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School improvement in chronically under-performing schools remains a formidable challenge for school leaders. Recent policies in the U.S. have created incentives for school leaders to attempt new strategies to improve outcomes, and increasingly, school leaders of charter management organizations and other multi-school organizations (MSOs) are taking on this work. Research suggests that the most successful school leaders of MSOs have established robust systems of instruction and professional development. This article is based on a longitudinal qualitative case study of a school leadership team at a new MSO and uses the framework of epistemic communities to consider how leaders can generate, manage, and transfer knowledge within and across school boundaries while operating within an accountability-focused school turnaround context. Given the diverse professional backgrounds of U.S. educators, creating the capacity for school leaders and teachers to develop a common theory of action and leverage common tools may both be necessary for improvement in student outcomes but also complex and resource-intensive work. Developing highly capable MSOs is an iterative process that requires significant time and resources in school leadership positions to build a shared curriculum, align on instructional design, and develop leadership capacity to support teaching and learning within and across schools.

Background Preseason movement screening can identify modifiable risk factors, deterioration of function, and potential for injury in baseball players. Limited resources and time intensive testing procedures prevent high school coaches from accurately performing frequent movement screens on their players. Purpose To establish the intra-rater and inter-rater reliability of a novel arm care screening tool based on the concepts of the Functional Movement Screen (FMS™) and Selective Functional Movement Assessment (SFMA™) in high school coaches. Study Design Methodological intra- and inter-rater reliability study Methods Thirty-one male high school baseball players (15.9 years ± 1.06) were independently scored on the Arm Care Screen (ACS) by three examiners (two coaches, one physical therapist) in real-time and again seven days later by reviewing video recordings of each players' initial screening performance. Results from each examiner were compared within and between raters using Cohen's kappa and percent absolute agreement. Results Substantial to excellent intra-rater and inter-rater reliability were established among all raters for each component of the ACS. The mean Cohen's kappa coefficient for intra-rater reliability was 0.76 (95% confidence interval, 0.54-0.95) and percent absolute agreement ranged from 0.82-0.94 among all raters. Inter-rater reliability demonstrated a mean Cohen's kappa value of 0.89 (95% confidence interval, 0.77-0.99) while percent absolute agreement between raters ranged from 0.81-1.00. Intra- and inter-rater reliability did not differ between raters with various movement screening experience (p>0.05). Conclusions High school baseball coaches with limited experience screening movement can reliably score all three components of the ACS in less than three minutes with minimal training. Level of Evidence Level 3, Reliability study [ABSTRACT FROM AUTHOR]

Background Arm care programs consisting of upper extremity strengthening and stretching have been recommended for injury prevention for pitchers of all ages. There has been no investigation into high school baseball coaches' usage and perceptions of arm care programs to mitigate physical impairments associated with injuries in baseball players. Hypothesis/Purpose The purpose of this study was to investigate the current usage of arm care programs by high school baseball coaches. The primary objective was to determine if coaches use group-based or individualized arm care programs. The secondary objective sought to determine if the use of arm care programs is influenced by coaches' age, education, and experience level. Finally, this study explored the potential barriers to arm care implementation and high school baseball coaches' current awareness and beliefs of injury prevention. Study Design Descriptive cross-sectional survey Methods A 29-item online survey was emailed to 18,500 high school baseball coaches throughout the United States. Data were collected for three months, and the response rate was 3.7%. Results A total of 87.3% (n=571/654) of responding coaches use arm care programs with their players. Of coaches performing arm care, only 18.5% of 571 individualize their arm care exercises based on specific player needs. However, older and more experienced coaches are more likely to individualize their programs. Among the 12.7% (n=83/654) of coaches who do not use arm care programs, the two most commonly cited reasons for not implementing arm care were lack of observed benefit (41%) and insufficient staff (31%). Although 42% of 654 coaches recognized reduced shoulder mobility as a major contributor to injury, risk factors such as throwing with a fatigued arm, previous injury history, and throwing > 8 months per year were not consistently identified as primary risk factors. Conclusion The results of this study suggest that the majority high school baseball coaches implement group-based arm care exercise programs to prevent injury. Lack of confidence in the effectiveness and staffing limitations were major barriers to implementation of arm care programming. However, the responding coaches exhibited inconsistent risk factor awareness and dated injury prevention beliefs. Therefore, better educational collaboration between rehabilitation professionals and high school coaches regarding injury risk factors and preventative strategies is warranted. [ABSTRACT FROM AUTHOR]

