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Key point: Social determinants of health interactively influence sinonasal cancer care and prognosis.Housing‐transportation and socioeconomic status showed the largest associations with disparities.The social vulnerability index can reveal the social determinants of sinonasal cancers. [ABSTRACT FROM AUTHOR]

The detection of cognitive patterns in children with learning disabilities (LD) has been a priority in the identification process. Subtest profile analysis from traditional cognitive assessment has drawn sharp criticism for inaccurate identification and weak connections to educational planning. Therefore, the purpose of this study is to use a new generation of cognitive tests with megacluster analysis to augment diagnosis and the instructional process. The Cognitive Assessment System uses a contemporary theoretical model in which composite scores, instead of subtest scores, are used for profile analysis. Ten core profiles from a regular education sample (N = 1,692) and 12 profiles from a sample of students with LD (N = 367) were found. The majority of the LD profiles were unique compared with profiles obtained from the general education sample. The implications of this study substantiate the usefulness of profile analysis on composite scores as a critical element in LD determination. (Contains 5 tables.)

Objective This study examined barriers to mental health service use and preferences for addressing emotional concerns among lung cancer patients ( N = 165) at two medical centers in the Midwestern United States. Methods Lung cancer patients completed an assessment of anxiety and depressive symptoms, mental health service use, barriers to using these services, and preferences for addressing emotional concerns. Results Only 45% of distressed patients received mental health care since their lung cancer diagnosis. The most prevalent patient-reported barriers to mental health service use among non-users of these services ( n = 110) included the desire to independently manage emotional concerns (58%) and inadequate knowledge of services (19%). In addition, 57% of distressed patients who did not access mental health services did not perceive the need for help. Seventy-five percent of respondents (123/164) preferred to talk to a primary care physician if they were to have an emotional concern. Preferences for counseling, psychiatric medication, peer support, spiritual care, or independently managing emotional concerns also were endorsed by many patients (range = 40-50%). Older age was associated with a lower likelihood of preferring to see a counselor. Conclusions Findings suggest that many distressed lung cancer patients underuse mental health services and do not perceive the need for such services. Efforts to increase appropriate use of services should address patients' desire for autonomy and lack of awareness of services. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The Patient Protection and Affordable Care Act signed into law in March 2010, has led to sweeping changes to the US health care system. The ensuing pace of change in health care regulation is unparalleled and difficult for physicians to keep up with. Because of the extraordinary challenges that have arisen, the public policy committee of the Society for Surgery of the Alimentary tract conducted a symposium at their 52nd Annual Meeting in May 2011 to educate participants on the myriad of public policy changes occurring in order to best prepare them for their future. Expert speakers presented their views on policy changes affecting diverse areas including patient safety, patient experience, hospital and provider fiscal challenges, and the life of the practicing surgeon. In all areas, surgical leadership was felt to be critical to successfully navigate the new health care landscape as surgeons have a long history of providing safe, high quality, low cost care. The recognition of shared values among the diverse constituents affected by health care policy changes will best prepare surgeons to control their own destiny and successfully manage new challenges as they emerge. [ABSTRACT FROM AUTHOR]

