A workbook of exercises for following directions to be used with high achieving children in grades one, three and five

Thesis (Ed.M.)--Boston Universit

Validity, Significance, Strengths, Limitations, and Evidentiary Value of Real-World Clinical Data for Combination Therapy in Alzheimer's Disease: Comparison of Efficacy and Effectiveness Studies

Background: Randomized controlled efficacy trials (RCTs), the scientific gold standard, are required for regulatory approval of Alzheimer's disease (AD) interventions, yet provide limited information regarding real-world therapeutic effectiveness. Objective: To compare the nature of evidence regarding the combination of approved AD treatments from RCTs versus long-term observational controlled studies (LTOCs). Methods: Comparisons of strengths, limitations, and evidence level for monotherapy [cholinesterase inhibitor (ChEI) or memantine] and combination therapy (ChEI + memantine) in RCTs versus LTOCs. Results: RCTs examined highly selected populations over months. LTOCs collected data across multiple AD stages in large populations over many years. RCTs and LTOCs show similar patterns favoring combination over monotherapy over placebo/no treatment. Long-term combination therapy compared to monotherapy reduced cognitive and functional decline and delayed time to nursing home admission. Persistent treatment was associated with slower decline. While LTOCs used control groups, adjusted for multiple covariates, had higher external validity, and favorable ethical, practical and cost considerations, their limitations included potential selection bias due to lack of placebo comparisons and randomization. Conclusions: Naturalistic LTOCs provide complementary long-term level II evidence to complement level I evidence from short-term RCTs regarding therapeutic effectiveness in AD that may otherwise be unobtainable. A coordinated strategy/consortium to pool LTOC data from multiple centers to estimate long-term comparative effectiveness, risks/benefits, and costs of AD treatments is needed

DISTRIBUTION AND STATUS OF THE SUWANNEE COOTER, PSEUDEMYS CONCINNA SUWANNIENSIS, IN THE ALAFIA RIVER (HILLSBOROUGH COUNTY, FLORIDA, USA)

The Suwannee Cooter, Pseudemys concinna suwanniensis, is a geographically limited turtle of conservation concern that inhabits Florida rivers draining into the northeastern Gulf of Mexico. Threats impacting its conservation status include take for human consumption, predation of turtles and nests, loss or degradation of nesting and basking habitat, water quality degradation, and boat strikes. Our surveys revealed that the Alafia River, which drains into Hillsborough Bay (northeastern Tampa Bay), is likely the stronghold of the southern distribution of P. c. suwanniensis. Multiple survey methods during 2015-2020 revealed that a substantial population of Suwannee Cooters inhabits much of this blackwater river system, including the main channel and at least one of its two primary tributaries. GIS analysis showed that more than half of the shoreline within the occupied extent is currently protected by conservation lands, although additional protection of private lands and improved habitat management protocols are needed to assure the population’s conservation

Reducing MCPA herbicide pollution at catchment scale using an agri-environmental scheme

Publication history: Accepted - 16 May 2022; Published online - 20 May 2022.In river catchments used as drinking water sources, high pesticide concentrations in abstracted waters require an expensive treatment step prior to supply. The acid herbicide 2-methyl-4-chlorophenoxyacetic acid (MCPA) is particularly problematic as it is highly mobile in the soil-water environment following application. Here, an agri-environmental scheme (AES) was introduced to a large-scale catchment (384 km2) to potentially reduce the burden of pesticides in the water treatment process. The main measure offered was contractor application of glyphosate by weed wiping as a substitute for boom spraying of MCPA, supported by educational and advisory activities. A combined innovation applied in the assessment was, i) a full before-after-control-impact (BACI) framework over four peak application seasons (April to October 2018 to 2021) where a neighbouring catchment (386 km2) did not have an AES and, ii) an enhanced monitoring approach where river discharge and MCPA concentrations were measured synchronously in each catchment. During peak application periods the sample resolution was every 7 h, and daily during quiescent winter periods. This sampling approach enabled flow- and time-weighted concentrations to be established, and a detailed record of export loads. These loads were up to 0.242 kg km−2 yr−1, and over an order of magnitude higher than previously reported in the literature. Despite this, and accounting for inter-annual and seasonal variations in river discharges, the AES catchment indicated a reduction in both flow- and time-weighted MCPA concentration of up to 21% and 24%, respectively, compared to the control catchment. No pollution swapping was detected. Nevertheless, the percentage of MCPA occurrences above a 0.1 μg L−1 threshold did not reduce and so the need for treatment was not fully resolved. Although the work highlights the advantages of catchment management approaches for pollution reduction in source water catchments, it also indicates that maximising participation will be essential for future AES.This work was carried out as part of Source to Tap (IVA5018), a project supported by the European Union's INTERREG VA Programme, managed by the Special EU Programmes Body (SEUPB)

