The Transfer Playbook: Essential Practices For Two- And Four-year Colleges

Recognizing the critical need to help millions of community college students failed by current transfer practices and policies.  A new report provides a detailed guide for two- and four-year colleges on how to improve bachelor's degree outcomes for students who start at community college.Every year, millions of students aiming to attain a bachelor's degree attend community colleges because of their affordability and accessibility. Most will not realize their goals. While the vast majority of students report they want to earn a bachelor's degree, only 14 percent of degree-seeking students achieve that goal within six years, according to recent research from CCRC, Aspen, and the National Student Clearinghouse Research Center. The odds are worse for low-income students, first-generation college students, and students of color—those most likely to start at a community college

Ethical considerations in using brain stimulation to treat eating disorders

Eating disorders (EDs), such as anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) are characterized by pathological eating behaviors and body image disturbance. These disorders are associated with high levels of mortality and morbidity, as well as significantly impaired quality of life (Arcelus et al., 2011). EDs are often associated with young adulthood, with the disorder typically being first diagnosed when the person is 15–19 years old (Hoek and van Hoeken, 2003; Hudson et al., 2007). Recently, there has been increased interest in the neurobiology of EDs as an insight into the mechanisms of pathological eating behavior, and as a potential avenue for treatment (Kaye et al., 2010). Brain-based interventions for EDs have in the past involved highly invasive deep-brain stimulation (DBS), in which surgically implanted electrodes deliver electrical pulses to brain areas such as the cingulate cortex (Israel et al., 2010) or the nucleus accumbens (Wu et al., 2013). These surgeries have proved reasonably effective in the small number of reported cases. However DBS has a number of problems that make it less attractive as a treatment option: DBS exposes the person to the risks of surgery; the potential side-effects are more serious; and it is difficult to adjust or to reverse the treatment. For these reasons, there is much interest in a treatment that modulates brain activity but that does not expose the patient to such serious side-effects. There has recently been an increase in interest in the use of so-called non-invasive brain stimulation to treat EDs. These techniques, principally transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), use magnetic or electric fields to transfer energy across the skull, and so to modulate neural activity. Here, we explore the rationale for using TMS/tDCS in EDs, and argue that many ethical and safety issues must be clarified before widespread adoption of these techniques is possible

Physician Practice Patterns and Variation in the Delivery of Preventive Services

BACKGROUND: Strategies to improve preventive services delivery (PSD) have yielded modest effects. A multidimensional approach that examines distinctive configurations of physician attributes, practice processes, and contextual factors may be informative in understanding delivery of this important form of care. OBJECTIVE: We identified naturally occurring configurations of physician practice characteristics (PPCs) and assessed their association with PSD, including variation within configurations. DESIGN: Cross-sectional study. PARTICIPANTS: One hundred thirty-eight family physicians in 84 community practices and 4,046 outpatient visits. MEASUREMENTS: Physician knowledge, attitudes, use of tools and staff, and practice patterns were assessed by ethnographic and survey methods. PSD was assessed using direct observation of the visit and medical record review. Cluster analysis identified unique configurations of PPCs. A priori hypotheses of the configurations likely to perform the best on PSD were tested using a multilevel random effects model. RESULTS: Six distinct PPC configurations were identified. Although PSD significantly differed across configurations, mean differences between configurations with the lowest and highest PSD were small (i.e., 3.4, 7.7, and 10.8 points for health behavior counseling, screening, and immunizations, respectively, on a 100-point scale). Hypotheses were not confirmed. Considerable variation of PSD rates within configurations was observed. CONCLUSIONS: Similar rates of PSD can be attained through diverse physician practice configurations. Significant within-configuration variation may reflect dynamic interactions between PPCs as well as between these characteristics and the contexts in which physicians function. Striving for a single ideal configuration may be less valuable for improving PSD than understanding and leveraging existing characteristics within primary care practices

