The Joinpoint-Jump and Joinpoint-Comparability Ratio Model for Trend Analysis with Applications to Coding Changes in Health Statistics

Analysis of trends in health data collected over time can be affected by instantaneous changes in coding that cause sudden increases/decreases, or “jumps,” in data. Despite these sudden changes, the underlying continuous trends can present valuable information related to the changing risk profile of the population, the introduction of screening, new diagnostic technologies, or other causes. The joinpoint model is a well-established methodology for modeling trends over time using connected linear segments, usually on a logarithmic scale. Joinpoint models that ignore data jumps due to coding changes may produce biased estimates of trends. In this article, we introduce methods to incorporate a sudden discontinuous jump in an otherwise continuous joinpoint model. The size of the jump is either estimated directly (the Joinpoint-Jump model) or estimated using supplementary data (the Joinpoint-Comparability Ratio model). Examples using ICD-9/ICD-10 cause of death coding changes, and coding changes in the staging of cancer illustrate the use of these models

The Joinpoint-Jump and Joinpoint-Comparability Ratio Model for Trend Analysis with Applications to Coding Changes in Health Statistics

Analysis of trends in health data collected over time can be affected by instantaneous changes in coding that cause sudden increases/decreases, or “jumps,” in data. Despite these sudden changes, the underlying continuous trends can present valuable information related to the changing risk profile of the population, the introduction of screening, new diagnostic technologies, or other causes. The joinpoint model is a well-established methodology for modeling trends over time using connected linear segments, usually on a logarithmic scale. Joinpoint models that ignore data jumps due to coding changes may produce biased estimates of trends. In this article, we introduce methods to incorporate a sudden discontinuous jump in an otherwise continuous joinpoint model. The size of the jump is either estimated directly (the Joinpoint-Jump model) or estimated using supplementary data (the Joinpoint-Comparability Ratio model). Examples using ICD-9/ICD-10 cause of death coding changes, and coding changes in the staging of cancer illustrate the use of these models

Measuring vertebrate telomeres: applications and limitations

Telomeres are short tandem repeated sequences of DNA found at the ends of eukaryotic chromosomes that function in stabilizing chromosomal end integrity. In vivo studies of somatic tissue of mammals and birds have shown a correlation between telomere length and organismal age within species, and correlations between telomere shortening rate and lifespan among species. This result presents the tantalizing possibility that telomere length could be used to provide much needed information on age, ageing and survival in natural populations where longitudinal studies are lacking. Here we review methods available for measuring telomere length and discuss the potential uses and limitations of telomeres as age and ageing estimators in the fields of vertebrate ecology, evolution and conservation

The CTSA University of Texas Health Science Center (UTHSC) Northeast—Tyler and Rio Grande Valley Success Story: How Rural, Underserved Academic Communities Rapidly Built a Robust Engine for Collaborative COVID-19 Clinical Research

In 2018, The University of Texas Health Science Center– Tyler and University of Texas Rio Grande Valley were invited to develop clinical research units for an existing Clinical and Translational Science Award (CTSA) consortium with the objective to equip medically underserved, economically disadvantaged communities and subsequently to deploy COVID-19 clinical trials in response to a public health emergency

Submerged in the mainstream? A case study of an immigrant learner in a New Zealand primary classroom

Immigrant children from diverse language backgrounds face not only linguistic challenges when enrolled in mainstream English-medium classrooms, but also difficulties adjusting to an unfamiliar learning community. The culture of primary school classrooms in New Zealand typically reflects conventions across three dimensions: interactional, instructional task performance and cognitive-academic development. All three dimensions are underpinned by the culturally specific discourse conventions involved in language socialisation. New learners may be helped by classmates or their teacher to understand and successfully use these conventions, but left on their own they may sink rather than swim. This is a case study of one Taiwanese 11-year old boy, 'John', who entered a New Zealand primary classroom midway through the school year. John's basic conversational ability was sound, but he did not possess the interactive classroom skills needed to operate in the new culture of learning. Selected from a wider study of the classroom, transcript data from audio-recorded excerpts of John's interactions over several months with his teacher and classmates are interpreted from perspectives derived from sociocultural and language socialisation theories. The article concludes with a brief consideration of the extent to which John constructed, or was constrained from constructing meaningful learning experiences, and suggestions for further research and reflection

