Kindergarten readiness and performance of Latino children participating in Reach Out and Read

Journal ArticleBackground: Literacy is a vital skill that forms the basis for academic, occupational, and social success. Minority populations, especially immigrant Latinos in the US, have achievement gaps in literacy when compared to the White population. The Reach Out and Read (ROR) program is a pediatric, primary-care intervention designed to promote emergent literacy skills. The objectives of this study were to provide descriptive information at kindergarten on Latino immigrant children's emergent literacy skills and home literacy environments, and correlation data between ROR exposure and emergent literacy skills. Method: A sample of 40 low-income Latino immigrant mothers and their children participated. Medical records were reviewed to determine level of ROR exposure. Home literacy environment was assessed through maternal interview. Children's emergent literacy skills were assessed before kindergarten through interviews with the children and with the Dynamic Indicators of Basic Early Literacy Skills (DIBELS), and at the end of kindergarten through teachers' reports based on a modified version of the Kindergarten Teacher Questionnaire - Part C from the Department of Education Early Childhood Longitudinal Study-K (ECLS-K). We completed descriptive analyses for the demographics of our sample, ROR exposure, home literacy environment, emergent literacy skills and teacher evaluations. We created composite scores of children's print awareness, teacher-rated literacy skills, and ROR exposure. Finally, partial correlations controlling for child age and maternal education were conducted between the composite score of ROR exposure and children's literacy skills as assessed by the child interview, the DIBELS test, and teacher-report. Child age and maternal education were controlled. Results: The majority of children evaluated came from two-parent households and had high compliance rates with well-child care. All children began ROR at 6 months; the mean number of ROR books received was 6. Home literacy environments of families were strong as demonstrated by book ownership and parent-reported adult-child reading. Evaluation of early literacy skills in the clinic demonstrated children had good familiarity with print, and greater ROR exposure was related to significantly greater print and phonemic awareness before kindergarten entry. DIBELS testing performed in the clinic setting identified 37%-45%of the children as at risk for reading difficulty prior to kindergarten. At the end of kindergarten, teachers reported ECLS-K identifying 60% of children as intermediate or proficient in reading and rated the literacy skills of 77% of the children exposed to ROR as average, above average, or far above average when compared to all students of the same grade. Discussion: The kindergarten literacy performance of this small sample of Latino children participating in the ROR program from infancy was good. Though these children were living in poverty and had other risk factors for poor-school performance, they had good home literacy environments and average or above average literacy skills by the end of kindergarten. Protective factors including family stability, well-child care, and early and consistent participation in the ROR program may have improved the school readiness of these high-risk children

Active Learning on Center Stage: Theater as a Tool for Medical Education

Introduction: Knowledge and skill development related to communication must incorporate both affective and behavioral components, which are often difficult to deliver in a learning activity. Using theater techniques and principles can provide medical educators with tools to teach communication concepts. Methods: This 75-minute faculty development workshop presents a variety of techniques from theater and adapts them for use in medical education. Using examples related to diversity and inclusion, this session addresses general educational and theater principles, role-play, sociodrama, applied improvisation, and practical aspects of involving theater partners. The session materials include a PowerPoint presentation with facilitator notes, interactive activities to demonstrate each modality, and an evaluation. The sessions can be extended to longer formats as needed. Results: Forty-five participants at Learn Serve Lead 2016: The AAMC Annual Meeting attended the 75-minute session. We emailed 32 participants 5 months after the conference, and eight responded. Participants reported that their confidence level in using theater techniques as a tool for medical education increased from low-to-medium confidence presession to high confidence postsession. All survey respondents who were actively teaching said they had made changes to their teaching based on the workshop. All commented that they appreciated the active learning in the session. Many indicated they would appreciate video or other follow-up resources. Discussion: Principles and techniques from theater are effective tools to convey difficult-to-teach concepts related to communication. This workshop presents tools to implement activities in teaching these difficult concepts

Promoting the work of librarians through the Academic Pediatric Association Educational Scholars Program

