New York City School Decentralization: The Respective Powers of the City Board of Education and the Community School Boards

The city of New York constitutes a single school district and the city Board of Education is charged with the general management and control of educational affairs in the city school district. The Board is subject to the plenary powers of the State Board of Regents and the State Commissioner of Education. Local school boards existed within the city school district but functioned largely advisory roles until the State Legislature began restructuring the New York City School District in 1968 and major legislation changed the city district into a decentralized system. The change resulted from the belief that community-base school boards would provide an opportunity for the community to take a more active and meaningful role in schools and permit the development of education policies that more closely related to the needs and goals of the community. This comment discusses the history of the decentralization legislation and its interpretation given by the New York courts as well. It also examines the conflicting positions of the community school boards and the City Board with regard to their respective powers under New York\u27s Education Law. The comment concludes that the legal relationship between the community school boards and the central City Board is well-defined by both legislation and court decisions: the community school board\u27s powers are limited to matters relating to its own community while the City Board is vested with overall statutory authority as to policies that have city-wide effects. Under close analysis, the real problem is one of politics rather than any inconsistency in the statutes

Evaluation of rural general practice experiences for pre-vocational medical graduates

Introduction: Despite substantial investment in rural workforce support, sustaining the necessary recruitment and retention of general practitioners (GPs) in rural areas remains a challenge. Insufficient medical graduates are choosing a general/rural practice career. Medical training at postgraduate level, particularly for those 'between' undergraduate medical education and specialty training, remains strongly reliant on hospital experience in larger hospitals, potentially diverting interest away from general/rural practice. The Rural Junior Doctor Training Innovation Fund (RJDTIF) program offered junior hospital doctors (interns) an experience of 10 weeks in a rural general practice, aiming to increase their consideration of general/rural practice careers This study aimed to evaluate the educational and potential workforce impact of the RJDTIF program. Methods: Up to 110 places were established during 2019-2020 for Queensland's interns to undertake an 8-12-week rotation (depending on individual hospital rosters) out of regional hospitals to work in a rural general practice. Participants were surveyed before and after the placement, although only 86 were invited due to the disruption caused by the COVID-19 pandemic. Descriptive quantitative statistics were applied to the survey data. Four semi-structured interviews were conducted to further explore the experiences post-placement, with audio-recordings transcribed verbatim. Semi-structured interview data were analysed using inductive, reflexive thematic analysis. Results: In total, 60 interns completed either survey, although only 25 were matched as completing both surveys. About half (48%) indicated they had preferenced the rural GP term and 48% indicated strong enthusiasm for the experience. General practice was indicated as the most likely career option for 50%, other general specialty 28% and subspecialty 22%. Likelihood to be working in a regional/rural location in 10 years was indicated as 'likely' or 'very likely' for 40%, 'unlikely' for 24% and 'unsure' for 36%. The two most common reasons for preferencing a rural GP term were experiencing training in a primary care setting (50%) and gaining more clinical skills through increased patient exposure (22%). The overall impact on pursuing a primary care career was self-assessed as much more likely by 41%, but much less by 15%. Interest in a rural location was less influenced. Those rating the term poor or average had low pre-placement enthusiasm for the term. The qualitative analysis of interview data produced two themes: importance of the rural GP term for interns (hands-on learning, skills improvement, influence on future career choice and engagement with the local community), and potential improvements to rural intern GP rotations. Conclusion: Most participants reported a positive experience from their rural GP rotation, which was recognised as a sound learning experience at an important time with respect to choosing a specialty. Despite the challenges posed by the pandemic, this evidence supports the investment in programs that provide opportunities for junior doctors to experience rural general practice in these formative postgraduate years to stimulate interest in this much-needed career pathway. Focusing resources on those who have at least some interest and enthusiasm may improve its workforce impact

