Success and failure in secondary education: socio-economic background effects on secondary school outcome in the Netherlands, 1927-1998

In the Netherlands, educational attainment is the result of a sequence of separate educational transitions. Because of the tracked nature of the Dutch educational system, students do not make binary stay-or-leave-decisions at each transition. After having entered one track of secondary education, students can change tracks during the entire secondary course. The initial track and the secondary school outcome therefore are incongruent for a significant proportion of the Dutch students. As social background partly predicts initial track placement, track changes and successful termination of the course, we suggest distinguishing conditional and unconditional effects of family background in the transition to secondary school outcome. This paper complements findings of previous research by taking into account the tracked structure of the Dutch educational system and the entire sequence of transitions in secondary education. For the empirical analysis, repeated cross-sections from the Family Survey Dutch Population (1992, 1998, 2000 and 2003) are used. Multinomial logistic regressions reveal that inequality in the outcome of secondary education is partly explained by the fact that initial track placement is socially selective and because this initial inequality is even enhanced by track changes during secondary education. The remaining ‘conditional’ effect of parental education, however, indicates that parental education works on top of this selection to prevent drop out. Inequality in secondary school outcome thus is a cumulative result of social background effects in a sequence of educational transitions throughout secondary education. Decreasing inequality over time is entirely explained by decreasing inequality in the transition from primary to secondary education.

DHCR7 Expression Predicts Poor Outcomes and Mortality From Sepsis

This is a study of lipid metabolic gene expression patterns to discover precision medicine for sepsis.ObjectivesSepsis patients experience poor outcomes including chronic critical illness (CCI) or early death (within 14 d). We investigated lipid metabolic gene expression differences by outcome to discover therapeutic targets.Design setting and particitpantsSecondary analysis of samples from prospectively enrolled sepsis patients (first 24 hr) and a zebrafish endotoxemia model for drug discovery. Patients were enrolled from the emergency department or ICU at an urban teaching hospital. Enrollment samples from sepsis patients were analyzed. Clinical data and cholesterol levels were recorded. Leukocytes were processed for RNA sequencing and reverse transcriptase polymerase chain reaction. A lipopolysaccharide zebrafish endotoxemia model was used for confirmation of human transcriptomic findings and drug discovery.Main outcomes and measuresThe derivation cohort included 96 patients and controls (12 early death, 13 CCI, 51 rapid recovery, and 20 controls) and the validation cohort had 52 patients (6 early death, 8 CCI, and 38 rapid recovery).ResultsThe cholesterol metabolism gene 7-dehydrocholesterol reductase (DHCR7) was significantly up-regulated in both derivation and validation cohorts in poor outcome sepsis compared with rapid recovery patients and in 90-day nonsurvivors (validation only) and validated using RT-qPCR analysis. Our zebrafish sepsis model showed up-regulation of dhcr7 and several of the same lipid genes up-regulated in poor outcome human sepsis (dhcr24, sqlea, cyp51, msmo1, and ldlra) compared with controls. We then tested six lipid-based drugs in the zebrafish endotoxemia model. Of these, only the Dhcr7 inhibitor AY9944 completely rescued zebrafish from lipopolysaccharide death in a model with 100% lethality.ConclusionsDHCR7, an important cholesterol metabolism gene, was up-regulated in poor outcome sepsis patients warranting external validation. This pathway may serve as a potential therapeutic target to improve sepsis outcomes