Background The Academic Pediatric Association Educational Scholars Program is a 3-year national faculty development program for pediatricians. This program is designed to aid junior faculty early in their academic careers, with each scholar creating and completing a scholarly project to build their skills and a niche in educational scholarship and leadership. In 2014, a medical librarian and two pediatric educators collaborated to conceive, create and design a new module centering on the topic of literature searching. The module provides the junior faculty scholars with fundamental skills to conduct their projects. Description As an entrée into understanding the place of a project in the literature, the module authors created a new rubric to evaluate the quality of a manuscript’s introduction, background, and reference sections. The authors created and narrated six narrated videos: 1) Turning Your Research Question/Project into Concepts, 2) Controlled Vocabulary, 3) Keyword Searching (MESH), 4) Inclusion and Exclusion Criteria, 5) Medical Education Databases and 6) Getting to the Full Text. After viewing the videos and completing a consultation worksheet, participants scheduled a meeting with their local medical librarian for further help with the development of their project. Next, participants viewed three videos focused on understanding the impact of their scholarly work (Impact Factors, H-Index and Citation Counts, Altmetrics, and Educational scholarship and promotion). Finally, scholars performed a guided reflective critique of their scholarship moving forward. Conclusion Currently, three cohorts of junior faculty scholars have completed the course. The rubric aided participants to be objective when evaluating papers and provides a tool for use in future manuscript evaluations. While the videos provided context and content, the scholars repeatedly mentioned the most valuable part of this module being the actual meeting with their local medical librarian. The librarian taught the junior faculty about specific databases and nuances of searching, making writing an introduction more manageable. Several participants now consider their librarians as part of “their team” and are working for future collaborations in publishing together

The Evolving Educational Challenge: Balancing Patient Numbers, Conference Attendance, Sleep, and Resident Wellness

The Accreditation Council on Graduate Medical Education (ACMGE) 2011 guidelines for resident physicians specifically limited interns to 16-hour shifts and forced a paradigm switch from traditional overnight call.1 In “Shift Schedules and Intern Work Hours, Patient Numbers, Conference Attendance, and Sleep at a Single Pediatric Residency Program,”2 we prospectively compared intern work hours, patient numbers, conference attendance, sleep duration, pattern, and quality in 2003 and 2011 ACGME duty hour compliant call schedules at a single pediatric residency program. We concluded that a shift schedule reduced intern work hours and improved sleep duration and pattern. Although intern didactic conference attendance declined significantly during high census months, opportunities for experiential learning in a shift schedule remained robust with unchanged or increased intern patient numbers. Since the publication of our study, the ACGME has removed the 16-hour intern work hour limit, but still requires a maximum 80-hour work week and limits consecutive time on-task to 24 hours, plus 4 hours to transition care.1 Educators aim to provide the best clinical education for residents, while meeting requirements. In this progress report, we consider our study's findings in light of what has been published since October 2016 and discuss innovative scheduling, didactic and experiential resident education, resident sleep, and wellness and areas for future work

Feasibility and cost analysis of implementing high intensity aphasia clinics within a sub-acute setting

The current study explored the clinical feasibility and costs of embedding three different intensive service delivery models for aphasia treatment (computer, group therapy, and therapy with a speech pathology therapy assistant) within three sub-acute facilities. The study employed a two cohort comparison design, with the first cohort (n = 22) receiving the standard service of treatment currently offered. This treatment was delivered by a speech-language pathologist and involved on average 3 hours of treatment/week over 8 weeks. Participants in the second cohort (n = 31) received one of the three intensive treatment models providing up to 9 hours of therapy/week for 11 weeks. Organizational data was collected throughout treatment, with participant, caregiver, and clinician satisfaction with the intensive models also being measured. Participants completed the spoken language production sub-tests and the Disability Questionnaire of the Comprehensive Aphasia Test (CAT) pre- and post-treatment. All intensive models yielded high participant attendance, satisfaction, and significant improvements to the CAT sub-tests. The pro-rata cost of providing treatment per hour per client for the computer and group therapy models was found to be ̃ 30% cheaper compared to the standard service. The outcomes support the potential feasibility of embedding the different models into sub-acute facilities to enhance client access to intensive treatment for aphasia

The TiM system: developing a novel telehealth service to improve access to specialist care in motor neurone disease using user-centered design

