Sustaining a Balanced Calendar in Hopewell City Public Schools

As the first school division in Virginia to implement a division-wide year-round school calendar, Hopewell City Public schools requested assistance in evaluating the impact of their work. In light of the COVID-19 pandemic the division paused implementation, shifting the focus of the study from evaluation to providing recommendations for structural, philosophical, and fiscal changes to the year round calendar initiative and its associated communication plan that would positively impact the long term sustainability of the initiative. The study employed a mixed methods approach including survey and focus group data along with an extensive literature review, and internal document and analysis. Findings suggested that creating structures to ensure sound instructional leadership during intersession instruction and the creation of career and life readiness pathways through vertical and horizontal intersession planning are critical in driving positive student outcomes. Additional findings identified a community where members that indicated they understood the initiative were more likely to support the initiative, and a cost analysis found stable and sustainable fiscal management. These findings were used first to inform a recommendation for a distributed leadership approach to monitoring student progress and effective intersession pedagogy. Further, recommendations informed the development of a communication plan designed to increase awareness and sustainable community support by celebrating and showcasing growth in students’ life and career readiness skills. By ensuring the recommended instructional and communication conditions Hopewell City Public Schools will be able to sustain internal and external support for the Balanced Calendar initiative over time

Processes to manage analyses and publications in a phase III multicenter randomized clinical trial

Background: The timely publication of findings in peer-reviewed journals is a primary goal of clinical research. In clinical trials, the processes leading to publication can be complex from choice and prioritization of analytic topics through to journal submission and revisions. As little literature exists on the publication process for multicenter trials, we describe the development, implementation, and effectiveness of such a process in a multicenter trial. Methods: The Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C) trial included a data coordinating center (DCC) and clinical centers that recruited and followed more than 1,000 patients. Publication guidelines were approved by the steering committee, and the publications committee monitored the publication process from selection of topics to publication. Results: A total of 73 manuscripts were published in 23 peer-reviewed journals. When manuscripts were closely tracked, the median time for analyses and drafting of manuscripts was 8 months. The median time for data analyses was 5 months and the median time for manuscript drafting was 3 months. The median time for publications committee review, submission, and journal acceptance was 7 months, and the median time from analytic start to journal acceptance was 18 months. Conclusions: Effective publication guidelines must be comprehensive, implemented early in a trial, and require active management by study investigators. Successful collaboration, such as in the HALT-C trial, can serve as a model for others involved in multidisciplinary and multicenter research programs. Trial registration The HALT-C Trial was registered with clinicaltrials.gov (NCT00006164)

The clinical burden of malaria in Nairobi: a historical review and contemporary audit

<p>Abstract</p> <p>Background</p> <p>Widespread urbanization over the next 20 years has the potential to drastically change the risk of malaria within Africa. The burden of the disease, its management, risk factors and appropriateness of targeted intervention across varied urban environments in Africa remain largely undefined. This paper presents a combined historical and contemporary review of the clinical burden of malaria within one of Africa's largest urban settlements, Nairobi, Kenya.</p> <p>Methods</p> <p>A review of historical reported malaria case burdens since 1911 within Nairobi was undertaken using archived government and city council reports. Contemporary information on out-patient case burdens due to malaria were assembled from the National Health Management and Information System (HMIS). Finally, an audit of 22 randomly selected health facilities within Nairobi was undertaken covering 12 months 2009-2010. The audit included interviews with health workers, and a checklist of commodities and guidelines necessary to diagnose, treat and record malaria.</p> <p>Results</p> <p>From the 1930's through to the mid-1960's malaria incidence declined coincidental with rapid population growth. During this period malaria notification and prevention were a priority for the city council. From 2001-2008 reporting systems for malaria were inadequate to define the extent or distribution of malaria risk within Nairobi. A more detailed facility review suggests, however that malaria remains a common diagnosis (11% of all paediatric diagnoses made) and where laboratories (n = 15) exist slide positivity rates are on average 15%. Information on the quality of diagnosis, slide reading and whether those reported as positive were imported infections was not established. The facilities and health workers included in this study were not universally prepared to treat malaria according to national guidelines or identify foci of risks due to shortages of national first-line drugs, inadequate record keeping and a view among some health workers (17%) that slide negative patients could still have malaria.</p> <p>Conclusion</p> <p>Combined with historical evidence there is a strong suggestion that very low risks of locally acquired malaria exist today within Nairobi's city limits and this requires further investigation. To be prepared for effective prevention and case-management of malaria among a diverse, mobile population in Nairobi requires a major paradigm shift and investment in improved quality of malaria diagnosis and case management, health system strengthening and case reporting.</p