Investigating the experience of Moodle adoption through expert voices

Virtual learning environments (VLEs) such as Moodle are now widely used in universities and other organisations. One crucial factor in the successful employment of such platforms is the ability and commitment of teaching staff to adopt the system. Despite the importance of this role, there has been little work to examine the experience of using VLEs in practice. This paper presents initial, qualitative research aimed at understanding how Moodle is being used and the different experiences and perspectives of the staff involved. To generate themes and areas of interest for future investigation this paper uses interview data from two “expert witnesses” who have a deep understanding of how the platform is used. Emergent themes include: divergence between confident and basic users; the spread of usage within an academic community; lack of progression to innovative teaching methods

Impact of the introduction of pneumococcal conjugate vaccine on immunization coverage among infants

Background The introduction of pneumococcal conjugate vaccine (PCV) to the U.S. recommended childhood immunization schedule in the year 2000 added three injections to the number of vaccinations a child is expected to receive during the first year of life. Surveys have suggested that the addition of PCV has led some immunization providers to move other routine childhood vaccinations to later ages, which could increase the possibility of missing these vaccines. The purpose of this study was to evaluate whether introduction of PCV affected immunization coverage for recommended childhood vaccinations among 13-month olds in four large provider groups. Methods In this retrospective cohort study, we analyzed computerized data on vaccinations for 33,319 children in four large provider groups before and after the introduction of PCV. The primary outcome was whether the child was up to date for all non-PCV recommended vaccinations at 13 months of age. Logistic regression was used to evaluate the association between PCV introduction and the primary outcome. The secondary outcome was the number of days spent underimmunized by 13 months. The association between PCV introduction and the secondary outcome was evaluated using a two-part modelling approach using logistic and negative binomial regression. Results Overall, 93% of children were up-to-date at 13 months, and 70% received all non-PCV vaccinations without any delay. Among the entire study population, immunization coverage was maintained or slightly increased from the pre-PCV to post-PCV periods. After multivariate adjustment, children born after PCV entered routine use were less likely to be up-to-date at 13 months in one provider group (Group C: OR = 0.5; 95% CI: 0.3 – 0.8) and were less likely to have received all vaccine doses without any delay in two Groups (Group B: OR = 0.4, 95% CI: 0.3 – 0.6; Group C: OR = 0.5, 95% CI: 0.4 – 0.7). This represented 3% fewer children in Group C who were up-to-date and 14% (Group C) to 16% (Group B) fewer children who spent no time underimmunized at 13 months after PCV entered routine use compared to the pre-PCV baseline. Some disruptions in immunization delivery were also observed concurrent with temporary recommendations to suspend the birth dose of hepatitis B vaccine, preceding the introduction of PCV. Conclusion These findings suggest that the introduction of PCV did not harm overall immunization coverage rates in populations with good access to primary care. However, we did observe some disruptions in the timely delivery of other vaccines coincident with the introduction of PCV and the suspension of the birth dose of hepatitis B vaccine. This study highlights the need for continued vigilance in coming years as the U.S. introduces new childhood vaccines and policies that may change the timing of existing vaccines

Evaluation of Sexual Communication Message Strategies

Parent-child communication about sex is an important proximal reproductive health outcome. But while campaigns to promote it such as the Parents Speak Up National Campaign (PSUNC) have been effective, little is known about how messages influence parental cognitions and behavior. This study examines which message features explain responses to sexual communication messages

Evaluation of Sexual Communication Message Strategies

Parent-child communication about sex is an important proximal reproductive health outcome. But while campaigns to promote it such as the Parents Speak Up National Campaign (PSUNC) have been effective, little is known about how messages influence parental cognitions and behavior. This study examines which message features explain responses to sexual communication messages

IL8 polymorphisms and overall survival in pazopanib- or sunitinib-treated patients with renal cell carcinoma.

