Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

The Teacher Evaluation Conundrum: Examining the Perceptions of Special Education Teachers

For more than a decade now, state and local education agencies have adopted high-stakes teacher evaluation systems in response to federal accountability mandates and the recognition of the critical role of teacher effectiveness in student achievement. Teacher evaluation systems have revealed relevant details regarding teacher effectiveness, especially in general education settings. However, no systems of teacher evaluation have been developed and evaluated for special education teachers and little is known about how special education teachers have fared under the accountability microscope. The study was informed by three significant issues pertaining to special education teacher evaluation: (1) the challenges surrounding evaluation of special education teacher effectiveness, (2) limited research documenting special education teacher views, perceptions, voices, and experiences pertaining to how they have fared under existing evaluations systems, and (3) the persistent problem of special education teacher attrition within the context of high-stake teacher evaluations. Special education teachers are typically evaluated with measures designed for use with general education teachers, and researchers have pointed out that those measures do not address the unique professional development and pedagogical needs of special education teachers. The purpose of the study was to explore how special education teachers perceived existing teacher evaluation systems that are used to evaluate their effectiveness. The study further sought to establish how special education teachers view the evaluation systems with regard to the significance and ability of the systems to distinguish the multiple roles, responsibilities, and contexts within which they work. Using quantitative methods, the study employed a census survey to solicit the perceptions of secondary level special education teachers from one school district in southwest Florida A total of 357 participants were asked to respond to an electronic survey about the perceptions of the teacher evaluation system used in their district. The number of respondents included in the final data analysis was 96, representing a 26.8% response rate. An instrument was adopted and revised for data collection. The reliability of the revised scales as measured by Cronbach’s alphas ranged from .70 to .89. Findings from the study reveal that participants did not have a deep understanding of the evaluation system used to assess their performance, especially as it relates to how all components are combined to generate summative performance scores. The findings also reveal that participants did not view that evaluation framework as practical to address their roles, responsibilities, and professional development needs. Although participants did not view the evaluation system as practical to their needs and jobs, they had a slightly favorable view of their evaluators’ ability to assess them in a fair and unbiased manner. As a result, participants strongly recommended for a separate evaluation system for special education teachers. Participants in the study further reported a high emotional cost of stress and anxiety associated with the evaluation process. The findings have implications for federal, state, and local education agencies and policy makers. Recommendation for future research are also discusse

Learning by doing: developing fellows' academic skills through collaborative research

Physicians in postgraduate training are expected to learn research methods but how best to achieve that curricular goal is unclear. This article describes a novel educational approach to develop research skills among infectious disease fellows. Five infectious disease fellows and two faculty members participated in a collaborative research project as a vehicle for active, problem-based learning. During the learning experience several tasks with specific learning objectives were achieved. The authors evaluated the weaknesses and strengths of the collaborative research project as an educational program. This problem-based approach for learning research methods seems more effective than traditional methods and may be applicable to a broad range of training programs

Exploring Factors That Facilitate Acculturation Strategies and Academic Success of West African Immigrant Youth in Urban Schools

Immigrant students in U.S. educational system experience challenges learning to adapt and integrate into new educational environments. Little is known, however, about factors that facilitate acculturation strategies of immigrant youth from West Africa and how they affect their academic success and challenges faced. Considering the current political discourse over the influence of immigration in U.S. schools, 20 immigrant youth from Ghana and Nigeria were recruited and interviewed in the metropolitan area of New York City. Analyses of semi-structured interviews revealed that teacher, parent, and peer support; social and electronic media; and extracurricular activities emerged as the factors that helped acculturation strategies and academic success. Challenging factors were dealing with sociocultural differences; discrimination, stress, and social integration; and language differences. The article discusses the implications of these findings for teachers to understand acculturation strategies to help West African immigrant youth to adapt, acculturate, and integrate into new school environments