Addressing the Wicked Problem of English Learner Disproportionality by Examining Speech-Language Pathologists’ Beliefs: Applying Q Methodology to Special Education

The attribution of academic failure to an educational disability instead of a lack of English proficiency is one factor contributing to the disproportionate representation of English learners (ELs) in special education. As gatekeepers to special education, speech-language pathologists (SLPs) must ensure that ELs found eligible for special education under the category of Speech and Language Impairment are truly those with an impairment due to Developmental Language Disorder (DLD) or another developmental disability, not children exhibiting differences from standard English use due to cultural or linguistic differences or lack of English proficiency. However, many SLPs’ ongoing reliance on invalid procedures to make a determination about an EL’s language learning ability makes their ability to make appropriate determinations of special education eligibility problematic. This exploratory study hypothesized that factor(s) besides the lack of knowledge or resources as previously documented may be presenting a barrier to the fidelity with which SLPs perform bilingual assessments. This study utilized Q methodology, a unique gestalt procedure whose aim is to reveal how configurations of themes are interconnected among a group of participants. A set of California school-based SLPs sorted a set of subjective statements about linguistic diversity, bilingualism, ELs’ learning potential, and the use of EL language assessment best practices. Sorts were intercorrelated and revealed 4 distinct profiles defined by their beliefs and attitudes. While areas of consensus among the 4 profiles were discovered, the profiles diverged in their beliefs about the importance and value of using EL assessment best practices, their perceptions of social pressure to utilize these best practices, their perceptions of ELs situated in either strengths-based or deficit thinking, and their perceptions of the degree of control they have over using EL assessment best practices. Results shed new light on the association of SLPs’ assessment practices with the issue of EL disproportionality and suggest ways to enhance the ability of pre-service educators, professional development providers, and school administrators to create targeted remedies for the “wicked” problem of EL disproportionality in special education

Two-Buck Chuck and Wine Quality: Hedonic Price Analysis of Cool Climate Wines

Demand and Price Analysis,

Utilizing the American Board of Surgery in-training exam in a Rwandan surgical residency program: Alignment of exam topics with the University of Rwanda general surgery curriculum

Background: University of Rwanda (UR) increased postgraduate surgery training and assessment strategies are needed. We compared American Board of Surgery In-Training Exam (ABSITE) topics with UR surgery curriculum to determine the applicability of ABSITE in Rwanda.Methods: Topics are outlined in the Surgical Council on Resident Education (SCORE) curriculum whereas the UR utilizes a modular system. Diseases and conditions in SCORE were compared with UR surgery module content. Operation and procedures in SCORE were compared with operative procedures in UR surgery curriculum.Results: Overall, 72% of diseases and conditions from SCORE were covered in UR curriculum. Of this, 76% of medical knowledge and 71% of patient care content was covered in UR curriculum. 41% of operations and procedures from SCORE were identified in UR curriculum. 55% of core operations and 16% of advanced operations from SCORE were included in UR general surgery curriculum. Content identified in UR curriculum and not SCORE included infectious and tropical diseases, orthopedics, urology and neurosurgery.Conclusions: There is alignment between ABSITE topics and UR general surgery curriculum suggesting that the ABSITE can be used as an in-training examination for Rwandan residents. Understanding the limitations of the ABSITE exam can help utilization of this examination.Keywords: internship and residency, curriculum, Rwanda, global healt

Scaling up a surgical residency program in Rwanda

Background: Beginning in 2012, the Government of Rwanda implemented the Human Resources for Health (HRH) program to enhance capacity building in the Rwandan health education sector. Through this program, surgical training at University of Rwanda (UR) has expanded. The aim of this presentation is to describe the scaling up of the UR surgical residency programMethods: We performed a descriptive analysis of the UR surgical residency program after initiation of the Rwanda HRH Program.Results: Through the HRH Program, faculty from US institutions supplements the existing Rwandan educational infrastructure to increase the teaching capacity in Rwanda. Intake of surgical trainees more than doubled within the first year of the program. Service-based surgical training has changed to competency-based training through curriculum development, dedicated academic days and surgical education within firms. Lectures remain a dominant feature of the educational program, but more focus is placed on bedside teaching and peer-education. Shortage of operative space and a tremendous number of emergency patients overwhelm public teaching hospitals posing a challenge towards providing residents with a broad spectrum of operative experiences, especially elective surgical cases.Conclusion: Through this program, the ursurgical residency program has greatly expanded. Over time, the quantity and quality of surgical residents is expected to increase

Epidemiological study of peritonitis among children and factors predicting mortality at a tertiary referral hospital in Rwanda