Increased Susceptibility to Dextran Sulfate Sodium Induced Colitis in the T Cell Protein Tyrosine Phosphatase Heterozygous Mouse

T cell protein tyrosine phosphatase (TC-PTP / PTPN2) is an enzyme that is essential for the proper functioning of the immune system and that participates in the control of cell proliferation, and inflammation. We previously observed that TC-PTP−/− mice display various immunodeficiencies, hypersensitivity to LPS and die within three weeks of birth due to anemia and widespread inflammation. A recent analysis of the Wellcome Trust Case Control Consortium (WTCC) genome wide scan data, reported in 2007, indicated a potential role for TC-PTP in inflammatory bowel disease (IBD). To further investigate the potential role of TC-PTP in IBD, we studied heterozygous TC-PTP mutant mice challenged with dextran sulfate sodium (DSS) in their drinking water. In comparison to control animals, we observed significant changes in the colon mucosa of DSS-treated TC-PTP+/− mice, in the ratio of colon to body weight, as well as an up-regulation of mRNA transcripts for IL-6, IL-23, 1L-12β, IFN-γ, TNF-α. Moreover, up-regulation of serum IL-6 levels in DSS-treated TC-PTP+/− mice confirms that mice with a single copy of the TC-PTP gene display increased susceptibility to systemic inflammation due to bowel epithelial erosion resulting from DSS challenge. Our findings support the lack of modulation of Janus kinases 1 and 3 (Jak1, Jak3), and the downstream signal transducer and activator of transcription 1,3 and 5 (Stat1, Stat3, Stat 5) by PTPN2 in the development of IBD like condition. Pathological and molecular analysis reveal that the deficiency of TC-PTP results in pro-inflammatory condition in the bowel of heterozygous TC-PTP+/− mice. These novel findings in TC-PTP hemi-deficiency support the hypothesis that TC-PTP is an important regulator of inflammatory cytokine signaling and that it may be implicated in the pathophysiology of IBD

The Effect of Pre-Diagnostic Alcohol Consumption on Survival after Breast Cancer in Young Women.

Background: Alcohol consumption has been comprehensively investigated as an etiologic risk factor for breast cancer but has received little attention in terms of its impact on prognosis after breast cancer, particularly for young women. Methods: 1286 women diagnosed with invasive breast cancer at or before 45 years of age from two population-based case-control studies in the Seattle-Puget Sound region were followed from their diagnosis of breast cancer (between January 1983 and December 1992) for survival through June 2002, during which time 364 women had died. Cox proportional hazards modeling was used to assess the effect of pre-diagnostic alcohol consumption on the risk of dying. Results: After adjusting for age and diagnosis year, compared to non-drinkers, women who consumed alcohol in the 5 years prior to diagnosis had a decreased risk of death [>0 to <3 drinks per week: HR(hazard ratio) = 0.7 (95% CI: 0.6-0.95); 3 to <7 drinks per week: RR = 0.6 (95% CI: 0.4-0.8); ≥ 7 drinks per week: RR = 0.7 (95% CI: 0.5-0.9)]. This association was unchanged upon additional adjustment for potential confounders including most notably treatment, stage at diagnosis, and mammogram history. Conclusion: These results suggest that women who consume alcohol prior to a diagnosis of breast cancer have improved survival which does not appear to be attributable to differences in stage, screening or treatment

