Policy Barriers to School Improvement: What's Real and What's Imagined?

Some of the most promising reforms are happening where school leaders are thinking differently about how to get the strongest student outcomes from the limited resources available. But even principals who use their autonomy to aggressively reallocate resources say that persistent district, state, and federal barriers prohibit them from doing more.What are these barriers? What do they block principals from doing? Is there a way around them?CRPE researchers probed these questions with principals in three states (NH, CT, MD). These principals cited numerous district, state, and federal barriers standing in the way of school improvement. The barriers, 128 in all, fell into three categories: 1) barriers to instructional innovations, 2) barriers to allocating resources differently, and 3) barriers to improving teacher quality.Upon investigation, researchers found that principals have far more authority than they think. Only 31% of the barriers cited were "real" -- immovable statutes, policies, or managerial directives that bring the threat of real consequences if broken.The report recommends educating principals on the authority they already possess, to help them find workarounds to onerous rules. The report also outlines a number of specific state and district policy changes to grant schools the autonomy they need to improve student outcomes

Subxiphoid Minimally Invasive Epicardial Ablation (Convergent Procedure) With Left Thoracoscopic Closure of the Left Atrial Appendage

The Convergent Procedure is a combined epicardial and endocardial ablation performed by a cardiac surgeon and electrophysiologist to treat symptomatic persistent and long standing persistent atrial fibrillation. The epicardial ablation is performed on the entire width of the posterior left atrial wall using monopolar radiofrequency via a subxiphoid incision. There is no sternotomy and cardiopulmonary bypass is not utilized. The surgical ablation is then followed by endocardial voltage mapping and ablation, allowing for complete lesion set creation. Left atrial appendage exclusion can be performed via left thoracoscopic approach at the same time as the surgical ablation. The Convergent Procedure is a truly hybrid, collaborative procedure which combines the strengths of minimally invasive cardiac surgery and percutaneous electrophysiologic techniques to treat a challenging disease process

Short and Intermediate Term Outcomes of the Convergent Procedure: Initial Experience in a Tertiary Referral Center

PURPOSE: The Convergent procedure is a hybrid, multidisciplinary treatment for symptomatic atrial fibrillation (AF) consisting of minimally invasive surgical epicardial ablation and percutaneous/catheter endocardial ablation. We investigated outcomes following introduction of the Convergent procedure at our institution. METHODS: Retrospective study examining single-center outcomes. Demographic, procedural, and post-procedural variables were collected with follow-up data obtained at 3, 6, and 12 months. RESULTS: In all, 36 patients with paroxysmal (11%) or persistent/long-standing persistent (89%) AF underwent the Convergent procedure. 36% also underwent concomitant left atrial appendage (LAA) exclusion by thoracoscopic placement of an epicardial clip. Mean age 60.6 ± 8.0 years with mean arrhythmia burden of 3.9 ± 2.7 years. All patients had failed prior attempts at medical management, 81% had failed prior cardioversion, and 17% had failed prior catheter ablation. Convergent was performed successfully in all patients with no peri-procedural deaths or major complications. At 3 and 12 months, 77.8% and 77.3% of patients, respectively, were free from symptomatic arrhythmia. 65.8% were off anti-arrhythmic medication at 12 months. CONCLUSIONS: The Convergent procedure is safe and has good short- and intermediate-term clinical success rates. This unique hybrid approach combines strengths of surgical and catheter ablation and should be part of any comprehensive AF treatment program

Current state-of-the-art of device therapy for advanced heart failure

Heart failure remains one of the most common causes of morbidity and mortality worldwide. The advent of mechanical circulatory support devices has allowed significant improvements in patient survival and quality of life for those with advanced or end-stage heart failure. We provide a general overview of past and current mechanical circulatory support devices encompassing options for both short- and long-term ventricular support

The Doctor is in, but is Academia? Re-Tooling IT Education for a New Era in Healthcare