Routine resite of peripheral intravenous devices every 3 days did not reduce complications compared with clinically indicated resite: a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Peripheral intravenous device (IVD) complications were traditionally thought to be reduced by limiting dwell time. Current recommendations are to resite IVDs by 96 hours with the exception of children and patients with poor veins. Recent evidence suggests routine resite is unnecessary, at least if devices are inserted by a specialised IV team. The aim of this study was to compare the impact of peripheral IVD 'routine resite' with 'removal on clinical indication' on IVD complications in a general hospital without an IV team.</p> <p>Methods</p> <p>A randomised, controlled trial was conducted in a regional teaching hospital. After ethics approval, 362 patients (603 IVDs) were randomised to have IVDs replaced on clinical indication (185 patients) or routine change every 3 days (177 patients). IVDs were inserted and managed by the general hospital medical and nursing staff; there was no IV team. The primary endpoint was a composite of IVD complications: phlebitis, infiltration, occlusion, accidental removal, local infection, and device-related bloodstream infection.</p> <p>Results</p> <p>IVD complication rates were 68 per 1,000 IVD days (clinically indicated) and 66 per 1,000 IVD days (routine replacement) (<it>P </it>= 0.86; HR 1.03; 95% CI, 0.74-1.43). Time to first complication per patient did not differ between groups (KM with log rank, <it>P </it>= 0.53). There were no local infections or IVD-related bloodstream infections in either group. IV therapy duration did not differ between groups (<it>P </it>= 0.22), but more (<it>P </it>= 0.004) IVDs were placed per patient in the routine replacement (mean, 1.8) than the clinical indication group (mean, 1.5), with significantly higher hospital costs per patient (<it>P </it>< 0.001).</p> <p>Conclusions</p> <p>Resite on clinical indication would allow one in two patients to have a single cannula per course of IV treatment, as opposed to one in five patients managed with routine resite; overall complication rates appear similar. Clinically indicated resite would achieve savings in equipment, staff time and patient discomfort. There is growing evidence to support the extended use of peripheral IVDs with removal only on clinical indication.</p> <p>Registration number</p> <p>Australian New Zealand Clinical Trials Registry (ANZCTR) Number ACTRN12608000421336.</p

Differential Mechanical Response of Mesenchymal Stem Cells and Fibroblasts to Tumor-Secreted Soluble Factors

The progression of neoplastic malignancies is a complex process resulting not only from the accumulation of mutations within tumor cells, but also modulation of the tumor microenvironment. Recent advances have shown that the recruitment and subsequent heterotypic interactions of stromal cells—including fibroblasts and bone marrow-derived mesenchymal stem cells (MSCs)—are crucial for carcinogenesis. Though extensive work has been done analyzing the signals that recruit these cells, the governing mechanical properties have not been fully investigated. Here, we report that despite their initial similarities, MSCs respond not only faster but also more dramatically to pro-migratory tumor-secreted soluble factors. Utilizing multiple particle tracking microrheology to probe the cytoskeletal mechanical properties, we show that MSCs stiffen completely within one hour, three times faster than fibroblasts. In addition, unlike fibroblasts, MSCs exposed to tumor-secreted soluble factors display a functionally different phenotype characterized by morphological elongation, decreased actin stress fiber density, and decreased adhesion. Quantitative real-time PCR indicates these phenomena occur based on differential expression of small GTPases RhoA and Cdc42, but not Rac1. These findings demonstrate a fundamental difference in the recruitment of fibroblasts and MSCs

Review of foundational concepts and emerging directions in metamaterial research: Design, phenomena, and applications

In the past two decades, artificial structures known as metamaterials have been found to exhibit extraordinary material properties that enable the unprecedented manipulation of electromagnetic waves, elastic waves, molecules, and particles. Phenomena such as negative refraction, bandgaps, near perfect wave absorption, wave focusing, negative Poissons ratio, negative thermal conductivity, etc., all are possible with these materials. Metamaterials were originally theorized and fabricated in electrodynamics, but research into their applications has expanded into acoustics, thermodynamics, seismology, classical mechanics, and mass transport. In this Research Update we summarize the history, current state of progress, and emerging directions of metamaterials by field, focusing the unifying principles at the foundation of each discipline. We discuss the different designs and mechanisms behind metamaterials as well as the governing equations and effective material parameters for each field. Also, current and potential applications for metamaterials are discussed. Finally, we provide an outlook on future progress in the emerging field of metamaterials.Comment: 22 pages, 3 figures, 1 tabl