BACKGROUND: We evaluated germline single nucleotide polymorphisms (SNPs) for association with overall survival (OS) in pazopanib- or sunitinib-treated patients with advanced renal cell carcinoma (aRCC). METHODS: The discovery analysis tested 27 SNPs within 13 genes from a phase III pazopanib trial (N=241, study 1). Suggestive associations were then pursued in two independent datasets: a phase III trial (COMPARZ) comparing pazopanib vs sunitinib (N=729, study 2) and an observational study of sunitinib-treated patients (N=89, study 3). RESULTS: In study 1, four SNPs showed nominally significant association (P≤0.05) with OS; two of these SNPs (rs1126647, rs4073) in IL8 were associated (P≤0.05) with OS in study 2. Because rs1126647 and rs4073 were highly correlated, only rs1126647 was evaluated in study 3, which also showed association (P≤0.05). In the combined data, rs1126647 was associated with OS after conservative multiple-test adjustment (P=8.8 × 10(-5); variant vs reference allele hazard ratio 1.32, 95% confidence interval: 1.15-1.52), without evidence for heterogeneity of effects between studies or between pazopanib- and sunitinib-treated patients. CONCLUSIONS: Variant alleles of IL8 polymorphisms are associated with poorer survival outcomes in pazopanib- or sunitinib-treated patients with aRCC. These findings provide insight in aRCC prognosis and may advance our thinking in development of new therapies

An inexact dual logarithmic barrier method for solving sparse semidefinite programs

A dual logarithmic barrier method for solving large, sparse semidefinite programs is proposed in this paper. The method avoids any explicit use of the primal variable X and therefore is well-suited to problems with a sparse dual matrix S. It relies on inexact Newton steps in dual space which are computed by the conjugate gradient method applied to the Schur complement of the reduced KKT system. The method may take advantage of low-rank representations of matrices Ai to perform implicit matrix-vector products with the Schur complement matrix and to compute only specific parts of this matrix. This allows the construction of the partial Cholesky factorization of the Schur complement matrix which serves as a good preconditioner for it and permits the method to be run in a matrix-free scheme. Convergence properties of the method are studied and a polynomial complexity result is extended to the case when inexact Newton steps are employed. A Matlab-based implementation is developed and preliminary computational results of applying the method to maximum cut and matrix completion problems are reported

Urinary albumin/creatinine ratio tertiles predict risk of diabetic retinopathy progression: a natural history study from the Adolescent Cardio-Renal Intervention Trial (AdDIT) observational cohort

Aims/hypothesis: We hypothesised that adolescents with type 1 diabetes with a urinary albumin/creatinine ratio (ACR) in the upper tertile of the normal range (high ACR) are at greater risk of three-step diabetic retinopathy progression (3DR) independent of glycaemic control. Methods: This was a prospective observational study in 710 normoalbuminuric adolescents with type 1 diabetes from the non-intervention cohorts of the Adolescent Cardio-Renal Intervention Trial (AdDIT). Participants were classified as ‘high ACR’ or ‘low ACR’ (lowest and middle ACR tertiles) using baseline standardised log10 ACR. The primary outcome, 3DR, was determined from centrally graded, standardised two-field retinal photographs. 3DR risk was determined using multivariable Cox regression for the effect of high ACR, with HbA1c, BP, LDL-cholesterol and BMI as covariates; diabetes duration was the time-dependent variable. Results: At baseline mean ± SD age was 14.3 ± 1.6 years and mean ± SD diabetes duration was 7.2 ± 3.3 years. After a median of 3.2 years, 83/710 (12%) had developed 3DR. In multivariable analysis, high ACR (HR 2.1 [1.3, 3.3], p=0.001), higher mean IFCC HbA1c (HR 1.03 [1.01, 1.04], p=0.001) and higher baseline diastolic BP SD score (HR 1.43 [1.08, 1.89], p=0.01) were independently associated with 3DR risk. Conclusions/interpretation: High ACR is associated with greater risk of 3DR in adolescents, providing a target for future intervention studies