Healthcare information technology is at a crossroads today. As legacy data systems converge with bleeding edge technologies, the technology environments of today’s hospitals and clinics are evolving rapidly, producing new care delivery models. As a result, we need to reassess how information technology education is meeting the needs of healthcare practitioners and institutions. The recent push to adopt Health Information Technology (HIT) with financial incentives and penalties attached was a bold move, but establishing policies is easier to pen than implement. The challenge faced by many healthcare organizations is the lack of technical and organizational infrastructure, as well as skilled man power. This special issue seeks to bring new approaches to the IT classroom, particularly with HIT curriculum, training, and education. Students entering the workforce or completing professional programs will have more career options with an understanding of how to leverage enabling technologies. Those in a healthcare management and leadership capacities will also benefit from this special edition as each of the articles presented address strategic level issues and the need for IT leadership in the planning and implementation of enterprise level systems, to ensure the safety, privacy and security off all patients are protected. The authors of this special issue offer interdisciplinary perspectives on key topics shaping HIT around the world. As members of academia, curriculum is at the heart of the matter and our authors offer justification and case studies on areas where academia needs to continue its growth to serve the healthcare industry

Crisaborole Ointment Improves Quality of Life of Patients with Mild to Moderate Atopic Dermatitis and Their Families.

IntroductionThe impact of crisaborole ointment, a nonsteroidal phosphodiesterase 4 inhibitor for the treatment of mild to moderate atopic dermatitis (AD), on quality of life (QoL) was assessed in two identically designed phase 3 studies (AD-301: NCT02118766; AD-302: NCT02118792, both at http://www.clinicaltrials.gov ).MethodsIn both studies, patients aged ≥ 2 years with mild to moderate AD per the Investigator's Static Global Assessment were randomly assigned 2:1 to receive crisaborole or vehicle twice daily for 28 days. QoL was assessed using the Children's Dermatology Life Quality Index (CDLQI) (2-15 years), the Dermatology Life Quality Index (DLQI) (≥ 16 years), and the Dermatitis Family Impact Questionnaire (DFI) (parents/caregivers/family of patients aged 2-17 years). Established QoL score severity bands provided clinical context.ResultsGreater mean improvement in QoL was observed in crisaborole-treated patients than in vehicle-treated patients at day 29 [mean change from baseline (∆BL), CDLQI: - 4.6 vs. - 3.0; P < 0.001; DLQI: - 5.2 vs. - 3.5; P = 0.015]. At baseline, more than half the patients had a "moderate effect" or higher of AD on QoL. At day 29, there was a trend toward more crisaborole- than vehicle-treated patients having "small effect" to "no effect", The QoL of parents/caregivers/family improved more for crisaborole-treated than for vehicle-treated patients (∆BL, DFI: - 3.7 vs. - 2.7; P = 0.003).ConclusionCrisaborole treatment results in clinically meaningful improvement in QoL for patients and their parents/caregivers/families.Trial registrationAD-301: http://www.clinicaltrials.gov , NCT02118766; AD-302: http://www.clinicaltrials.gov , NCT02118792.FundingAnacor Pharmaceuticals, Inc., a wholly owned subsidiary of Pfizer Inc., New York, NY

Aeroacoustic Data for a High Reynolds Number Axisymmetric Subsonic Jet

The near field fluctuating pressure and aerodynamic mean flow characteristics of a cold subsonic jet issuing from a contoured convergent nozzle are presented. The data are presented for nozzle exit Mach numbers of 0.30, 0.60, and 0.85 at a constant jet stagnation temperature of 104 F. The fluctuating pressure measurements were acquired via linear and semi-circular microphone arrays and the presented results include plots of narrowband spectra, contour maps, streamwise/azimuthal spatial correlations for zero time delay, and cross-spectra of the azimuthal correlations. A pitot probe was used to characterize the mean flow velocity by assuming the subsonic flow to be pressure-balanced with the ambient field into which it exhausts. Presented are mean flow profiles and the momentum thickness of the free shear layer as a function of streamwise position

Exploring structural and electronic effects in three isomers of tris{bis(trifluoromethyl)phenyl}borane: Towards the combined electrochemical-frustrated Lewis pair activation of H2

Three structural isomers of tris{bis(trifluoromethyl)phenyl}borane have been studied as the acidic com- ponent of frustrated Lewis pairs. While the 3,5-substituted isomer is already known to heterolytically cleave H2 to generate a bridging-hydride; ortho-substituents in the 2,4- and 2,5-isomers quench such reactivity through electron donation into the vacant boron pz orbital and steric blocking of the boron centre; as shown by electrochemical, structural and computational studies. Electrochemical studies of the corresponding borohydrides identify that the two-electron oxidation of terminal-hydrides occurs at more positive potentials than observed for [HB(C6F5)3]−, while the bridging-hydride oxidizes at a higher poten- tial still, comparable to that of free H2