PRINCIPAL LEADERSHIP PRACTICES AT KENTUCKY HIGH SCHOOLS ADMINISTERING THE PISA FOR SCHOOLS: LEADING FOR GLOBAL COMPETITIVENESS

Since launching Sputnik in 1957, the United States education system has been trying to climb to the top of the international education rankings. The Organisation for Economic and Co-operative Development (OECD) began analyzing how well school systems prepared students to compete in the global economy in 2000. The OECD uses the Programme for International Student Assessment (PISA). U.S. students rank at or near the OECD averages in reading and science but consistently perform below the OECD average in mathematics. In addition to the PISA, the OECD released the PISA for Schools, which provides PISA data at the school level. In 2010, the OECD released its report, Strong Performers and Successful Reformers in Education: Lessons from PISA for the United States, in which the OECD proposes strategies and recommendations for the USA education system. Among these recommendations are highly qualified school administrators. Through extensive analysis of studies about effective leadership practices, Hitt and Tucker (2016) developed a unified model of effective leadership practices that yields theoretical support for the framework used for this study. The framework used for this study is the Globally Competent Educational Leadership Framework (GCELF). This study aims to determine if Kentucky high school principals whose schools use PISA for Schools use effective leadership practices for global competence identified by Tichnor-Wagner and Manise (2019). The principals were selected because their schools use PISA for Schools and focus on global competency for students in mission. A qualitative methods approach integrating two parts was used for this study. This is an exploratory case study using a set of researcher-created principal interview questions, a tour of the high schools, a document analysis, and an analysis of the schools’ PISA for Schools results as background data. The goals for the study were to (a) produce research about how leadership practices relate to the global preparedness of students in Kentucky schools administering PISA for Schools using the Globally Competent Educational Leadership framework (Tichnor-Wagner, 2019), (b) identify global competency leadership practices of selected Kentucky principals and their level of immersion in these practices using the high schools’ success on PISA for Schools founded on the baseline proficiency indicating preparedness for global competitiveness, and (c) explore potential additional research in this area to increase the knowledge base and inform leadership practice and policy. The study’s findings show that the principals lead with different styles but incorporate leadership practices that align with the GCELF, mainly at the “First Steps” level. These principals are preparing their graduates to be globally competent at initial levels based on GCELF alignment and PISA for Schools results. An extension of this study that could provide additional beneficial information is to change the parameters and conduct the study with principals whose schools do not administer PISA for Schools to determine if their leadership practices align with the GCELF

Eligibility for Minimally Invasive Coronary Artery Bypass Examination of Epicardial Adipose Tissue Using Computed Tomography

Objective: A variable that necessitates conversion to a conventional full-sternotomy coronary artery bypass procedure from a robotic-assisted endoscopic single-vessel small thoracotomy is the inability to visualize the left anterior descending coronary artery within the surrounding epicardial adipose tissue using the endoscopic camera. The purpose of this study was to determine whether anatomical properties of the epicardial adipose tissue examined using preoperative computed tomography (CT) images are able to predict and thus reduce the need for intraoperative conversion based on effective preoperative exclusion criteria. Methods: Retrospective analysis of patient preoperative CT angiography scans from both converted (n = 17) and successful robotic-assisted (n = 17) procedures was performed. Where possible, measurements of epicardial adipose tissue were acquired from axial slices, at the most accessible segment of the left anterior descending coronary artery. Results: Results indicate that patients who successfully underwent the endoscopic single-vessel small thoracotomy procedure (mean +/- SD depth, 4.9 +/- 1.9 mm) had significantly less epicardial adipose tissue (38%, P = 0.002) overlying the vessel toward the lateral chest wall than those who were converted to the full-sternotomy approach intraoperatively (mean +/- SD depth, 7.9 +/- 3.2 mm). Using this as a retrospective exclusion criterion reduces the conversion rate for this group by 47%, while maintaining a high specificity (94%). No significant differences exist between the two groups with respect to the remaining epicardial adipose tissue measurements or body mass index. Conclusions: The addition of CT angiography measurements of the epicardial adipose tissue overlying the left anterior descending coronary artery may enhance preoperative surgical planning for this procedure, thereby reducing the instances of procedural changes

What evaluation is best for an isolated, enlarged cervical lymph node?

The evaluation and follow-up of an isolated, enlarged cervical lymph node is determined by the presence of inflammation, duration, size, and associated symptoms. For patients with inflammatory symptoms (ie, fever, pain, erythema, and recent infection), a single course of broad-spectrum antibiotic and reassessment in 1 to 2 weeks is reasonable (strength of recommendation [SOR]: C, expert opinion). If lymph node enlargement persists despite antibiotics, yet an infectious or inflammatory cause is still suspected, further evaluation may include a PPD skin test and chest radiograph1 (SOR: C, expert opinion)

A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament.

