Fostering Academic and Social Growth in a Primary Literacy Workshop Classroom: Restorying Students with Negative Reputations

In most classrooms, there are students who have academic, behavioral, and/or interpersonal challenges that can disrupt the classroom community. In some cases, these challenges can build momentum, leading to a negative reputation or “story” that can follow the student throughout school. This academic, yearlong case study focused on Mae Graham, an exemplary teacher, and the cases of two students who began second grade with negative behavioral, emotional, and academic reputations from previous years in school. We describe how Mae “restoried” the students through personalized instruction and attention, classroom structure and curriculum, and social interactions in the classroom. We base restorying on theory and research in social identification, effective teaching, culturally responsive/relevant pedagogy, and the ethic of care

Ophthalmic and clinical factors that predict four-year development and worsening of diabetic retinopathy in type 1 diabetes

To investigate the role of ophthalmic imaging markers - namely retinal thickness measures and corneal nerve morphology - in predicting four-year development and worsening of diabetic retinopathy (DR) in type 1 diabetes (T1DM).126 eyes of 126 participants with T1DM were examined at baseline and after four years. Diabetic retinopathy (DR) was graded using the Early Treatment Diabetic Retinopathy Study scale. HbA1c, nephropathy, neuropathy, cardiovascular factors, and retinal thickness using optical coherence tomography (OCT) and corneal nerve fiber length (CNFL) using corneal confocal microscopy at baseline were assessed by univariate and step-wise multiple logistic regression, and their diagnostic capabilities for single and combined measures.Four-year development of DR was 19% (13 of 68 without DR at baseline). Worsening of DR was seen in 43% (25 of 58 with DR at baseline). When adjusted for potential confounders, a lower CNFL (AUC=0.637, p=0.040, 64% sensitivity and 64% specificity at 14.9mm/mm(2) cut-off), higher triglycerides (AUC=0.669, p=0.012, 64% sensitivity, 62% specificity at 0.85mmol/L) and an elevated vibration threshold (AUC=0.708, p=0.002, 96% sensitivity, 40% specificity at 3.55Hz) were significant predictors for four-year worsening of DR.Reduced CNFL, elevated vibration perception threshold and higher triglycerides can predict future worsening of DR

Musculoskeletal deformities following repair of large congenital diaphragmatic hernias

Split-abdominal wall muscle flap Purpose: Large congenital diaphragmatic hernias (CDH) can be repaired with either a muscle flap or prosthetic patch. The purpose of this study was to assess the frequency and severity of scoliosis, chest wall, and abdominal wall deformities following these repairs. Methods: Neonates who underwent CDH repair (1989-2012) were retrospectively reviewed. We then validated our retrospective review by comparing results of a focused radiologic evaluation and clinical examination of patients with large defects seen in prospective follow-up clinic. Tests for association were made using Fisher's exact test. Results: 236 patients survived at least 1 year. Of these patients, 30 had a muscle flap, and 13 had a patch repair. Retrospectively, we identified pectus in 9% of primary repairs, 47% of flap repairs, and 54% of patch repairs. We identified scoliosis in 7% of primary repairs, 13% of flap repairs, and 15% of patch repairs. Prospectively, 75% of flap patients and 67% of patch patients had pectus and 13% of flap patients and 33% of patch patients had scoliosis. There was no significant difference between flap and patch patients. Conclusions: Scoliosis and pectus deformity were common in children with large CDH. The operative technique did not appear to affect the incidence of subsequent skeletal deformity. © 2014 Elsevier Inc. All rights reserved. Large congenital diaphragmatic hernias (CDHs) require repair with either a patch or an autologous tissue transfer. Repair with a prosthetic patch is the technique used by most surgeons Methods Study population After obtaining approval from the Institutional Review Board, a retrospective review of all children with CDH repair at our regional tertiary care children's hospital from 1989 to 2012 was performed. The patients were categorized by the technique of their repair. Repair types included primary repair, split abdominal wall muscle flap and synthetic patch. Paper and electronic medical records were reviewed to obtain demographic data, and diagnosis of skeletal deformities as well as any treatment for the skeletal deformities. Electronic charts were searched for the key words "pectus" and "scoliosis," and those specific notes were reviewed. These diagnoses were made by a variety of physicians including radiologists, orthopedists and primary care physicians and were not always confirmed by a focused follow-up visit by a pediatric surgeon. In order to check the validity of our retrospective review, patients with large defects were seen prospectively for focused follow-up and a single pediatric radiologist (G.H.) reviewed the most current chest radiograph to evaluate for scoliosis greater than 10 degrees. The results of follow-up were correlated with our retrospective review