Objectives: Attendance at a specialist multidisciplinary motor neurone disease (MND) clinic is associated with improved survival and may also improve quality of life and reduce hospital admissions. However, patients struggle to travel to clinic and may experience difficulties between clinic visits that may not be addressed in a timely manner. We wanted to explore how we could improve access to specialist MND care. Methods: We adopted an iterative, user-centered co-design approach, collaborating with those with experience of providing and receiving MND care including patients, carers, clinicians, and technology developers. We explored the unmet needs of those living with MND, how they might be met through service redesign and through the use of digital technologies. We developed a new digital solution and performed initial testing with potential users including clinicians, patients, and carers. Results: We used these findings to develop a telehealth system (TiM) using an Android app into which patients and carers answer a series of questions about their condition on a weekly basis. The questions aim to capture all the physical, emotional, and social difficulties associated with MND. This information is immediately uploaded to the internet for review by the MND team. The data undergoes analysis in order to alert clinicians to any changes in a patient or carer’s condition. Conclusions: We describe the benefits of developing a novel digitally enabled service underpinned by participatory design. Future trials must evaluate the feasibility and acceptability of the TiM system within a clinical environment

Positive relationships between association strength and phenotypic similarity characterize the assembly of mixed-species bird flocks worldwide

Competition theory predicts that local communities should consist of species that are more dissimilar than expected by chance. We find a strikingly different pattern in a multicontinent data set (55 presence-absence matrices from 24 locations) on the composition of mixed-species bird flocks, which are important sub-units of local bird communities the world over. By using null models and randomization tests followed by meta-analysis, we find the association strengths of species in flocks to be strongly related to similarity in body size and foraging behavior and higher for congeneric compared with noncongeneric species pairs. Given the local spatial scales of our individual analyses, differences in the habitat preferences of species are unlikely to have caused these association patterns; the patterns observed are most likely the outcome of species interactions. Extending group-living and social-information-use theory to a heterospecific context, we discuss potential behavioral mechanisms that lead to positive interactions among similar species in flocks, as well as ways in which competition costs are reduced. Our findings highlight the need to consider positive interactions along with competition when seeking to explain community assembly

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Developing a collaborative agenda for humanities and social scientific research on laboratory animal science and welfare.

Improving laboratory animal science and welfare requires both new scientific research and insights from enquiry in the humanities and social sciences. Whilst scientific research provides evidence to replace, reduce and refine procedures involving laboratory animals (the ‘3Rs’), work in the humanities and social sciences can help understand the social, economic and cultural processes that enhance or impede humane ways of knowing and working with laboratory animals. However, communication across these disciplinary perspectives is currently limited, and they frame questions, generate results, engage users, and seek to influence policy in different ways. To facilitate dialogue and future research at this interface, we convened an interdisciplinary group of 45 life scientists, social scientists, humanities scholars, non-governmental organisations and policy-makers to generate a collaborative research agenda. This drew on other agenda-setting exercises in science policy, using a collaborative and deliberative approach for the identification of research priorities. Participants were recruited from across the community, invited to submit research questions and vote on their priorities. They then met at an interactive workshop in the UK, discussed all 136 questions submitted, and collectively defined the 30 most important issues for the group. The output is a collaborative future agenda for research in the humanities and social sciences on laboratory animal science and welfare. The questions indicate a demand for new research in the humanities and social sciences to inform emerging discussions and priorities on the governance and practice of laboratory animal research, including around: international harmonisation, openness and public engagement, ‘cultures of care’, harm-benefit analysis and the future of the 3Rs. The process underlines the value of interdisciplinary exchange for improving mutual understanding of different research cultures and identifies ways of enhancing the effectiveness of future research at the interface between the humanities, social sciences, science and science policy

Discovery of four recessive developmental disorders using probabilistic genotype and phenotype matching among 4,125 families.

Discovery of most autosomal recessive disease-associated genes has involved analysis of large, often consanguineous multiplex families or small cohorts of unrelated individuals with a well-defined clinical condition. Discovery of new dominant causes of rare, genetically heterogeneous developmental disorders has been revolutionized by exome analysis of large cohorts of phenotypically diverse parent-offspring trios. Here we analyzed 4,125 families with diverse, rare and genetically heterogeneous developmental disorders and identified four new autosomal recessive disorders. These four disorders were identified by integrating Mendelian filtering (selecting probands with rare, biallelic and putatively damaging variants in the same gene) with statistical assessments of (i) the likelihood of sampling the observed genotypes from the general population and (ii) the phenotypic similarity of patients with recessive variants in the same candidate gene. This new paradigm promises to catalyze the discovery of novel recessive disorders, especially those with less consistent or nonspecific clinical presentations and those caused predominantly by compound heterozygous genotypes