PURPOSE: The purpose of this study was to verify and characterize the anatomical properties of the anterolateral capsule, with the aim of establishing a more accurate anatomical description of the anterolateral ligament (ALL). Furthermore, microscopic analysis of the tissue was performed to determine whether the ALL can morphologically be classified as ligamentous tissue, as well as reveal any potential functional characteristics. METHODS: Three different modalities were used to validate the existence of the ALL: magnetic resonance imagining (MRI), anatomical dissection, and histological analysis. Ten fresh-frozen cadaveric knee specimens underwent MRI, followed by anatomical dissection which allowed comparison of MRI to gross anatomy. Nine additional fresh-frozen cadaveric knees (19 total) were dissected for a further anatomical description. Four specimens underwent H&E staining to look at morphological characteristics, and one specimen was analysed using immunohistochemistry to locate peripheral nervous innervation. RESULTS: The ALL was found in all ten knees undergoing MRI and all nineteen knees undergoing anatomical dissection, with MRI being able to predict its corresponding anatomical dissection. The ALL was found to have bone-to-bone attachment points from the lateral femoral epicondyle to the lateral tibia, in addition to a prominent meniscal attachment. Histological sectioning showed ALL morphology to be characteristic of ligamentous tissue, having dense, regularly organized collagenous bundles. Immunohistochemistry revealed a large network of peripheral nervous innervation, indicating a potential proprioceptive role. CONCLUSION: From this study, the ALL is an independent structure in the anterolateral compartment of the knee and may serve a proprioceptive role in knee mechanics

Deducing signaling pathways from parallel actions of arsenite and antimonite in human epidermal keratinocytes.

Inorganic arsenic oxides have been identified as carcinogens in several human tissues, including epidermis. Due to the chemical similarity between trivalent inorganic arsenic (arsenite) and antimony (antimonite), we hypothesized that common intracellular targets lead to similarities in cellular responses. Indeed, transcriptional and proteomic profiling revealed remarkable similarities in differentially expressed genes and proteins resulting from exposure of cultured human epidermal keratinocytes to arsenite and antimonite in contrast to comparisons of arsenite with other metal compounds. These data were analyzed to predict upstream regulators and affected signaling pathways following arsenite and antimonite treatments. A majority of the top findings in each category were identical after treatment with either compound. Inspection of the predicted upstream regulators led to previously unsuspected roles for oncostatin M, corticosteroids and ephrins in mediating cellular response. The influence of these predicted mediators was then experimentally verified. Together with predictions of transcription factor effects more generally, the analysis has led to model signaling networks largely accounting for arsenite and antimonite action. The striking parallels between responses to arsenite and antimonite indicate the skin carcinogenic risk of exposure to antimonite merits close scrutiny

Defining the Efficacy of Aortic Root Enlargement Procedures: A Comparative Analysis of Surgical Techniques

Background: Aortic root enlargement (ARE) procedures are believed to allow implantation of larger valve prostheses; however, little evidence exists to support the specific efficacy of various techniques. Methods: Using a cadaveric model, 20 adult (72.4 +/- 15.3 years) hearts were stratified into 4 groups based on annular diameter: \u3c20 mm, 20-22 mm, 22-24 mm, and \u3e24 mm. Each heart underwent an aortic valve replacement following a Nicks, Manougian, aortoventriculoplasty and modified Bentall procedure, with appropriate reversals between procedures. Results: All 4 groups experienced similar increases in annular diameter (P = 0.43) and prosthesis size implanted (P = 0.51) with each enlargement technique. The Nicks, Manougian, modified Bentall and aortoventriculoplasty procedures enlarged the annulus by 0.43 +/- 0.45 mm, 3.63 +/- 0.95 mm, 0.78 +/- 0.65 mm, and 6.08 +/- 1.19 mm, respectively (P \u3c 0.001). No significant change in prosthesis size was observed after the Nicks procedure (P = not significant). Increases of 1.3 +/- 0.5, 1.3 +/- 0.5, and 2.7 +/- 0.6 prosthesis sizes were achieved with the Manougian, modified Bentall and aortoventriculoplasty techniques respectively (P \u3c 0.001). Conclusions: ARE procedures appear equally efficacious in both small and larger aortic roots. Although all 4 ARE techniques increased the annular diameter, only the Manougian, modified Bentall and aortoventriculoplasty procedures allowed for the implantation of a larger prosthetic valve. The Nicks procedure, which is likely the most commonly performed ARE, does not allow for the implantation of a larger prosthesis. Surgeon preference and patient factors may help in selecting the most appropriate ARE technique, as the modified Bentall and Manougian procedures achieved similar increases in valve size