Building Intercultural Capacity in School Teams to Support Refugee Students

In a period of globalization and forced migration, refugee numbers are increasing exponentially, and unprepared school systems embrace students as families settle in unfamiliar territory. This Organizational Improvement Plan (OIP) explores the experiences of a school team at Calluna Elementary School (CES, a pseudonym) in Southern Ontario, where staff strive to build their collective intercultural capacity in order to best serve an influx of newcomers who have survived war and significant loss. The Problem of Practice (PoP) involves addressing staff struggles with trauma-informed pedagogy, early literacy instruction, and maintaining an asset-focused perspective, through a refugee critical race theory lens. To inspire radical change in the current organization, and to flex with the rapidly changing demographics of the school community, the principal adopts both a transformative and adaptive leadership approach. While the organization evolves and oppressive programs and practices are identified and addressed, a change plan and communication plan are applied. Implementing formal professional learning sessions for staff through a 4C framework will be instrumental in developing culturally sustaining practices which adequately provide essential supports for refugee students. Training for the school team which focuses on developing intercultural competence will improve the ability of the system to address the unique challenges encountered. This morally imperative work is applicable to school contexts around the world where refugees are accepted and barriers are faced when supporting effective settlement for newcomers

Effect of a Fruit and Vegetable Prescription Program on Children's Fruit and Vegetable Consumption.

IntroductionMost children in families with low income do not meet dietary guidance on fruit and vegetable consumption. Fruit and vegetable prescription programs improve access to and affordability of health-supporting foods for adults, but their effect on dietary behavior among children is not known. The objective of this study was to describe the extent to which exposure to a fruit and vegetable prescription program was associated with changes in consumption among participants aged 2 to 18.MethodsWe used data from a modified National Cancer Institute screener to calculate fruit and vegetable intake among 883 children who were overweight or had obesity and participated in a 4- to 6-month fruit and vegetable prescription program at federally qualified health centers during 4 years (2012-2015). Secondary analyses in 2017 included paired t tests to compare change in fruit and vegetable consumption (cups/day) between first and last visits and multivariable linear regressions, including propensity dose-adjusted models, to model this change as a function of sociodemographic and program-specific covariates, such as number of clinical visits and value of prescription redemption.ResultsWe found a dose propensity-adjusted increase of 0.32 cups (95% confidence interval, 0.19-0.45 cups) for each additional visit while holding constant the predicted number of visits and site. An equal portion of the change-score increase was attributed to vegetable consumption and fruit consumption (β = 0.16 for each).ConclusionFruit and vegetable prescription programs in clinical settings may increase fruit and vegetable consumption among children in low-income households. Future research should use a comparison group and consider including qualitative analysis of site-specific barriers and facilitators to success

Social Determinants of Health: Underreported Heterogeneity in Systematic Reviews of Caregiver Interventions.

BACKGROUND AND OBJECTIVES:Although most people have some experience as caregivers, the nature and context of care are highly variable. Caregiving, socioeconomic factors, and health are all interrelated. For these reasons, caregiver interventions must consider these factors. This review examines the degree to which caregiver intervention research has reported and considered social determinants of health. RESEARCH DESIGN AND METHODS:We examined published systematic reviews and meta-analyses of interventions for older adults with age-related chronic conditions using the PRISMA and AMSTAR 2 checklists. From 2,707 papers meeting search criteria, we identified 197 potentially relevant systematic reviews, and selected 33 for the final analysis. RESULTS:We found scant information on the inclusion of social determinants; the papers lacked specificity regarding race/ethnicity, gender, sexual identity, socioeconomic status, and geographic location. The majority of studies focused on dementia, with other conditions common in later life vastly underrepresented. DISCUSSION AND IMPLICATIONS:Significant gaps in evidence persist, particularly for interventions targeting diverse conditions and populations. To advance health equity and improve the effectiveness of interventions, research should address caregiver heterogeneity and improve assessment, support, and instruction for diverse populations. Research must identify aspects of heterogeneity that matter in intervention design, while recognizing opportunities for common elements and strategies

