US Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations for the management of non-tuberculous mycobacteria in individuals with cystic fibrosis

Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms that can cause chronic pulmonary infection, particularly in individuals with preexisting inflammatory lung disease such as cystic fibrosis(CF). Pulmonary disease caused by NTM has emerged as a major threat to the health of individuals with CF but remains difficult to diagnose and problematic to treat. In response to this challenge, the US Cystic Fibrosis Foundation (CFF) and the European Cystic Fibrosis Society (ECFS) convened an expert panel of specialists to develop consensus recommendations for the screening, investigation, diagnosis and management of NTM pulmonary disease in individuals with CF. Nineteen experts were invited to participate in the recommendation development process. Population, Intervention, Comparison, Outcome (PICO) methodology and systematic literature reviews were employed to inform draft recommendations. An anonymous voting process was used by the committee to reach consensus. All committee members were asked to rate each statement on a scale of: 0, completely disagree, to 9, completely agree; with 80% or more of scores between 7 and 9 being considered ‘good’ agreement. Additionally, the committee solicited feedback from the CF communities in the USA and Europe and considered the feedback in the development of the final recommendation statements. Three rounds of voting were conducted to achieve 80% consensus for each recommendation statement. Through this process, we have generated a series of pragmatic, evidence-based recommendations for the screening, investigation, diagnosis and treatment of NTM infection in individuals with CF as an initial step in optimising management for this challenging condition

A cluster of multidrug-resistant Mycobacterium tuberculosis among patients arriving in Europe from the Horn of Africa: a molecular epidemiological study

SummaryBackground The risk of tuberculosis outbreaks among people fleeing hardship for refuge in Europe is heightened. We describe the cross-border European response to an outbreak of multidrug-resistant tuberculosis among patients from the Horn of Africa and Sudan. Methods On April 29 and May 30, 2016, the Swiss and German National Mycobacterial Reference Laboratories independently triggered an outbreak investigation after four patients were diagnosed with multidrug-resistant tuberculosis. In this molecular epidemiological study, we prospectively defined outbreak cases with 24-locus mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) profiles; phenotypic resistance to isoniazid, rifampicin, ethambutol, pyrazinamide, and capreomycin; and corresponding drug resistance mutations. We whole-genome sequenced all Mycobacterium tuberculosis isolates and clustered them using a threshold of five single nucleotide polymorphisms (SNPs). We collated epidemiological data from host countries from the European Centre for Disease Prevention and Control. Findings Between Feb 12, 2016, and April 19, 2017, 29 patients were diagnosed with multidrug-resistant tuberculosis in seven European countries. All originated from the Horn of Africa or Sudan, with all isolates two SNPs or fewer apart. 22 (76%) patients reported their travel routes, with clear spatiotemporal overlap between routes. We identified a further 29 MIRU-VNTR-linked cases from the Horn of Africa that predated the outbreak, but all were more than five SNPs from the outbreak. However all 58 isolates shared a capreomycin resistance-associated tlyA mutation. Interpretation Our data suggest that source cases are linked to an M tuberculosis clone circulating in northern Somalia or Djibouti and that transmission probably occurred en route before arrival in Europe. We hypothesise that the shared mutation of tlyA is a drug resistance mutation and phylogenetic marker, the first of its kind in M tuberculosis sensu stricto. Funding The Swiss Federal Office of Public Health, the University of Zurich, the Wellcome Trust, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), the Medical Research Council, BELTA-TBnet, the European Union, the German Center for Infection Research, and Leibniz Science Campus Evolutionary Medicine of the Lung (EvoLUNG)

Updating the approaches to define susceptibility and resistance to anti-tuberculosis agents: implications for diagnosis and treatment

11 páginas, 2 figuras, 1 tablaInappropriately high breakpoints have resulted in systematic false-susceptible AST results to anti-TB drugs. MIC, PK/PD and clinical outcome data should be combined when setting breakpoints to minimise the emergence and spread of antimicrobial resistance.I. Comas was supported by PID2019-104477RB-I00 from the Spanish Science Ministry and by ERC (CoG 101001038)Peer reviewe

Preparing Teachers to Apply Research to Mathematics Teaching: Using Design-Based Research to Define and Assess the Process of Evidence-Based Practice