Offers a series of hands-on activities for introducing students to concepts of energy transfer and conversion. Describes how simple devices as marbles, ramps, and sliders can be used to gauge the transfer of energy and assist in the development of investigative skills. (ML)

Assessed the effectiveness of conducting an elementary science methods course based on the Concerns Based Adoption Model (CBAM) on the concerns and attitudes of 85 preservice elementary teachers. Results indicate that neither traditional nor CBAM methods courses proved superior in affecting concerns or attitudes of the preservice teachers. (Author/JN)

Determined whether the field experience component of an undergraduate science methods course influenced teachers' concerns and attitudes toward science and science teaching. Age, grade-point average, openmindedness, and school assignment were examined as variables which might explain some of the variance in the dependent measures. (Author/JN)

Reports on a study intended to compare the effects of two methods of instruction designed to teach preservice elementary teachers to acquire and retain integrated science process skills. Results indicated that the self-instructional method was significantly more effective than the teacher-directed method. (TW)

Relationships of student characteristics to student performance/attitudes were explored by meta-analysis for studies for years 1960-1981. Six characteristics (general ability, language ability, mathematics ability, socio-economic status, sex, and race) were selected for inclusion in the study. Indicates strong positive relationships between general/language/mathematics ability and achievement and attitude measures. (JN)

Abstract: Approximately 25% of patients undergoing carotid endarterectomy (CEA) exhibit cognitive dysfunction (CD) 1day and 1month after CEA. The apolipoprotein E (apoE)-ε4 polymorphism has been previously identified as a robust independent risk factor for CD 1month after CEA. We aimed to determine whether the apoE-ε4 polymorphism is also an independent risk factor for CD as early as 1day after CEA and to confirm the previous findings at 1month. Patients undergoing elective CEA (n=411) were enrolled with written informed consent in this follow-up observational study. CD was evaluated via an extensive neuropsychometric battery. apoE-ε4 carriers exhibited significantly more CD 1day (30.1% versus 17.9%, p =0.01) and 1month (25.7% versus 9.8%, p =0.001) after CEA compared to non-carriers. Multivariate regression models were generated to determine independent predictors of CD. At 1day, apoE-ε4 was significantly associated with higher risk of CD (odds ratio [OR]: 2.24 [95% confidence interval 1.29–3.84], p =0.004), while statin use was significantly associated with lower risk (OR: 0.40 [0.24–0.67], p <0.001). At 1month, apoE-ε4 was significantly associated with higher risk of CD (OR: 3.14 [1.53–6.38], p =0.002), while symptomatic status was significantly associated with lower risk (OR: 0.45 [0.20–0.94], p =0.03). The apoE-ε4 polymorphism is an independent risk factor for CD as early as 1day after CEA and is confirmed to be an independent risk factor for CD at 1month as well. [Copyright &y& Elsevier]

This case presents the challenges of management associated with a young throwing athlete presenting with a history of bilateral anterior shoulder instability. This athlete had multiple surgical interventions over a three-year period. The imaging modalities provided partial elucidation (at best) of the true picture of the pathology. This case report outlines the decision making process utilized to provide individualized care to a young throwing athlete with bilateral glenohumeral joint instability, recurrent dislocations, and resultant glenoid bone loss. [ABSTRACT FROM AUTHOR]

An interview with Jerry Bussell, president of Bussell Lean Associates, is presented. Bussell is a recipient of the Medtronic Wallin Leadership award for transforming Medtronic ENT's traditional manufacturing operation into the lean manufacturing system. He explains the concept of lean leadership, and its importance in building and sustaining a lean culture. He offers advice for people who want to grow in lean leadership.