Abstract: One known complication of induced abortion is upper genital tract infection, which is relatively uncommon in the current era of safe, legal abortion. Currently, rates of upper genital tract infection in the setting of legal induced abortion in the United States are generally less than 1%. Randomized controlled trials support the use of prophylactic antibiotics for surgical abortion in the first trimester. For medical abortion, treatment-dose antibiotics may lower the risk of serious infection. However, the number-needed-to-treat is high. Consequently, the balance of risk and benefits warrants further investigation. Perioperative oral doxycycline given up to 12 h before a surgical abortion appears to effectively reduce infectious risk. Antibiotics that are continued after the procedure for extended durations meet the definition for a treatment regimen rather than a prophylactic regimen. Prophylactic efficacy of antibiotics begun after abortion has not been demonstrated in controlled trials. Thus, the current evidence supports pre-procedure but not post-procedure antibiotics for the purpose of prophylaxis. No controlled studies have examined the efficacy of antibiotic prophylaxis for induced surgical abortion beyond 15 weeks of gestation. The risk of infection is not altered when an intrauterine device is inserted immediately post-procedure. The presence of Chlamydia trachomatis, Neisseria gonorrhoeae or acute cervicitis carries a significant risk of upper genital tract infection; this risk is significantly reduced with antibiotic prophylaxis. Women with bacterial vaginosis (BV) also have an elevated risk of post-procedural infection as compared with women without BV; however, additional prophylactic antibiotics for women with known BV has not been shown to reduce their risk further than with use of typical pre-procedure antibiotic prophylaxis. Accordingly, evidence to support pre-procedure screening for BV is lacking. Neither povidone-iodine nor chlorhexidine have been shown to alter the risk of infection when used as cervicovaginal preparation. However, chlorhexidine appears to be more effective than povidone iodine at reducing bacteria within the vagina. The Society of Family Planning recommends the routine use of antibiotic prophylaxis, preferably with doxycycline, before surgical abortion. Use of treatment doses of antibiotics with medical abortion may decrease the rare risk of serious infection but universal requirement for such treatment has not been established. [Copyright &y& Elsevier]

The article explores the use of the Groningen protocol over the treatment of terminally-ill infants in the U.S., England, and the Netherlands. Noted was that the Groningen protocol was established with a help of a local prosecutor after the prosecution of physicians that have euthanized infants in 2004. It refers to the cases, Kadijk and Pearson, which have illustrated the application of the Groningen protocol based on the comparisons over the treatment of terminally-ill infants.

Details the activities and outcomes of the Listening Project, a collaboration of professionals active in the victim community and the field of restorative justice in the U.S. Design and objectives of the project; Impediments and challenges to restorative justice; Proposed agendas that might be pursued independently or collaboratively by the victim community and restorative justice advocates in the U.S.

Small classes in the elementary grades have been shown to boost students' academic performance. However, researchers continue to seek a consistent, integrated explanation of "why" small classes have positive effects. This article forwards the hypothesis that when class sizes are reduced, major changes occur in students' engagement in the classroom. Engagement is composed of "learning behavior" and pro- and antisocial behavior. Both are highly related to academic performance. We first review research on the relationship between class size and student engagement. Second, we review sociological and psychological theory about the behavior of individuals in groups to explain how student behavior can be affected by changes in class size. Both theory and empirical findings support our hypothesis, although additional research is required. High-priority questions needing further research are identified in the conclusion. [ABSTRACT FROM AUTHOR]

Focuses on a study which investigated the probability of contact between government agencies and youths who committed suicide in Utah. Rate of increase in youth suicide; Relationship between school status and juvenile justice contact; Implications for clinical practice.

Despite more than 600,000 teacher aides in American schools today, research provides little information about their classroom activities, their qualifications for carrying out their duties, or their impact on student achievement and behavior. This investigation asked whether the presence of a teacher aide in the classroom has any noticeable impact on pupils' learning. Three primary questions were addressed: (1) In Grades K through 3, does the presence of a full-time teacher aide in the classroom affect students' academic achievement? (2) If teacher aides have a positive effect on students' performance, does the effect depend on the number of years the student attends classes with a teacher aide? (3) Do some functions of aides (i.e., clerical tasks, instructional tasks, noninstructional tasks) have a greater impact on student achievement than others? This investigation showed that the teacher aide movement in the United States has created a state of affairs that requires many aides to perform tasks for which they are ill-prepared. In addition, teacher aide data were analyzed from Tennessee's Project STAR, a longitudinal experiment in which students were assigned at random to small classes, regular-size classes without an aide, or regular-size classes with a full-time teacher aide. The analyses reported here extend previous investigations, examining the functions and effects of teacher aides in depth. The results showed that teacher aides have little, if any, positive effect on students' academic achievement. The only positive effect was an improvement in reading scores for students who attended a class with a teacher aide for 2 or 3 years. These results were the only exceptions to a plethora of negative findings. The study also showed that the types of duties aides performed had no bearing on student achievement. Because teacher aides are called upon increasingly to provide instruction to pupils, policies and research must help us select and prepare aides to perform effectively. [ABSTRACT FROM AUTHOR]

Discusses several programs or reform on educational administration in the United States from the 1950s to the 1990s. Differences between the problems and projected remedies on educational administration in the 1990s from the issues in the 1950s; Discussion on early 1990s ideas about educational administration preparation in juxtaposition with prior ideas for reform.