Cancer Patient and clinician acceptability and feasibility of a supportive care screening and referral process

Background: Incorporating supportive care into routine cancer care is an increasing priority for the multi-disciplinary team with growing evidence of its importance to patient-centred care. How to design and deliver a process which is appropriate for patients, clinicians and health services in rural areas needs further investigation. Objective: To (i) examine the patient and clinician acceptability and feasibility of incorporating a supportive care screening and referral process into routine cancer care in a rural setting, and (ii) explore any potential influences of patient variables on the acceptability of the process. Methods: A total of 154 cancer patients and 36 cancer clinicians across two rural areas of Victoria, Australia participated. During treatment visits, patients and clinicians participated in a supportive care process involving screening, discussion of problems, and provision of information and referrals. Structured questionnaires with open and closed questions were used to measure patient and clinician acceptability and feasibility. Results: Patients and clinicians found the supportive care process highly acceptable. Screening identified relevant patient problems (90%) and problems that may not have otherwise been identified (83%). The patient-clinician discussion helped patients realize help was available (87%) and enhanced clinician-patient rapport (72%). Patients received useful referrals to services (76%). Feasibility issues included timing of screening for newly diagnosed patients, privacy in discussing problems, clinician time and availability of referral options. No patient demographic or disease factors influenced acceptability or feasibility. Conclusions: Patients and clinicians reported high acceptability for the supportive care process, although mechanisms for incorporating the process into health care need to be further developed

The pathway to more rural doctors: the role of universities

[Extract] Rural communities across Australia face an ongoing shortage of doctors, which reduces access to care and leads to poorer health outcomes for people living in rural areas. Significant undersupply exists, particularly in rural general practice, priority-need generalist specialties and rural generalism. The coronavirus disease 2019 (COVID-19) pandemic exacerbated vacancies as immigration of international medical graduates came to a standstill and interstate movement of rural locum doctors reduced. The recently released National Medical Workforce Strategy emphasises the need to grow a workforce of our own that is fit for purpose, to deliver culturally safe and context-specific medical services to all Australian people. Over the past 20 years, there have been significant political and educational initiatives to increase the rural workforce, with accompanying research investigating their outcomes

Comparison of performance outcomes after general practice training in remote and rural or and regional locations in Australia

General practice training is provided in geographically diverse locations across Australia to promote the development of the rural and remote medical workforce. Training in rural and remote locations supports learning locally required types of medical practice and builds both social and professional connections that increase the likelihood of trainees later practising in these communities.1,2 The remote learning model appears to be successful,3 but a 2020 scoping review found only limited evidence for the equivalence of learning outcomes after training in remote or less remote locations.4 We therefore compared formative assessment outcomes for general practice trainees in remote locations with those of trainees in rural or regional locations

The RNA binding protein Cwc2 interacts directly with the U6 snRNA to link the nineteen complex to the spliceosome during pre-mRNA splicing

Intron removal during pre-messenger RNA (pre-mRNA) splicing involves arrangement of snRNAs into conformations that promote the two catalytic steps. The Prp19 complex [nineteen complex (NTC)] can specify U5 and U6 snRNA interactions with pre-mRNA during spliceosome activation. A candidate for linking the NTC to the snRNAs is the NTC protein Cwc2, which contains motifs known to bind RNA, a zinc finger and RNA recognition motif (RRM). In yeast cells mutation of either the zinc finger or RRM destabilize Cwc2 and are lethal. Yeast cells depleted of Cwc2 accumulate pre-mRNA and display reduced levels of U1, U4, U5 and U6 snRNAs. Cwc2 depletion also reduces U4/U6 snRNA complex levels, as found with depletion of other NTC proteins, but without increase in free U4. Purified Cwc2 displays general RNA binding properties and can bind both snRNAs and pre-mRNA in vitro. A Cwc2 RRM fragment alone can bind RNA but with reduced efficiency. Under splicing conditions Cwc2 can associate with U2, U5 and U6 snRNAs, but can only be crosslinked directly to the U6 snRNA. Cwc2 associates with U6 both before and after the first step of splicing. We propose that Cwc2 links the NTC to the spliceosome during pre-mRNA splicing through the U6 snRNA