Abstract: Models employing peripheral nerve to bypass spinal cord injury (SCI), although highly promising, may benefit from improved nerve regeneration and motor bridge connectivity. Recent studies have demonstrated that neuronal growth factor-induced enhancement of endogenous neurorestoration may improve neuronal connectivity after severe neurologic injury, particularly if delivered intraparenchymally with zero-order kinetics. We sought to investigate the effect of convection-enhanced delivery of brain-derived neurotrophic factor (BDNF), a neuronal growth factor, on the connectivity of a peripheral motor-nerve bridge in a rodent model using electrophysiology and immunohistochemistry (IHC). Spinal cords of 29 female rats were hemisected at the L1 level. Ipsilateral T13 peripheral nerves were dissected from their muscular targets distally, while maintaining their connections with the spinal cord, and inserted caudal to the injury site to establish the nerve bridge. A microcannula attached to a six-week mini-osmotic pump was used to deliver either BDNF (n =12), saline (n =14), or fluorescein dye (n =3) directly into the spinal cord parenchyma between the site of nerve insertion and hemisection to a depth of 2mm into the area of the lateral motor pool. After four weeks, gastrocnemius muscle activation was assessed electromyographically in five animals from each group. Spinal cords were harvested and analyzed with IHC for cannula-associated injury, and nerve regeneration. Strength of motor bridge connection was illustrated by electrophysiology data. Intraspinal BDNF levels were measured using enzyme-linked immunosorbent assay. IHC revealed increased intraparenchymal BDNF concentration at the nerve bridge insertion site with evidence of minimal trauma from cannulation. BDNF infusion resulted in stronger connections between bridge nerves and spinal motor axons. Bridge nerve electrical stimulation in BDNF-treated rats evoked hind leg electromyogram responses of shorter latency and larger amplitudes than saline-infused controls. Thus, direct convection-assisted delivery provides reliable administration of potent growth factors directly into the spinal cord parenchyma. Delivery of BDNF at the peripheral nerve bridge site results in enhanced connectivity of the peripheral motor bridge in a rodent model of SCI. [Copyright &y& Elsevier]

Purpose/Background: Historically, patellofemoral pain syndrome (PFPS) has been viewed exclusively as a knee problem. Recent findings have suggested an association between hip muscle weakness and PFPS. Altered neuromuscular activity about the hip also may contribute to PFPS; however, more limited data exist regarding this aspect. Most prior investigations also have not concurrently examined hip and knee strength and neuromuscular activity in this patient population. Additional knowledge regarding the interaction between hip and knee muscle function may enhance the current understanding of PFPS. The purpose of this study was to compare hip and knee strength and electromyographic (EMG) activity in subjects with and without PFPS. Methods: Eighteen females with PFPS and 18 matched controls participated in this study. First, surface EMG electrodes were donned on the gluteus medius, vastus medialis, and vastus lateralis. Strength measures then were taken for the hip abductors, hip external rotators, and knee extensors. Subjects completed a standardized stair-stepping task to quantify muscle activation amplitudes during the loading response, single leg stance, and preswing intervals of stair descent as well as to determine muscle onset timing differences between the gluteus medius and vastii muscles and between the vastus medialis and vastus lateralis at the beginning of stair descent. Results: Females with PFPS demonstrated less strength of the hip muscles. They also generated greater EMG activity of the gluteus medius and vastus medialis during the loading response and single leg stance intervals of stair descent. No differences existed with respect to onset activation of the vastus medialis and vastus lateralis. All subjects had a similar delay in gluteus medius onset activation relative to the vastii muscles. Conclusion: Rehabilitation should focus on quadriceps and hip strengthening. Although clinicians have incorporated gluteus medius exercise in rehabilitation programs, additional attention to the external rotators may be useful. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Abstract: Background/purpose: Despite advances in pediatric nutritional support and a renewed focus on management of intestinal failure, there are limited recent data regarding the risk of parenteral nutrition (PN)–associated liver disease in surgical infants. This study investigated the incidence of cholestasis from PN and risk factors for its development in this population. Methods: A retrospective review was performed of all neonates in our institution who underwent abdominal surgery and required postoperative PN from 2001 to 2006. Cholestasis was defined as 2 conjugated bilirubin levels greater than 2 mg/dL over 14 days. Nonparametric univariate analyses and multivariate logistic regression were used to model the likelihood of developing cholestasis. Median values with range are presented. Results: One hundred seventy-six infants met inclusion criteria, and patients received PN for 28 days (range, 2-256 days). The incidence of cholestasis was 24%. Cholestatic infants were born at an earlier gestational age (34 vs 36 weeks; P < .01), required a 3-fold longer PN duration (76 vs 21 days; P < .001), had longer inpatient stays (86 vs 29 days; P < .001), and were more likely to be discharged on PN. The median time to cholestasis was 23 days. Cholestasis was an early development; 77% of cholestatic infants developed cholestasis by 5 weeks of PN exposure. On multivariate regression, only prematurity was significantly associated with development of cholestasis (P < .05). Conclusion: In this analysis, the development of PN-associated liver disease occurred early in the course of exposure to PN. These data help to define the time course and prognosis for PN-associated cholestasis in surgical infants. [Copyright &y& Elsevier]

