Vol. 22, No. 4

Contents: Privatization of Public Educational Services: The Application of the Doctrine of Successorship in the No Child Left Behind Era, by Rochelle Gordon and Brian Clauss Recent Developments Further References, compiled by Yoo-Seong Songhttps://scholarship.kentlaw.iit.edu/iperr/1032/thumbnail.jp

Supporting Evidence-Informed Teaching in Biomedical and Health Professions Education Through Knowledge Translation: An Interdisciplinary Literature Review

PHENOMENON: The purpose of “systematic” reviews/reviewers of medical and health professions educational research is to identify best practices. This qualitative paper explores the question of whether systematic reviews can support “evidence informed” teaching, and contrasts traditional systematic reviewing with a knowledge-translation approach to this objective. APPROACH: Degrees of Freedom Analysis is used to examine the alignment of systematic review methods with educational research and the pedagogical strategies and approaches that might be considered with a decision-making framework developed to support valid assessment. This method is also used to explore how knowledge translation can be used to inform teaching and learning. FINDINGS: The nature of educational research is not compatible with most (11/14) methods for systematic review. The inconsistency of systematic reviewing with the nature of educational research impedes both the identification and implementation of ‘best-evidence’ pedagogy and teaching. This is primarily because research questions that do support the purposes of review do not support educational decision-making. By contrast to systematic reviews of the literature, both a Degrees of Freedom Analysis (DOFA) and knowledge translation (KT) are fully compatible with informing teaching using evidence. A DOFA supports the translation of theory to a specific teaching or learning case, so could be considered a type of KT. The DOFA results in a test of alignment of decision options with relevant educational theory and KT leads to interventions in teaching or learning that can be evaluated. Examples of how to structure evaluable interventions are derived from a knowledge-translation approach that are simply not available from a systematic review. INSIGHTS: Systematic reviewing of current empirical educational research is not suitable for deriving or supporting best practices in education. However, both “evidence-informed” and scholarly approaches to teaching can be supported as knowledge translation projects, which are inherently evaluable and can generate actionable evidence about whether the decision or intervention worked for students, instructors, and the institution. A Degrees of Freedom Analysis can also support evidence- and theory-informed teaching to develop an understanding of what works, why, and for whom. Thus, knowledge translation, but not systematic reviewing, can support decision-making around pedagogy (and pedagogical innovation) that can also inform new teaching and learning initiatives; it can also point to new avenues of empirical research in education that are informed by, and can inform, theory

Caesarean section and risk of unexplained stillbirth in subsequent pregnancy

Background Caesarean section is associated with an increased risk of disorders of placentation in subsequent pregnancies, but effects on the rate of antepartum stillbirth are unknown. We aimed to establish whether previous caesarean delivery is associated with an increased risk of antepartum stillbirth. Methods We linked pregnancy discharge data from the Scottish Morbidity Record (1980–98) and the Scottish Stillbirth and Infant Death Enquiry (1985–98). We estimated the relative risk of antepartum stillbirth in second pregnancies using time-to-event analyses. Findings For 120 633 singleton second births, there were 68 antepartum stillbirths in 17 754 women previously delivered by caesarean section (2–39 per 10 000 women per week) and 244 in 102879 women previously delivered vaginally (1·44; p<0·001). Risk of unexplained stillbirth associated with previous caesarean delivery differed significantly with gestational age (p=0·04); the excess risk was apparent from 34 weeks (hazard ratio 2·23 [95% Cl 1·48–3·36]). Risk was not attenuated by adjustment for maternal characteristics or outcome of the first pregnancy (2·74 [1·74–4·30]). The absolute risk of unexplained stillbirth at or after 39 weeks' gestation was 1·1 per 1000 women who had had a previous caesarean section and 0·5 per 1000 in those who had not. The difference was due mostly to an excess of unexplained stillbirths among women previously delivered by caesarean section. Interpretation Delivery by caesarean section in the first pregnancy could increase the risk of unexplained stillbirth in the second. In women with one previous caesarean delivery, the risk of unexplained antepartum stillbirth at or after 39 weeks' gestation is about double the risk of stillbirth or neonatal death from intrapartum uterine rupture