Background: Peritonitis is a commonly encountered paediatric surgical emergency. We conducted this study to identify common causes of peritonitis among Rwandan children and factors affecting morbidity and mortality.Methods: The study sample consisted of children with peritonitis who underwent surgical treatment at a tertiary referral hospital in Rwanda from 1 September 2015 to 28 February 2016. Collected data included sociodemographic, clinical, paraclinical, management, and outcome information. The analysis included Pearson's chi-square test and multivariate logistic regression to determine factors associated with morbidity and mortality.Results: Of 63 patients, 28 were female. Ages ranged from 4 months to 15 years, with a mean of 8.8 years. Seventy-three percent of patients presented within the first week of symptom onset. Appendicular perforation (25.4%) and gangrenous intussusception (23.8%) were the most common causes of peritonitis. Fourteen patients (22.2%) died. On multivariate analysis, factors associated with mortality included sepsis (odds ratio [OR] = 11.60; 95% confidence interval [CI] = 2.15 to 62.5; P = 0.004) and intensive care unit (ICU) admission (OR = 7.38; 95% CI = 1.20 to 45.3; P = 0.031).Conclusions: Peritonitis among children is common and bears significant morbidity and mortality at our centre. Training of healthcare providers in district hospitals for early recognition of peritonitis, and improved ICU care availability may reduce mortality secondary to peritonitis in children.Keywords: epidemiology; peritonitis; paediatric surgery; Rwand

Dressings and securements for the prevention of peripheral intravenous catheter failure in adults (SAVE): a pragmatic, randomised controlled, superiority trial

Background: Two billion peripheral intravenous catheters (PIVCs) are used globally each year, but optimal dressing and securement methods are not well established. We aimed to compare the efficacy and costs of three alternative approaches to standard non-bordered polyurethane dressings. Methods: We did a pragmatic, randomised controlled, parallel-group superiority trial at two hospitals in Queensland, Australia. Eligible patients were aged 18 years or older and required PIVC insertion for clinical treatment, which was expected to be required for longer than 24 h. Patients were randomly assigned (1:1:1:1) via a centralised web-based randomisation service using random block sizes, stratified by hospital, to receive tissue adhesive with polyurethane dressing, bordered polyurethane dressing, a securement device with polyurethane dressing, or polyurethane dressing (control). Randomisation was concealed before allocation. Patients, clinicians, and research staff were not masked because of the nature of the intervention, but infections were adjudicated by a physician who was masked to treatment allocation. The primary outcome was all-cause PIVC failure (as a composite of complete dislodgement, occlusion, phlebitis, and infection [primary bloodstream infection or local infection]). Analysis was by modified intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000769987. Findings: Between March 18, 2013, and Sept 9, 2014, we randomly assigned 1807 patients to receive tissue adhesive with polyurethane (n=446), bordered polyurethane (n=454), securement device with polyurethane (n=453), or polyurethane (n=454); 1697 patients comprised the modified intention-to-treat population. 163 (38%) of 427 patients in the tissue adhesive with polyurethane group (absolute risk difference −4·5% [95% CI −11·1 to 2·1%], p=0·19), 169 (40%) of 423 of patients in the bordered polyurethane group (–2·7% [–9·3 to 3·9%] p=0·44), 176 (41%) of 425 patients in the securement device with poplyurethane group (–1·2% [–7·9% to 5·4%], p=0·73), and 180 (43%) of 422 patients in the polyurethane group had PIVC failure. 17 patients in the tissue adhesive with polyurethane group, two patients in the bordered polyurethane group, eight patients in the securement device with polyurethane group, and seven patients in the polyurethane group had skin adverse events. Total costs of the trial interventions did not differ significantly between groups. Interpretation: Current dressing and securement methods are commonly associated with PIVC failure and poor durability, with simultaneous use of multiple products commonly required. Cost is currently the main factor that determines product choice. Innovations to achieve effective, durable dressings and securements, and randomised controlled trials assessing their effectiveness are urgently needed

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Early Fasting Is Long Lasting: Differences in Early Nutritional Conditions Reappear under Stressful Conditions in Adult Female Zebra Finches

Conditions experienced during early life can have profound effects on individual development and condition in adulthood. Differences in nutritional provisioning in birds during the first month of life can lead to differences in growth, reproductive success and survival. Yet, under natural conditions shorter periods of nutritional stress will be more prevalent. Individuals may respond differently, depending on the period of development during which nutritional stress was experienced. Such differences may surface specifically when poor environmental conditions challenge individuals again as adults. Here, we investigated long term consequences of differences in nutritional conditions experienced during different periods of early development by female zebra finches (Taeniopygia guttata) on measures of management and acquisition of body reserves. As nestlings or fledglings, subjects were raised under different nutritional conditions, a low or high quality diet. After subjects reached sexual maturity, we measured their sensitivity to periods of food restriction, their exploration and foraging behaviour as well as adult resting metabolic rate (RMR). During a short period of food restriction, subjects from the poor nutritional conditions had a higher body mass loss than those raised under qualitatively superior nutritional conditions. Moreover, subjects that were raised under poor nutritional conditions were faster to engage in exploratory and foraging behaviour. But RMR did not differ among treatments. These results reveal that early nutritional conditions affect adult exploratory behaviour, a representative personality trait, foraging and adult's physiological condition. As early nutritional conditions are reflected in adult phenotypic plasticity specifically when stressful situations reappear, the results suggest that costs for poor developmental conditions are paid when environmental conditions deteriorate