Abstract: Purpose: Multidisciplinary treatment of pediatric intestinal failure has shown promising results. However, there are limited data as to the optimal time frame for referral of patients to intestinal failure programs. The aim of this study was to explore the relationship of hyperbilirubinemia at referral with patient outcomes in a multidisciplinary program. Methods: A retrospective analysis was performed of a prospectively collected database from a multidisciplinary intestinal failure program. Multivariable logistic regression adjusted for age at referral was used to model the association between the conjugated bilirubin at referral and risk of mortality. Median values with range are reported. Results: Sixty-two patients were referred from 2005 to 2009. Patients presented at age 6.4 months (0.4-261.4 months) and were followed up for 16.8 (0.3-53.0) months. Nine subjects (14.5%) died, and 12 subjects (19.4%) were listed for combined liver-intestine transplant. A 50% mortality was seen in patients referred with a conjugated bilirubin ≥7.2 mg/dL (n = 12), whereas mortality at referral bilirubin levels <7.2 mg/dL was 6%. After adjusting for age at referral, patients with a conjugated bilirubin ≥7.2 mg/dL at referral were 15.4 times more likely to die than patients who presented with lower bilirubin levels (P = .001; 95% confidence interval, 2.8-83.4). Conclusion: Within a pediatric intestinal failure program, mortality is associated with the degree of hyperbilirubinemia at time of referral. These data strongly suggest that these patients should be referred to a multidisciplinary program early in the evolution of their liver disease. [Copyright &y& Elsevier]

Purpose: We determined the role of factor inhibiting hypoxia-inducible factor-1 in prostate cancer specimens. Materials and Methods: A tissue microarray of 152 prostate cancers was constructed and stained for factor inhibiting hypoxia-inducible factor-1, hypoxia-inducible factor-1α and 2α, and glucose transporter 1 as a prototypical downstream target of hypoxia-inducible factor-1α. Correlation analysis was done between these variables, and between factor inhibiting hypoxia-inducible factor-1, and clinical and pathological variables, including prostate specific antigen as a surrogate of recurrence. Results: Factor inhibiting hypoxia-inducible factor-1 was expressed in the cytoplasm and/or the nucleus in 86.5% of tumors, including exclusive cytoplasmic expression in 51.3% and exclusive nuclear expression in 5.3%. Any nuclear and exclusive expression of factor inhibiting hypoxia-inducible factor was associated with poor prognosis on univariate analysis (p = 0.007 and 0.042, respectively). On multivariate analysis men with nuclear expression in tumors were twice as likely to experience recurrence (p = 0.034). Conclusions: Factor inhibiting hypoxia-inducible factor-1 is widely expressed in prostate tumors. Its differential subcellular expression suggests that regulation of its expression is an important factor in the activity of the hypoxia-inducible factor pathway. Its modulation may help treat hypoxia-inducible factor driven aggressive prostate cancer. [ABSTRACT FROM AUTHOR]