Persistent lack of mathematics achievement and disparity in achievement has led to the publication of research findings related to equitable teaching practices. Although the publication of such research provides insights about approaches for potentially increasing equity in mathematics education, teachers must be able to apply what has been learned from these studies to their classroom teaching practices. Despite the widespread expectation that teachers use research-supported teaching strategies to meet the needs of their diverse classrooms, the research to practice gap persists. Little research is currently available to guide mathematics teacher educators in how to prepare future teachers to apply research to teaching practices. Inspired by advancements in social work and other health-related fields, this study departed from the standard approach of preparing teachers to utilize specific, research- based teaching strategies to preparing teachers to engage in the meta-process of applying research to practice. This meta-process has been defined by the health-related disciplines as the process of evidence-based practice (EBP). This process is explicated in a conceptual framework that is composed of the following five steps. The practitioner (1) formulates an answerable practice question, (2) searches for the best research evidence, (3) critically appraises the evidence, (4) selects the best intervention for a specific practice context, and (5) evaluates the outcome of the intervention. The purpose of this study was to examine the process of preparing preservice elementary teachers of mathematics to engage in the five-step process of EBP. Because this process, which can be conceptualized as a routine of practice, has not been identified for the field of mathematics education previously, it was examined using a design-based research (DBR) methodological approach. There were two objectives to the study: (1) to create an empirically tested teaching intervention that mathematics teacher educators can use to prepare preservice teachers to apply research to teaching practice and (2) to create a system of assessment that supports the teaching of this intervention. The study involved five iterations of the DBR process that permited the intervention to be evaluated and revised after each iteration. Although each iteration is discussed, this study focuses primarily on the process used in the fifth iteration of the DBR process. This iteration took place in the context of a mathematics methods course in a clinically-rich, undergraduate residency program for initial preparation of elementary school teachers. The twelve participants were simultaneously enrolled in the methods course and embedded in co-teaching assignments at an elementary school. The intervention to prepare teachers to engage in EBP included two workshops that were co-facilitated by an education librarian and a mathematics teacher educator and a semester-long Education Research Project. The project required participants to identify a problem of practice related to teaching or learning mathematics, find relevant research to address that problem, create an intervention to apply the research findings to classroom instruction, implement that intervention, and collect data to evaluate the effectiveness of the designed intervention. Instruments used to collect data included: (1) a self-report Information Literacy Questionnaire, (2) a self-report Familiarity with the Process of Evidence-Based Practice in Education Scale, (3) the Education Research Project report, and (4) a standardized performance assessment. The standardized performance assessment was used to assess beginning proficiency with the process of EBP. Generalizeability theory was used to evaluate the reliability of the system created for the standardized performance assessment. The system that included three raters, two tasks, and two scoring occasions was found to be fairly reliable (absolute generalizability coefficient = .81). Results from this study revealed that participants were more successful at creating implementation plans and linking those plans to research than they were at modifying their plans to meet the needs of specific students or evaluating their research implementation. This study contributes to both research and mathematics education communities\u27 understandings about the potential of EBP as a high-leverage routine of practice and the use of generalizability theory in the creation of a reliable assessment to evaluate this routine of practice. This study documents the complexity of the process of linking research to practice and provides an empirically tested conceptual framework for preparing preservice teachers to engage in this complex practice

Making the Invisible Visible: Preparing Preservice Teachers for First Steps in Linking Research to Practice

Despite the widespread expectation that teachers leverage research to meet the needs of diverse students, little is known about how to prepare preservice teachers to engage in this complex process. This quasi-experimental study examines a collaborative, standards-based intervention that prepares preservice teachers to articulate classroom-based problems, create research-guiding questions, and design effective search strategies. A MANOVA test indicated that the intervention is associated with stronger performance on those first steps. The authors provide detailed descriptions of the intervention and its results in order to offer a roadmap for supporting preservice teachers in the foundational steps of linking research to practice

Evidence of the Need to Prepare Prospective Teachers to Engage in Mathematics Consultations

The mathematics consultation represents a powerful opportunity for mathematics teachers to leverage the knowledge base of special education professionals to advance equity for students with special education needs. Yet, most teacher preparation programs do not specifically prepare prospective teachers to engage in mathematics consultations. We designed this baseline study to understand the consequences of this lack of preparation. We provided an opportunity for prospective elementary teachers of mathematics and prospective special education teachers to engage in a consultation about the mathematics learning of a student with special education needs. We analysed the characteristics of these consultations and found that the prospective teachers’ questions and responses lacked mathematics context and ignored student engagement in mathematical practices. Given these findings, we provide recommendations for how mathematics teacher educators might better prepare prospective teachers for the questioning and answering stages of mathematics consultations