Seeks how site-based-administration (SBA) principals can develop a democratic school. Principals' role among teachers; Principals as role models; Principals and the community.

Asserts the need for a paradigm shift in public schools to prevent minority student alienation. Essays about majority-minority relations in the United States; Factors influencing the education reform; Concept of paradigm shift.

Examines the education reforms in Tennessee during the 1980s. Development and analysis of educational goals; Governance and organizational structure; Influences of politics on Tennessee education; Key factors considered in formulating school enrollment projections; Instructional quality; Coalition of educators around the reform issues; Distribution of funds to each level of public education; Legal nature of education reform actions. actions.

States that research on school restructuring provides little evidence that teacher-student-principal relationships are changing. Staffs may be confusing structural thinking (adopting and implementing organization structures such as shared governanc e, co-operative learning groups, teacher-student advisories) with normative thinking (reconceptualizing how norms characterizing ideal relationships among teachers, principals, and students can be supported and developed through organization structures). Argues that normative thinking requires staffs to reflect critically about their schools as workplaces but that US schools have not been reflective workplaces. As a vehicle for this normative thinking, suggests school-site constructed theories in practi ce, which have two steps: critical inquiry and monitoring the change progress. Makes three policy suggestions based on the need for staffs to theorize about their practice: an action research role for professors; a caveat about prescribing only measurabl e outcomes for administrator preparation programmes; and time for teacher-leader and principal reflection on their practice. [ABSTRACT FROM AUTHOR]

A large-scale experiment is described in which kindergarten students and teachers were randomly assigned to small and large classes within each participating school. Students remained in these classes for 2 years. At the end of each grade they were measured in reading and mathematics by standardized and curriculum-based tests. The results are definitive (a) a significant benefit accrues to students in reduced-size classes in both subject areas and (b) there is evidence that minority students in particular benefit from the smaller class environment, especially when curriculum-based tests are used as the learning criteria. A longitudinal analysis of a portion of the sample indicated that students in small classes outperform their peers in kindergarten classes of regular size and also gain more in reading outcomes during the second rear The question of why these effects are realized remains largely unanswered, but in light of these findings, is particularly important to pursue. [ABSTRACT FROM AUTHOR]

This article focuses on the problems plaguing educational program evaluation in the U.S. There has been growth in interest in educational evaluation. Until recently, few colleges and universities have had special preparation programs for evaluators. Aspiring evaluators usually studied research and statistics, and they learn about evaluation on the job. The science of evaluation seemed well suited to the arts/crafts apprenticeship approach. Evaluators, need to win the confidence and respect of personnel where evaluations occur so that they can obtain accurate and complete data. Selection of a control group for evaluation is often hindered because all schools in a particular system are a part of a project, or all schools meeting certain criteria are in the project. It is better to seek a control group from a similar district. It may be possible to obtain a control group from the same system when only some schools are to be evaluated. However, this control group is contaminated by the fact that in-service and teacher meetings will feature the innovative project.

Presents R. Murray Schafer's answers to questions dealing with creative music making and lifelong learning. Schafer's views on creative music making and lifelong learning.