A social pedagogical intervention to support children in care:Back on Track

This paper focuses on an intervention project, Back on Track (BoT), implemented as a part of the Resilience Revolution: HeadStart Blackpool (RR:HS) programme in the UK. Whilst it is a famous family holiday resort, Blackpool is also one of the most deprived towns in England. This makes life challenging for young people (YP) to maintain wellbeing and reach their potential. Blackpool also has an above average and growing proportion of children in care. They are at a higher risk of developing mental health difficulties and of being permanently excluded from school. BoT aimed to support fostered children who have been referred by schools or social workers to the project for having emotional and behavioural struggles. As a consequence of their difficulties, they were at risk of permanent exclusion from the school. The intervention was grounded in a social pedagogical approach and Resilient Therapy. Resilience Coaches (i.e., wellbeing practitioners) had the role of enhancing communication between YP, family, social care, and school, whilst working with YP to co-produce coping strategies. Between November 2016 and June 2021, 39 YP (61.5% male) aged 10 to 15 (M = 12.74, SD = 1.60) received BoT support over a period lasting between 4 months to 2.5 years (M = 14 months, SD = 6.8 months). Using a mixed-methods design, this paper explored the BoT implementation. YP completed questionnaires before and after BoT. Triangulation interviews were conducted with a randomly selected YP, foster parent and the Resilience Coach. Results showed the benefit of equipping YP with ‘resilient moves’ and joining up systems to work together and better support YP and families. YP reported reduced difficulties, improved strengths (i.e., prosocial behaviour) and educational outcomes. This helped build resilience and reduce the risk of permanent exclusions from school. Policy and practice implications for children in care are discussed

A pilot study of rapid benchtop sequencing of Staphylococcus aureus and Clostridium difficile for outbreak detection and surveillance

OBJECTIVES: To investigate the prospects of newly available benchtop sequencers to provide rapid whole-genome data in routine clinical practice. Next-generation sequencing has the potential to resolve uncertainties surrounding the route and timing of person-to-person transmission of healthcare-associated infection, which has been a major impediment to optimal management. DESIGN: The authors used Illumina MiSeq benchtop sequencing to undertake case studies investigating potential outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile. SETTING: Isolates were obtained from potential outbreaks associated with three UK hospitals. PARTICIPANTS: Isolates were sequenced from a cluster of eight MRSA carriers and an associated bacteraemia case in an intensive care unit, another MRSA cluster of six cases and two clusters of C difficile. Additionally, all C difficile isolates from cases over 6 weeks in a single hospital were rapidly sequenced and compared with local strain sequences obtained in the preceding 3 years. MAIN OUTCOME MEASURE: Whole-genome genetic relatedness of the isolates within each epidemiological cluster. RESULTS: Twenty-six MRSA and 15 C difficile isolates were successfully sequenced and analysed within 5 days of culture. Both MRSA clusters were identified as outbreaks, with most sequences in each cluster indistinguishable and all within three single nucleotide variants (SNVs). Epidemiologically unrelated isolates of the same spa-type were genetically distinct (≥21 SNVs). In both C difficile clusters, closely epidemiologically linked cases (in one case sharing the same strain type) were shown to be genetically distinct (≥144 SNVs). A reconstruction applying rapid sequencing in C difficile surveillance provided early outbreak detection and identified previously undetected probable community transmission. CONCLUSIONS: This benchtop sequencing technology is widely generalisable to human bacterial pathogens. The findings provide several good examples of how rapid and precise sequencing could transform identification of transmission of healthcare-associated infection and therefore improve hospital infection control and patient outcomes in routine clinical practice

Differences in reproductive risk factors for breast cancer in middle-aged women in Marin County, California and a sociodemographically similar area of Northern California

<p>Abstract</p> <p>Background</p> <p>The Northern California county of Marin (MC) has historically had high breast cancer incidence rates. Because of MC's high socioeconomic status (SES) and racial homogeneity (non-Hispanic White), it has been difficult to assess whether these elevated rates result from a combination of established risk factors or other behavioral or environmental factors. This survey was designed to compare potential breast cancer risks and incidence rates for a sample of middle-aged MC women with those of a demographically similar population.</p> <p>Methods</p> <p>A random sample of 1500 middle-aged female members of a large Northern California health plan, half from Marin County (MC) and half from a comparison area in East/Central Contra Costa County (ECCC), were mailed a survey covering family history, reproductive history, use of oral contraceptives (OC) and hormone replacement therapy (HRT), behavioral health risks, recency of breast screening, and demographic characteristics. Weighted data were used to compare prevalence of individual breast cancer risk factors and Gail scores. Age-adjusted cumulative breast cancer incidence rates (2000–2004) were also calculated for female health plan members aged 40–64 residing in the two geographic areas.</p> <p>Results</p> <p>Survey response was 57.1% (n = 427) and 47.9% (n = 359) for MC and ECCC samples, respectively. Women in the two areas were similar in SES, race, obesity, exercise frequency, current smoking, ever use of OCs and HRT, age at onset of menarche, high mammography rates, family history of breast cancer, and Gail scores. However, MC women were significantly more likely than ECCC women to be former smokers (43.6% vs. 31.2%), have Ashkenazi Jewish heritage (12.8% vs. 7.1%), have no live births before age 30 (52.7% vs. 40.8%), and be nulliparous (29.2% vs. 15.4%), and less likely to never or rarely consume alcohol (34.4% vs. 41.9%). MC and ECCC women had comparable 2000–2004 invasive breast cancer incidence rates.</p> <p>Conclusion</p> <p>The effects of reproductive risks factors, Ashkenazi Jewish heritage, smoking history, and alcohol consumption with regard to breast cancer risk in Marin County should be further evaluated. When possible, future comparisons of breast cancer incidence rates between regions should adjust for differences in income and education in addition to age and race/ethnicity, preferably by using a sociodemographically similar comparison group.</p

