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The abrupt emergence and spread of the COVID-19 virus compelled institutions worldwide to swiftly suspend face-to-face instruction in favor of a remote teaching mode. This extraordinary shift of instructional delivery created one of the biggest infrastructural, pedagogical and operational challenges for universities in recent history. As institutions that traditionally have been slow to respond to sudden external influences, universities struggled to respond effectively to COVID-19. Using the Human Systems Dynamics approach as conceptual framework, this paper retrospectively explores how academic staff adapted their Emergency Remote Teaching strategies and became more learning-agile to respond to such challenges in the future. This exploratory case-study article summarizes the results of a survey of teaching staff's readiness, experience and struggles with Emergency Remote Teaching during COVID-19 in the United States, the United Kingdom and Australia, at the height of the pandemic. A total of 73 usable responses were received between July 17 and August 7, 2020. The results were classified into four categories: (1) Preparation and training; (2) Faculty impressions of own teaching; (3) Faculty experience; and (4) Faculty impressions of student experience.

Chinese students are more likely than US students to hold a malleable view of success in school, yet are more likely to hold fixed mindsets about intelligence. We demonstrate that this apparently contradictory pattern of cross-cultural differences holds true across multiple samples and is related to how students conceptualize intelligence and its relationship with academic achievement. Study 1 (N > 15,000) confirmed that US students endorsed more growth mindsets than Chinese students. Importantly, US students' mathematics grades were positively related to growth mindsets with a medium-to-large effect, but for Chinese students, this association was slightly negative. Study 2 conceptually replicated Study 1 findings with US and Chinese college samples, and further discovered that cross-cultural differences in intelligence mindset beliefs corresponded to how students defined intelligence. Together, these studies demonstrated systematic cross-cultural differences in intelligence mindset and suggest that intelligence mindsets are not necessarily associated with academic motivation or success in the same way across cultures.

A phenomenological study explored how five U.S. school counselors-in-training experienced cultural immersion in family life, schools, agencies, and community in the Netherlands. The central phenomenon emerging from reflection papers was that insights about cultural values led to making sense of how school counseling and special education were conceptualized. Students' growth in cultural competence evolved from an initial preoccupation with concrete differences to a nuanced understanding of, and preference for, Dutch institutions and policies, and finally to a balanced view of U.S. and Dutch cultures. Findings attest that deep learning can occur in 2 weeks if thoughtful preparation, mutual benefit, collaboration, homestays, and community experiences are elements.

The article focuses on the dual loyalty crisis faced by U.S. clinicians as they attempt to practice patient-centered health care. Topics discussed include background on the concept of dual loyalty, impact of the challenges faced by clinicians to provide their patients with standard and evidence-based health care, and range of dual loyalty challenges in the U.S.

OBJECTIVE: We sought to confirm, refute, or modify a 4-step process for implementing shared decision-making (SDM) in pediatrics that involves determining 1) if the decision includes >1 medically reasonable option; 2) if one option has a favorable medical benefit-burden ratio compared to other options; and 3) parents' preferences regarding the options; then 4) calibrating the SDM approach based on other relevant decision characteristics. METHODS: We videotaped a purposive sample of pediatric inpatient and outpatient encounters at a single US children's hospital. Clinicians from 7 clinical services (craniofacial, neonatology, oncology, pulmonary, pediatric intensive care, hospital medicine, and sports medicine) were eligible. English-speaking parents of children who participated in inpatient family care conferences or outpatient problem-oriented encounters with participating clinicians were eligible. We conducted individual postencounter interviews with clinician and parent participants utilizing video-stimulated recall to facilitate reflection of decision- making that occurred during the encounter. We utilized direct content analysis with open coding of interview transcripts to determine the salience of the 4-step SDM process and identify themes that confirmed, refuted, or modified this process. RESULTS: We videotaped 30 encounters and conducted 53 interviews. We found that clinicians' and parents' experiences of decision-making confirmed each SDM step. However, there was variation in the interpretation of each step and a need for flexibility in implementing the process depending on specific decisional contexts. CONCLUSIONS: The 4-step SDM process for pediatrics appears to be salient and may benefit from further guidance about the interpretation of each step and contextual factors that support a modified approach. [ABSTRACT FROM AUTHOR]

In an environment of tight resources, tough academic challenges, and increasingly stiff competition from new education providers, smart leadership may matter more than ever for the success of America's school districts. Against this backdrop, "Education Week" introduces the first of what will be an annual "Leaders To Learn From" report--a way to recognize forward-thinking education leaders and share their ideas. This 2013 report profiles 16 district-level leaders--superintendents, assistant superintendents, and others, including a union president--who seized on creative but practical approaches and put them to work in their school districts.

To effectively provide early interventions to children, identifying those who are in need of these interventions is essential. In India, several problems hinder the process of early identification, including a lack of standardized measures for assessment. This study investigates the utility of the Bracken School Readiness Assessment, Third Edition (BSRA-3; Bracken, 2007) with an urban sample of children ages 3 to 5 years (N = 254) attending school in Mumbai, India. Reliability of BSRA-3 scores was assessed using coefficient alpha and split-half coefficients. Potentially problematic or biased items were identified using item analysis indexes of difficulty and discrimination. The BSRA-3 test scores with the Indian (Mumbai) population were reliable, and raw score means and rank orders were comparable with those for the U.S. normative sample. None of the test items on the test function differently with the Mumbai, India sample, thus providing initial evidence of BSRA-3's applicability with the Indian population.