Background: BufferGel is a novel spermicidal and microbicidal gel formulated to maintain the natural protective acidity of the vagina by acidifying semen, which otherwise alkalinizes the vagina.Goal: To test the efficacy of BufferGel for preventing sexually transmitted infections and pregnancy in animal models.Study Design: Animals were challenged with pathogens or sperm after pretreatment with both test and control agents, or after no pretreatment, then evaluated for infection or pregnancy using standard methods.Results: BufferGel provided significant contraceptive efficacy in the rabbit, and significant protection against vaginal and rectal transmission of herpes simplex virus type 2 (HSV-2) in the mouse, vaginal transmission of Chlamydia trachomatis in the mouse, and skin transmission of cottontail rabbit papillomavirus in the rabbit. It did not protect against vaginal transmission of Neisseria gonorrhoeae in the mouse.Conclusions: The protective efficacy of BufferGel in five of the six animal models suggests that this microbicide warrants clinical evaluation for both contraception and disease prevention. [ABSTRACT FROM AUTHOR]

Editorial. Focuses on lifelong learning in music, with emphasis on how older adults continue to find deeper meanings and a sense of purpose in their lives. Various settings in which music making in adulthood takes place; What has been changed to accommodate adult learning styles; Realization of music educators when they work with learners of any age-group.

Objectives: Crisis pregnancy centers (CPCs) seek to dissuade people from having abortions. Twenty-five states have policies supporting CPCs. We aimed: (1) to characterize access to early pregnancy confirmation at CPCs compared to abortion facilities nationwide and (2) to understand the role of state CPC policy in service access.Study Design: We conducted a national mystery caller study of 445 CPCs and geographically paired abortion facilities, posing as patients seeking pregnancy confirmation. Facility type (CPC vs abortion facility) was the primary exposure in Aim 1. Wait time to first available early pregnancy appointment was the primary outcome. In Aim 2, state-level CPC policy designation (supportive vs not supportive of CPCs) was the primary exposure. Difference in wait time ≥7 days to first available appointment between CPCs and paired abortion facilities was the primary outcome.Results: CPCs were more likely than abortion facilities to provide same-day appointments (68.5% vs 37.2%, p < 0.0001), and free pregnancy testing (98.0% vs 16.6%, p < 0.0001). The median wait to first available appointment at a CPC was 0 days (IQR 0,1), compared to 1 day at abortion facilities (IQR 0, 5), p < 0.0001. In states with supportive CPC policy environments, abortion facilities were less likely to have wait times exceeding their paired CPC by a week or more, compared to paired facilities in states with non-supportive CPC policy environments (p = 0.033). This remained true after adjusting for state abortion policy environment (p = 0.011).Conclusions: Pregnancy confirmation is more accessible at CPCs compared to abortion facilities. Factors other than state-level CPC policies likely influence service accessibility. There is a need for improved access to pregnancy confirmation in medical settings.Implications: Our findings demonstrating that pregnancy confirmation is more accessible at crisis pregnancy centers than at abortion facilities are predicted to be exacerbated in the wake of abortion clinic closures following the Dobbs v Jackson Women's Health Organization Supreme Court decision. This highlights the need for improved funding and support for pregnancy confirmation service delivery in medical settings, including abortion facilities. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: This study examined support service use and interest in support services among lung cancer patients (N =165) at two comprehensive medical centers in the midwestern United States. Materials and methods: Patients completed an assessment of support service use (i.e., receipt of mental health services, complementary and alternative medicine [CAM], and help from a spiritual leader), interest in support services, and physical and psychological symptoms. Results: Only 40% of patients with significant anxiety and depressive symptoms and 28% of the entire sample reported current mental health service use. However, nearly half (47%) of all patients were receiving support from a spiritual leader. Having late-stage lung cancer and a religious affiliation predicted receipt of spiritual support. Few patients who were not receiving mental health services or spiritual support were interested in these services (range=4–18%). Conversely, although interest in CAM was expressed by a substantial minority of patients (27%) who were not using these services, rates of CAM use were relatively low (22%). Conclusions: Findings suggest that distressed lung cancer patients underuse mental health services, but many patients receive help from spiritual leaders. Given the lack of interest in mental health services among patients who are not receiving them, efforts are needed to enhance palatability of services and identify and reduce barriers to evidence-based service use. [Copyright &y& Elsevier]