What do coaches orchestrate? Unravelling the 'quiddity' of practice

The general purpose of this article is threefold. Firstly, it is to further the notion of coaching as orchestration through developing insight into precisely how and what coaches orchestrate. Secondly, it is to firmly position coaching as a relational practice, whilst thirdly it is to better define coaching’s complex nature and how it can be somewhat ordered. Following an introduction where the purpose and value of the paper are outlined, we present the reflective method of critical companionship through which we explored and addressed the aforementioned purposes. The case for the quiddity, or the 'just whatness' (i.e., the inherent nature or essence) of coaching as involving complex, relational acts which can be somewhat explained through recourse to the developing theory of orchestration is subsequently made. In doing so, two precise examples of how we as coaches orchestrate sporting practice are presented. The paper concludes with both a summary of the principal argument(s) made, and some reflective considerations for future directions

Candidiasis caused by Candida kefyr in a neonate: Case report

<p>Abstract</p> <p>Background</p> <p>Systemic <it>Candidia </it>infections are of major concern in neonates, especially in those with risk factors such as longer use of broad spectrum antibiotics. Recent studies showed that also term babies with underlying gastrointestinal or urinary tract abnormalities are much more prone to systemic <it>Candida </it>infection. We report a very rare case of candidiasis caused by <it>Candida kefyr </it>in a term neonate.</p> <p>Case Presentation</p> <p>Renal agenesis on the left side was diagnosed antenatally and anal atresia postnatally. Moreover, a vesico-ureteral-reflux (VUR) grade V was detected by cystography. The first surgical procedure, creating a protective colostoma, was uneventful. Afterwards our patient developed urosepsis caused by <it>Enterococcus faecalis </it>and was treated with piperacillin. The child improved initially, but deteriorated again. A further urine analysis revealed <it>Candida kefyr </it>in a significant number. As antibiotic resistance data about this non-<it>albicans Candida </it>species are limited, we started liposomal amphotericin B (AMB), but later changed to fluconazole after receiving the antibiogram. Candiduria persisted and abdominal imaging showed a <it>Candida </it>pyelonephritis. Since high grade reflux was prevalent we instilled AMB into the child's bladder as a therapeutic approach. While undergoing surgery (creating a neo-rectum) a recto-vesical fistula could be shown and subsequently was resected. The child recovered completely under systemic fluconazole therapy over 3 months.</p> <p>Conclusions</p> <p>Candidiasis is still of major concern in neonates with accompanying risk factors. As clinicians are confronted with an increasing number of non-<it>albicans Candida </it>species, knowledge about these pathogens and their sensitivities is of major importance.</p

Move over Nelly: lessons from 30 years of employment-based initial teacher education in England

Recruiting, preparing and retaining high-quality teachers are recurrent themes of local, national and international education agendas. Traditional university-led forms of teacher education continue to be challenged, and defended, as nations strive to secure a teaching force equipped to achieve high-quality learning outcomes for all students. One commonly adopted policy solution has been the diversification of teacher preparation routes: the alternative certification agenda. In this article, we examine the entire history of one alternative route in place in England from 1997 to 2012, the Graduate Teacher Programme. Using one example of an employment-based programme, we argue that opportunities to engineer innovative and creative spaces in the face of the current teacher preparation reform agenda need to be seized. This case study, which is contextualised in both the international debates about alternative teacher certification routes and the current policy agenda in England, demonstrates the extent to which successive administrations have failed to learn from the lessons of the past in the rush to recycle policies and claim them as their own

Thinking dispositions for teaching : enabling and supporting resilience in context

Preparing pre-teachers for an increasingly challenging teaching profession is a complex work and requires teacher educators to engage in the careful design of both programmes and professional learning opportunities. This chapter explores how an explicit focus on thinking dispositions that enable effective teaching are developed in a Master of Teaching (Secondary) programme. This programme, delivered on-site at a secondary school, included carefully constructed teaching opportunities to support development of thinking dispositions. Ways of thinking and the impact they have on feelings, actions and beliefs will be examined along with how the implementation of our thinking dispositions framework supports the development of resilience in challenging teaching and learning contexts