Care of HIV-Infected Pregnant Women in Maternal–Fetal Medicine Programs

Objective: To survey the evolution over the past decade of attitudes and practices of obstetricians in maternal–fetal medicine fellowship programs regarding the management of human immunodeficiency virus (HIV)-infected pregnant women. Methods: Directors of all 65 approved maternal–fetal medicine training programs were sent questionnaires, responses to which were to reflect the consensus among members of their faculties. Programs were stratified based upon the number of HIV-infected pregnant patients cared for in the previous year. Results: Responses reflect experience with over 1000 infected pregnantwomen per year, nearly one-quarter with advanced disease. Combination antiretroviral therapy was prescribed by all respondents, universally in the 2nd and 3rd trimesters. A three-drug regimen (often containing a protease inhibitor) was used more often by those who treated at least 20 HIV-infected pregnant patients per year than by those programs seeing a lower number of patients (80 vs 59%).Despite the known and unknown risks of the use of antiretrovirals during pregnancy, only half of all responding programs report adverse events to the Antiretroviral Pregnancy Registry; reporting was more common among the institutions seeing a higher number of patients (61 vs 45%). Seventy-eight percent of higher volume programs enroll their patients in clinical studies, usually multicenter, versus 35% of lower volume programs. Conclusions: Care for HIV² pregnant women has dramatically changed over the past decade. Antiretroviral therapy is now universally prescribed by physicians involved in maternal–fetal medicine training programs. Given limited experience with these agents in the setting of pregnancy, it is essential for maternal–fetal medicine practitioners to actively report on adverse events and participate in clinical trials

Structure of an Enclosed Dimer Formed by the Drosophila Period Protein

Period (PER) is the major transcription inhibitor in metazoan circadian clocks and lies at the center of several feedback loops that regulate gene expression. Dimerization of Drosophila PER influences nuclear translocation, repressor activity, and behavioral rhythms. The structure of a central, 346-residue PER fragment reveals two associated PAS (Per-Arnt-Sim) domains followed by a protruding α-helical extension (αF). A closed, pseudosymmetric dimer forms from a cross handshake interaction of the N-terminal PAS domain with αF of the opposing subunit. Strikingly, a shift of αF against the PAS β-sheet generates two alternative subunit interfaces in the dimer. Taken together with a previously reported PER structure in which αF extends, these data indicate that αF unlatches to switch association of PER with itself to its partner Timeless. The variable positions of the αF helix provide snapshots of a helix dissociation mechanism that has relevance to other PAS protein systems. Conservation of PER interaction residues among a family of PAS-AB-containing transcription factors suggests that contacts mediating closed PAS-AB dimers serve a general function

Metallicity Gradients in the Milky Way Disk as Observed by the SEGUE Survey

The observed radial and vertical metallicity distribution of old stars in the Milky Way disk provides a powerful constraint on the chemical enrichment and dynamical history of the disk. We present the radial metallicity gradient, \Delta[Fe/H]/\Delta R, as a function of height above the plane, |Z|, using 7010 main sequence turnoff stars observed by the Sloan Extension for Galactic Understanding and Exploration (SEGUE) survey. The sample consists of mostly old thin and thick disk stars, with a minimal contribution from the stellar halo, in the region 6 < R < 16 kpc, 0.15 < |Z| < 1.5 kpc. The data reveal that the radial metallicity gradient becomes flat at heights |Z| > 1 kpc. The median metallicity at large |Z| is consistent with the metallicities seen in outer disk open clusters, which exhibit a flat radial gradient at [Fe/H] ~ -0.5. We note that the outer disk clusters are also located at large |Z|; because the flat gradient extends to small R for our sample, there is some ambiguity in whether the observed trends for clusters are due to a change in R or |Z|. We therefore stress the importance of considering both the radial and vertical directions when measuring spatial abundance trends in the disk. The flattening of the gradient at high |Z| also has implications on thick disk formation scenarios, which predict different metallicity patterns in the thick disk. A flat gradient, such as we observe, is predicted by a turbulent disk at high redshift, but may also be consistent with radial migration, as long as mixing is strong. We test our analysis methods using a mock catalog based on the model of Sch\"onrich & Binney, and we estimate our distance errors to be ~25%. We also show that we can properly correct for selection biases by assigning weights to our targets.Comment: Submitted to ApJ; 22 pages, 14 figures in emulateapj format; Full resolution version available at http://www.ucolick.org/~jyc/gradient/cheng_apj_fullres.pd

Interruptions of antiretroviral therapy in children and adolescents with HIV infection in clinical practice: a retrospective cohort study in the USA.