Background and Objectives: The absence of accepted patient-centered outcomes in research can limit shared decision-making in peritoneal dialysis (PD), particularly because PD-related treatments can be associated with mortality, technique failure, and complications that can impair quality of life. We aimed to identify patient and caregiver priorities for outcomes in PD, and to describe the reasons for their choices., Design, Setting, Participants, & Measurements: Patients on PD and their caregivers were purposively sampled from nine dialysis units across Australia, the United States, and Hong Kong. Using nominal group technique, participants identified and ranked outcomes, and discussed the reasons for their choices. An importance score (scale 0-1) was calculated for each outcome. Qualitative data were analyzed thematically., Results: Across 14 groups, 126 participants (81 patients, 45 caregivers), aged 18-84 (mean 54, SD 15) years, identified 56 outcomes. The ten highest ranked outcomes were PD infection (importance score, 0.27), mortality (0.25), fatigue (0.25), flexibility with time (0.18), BP (0.17), PD failure (0.16), ability to travel (0.15), sleep (0.14), ability to work (0.14), and effect on family (0.12). Mortality was ranked first in Australia, second in Hong Kong, and 15th in the United States. The five themes were serious and cascading consequences on health, current and impending relevance, maintaining role and social functioning, requiring constant vigilance, and beyond control and responsibility., Conclusions: For patients on PD and their caregivers, PD-related infection, mortality, and fatigue were of highest priority, and were focused on health, maintaining lifestyle, and self-management. Reporting these patient-centered outcomes may enhance the relevance of research to inform shared decision-making., (Copyright © 2019 by the American Society of Nephrology.)

Aims: To report interpatient, intrapatient, and study site variability of urodynamic study (UDS) parameters in patients with overactive bladder (OAB)., Methods: Fifty-eight patients with OAB participated in a randomized, double-blind, placebo-controlled, urodynamic trial of an experimental OAB drug. Patients underwent 3 serial cystometries (CMGs) at three times: screening, pre-dose, and 4-hr postdose. This post hoc analysis describes intrapatient, interpatient, and site variability for the 6 CMGs prior to administration of study drug. Sites were given standard procedures for equipment calibration and UDS technique. Instilled volumes and pressures were recorded at first sensation of filling, first desire to void (FDV), strong desire to void (SDV), and maximum cystometric capacity (MCC)., Results: The UDS volume endpoint with the smallest observed within-patient variability based on coefficient of variation (%CV) was MCC (%CV 24). Pressure measurements of all bladder sensations had larger within-patient variability than volume (MCC %CV 105). The between-patient variability was greater than within-patient variability for all bladder sensation volumes. Between-patient MCC variability for the 6 pre-treatment CMGs ranged from %CV of 50 to 58, whereas the within-patient %CV for MCC was 21-23. Excellent reproducibility was observed for bladder volume for MCC (intraclass correlation coefficients, range: 0.80-0.84). The between-site variability was large, as demonstrated by the mean volumes by site for MCC (132-397  ml)., Conclusions: MCC was the most reproducible sensation. Pressure measurements were substantially more variable than volume. Between-patient variability was substantially greater than within-patient variability. The observed intersite variability suggests that despite detailed instructions, sensations may not have been measured in a consistent manner across sites., (Copyright © 2011 Wiley Periodicals, Inc.)

This study investigated participants' reactions to employee testimonials presented on recruitment Web sites. The authors manipulated the presence of employee testimonials, richness of media communicating testimonials (video with audio vs. picture with text), and representation of racial minorities in employee testimonials. Participants were more attracted to organizations and perceived information as more credible when testimonials were included on recruitment Web sites. Testimonials delivered via video with audio had higher attractiveness and information credibility ratings than those given via picture with text. Results also showed that Blacks responded more favorably, whereas Whites responded more negatively, to the recruiting organization as the proportion of minorities shown giving testimonials on the recruitment Web site increased. However, post hoc analyses revealed that use of a richer medium (video with audio vs. picture with text) to communicate employee testimonials tended to attenuate these racial effects.