identifying patients with relapsing remitting multiple sclerosis using algorithms applied to us integrated delivery network healthcare data

Abstract Background Relapsing-remitting multiple sclerosis (RRMS) has a major impact on affected patients; therefore, improved understanding of RRMS is important, particularly in the context of real-world evidence. Objectives To develop and validate algorithms for identifying patients with RRMS in both unstructured clinical notes found in electronic health records (EHRs) and structured/coded health care claims data. Methods US Integrated Delivery Network data (2010–2014) were queried for study inclusion criteria (possible multiple sclerosis [MS] base cohort): one or more MS diagnosis code, patients aged 18 years or older, 1 year or more baseline history, and no other demyelinating diseases. Sets of algorithms were developed to search narrative text of unstructured clinical notes (EHR clinical notes–based algorithms) and structured/coded data (claims-based algorithms) to identify adult patients with RRMS, excluding patients with evidence of progressive MS. Medical records were reviewed manually for algorithm validation. Positive predictive value was calculated for both EHR clinical notes–based and claims-based algorithms. Results From a sample of 5308 patients with possible MS, 837 patients with RRMS were identified using only the EHR clinical notes–based algorithms and 2271 patients were identified using only the claims-based algorithms; 779 patients were identified using both algorithms. The positive predictive value was 99.1% (95% confidence interval [CI], 94.2%–100%) for the EHR clinical notes–based algorithms and 94.6% (95% CI, 89.1%–97.8%) to 94.9% (95% CI, 89.8%–97.9%) for the claims-based algorithms. Conclusions The algorithms evaluated in this study identified a real-world cohort of patients with RRMS without evidence of progressive MS that can be studied in clinical research with confidence

Language and learning science in South Africa

South Africa is a multilingual country with 11 official languages. However, English dominates as the language of access and power and although the Language-in- Education Policy (1997) recommends school language policies that will promote additive bilingualism and the use of learners' home languages as languages of learning and teaching, there has been little implementation of these recommendations by schools. This is despite the fact that the majority of learners do not have the necessary English language proficiency to successfully engage with the curriculum and that teachers frequently are obliged to resort to using the learners' home language to mediate understanding. This research investigates the classroom language practices of six Grade 8 science teachers, teaching science through the medium of English where they and their learners share a common home language, Xhosa. Teachers' lessons were videotaped, transcribed and analysed for the opportunities they offered learners for language development and conceptual challenge. The purpose of the research is to better understand the teachers' perceptions and problems and to be able to draw on examples of good practice, to inform teacher training and to develop a coherent bilingual approach for teaching science through the medium of English as an additional language

Great Aunt Edna's vase: metaphor use in working with heritage language families

This article explores the use of a particular metaphor—Great Aunt Edna’s Vase—as a means to facilitating multilingual families in contextualizing and engaging with complex emotional connections as linked to language, identity, and belonging. Building from the premise that language is linked to the construction of identity, but that individual family members will have different views and opinions on the heritage language within this context, this article highlights the use of metaphors in family work, before introducing the metaphor of Great Aunt Edna’s Vase and situating it in relevant literature around language, heritage, and identity. The concepts introduced add to the existing body of literature in addressing the growing need for work specifically aimed at multilingual families, in a globally ever-more-diverse society, highlighting the links between language and well-being, and making a contribution to the global knowledge necessary for practitioners and families to explore these links successfully

In vitro irradiation of basement membrane enhances the invasiveness of breast cancer cells

Following removal of the primary breast tumour by conservative surgery, patients may still have additional malignant foci scattered throughout the breast. Radiation treatments are not designed to eliminate all these residual cancer cells. Rather, the radiation dose is calculated to optimise long-term results with minimal complications. In a tumour, cancer cells are surrounded by a basement membrane, which plays an important role in the regulation of gene expression. Using an invasion chamber, we have shown that irradiation before cell plating of a reconstituted basement membrane (Matrigel; Becton Dickinson, Bedford, MA, USA) increased the invasiveness of the breast cancer cells MDA-MB-231. This radiation enhancement of invasion was associated with the upregulation of the pro-invasive gene matrix metalloproteinase (MMP)-2. The expression of membrane type 1 matrix metalloproteinase (MT1-MMP) and tissue inhibitor of metalloproteinase-2 (TIMP), which are required to activate the MMP-2, were also increased. Confirming the role of MMP-2 and MT1-MMP, radiation enhancement of cancer cell invasion was prevented by an MMP-2 inhibitor and an anti-MT1-MMP antibody. This study also demonstrated that radiation can potentially enhance the invasion ability by inducing the release of pro-invasive factors stored in the Matrigel. Conversely, no enhancement of invasiveness was observed with the low metastatic cell line MCF-7. This lack of invasiveness correlated with the absence of the MMP-2 activator MT1-MMP in the MCF-7 cells. Radiotherapy is an efficient modality to treat breast cancer which could be further improved by inhibiting the pro-invasive gene upregulated by radiation

Language use in kindergarten science lessons:Language production and academic language during a video feedback coaching intervention in kindergarten science lessons

This paper aims to gain insight into language production and academic language of 4- and 5-year-old students and their teachers in the course of a teacher intervention during kindergarten science education. The study is based on videotaped classroom observations, and specifically focuses on the academic language use of students (Nintervention = 18, Ncontrols = 26) and teachers (Nintervention = 5, Ncontrols = 5). The results suggest that this general teacher intervention yields interesting changes in language use and production. Patterns of change over time confirm the idiosyncratic and non-linear nature of these changes. Science lessons represent an appropriate context in which to acquaint students with academic language, which can be used as a basis to build upon more sophisticated language skills