Risk Factors for Triple-Negative Breast Cancer in Women Under Age 45

Little is known about the etiologic profile of triple-negative breast cancer (negative for estrogen receptor/progesterone receptor/human epidermal growth factor), a breast cancer subtype associated with high mortality and inadequate therapeutic options. We undertook this study to assess the risk for triple-negative breast cancer among women 45 years of age and younger in relation to demographic/lifestyle factors, reproductive history, and oral contraceptive use. Study participants were ascertained in two previous population-based, case-control studies. Eligible cases included all primary invasive breast cancers among women ages 20 to 45 years in the Seattle-Puget Sound area, diagnosed between January 1983 and December 1992, for whom complete data was obtained for estrogen receptor, progesterone receptor, and human epidermal growth factor status (n = 897; including n = 187 triple-negative breast cancer cases). Controls were age matched and ascertained via random digit dialing. Oral contraceptive use >/=1 year was associated with a 2.5-fold increased risk for triple-negative breast cancer (95% confidence interval, 1.4-4.3) and no significantly increased risk for non-triple-negative breast cancer (Pheterogeneity = 0.008). Furthermore, the risk among oral contraceptive users conferred by longer oral contraceptive duration and by more recent use was significantly greater for triple-negative breast cancer than non-triple-negative breast cancer (Pheterogeneity = 0.02 and 0.01, respectively). Among women /=1 year was 4.2 (95% confidence interval, 1.9-9.3), whereas there was no significantly increased risk with oral contraceptive use for non-triple-negative breast cancer among women </=40 years, nor for triple-negative breast cancer or non-triple-negative breast cancer among women 41 to 45 years of age. In conclusion, significant heterogeneity exists for the association of oral contraceptive use and breast cancer risk between triple-negative breast cancer and non-triple-negative breast cancer among young women, lending support to a distinct etiology

Clinical supervision: A panacea for missed care

© 2020 John Wiley & Sons Ltd Aim: Clinical supervision is proposed as a solution-focused approach that supports nurses in busy health care environments, helping address the mounting incidents of missed care. Background: The pervasive nature of missed nursing care is concerning. The growing body of evidence on missed care predominantly focuses on types and causes. However, the effectiveness of solution-focused interventions used to reduce incidents of missed care has received less attention. Methods: Drawing on the literature, it is proposed that clinical supervision supports personal and professional development, positive working environments and quality patient care outcomes, and therefore reduces missed care incidents. Results: Clinical supervision fosters a supportive working environment where opportunities to critically reflect on caring values are provided, commitment to improving standards of care is nurtured, and courage to challenge care standards is encouraged. Conclusion: In an era of reports highlighting declining standards of nursing care and a wealth of evidence highlighting the benefits of clinical supervision, it remains underused in many areas of nursing. Implications for Nursing Management: Nurse managers need to recognize the value of clinical supervision in improving standards of nursing care and assume leadership in its successful implementation

Are agri‐environment schemes successful in delivering conservation grazing management on saltmarsh?

1.Grasslands occur around the globe and, in temperate regions, their natural management by fire, drought and wild herbivores has largely been replaced by grazing with domestic livestock. Successful management for agriculture is not always suitable for conservation and can have a detrimental effect on biodiversity. Conservation grazing of saltmarshes, delivered through agri‐environment schemes, may provide a solution to counteract biodiversity loss by providing farmers with financial incentives to graze these internationally important coastal wetlands more sensitively. 2.To assess whether conservation grazing is being achieved, and whether agri‐environment schemes are effective in delivering this management, we conducted a national survey on English saltmarshes, scoring the management on each site as optimal, suboptimal or detrimental in terms of suitability for achieving conservation aims for five aspects of grazing: presence, stock type, intensity, timing and habitat impact. 3.Although most saltmarshes suitable for grazing in England were grazed, conservation grazing was not being achieved. Sites under agri‐environment management for longer did score higher and approached optimal levels in terms of grazing intensity in one region, but sites with agri‐environment agreements were no more likely to be grazed at optimal conservation levels than sites without them overall, indicating that agri‐environment schemes, in their current form, are an ineffective delivery mechanism for conservation grazing on saltmarsh. 4.The low specificity of agri‐environment prescription wording may contribute to this failure, with prescriptions either being vague or specifying suboptimal or detrimental management objectives, particularly for grazing intensity, timing and stock type. These objectives are often set too high or too low, during unsuitable periods, or using stock types inappropriate for achieving conservation aims. 5.Synthesis and applications. Our national survey indicates that agri‐environment schemes are not currently delivering conservation grazing on English saltmarshes. Agri‐environment schemes are the only mechanism through which such grazing can be implemented on a national scale, so improving their effectiveness is a priority. Policymakers, researchers and managers need to work together to ensure better translation of conservation guidelines into schemes, increasing the specificity of management prescriptions and improving understanding of the need for management measures. A more detailed and reliable system of auditing to ensure that management activities are taking place would be beneficial, or alternatively moving to a results‐based scheme where payments are made on desirable outcomes rather than on evidence of management