The Integration of the Program Evaluation Standards into an Evaluation Toolkit for a Transformative Model of Care for Mental Health Service Delivery

Background: Stepped Care 2.0 (SC2.0) is a transformative model of mental health service delivery. This model was created by Stepped Care Solutions (SCS), a not-for-profit consultancy that collaborates with governments, public service organizations, and other institutions that wish to redesign their mental health and addictions systems of care. The SC2.0 model is based on 10 foundational principles and 9 core components that can be flexibly adapted to an organization’s or community’s needs. The model supports groups to reorganize and deliver mental health care in an evidence-informed, person-centric way. SCS partnered with evaluators from the Centre for Health Evaluation and Outcome Sciences (CHÉOS) to create a toolkit that provides evaluation guidance. The toolkit includes a theory of change, guidance on selecting evaluation questions and designs, and an evaluation matrix including suggested process and outcome metrics, all of which can be tailored to each unique implementation of the SC2.0 model. The objective of this resource is to support organizations and communities to conduct high-quality evaluations for the purpose of continuous improvement (a core component of the model of care) and to assess the model’s impact. Purpose: The purpose of this paper is to discuss the integration of the program evaluation standards (PES) into an evaluation toolkit for SC2.0. Setting: In this paper, we describe the toolkit development, focusing on how the PES were embedded in the process and tools. We explore how the integration of the PES into the toolkit supports evaluators to enhance the quality of their evaluation planning, execution, and meta-evaluation. Intervention: Not applicable Research Design: Not applicable Data Collection and Analysis: Not applicable Findings: In this paper, we describe the toolkit development, focusing on how the PES were embedded in the process and tools. We explore how the integration of the PES into the toolkit supports evaluators to enhance the quality of their evaluation planning, execution, and meta-evaluation. Keywords: program evaluation standards; evaluation; mental healt

The risks of malariainfection in Kenya in 2009

BACKGROUND: To design an effective strategy for the control of malaria requires a map of infection and disease risks to select appropriate suites of interventions. Advances in model based geo-statistics and malaria parasite prevalence data assemblies provide unique opportunities to redefine national Plasmodium falciparum risk distributions. Here we present a new map of malaria risk for Kenya in 2009. METHODS: Plasmodium falciparum parasite rate data were assembled from cross-sectional community based surveys undertaken from 1975 to 2009. Details recorded for each survey included the month and year of the survey, sample size, positivity and the age ranges of sampled population. Data were corrected to a standard age-range of two to less than 10 years (PfPR2-10) and each survey location was geo-positioned using national and on-line digital settlement maps. Ecological and climate covariates were matched to each PfPR2-10 survey location and examined separately and in combination for relationships to PfPR2-10. Significant covariates were then included in a Bayesian geostatistical spatial-temporal framework to predict continuous and categorical maps of mean PfPR2-10 at a 1 x 1 km resolution across Kenya for the year 2009. Model hold-out data were used to test the predictive accuracy of the mapped surfaces and distributions of the posterior uncertainty were mapped. RESULTS: A total of 2,682 estimates of PfPR2-10 from surveys undertaken at 2,095 sites between 1975 and 2009 were selected for inclusion in the geo-statistical modeling. The covariates selected for prediction were urbanization; maximum temperature; precipitation; enhanced vegetation index; and distance to main water bodies. The final Bayesian geo-statistical model had a high predictive accuracy with mean error of -0.15% PfPR2-10; mean absolute error of 0.38% PfPR2-10; and linear correlation between observed and predicted PfPR2-10 of 0.81. The majority of Kenya's 2009 population (35.2 million, 86.3%) reside in areas where predicted PfPR2-10 is less than 5%; conversely in 2009 only 4.3 million people (10.6%) lived in areas where PfPR2-10 was predicted to be &gt; or =40% and were largely located around the shores of Lake Victoria. CONCLUSION: Model based geo-statistical methods can be used to interpolate malaria risks in Kenya with precision and our model shows that the majority of Kenyans live in areas of very low P. falciparum risk. As malaria interventions go to scale effectively tracking epidemiological changes of risk demands a rigorous effort to document infection prevalence in time and space to remodel risks and redefine intervention priorities over the next 10-15 years