Morphometric Stability of the Corneal Subbasal Nerve Plexus in Healthy Individuals: A 3-Year Longitudinal Study Using Corneal Confocal Microscopy

PURPOSE. We examined the age-dependent alterations and longitudinal course of subbasal nerve plexus (SNP) morphology in healthy individuals. METHODS. Laser-scanning corneal confocal microscopy, ocular screening, and health and metabolic assessment were performed on 64 healthy participants at baseline and at 12-month intervals for 3 years. At each annual visit, eight central corneal images of the SNP were selected and analyzed using a fully-automated analysis system to quantify corneal nerve fiber length (CNFL). Two linear mixed model approaches were fitted to examine the relationship between age and CNFL, and the longitudinal changes of CNFL over three years. RESULTS. At baseline, mean age was 51.9 6 14.7 years. The cohort was sex balanced (v 2 ¼ 0.56, P ¼ 0.45). Age (t ¼ 1.6, P ¼ 0.12) and CNFL (t ¼ À0.50, P ¼ 0.62) did not differ between sexes. A total of 52 participants completed the 36-month visit and 49 participants completed all visits. Age had a significant effect on CNFL (F CONCLUSIONS. The CNFL showed a stable course over a 36-month period in healthy individuals, although there was a slight linear reduction in CNFL with age. The findings of this study have implications for understanding the time-course of the effect of pathology and surgical or therapeutic interventions on the morphology of the SNP, and serves to confirm the suitability of CNFL as a screening/monitoring marker for peripheral neuropathies

Investigating the Genetics of Chronic Intractable Migraine with Reactive Hypoglycemia

Migraines affect roughly 1-in-6 males and 1-in-5 females in the United States. Of these, approximately 5-30% experience intractable migraines, or migraines resistant to abortive treatments. Despite this large population, relatively little is known about intractable migraines compared to other types of migraines. Our recent work indicates that reactive hypoglycemia is common among these individuals. Additionally, empirical evidence suggests that individuals in families with chronic intractable migraines are more likely to have the same condition than people of the general population, suggesting a possible genetic link between both migraines and metabolic abnormalities. Previous Genome Wide Association Studies (GWAS) have found several genetic markers for migraines, but the studies have not differentiated groups by important factors including severity and frequency of migraines or treatment response. Furthermore, GWA studies investigate only common variation. Despite these limitations, a variant in the LEPR gene (rs751167), the leptin receptor gene was found to be significantly associated with migraines. Variants in the LEPR gene are associated with weight gain and metabolic syndrome, indicating a link between metabolism and migraines. In the present study, we aim to broaden the scope, investigating chronic intractable migraine with reactive hypoglycemia specifically, and using all variant types including small insertions/deletions, rare variants, and copy number variants. To investigate heritability, we will take pedigrees of individuals that fit this phenotype

Outpatient Opioid Prescriptions are Associated with Future Substance use Disorders and Overdose Following Adolescent Trauma