Multisite implementation of trained volunteer doula support for disadvantaged childbearing women: a mixed-methods evaluation

Our study looked at five schemes in England which offer support to disadvantaged women having babies. The support starts in pregnancy and goes on for 6 weeks after the baby’s birth. It is provided by specially trained volunteers (called ‘doulas’). The idea started with one of the five schemes and was then taken up by the other four, with the help of funding from the Department of Health. The philosophy behind the original doula service was to provide women with the support needed for a positive birth experience and breastfeeding. We looked at impacts on the NHS, on the women and on the volunteers and at how services had started the schemes and kept them running. Participation rates were lower than we had hoped among women and doulas; 167 women and 89 doulas completed questionnaires. However, from those who filled in questionnaires or took part in focus groups we heard that most women really appreciated the service. Where women were less pleased with the service, it was because they had not received as much support as they wanted. There was some evidence that women who had doula support had fewer caesarean sections although the numbers were not sufficient to rule out the possibility that this difference was due to chance. Women supported by doulas were more likely to start and to be continuing breastfeeding when their baby was 6 weeks old. Through questionnaires and telephone interviews we learned that most volunteers enjoyed their role and called it a privilege to support a woman at such an important time. They felt that they had learned a lot and gained confidence and some had gone on to further training. Midwives who took part in focus groups and the heads of midwifery who were interviewed were generally positive about the scheme. Starting the schemes and keeping them running: funding was a major issue that persisted for all the doula services; other challenges included ensuring a steady rate of women referred and available volunteers

Seafloor mapping – the challenge of a truly global ocean bathymetry

Detailed knowledge of the shape of the seafloor is crucial to humankind. Bathymetry data is critical for safety of navigation and is used for many other applications. In an era of ongoing environmental degradation worldwide, bathymetry data (and the knowledge derived from it) play a pivotal role in using and managing the world’s oceans in a way that is in accordance with the United Nations Sustainable Development Goal 14 – conserve and sustainably use the oceans, seas and marine resources for sustainable development. However, the vast majority of our oceans is still virtually unmapped, unobserved, and unexplored. Only a small fraction of the seafloor has been systematically mapped by direct measurement. The remaining bathymetry is predicted from satellite altimeter data, providing only an approximate estimation of the shape of the seafloor. Several global and regional initiatives are underway to change this situation. This paper presents a selection of these initiatives as best practice examples for bathymetry data collection, compilation and open data sharing as well as the Nippon Foundation-GEBCO (The General Bathymetric Chart of the Oceans) Seabed 2030 Project that complements and leverages these initiatives and promotes international collaboration and partnership. Several non-traditional data collection opportunities are looked at that are currently gaining momentum as well as new and innovative technologies that can increase the efficiency of collecting bathymetric data. Finally, recommendations are given toward a possible way forward into the future of seafloor mapping and toward achieving the goal of a truly global ocean bathymetry

Genomic architecture and evolution of clear cell renal cell carcinomas defined by multiregion sequencing

Clear cell renal carcinomas (ccRCCs) can display intratumor heterogeneity (ITH). We applied multiregion exome sequencing (M-seq) to resolve the genetic architecture and evolutionary histories of ten ccRCCs. Ultra-deep sequencing identified ITH in all cases. We found that 73–75% of identified ccRCC driver aberrations were subclonal, confounding estimates of driver mutation prevalence. ITH increased with the number of biopsies analyzed, without evidence of saturation in most tumors. Chromosome 3p loss and VHL aberrations were the only ubiquitous events. The proportion of C>T transitions at CpG sites increased during tumor progression. M-seq permits the temporal resolution of ccRCC evolution and refines mutational signatures occurring during tumor development