call of theWaterWorks2017 ERA-NET Cofund. This ERA-NET is an integral part of the activities developed by the Water JPI. We also acknowledge the International Institute for Sustainability for providing an in-kind contribution to this research. We also acknowledge that AEL received a grant from the Newton Advanced Fellowship (NAF/R2/18676), CAPES (001), CNPQ (308536/2018-5), FAPERJ (E-26/202.680/2018).Peer ReviewedPostprint (published version

Renal artery sympathetic denervation:observations from the UK experience

Background: Renal denervation (RDN) may lower blood pressure (BP); however, it is unclear whether medication changes may be confounding results. Furthermore, limited data exist on pattern of ambulatory blood pressure (ABP) response—particularly in those prescribed aldosterone antagonists at the time of RDN. Methods: We examined all patients treated with RDN for treatment-resistant hypertension in 18 UK centres. Results: Results from 253 patients treated with five technologies are shown. Pre-procedural mean office BP (OBP) was 185/102 mmHg (SD 26/19; n = 253) and mean daytime ABP was 170/98 mmHg (SD 22/16; n = 186). Median number of antihypertensive drugs was 5.0: 96 % ACEi/ARB; 86 % thiazide/loop diuretic and 55 % aldosterone antagonist. OBP, available in 90 % at 11 months follow-up, was 163/93 mmHg (reduction of 22/9 mmHg). ABP, available in 70 % at 8.5 months follow-up, was 158/91 mmHg (fall of 12/7 mmHg). Mean drug changes post RDN were: 0.36 drugs added, 0.91 withdrawn. Dose changes appeared neutral. Quartile analysis by starting ABP showed mean reductions in systolic ABP after RDN of: 0.4; 6.5; 14.5 and 22.1 mmHg, respectively (p < 0.001 for trend). Use of aldosterone antagonist did not predict response (p < 0.2). Conclusion: In 253 patients treated with RDN, office BP fell by 22/9 mmHg. Ambulatory BP fell by 12/7 mmHg, though little response was seen in the lowermost quartile of starting blood pressure. Fall in BP was not explained by medication changes and aldosterone antagonist use did not affect response

Obesity and the Dysregulation of Fatty Acid Metabolism: Implications for Healthy Aging

This is an Accepted Manuscript of an article published by Taylor & Francis in Expert Review of Endocrinology & Metabolism on 17/10/2016, available online: http://dx.doi.org/10.1080/17446651.2016.1245141The population of the world is aging. In 2010, an estimated 524 million people were aged 65 years or older presenting eight percent of the global population. By 2050, this number is expected to nearly triple to approximately 1.5 billion, 16 percent of the world’s population. Although people are living longer, the quality of their lives are often compromised due to ill-health. Areas covered. Of the conditions which compromise health as we age, obesity is at the forefront. Over half of the global older population were overweight or obese in 2010, significantly increasing the risk of a range of metabolic diseases. Although, it is well recognised excessive calorie intake is a fundamental driver of adipose tissue dysfunction, the relationship between obesity; intrinsic aging; and fat metabolism is less understood. In this review we discuss the intersection between obesity, aging and the factors which contribute to the dysregulation of whole-body fat metabolism. Expert Commentary. Being obese disrupts an array of physiological systems and there is significant crosstalk among these. Moreover it is imperative to acknowledge the contribution intrinsic aging makes to the dysregulation of these systems and the onset of disease

Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial

BackgroundAnterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability.MethodsWe did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score—4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367.FindingsBetween Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5–13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications.InterpretationSurgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

25th annual computational neuroscience meeting: CNS-2016

The same neuron may play different functional roles in the neural circuits to which it belongs. For example, neurons in the Tritonia pedal ganglia may participate in variable phases of the swim motor rhythms [1]. While such neuronal functional variability is likely to play a major role the delivery of the functionality of neural systems, it is difficult to study it in most nervous systems. We work on the pyloric rhythm network of the crustacean stomatogastric ganglion (STG) [2]. Typically network models of the STG treat neurons of the same functional type as a single model neuron (e.g. PD neurons), assuming the same conductance parameters for these neurons and implying their synchronous firing [3, 4]. However, simultaneous recording of PD neurons shows differences between the timings of spikes of these neurons. This may indicate functional variability of these neurons. Here we modelled separately the two PD neurons of the STG in a multi-neuron model of the pyloric network. Our neuron models comply with known correlations between conductance parameters of ionic currents. Our results reproduce the experimental finding of increasing spike time distance between spikes originating from the two model PD neurons during their synchronised burst phase. The PD neuron with the larger calcium conductance generates its spikes before the other PD neuron. Larger potassium conductance values in the follower neuron imply longer delays between spikes, see Fig. 17.Neuromodulators change the conductance parameters of neurons and maintain the ratios of these parameters [5]. Our results show that such changes may shift the individual contribution of two PD neurons to the PD-phase of the pyloric rhythm altering their functionality within this rhythm. Our work paves the way towards an accessible experimental and computational framework for the analysis of the mechanisms and impact of functional variability of neurons within the neural circuits to which they belong