Excess mortality in patients with advanced chronic hepatitis C treated with long-term peginterferon

Chronic hepatitis C virus infection can cause chronic liver disease, cirrhosis and liver cancer. The Hepatitis C Antiviral Long-term Treatment against Cirrhosis (HALT-C) Trial was a prospective, randomized controlled study of long-term, low-dose peginterferon therapy in patients with advanced chronic hepatitis C who failed to respond to a previous course of optimal antiviral therapy. The aim of this follow-up analysis is to describe the frequency and causes of death among this cohort of patients. Deaths occurring during and after the HALT-C Trial were reviewed by a committee of investigators to determine the cause of death and to categorize each death as liver- or nonliver-related and as related or not to complications of peginterferon. Rates of liver transplantation were also assessed. Over a median of 5.7 years, 122 deaths occurred among 1,050 randomized patients (12%), of which 76 were considered liver-related (62%) and 46 nonliver-related (38%); 74 patients (7%) underwent liver transplantation. At 7 years the cumulative mortality rate was higher in the treatment compared to the control group (20% versus 15%, P = 0.049); the primary difference in mortality was in patients in the fibrosis compared to the cirrhosis stratum (14% versus 7%, P = 0.01); comparable differences were observed when liver transplantation was included. Excess mortality, emerging after 3 years of treatment, was related largely to nonliver-related death; liver-related mortality was similar in the treatment and control groups. No specific cause of death accounted for the excess mortality and only one death was suspected to be a direct complication of peginterferon. Conclusion: Long-term maintenance peginterferon in patients with advanced chronic hepatitis C is associated with an excess overall mortality, which was primarily due to nonliver-related causes among patients with bridging fibrosis. (H EPATOLOGY 2011;)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/83750/1/24169_ftp.pd

Normal levels of p27Xic1 are necessary for somite segmentation and determining pronephric organ size

The Xenopus laevis cyclin dependent kinase inhibitor p27Xic1 has been shown to be involved in exit from the cell cycle and differentiation of cells into a quiescent state in the nervous system, muscle tissue, heart and retina. We show that p27Xic1 is expressed in the developing kidney in the nephrostomal regions. Using over-expression and morpholino oligonucleotide (MO) knock-down approaches we show normal levels of p27Xic1 regulate pronephros organ size by regulating cell cycle exit. Knock-down of p27Xic1 expression using a MO prevented myogenesis, as previously reported; an effect that subsequently inhibits pronephrogenesis. Furthermore, we show that normal levels of p27Xic1 are required for somite segmentation also through its cell cycle control function. Finally, we provide evidence to suggest correct paraxial mesoderm segmentation is not necessary for pronephric induction in the intermediate mesoderm. These results indicate novel developmental roles for p27Xic1, and reveal its differentiation function is not universally utilised in all developing tissues

Using an Observational Framework to investigate adult language input to young children in a naturalistic environment

The correlation between the communicative intent of parents, in terms of their expectation of a response and the response patterns of young children aged 23—25 months during parent—child interactions, was investigated. An Observational Framework was used to code these parameters in interactions between 36 children and their mothers. The children were assigned by cluster analysis to `advanced', `typical' and `delayed' language groups and their responses were coded with respect to the degree of correctness or appropriateness within the interaction. Differences in both the parental response expectations and the children's response patterns across the three clusters are discussed