INTRODUCTION: Changes in combination antiretroviral therapy (cART) throughout childhood challenge the continuity of paediatric HIV treatment. This study aimed to evaluate the prevalence of treatment interruption (TI), including lamivudine (3TC) monotherapy, and the relationship of TI to virologic and immunologic parameters in HIV-infected paediatric patients. METHODS: Nested within a prospective observational study of a city-wide cohort of HIV-infected persons in the District of Columbia, this sub-study collected retrospective data on antiretroviral therapy, enrolment (endpoint) and historic (lifelong) CD4 counts and HIV RNA viral load (VL) of the paediatric cohort. TI was defined as interruption of cART ≥4 consecutive weeks. Data on TI, including 3TC monotherapy TI (MTI), were collected. Descriptive statistics and univariate testing were used to compare children with TI and MTI to children on continuous treatment (CT). RESULTS: Thirty-eight (28%) out of 136 enrolled children (median age=12.9 years) experienced TI, with 14 (37%) of those placed on 3TC MTI. Significantly lower endpoint median CD4 counts (598 cells/mm(3) vs. 815 cells/mm(3); p=0.003) and CD4% (27.5% vs. 33%; p=0.006) were observed in the TI cohort as compared to the CT cohort. The median endpoint VL in the overall TI cohort was ~4 times higher than among the CT cohort (1427 copies/mL vs. 5581 copies/mL; p CONCLUSIONS: In our study, we observed high frequency of the TI in HIV in paediatric HIV clinical practice. All TIs, including 3TC MTI, were associated with significantly lower endpoint median CD4 counts and higher median VLs, as compared to CT in paediatric patients. The high frequency of TI and associated poor outcomes suggest a need for a better strategy in managing the course of the paediatric and adolescent cART

Moving Beyond Dichotomies: How the Intersection of Race, Class and Place Impacts High School Graduation Rates for African American Students

Over thirty years ago, William Julius Wilson declared that class trumped race as the more significant determinant of social mobility and economic opportunity. Despite the acclaim and scrutiny for Wilson\u27s work, the United States has grown increasingly divided by intersecting factors of race, class and other demographic factors such as place (Massey, 2007). These divisions are especially evident in the public education system. We analyze how race, class and place interact to predict high school graduation rates in a national sample of schools and students. Results confirm that a singular focus on race, class, or locale is insufficient to explain high school graduation rates. However, a more contextualized focus on the interactions between multiple determinants of inequality (e.g. race, class and place) can yield a more nuanced understanding of the indicators driving educational inequalities. Scholars and practitioners need to focus on the manner in which multiple positionalities influence the academic achievement of African American children and young adults

Estimation of cardiac output and pulmonary vascular resistance by contrast echocardiography transit time measurement: a prospective pilot study

Background Studies with other imaging modalities have demonstrated a relationship between contrast transit and cardiac output (CO) and pulmonary vascular resistance (PVR). We tested the hypothesis that the transit time during contrast echocardiography could accurately estimate both CO and PVR compared to right heart catheterization (RHC). Methods 27 patients scheduled for RHC had 2D-echocardiogram immediately prior to RHC. 3 ml of DEFINITY contrast followed by a 10 ml saline flush was injected, and a multi-cycle echo clip was acquired from the beginning of injection to opacification of the left ventricle. 2D-echo based calculations of CO and PVR along with the DEFINITY-based transit time calculations were subsequently correlated with the RHC-determined CO and PVR. Results The transit time from full opacification of the right ventricle to full opacification of the left ventricle inversely correlated with CO (r = -0.61, p \u3c 0.001). The transit time from peak opacification of the right ventricle to first appearance in the left ventricle moderately correlated with PVR (r = 0.46, p \u3c 0.01). Previously described echocardiographic methods for the determination of CO (Huntsman method) and PVR (Abbas and Haddad methods) did not correlate with RHC-determined values (p = 0.20 for CO, p = 0.18 and p = 0.22 for PVR, respectively). The contrast transit time method demonstrated reliable intra- (p \u3c 0.0001) and inter-observer correlation (p \u3c 0.001). Conclusions We describe a novel method for the quantification of CO and estimation of PVR using contrast echocardiography transit time. This technique adds to the methodologies used for noninvasive hemodynamic assessment, but requires further validation to determine overall applicability

Qualitative study exploring the key determinants of information gathering to inform the management of over-the-counter (OTC) consultations in community pharmacies

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