US Public Education Policy: Missing Voices

Public education is a cornerstone of democracy. In the U.S., however, a growing number of families are withdrawing from the public school system, by choice or because that is their only option. Many of these families did try public school, but found it did not meet the needs of their children at at that time and place. Dismissing all homeschoolers as anti-school would be an unfortunate mischaracterization

A posture and mobility training package for care home staff: results of a cluster randomised controlled feasibility trial (the PATCH trial)

Background: provision of care for care home residents with complex needs is challenging. Physiotherapy and activity interventions can improve well-being but are often time-limited and resource intensive. A sustainable approach is to enhance the confidence and skills of staff who provide care. This trial assessed the feasibility of undertaking a definitive evaluation of a posture and mobility training programme for care staff. Design and setting: a cluster randomised controlled feasibility trial with embedded process evaluation. Ten care homes in Yorkshire, United Kingdom, were randomised (1:1) to the skilful care training package (SCTP) or usual care (UC). Participants: residents who were not independently mobile. Intervention: SCTP—delivered by physiotherapists to care staff. Objectives and measurements: key objectives informed progression to a definitive trial. Recruitment, retention and intervention uptake were monitored. Data, collected by a blinded researcher, included pain, posture, mobility, hospitalisations and falls. This informed data collection feasibility and participant safety. Results: a total of 348 residents were screened; 146 were registered (71 UC, 75 SCTP). Forty two were lost by 6 months, largely due to deaths. While data collection from proxy informants was good (>95% expected data), attrition meant that data completion rates did not meet target. Data collection from residents was poor due to high levels of dementia. Intervention uptake was variable—staff attendance at all sessions ranged from 12.5 to 65.8%. There were no safety concerns. Conclusion: care home and resident recruitment are feasible, but refinement of data collection approaches and intervention delivery are needed for this trial and care home research more widely

Enhancing communication through gesture and naming therapy

Purpose: This study investigated whether gesture, naming and strategic treatment improved the communication skills of 14 people with severe aphasia. Method: All participants received 15 hours of gesture and naming treatment (reported in a companion paper). Half the group received a further 15 hours of strategic therapy, while the remaining seven participants received no further input. The effects of therapy on communication were assessed with two novel measures. These required participants to convey simple messages and narratives to their communication partner. In both assessments a subset of the stimuli featured items that had been targets in gesture or naming treatment. Results: Performance on the communication measures was stable over two baseline assessments, but improved after gesture and naming treatment. Those who received additional strategic therapy made further gains on the message but not the narrative task. Communication gains were not specific to the stimuli featuring trained items. Conclusions: This study suggests that gesture and naming treatments can benefit interactive communication. The additional benefits of strategic therapy were less clear cut, but did impact on the transmission of simple messages. Gains seem to reflect the development of general communication skills, rather than the use of trained gestures and/or words

PATCH: posture and mobility training for care staff versus usual care in care homes: study protocol for a randomised controlled trial

Background: Residents of care homes have high levels of disability and poor mobility, but the promotion of health and wellbeing within care homes is poorly realised. Residents spend the majority of their time sedentary which leads to increased dependency and, coupled with poor postural management, can have many adverse outcomes including pressure sores, pain and reduced social interaction. The intervention being tested in this project (the Skilful Care Training Package) aims to increase the awareness and skills of care staff in relation to poor posture in the older, less mobile adult and highlight the benefits of activity, and how to skilfully assist activity, in this group to enable mobility and reduce falls risk. Feasibility work will be undertaken to inform the design of a definitive cluster randomised controlled trial. Methods: This is a cluster randomised controlled feasibility trial, aiming to recruit at least 12–15 residents at each of 10 care homes across Yorkshire. Care homes will be randomly allocated on a 1:1 basis to receive either the Skilful Care Training Package alongside usual care or to continue to provide usual care alone. Assessments will be undertaken by blinded researchers with participating residents at baseline (before care home randomisation) and at three and six months post randomisation. Data relating to changes in physical activity, mobility, posture, mood and quality of life will be collected. Data at the level of the home will also be collected and will include staff experience of care and changes in the numbers and types of adverse events residents experience (for example, hospital admissions, falls). Details of NHS service usage will be collected to inform the economic analysis. An embedded process evaluation will explore intervention delivery and its acceptability to staff and residents. Discussion: Participant uptake, engagement and retention are key feasibility outcomes. Exploration of barriers and facilitators to intervention delivery will inform intervention optimisation. Study results will inform progression to a definitive trial and add to the body of evidence for good practice in care home research. Trial registration: ISRCTN Registry, ISRCTN50080330. Registered on 27 March 2017

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Psychosocial Distress and T Cell Immunity in Patients with Head and Neck Carcinoma

Problem: Patients with head and neck squamous cell carcinoma (HNSCC) have significant dysfunction of anti-tumor immunity. In addition, these patients experience a high degree of psychological distress associated with the diagnosis, physical effects, and the ablative treatments designed to cure cancer in the upper aerodigestive tract. Few studies, however, have longitudinally and systematically assessed the extent to which psychosocial factors may impact on immune responses in this population. Methods: Patients with HNSCC undergoing treatment with surgery, radiotherapy, or both were administered a battery of validated questionnaires to assess mental status and cognition, life stress, social support, coping, psychological distress, health behaviors, and quality of life at 2 time points: pretreatment and 6 weeks posttreatment. Peripheral blood was obtained at these 2 time points and CD4+, CD8+, and gamma-delta T cell subsets were isolated and analyzed by flow cytometry. Pearson-zero order correlations were performed between psychosocial stressors and percentages of T cell subsets. Results: Preliminary analysis of 38 patients showed that behavioral disengagement (giving up attempts to deal with the cancer diagnosis) prior to treatment was correlated to decreased levels of CD8+ T cells both pretreatment and posttreatment, while an increase in coping-planning (devising strategies to deal with the problem) after the diagnosis of carcinoma was correlated with increased levels of CD4+ T cells. Conclusion: Patients who respond to the diagnosis of cancer with denial/avoidance may be at risk for T cell immune dysfunction. Health care professionals may be instrumental in recognizing and helping patients with adjustment difficulties and negative coping behaviors after diagnosis of and during treatment for HNSCC. Significance: Understanding the effect of psychosocial factors on anti-tumor immunity is important in order to develop effective cognitive behavioral stress management interventions that aim to enhance or sustain immune function and overall health status through stress management techniques including effective coping and use of efficacious social networks. Support: None reported