Objective: This study aims to determine if outpatient opioid prescriptions are associated with future substance use disorder (SUD) diagnoses and overdose in injured adolescents five years following hospital discharge. Summary Background Data: Approximately, 1 in 8 adolescents are diagnosed with an SUD and 1 in 10 experience an overdose in the five years following injury. State laws have become more restrictive on opioid prescribing by acute care providers for treating pain, however, prescriptions from other outpatient providers are still often obtained. Methods: This was a retrospective cohort study of patients ages 12–18 admitted to two level I trauma centers. Demographic and clinical data contained in trauma registries were linked to a regional database containing five years of electronic health records and prescription data. Regression models assessed whether number of outpatient opioid prescription fills after discharge at different time points in recovery were associated with a new SUD diagnosis or overdose, while controlling for demographic and injury characteristics, as well as depression and PTSD diagnoses. Results: We linked 669 patients (90.9%) from trauma registries to a regional health information exchange database. Each prescription opioid refill in the first 3 months after discharge increased the likelihood of new SUD diagnoses by 55% (OR:1.55, CI:1.04–2.32). Odds of overdose increased with ongoing opioid use over 2–4 years post-discharge (p = 0.016–0.025). Conclusions: Short-term outpatient opioid prescribing over the first few months of recovery had the largest effect on developing an SUD, while long-term prescription use over multiple years was associated with a future overdose

Causes of death and associated conditions (Codac): a utilitarian approach to the classification of perinatal deaths.

A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD), although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes.We tested the Causes of Death and Associated Conditions (Codac) classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions.The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies), two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy), a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal).For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured.The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions associated with them, and the most common clinical scenarios for future study and comparisons.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

The retirement experiences of elite female gymnasts: Self identity and the physical self

This study explored experiences of retirement from elite sport among a sample of retired female gymnasts. Given the young age at which female gymnasts begin and end their sport careers, particular attention was afforded to the role of identity and the physical self in the process of adaptation. Retrospective, semi-structured interviews were conducted and interview transcripts analyzed using interpretative phenomenological analysis. Analysis indicated that retirement from gymnastics engendered adjustment difficulties for six of the seven participants. Identity loss was particularly salient, and for two gymnasts, physical changes associated with retirement were a further source of distress. The challenge of athletic retirement was intensified because the gymnasts had heavily invested in sport during adolescence, a period demarcated for the pursuit of an identity. Furthermore, their retirement coincided with a time when adolescents typically undergo profound changes physiologically. Practical suggestions to facilitate athletes' disengagement from sport are discussed

SARS-CoV-2 RNA detected in blood products from patients with COVID-19 is not associated with infectious virus

Background: Laboratory diagnosis of SARS-CoV-2 infection (the cause of COVID-19) uses PCR to detect viral RNA (vRNA) in respiratory samples. SARS-CoV-2 RNA has also been detected in other sample types, but there is limited understanding of the clinical or laboratory significance of its detection in blood. Methods: We undertook a systematic literature review to assimilate the evidence for the frequency of vRNA in blood, and to identify associated clinical characteristics. We performed RT-PCR in serum samples from a UK clinical cohort of acute and convalescent COVID-19 cases (n=212), together with convalescent plasma samples collected by NHS Blood and Transplant (NHSBT) (n=462 additional samples). To determine whether PCR-positive blood samples could pose an infection risk, we attempted virus isolation from a subset of RNA-positive samples. Results: We identified 28 relevant studies, reporting SARS-CoV-2 RNA in 0-76% of blood samples; pooled estimate 10% (95%CI 5-18%). Among serum samples from our clinical cohort, 27/212 (12.7%) had SARS-CoV-2 RNA detected by RT-PCR. RNA detection occurred in samples up to day 20 post symptom onset, and was associated with more severe disease (multivariable odds ratio 7.5). Across all samples collected ≥28 days post symptom onset, 0/494 (0%, 95%CI 0-0.7%) had vRNA detected. Among our PCR-positive samples, cycle threshold (ct) values were high (range 33.5-44.8), suggesting low vRNA copy numbers. PCR-positive sera inoculated into cell culture did not produce any cytopathic effect or yield an increase in detectable SARS-CoV-2 RNA. Conclusions: vRNA was detectable at low viral loads in a minority of serum samples collected in acute infection, but was not associated with infectious SARS-CoV-2 (within the limitations of the assays used). This work helps to inform biosafety precautions for handling blood products from patients with current or previous COVID-19