Background: Patient satisfaction is an important indicator of quality of care, but its measurement remains challenging. The Consumer Emergency Care Satisfaction Scale (CECSS) was developed to measure patient satisfaction in the emergency department (ED). Although this is a valid and reliable tool, several aspects of the CECSS need to be improved, including the definition, dimension, and scoring of scales. Purpose: The purpose of this study was to examine the construct validity of the CECSS and make suggestions on how to improve the tool to measure overall satisfaction with ED care. Methods: We administered 2 surveys to older adults who presented with a fall to the ED and used electronic health record data to examine construct validity of the CECSS and ceiling effects. Results: Using several criteria, we improved construct validity of the CECSS, reduced ceiling effects, and standardized scoring. Conclusion: We addressed several methodological issues with the CECSS and provided recommendations for improvement. [ABSTRACT FROM AUTHOR]

In this article, the authors explore the potential of youth organizing to promote civic development, new forms of civic engagement that make public institutions more accountable and responsive to the needs of their constituencies, and an expanded commitment to acting in the interest of the public good. Their analysis draws from both the literature on youth organizing and civic engagement. Some scholars of youth organizing speak to the civic dimensions of organizing, and some scholars of civic engagement attend to organizing as one stream of civic practice. The authors aim to synthesize these literatures in order to offer a more comprehensive picture of the relationship between youth organizing and civic engagement. This paper unfolds in five parts. The first section provides a brief review of the literature on the civic engagement and civic development of low-income youth of color. The next section describes the field of youth organizing, highlighting the origins of this work and how the field has grown in the past two decades. The third section explores how, and in what ways, participation in youth organizing supports the development of new civic skills and commitments. The penultimate section examines how youth organizing shapes public policy and who participates in public life. The final section considers directions for further research on youth organizing for the public good. (Contains 1 figure and 4 notes.)

In recent years, more and more attention has been paid to international education in schools in the USA. Education professionals, business leaders, and politicians realize that schools and school leaders must identify multiple opportunities for students to interact with and experience a global society. Nationally, there has been a considerable investment of funds by several key foundations and much political talk about the need to push American education towards a model of schooling that expressly responds to the need for internationally competent citizens. Using mixed methodology design, this study is fueled by a desire to better understand several overarching elements in international education. In short, the authors of this paper posit that no further research, policy formation, or program development within the realm of international education for public schools can be undertaken until an understanding of the current state of international education and the capacity for internationalization is empirically explored. (Contains 1 table and 2 notes.)

Purpose: The aim of this paper is to analyze international and national research and development (R&D) programs and roadmaps for the manufacturing sector, presenting how agile and lean manufacturing models are addressed in these programs. Design/methodology/approach: In this review, several manufacturing research and development programs and roadmaps--national programs from the USA and Canada, and international programs from the European Union and from one international organization--are reviewed. Findings: The major finding of this review is that the main concerns in agile manufacturing, as highlighted in these programs, are networks, supply chain and product/service customization, and lean manufacturing's inclination towards achieving better cost efficiency. Although the lean manufacturing approach has been considered in many past and present programs, analysis of the most recent programs shows a greater priority is given to the agile manufacturing approach. The path towards sustainable manufacturing is delineated by pro-active attitude and action towards customers. Research limitations/implications: The study analyzes two national R&D programs from the USA, one international program from the European Union, three international roadmaps from the European Union, one business plan from Canada and one international roadmap from the global organization Intelligent Manufacturing Systems. Practical implications: The findings of this paper are intended to help managers, researchers and practitioners from the manufacturing sector to enhance their understanding and define suitable strategy for their organizations' sustainability and identify suitable manufacturing path with respect to agile and lean philosophies. This study could also help academics in defining course curricula for students more coherent with the R&D policies and/or requirements towards sustainable manufacturing with respect to agile and lean philosophies. Originality/value: There are reviews comparing agile and lean manufacturing paradigms, but there are no reviews about how the two manufacturing concepts are addressed in manufacturing R&D programs and roadmaps. (Contains 3 tables.)

Objective: To examine serving size knowledge in African Americans and how it is related to body mass index (BMI). Design: Serving size knowledge of food commonly consumed by African Americans was assessed by asking the subjects to select the amount of food considered to be a single serving size by the United States Department of Agriculture and the Food and Drug Administration. Seventeen food items were tested, and the amounts selected were weighed. Body mass index was estimated from measured height and weight. Setting: Churches. Participants: Ninety-five African American women. Main Outcome Measures: Amount of food selected and BMI. Analyses: The amount of food selected was compared with the respective standard serving using the 1-sample Wilcoxon signed rank test. The association between BMI and the amount selected was assessed by logistic regression. Results: The subjects significantly overestimated (P = 0.001 to 0.02) serving sizes for cornflakes, apple, watermelon, butter, whole milk, chips, and regular soda. Body mass index was significantly associated with overestimation of cornflakes, butter, cookies, and macaroni and cheese (P = 0.01 to 0.03), and the odds ratio for overestimating these food items was 1.46-1.65 times greater per 5-unit increase in BMI. Conclusions and Implications: African American women overestimated the serving sizes for 7 of the food items tested, and 4 of the estimates were correlated with BMI. Education regarding serving size is recommended for certain food items. (Contains 3 tables and 1 figure.)

The use of ICT in the Middle East is expanding at a fast rate; hence managers and decision makers must decide on the best learning solution for their organizations. This article describes how a small team of individuals in Jordan developed an effective learning solution to a social problem. This may provide some useful lessons for other organizations which would like to start using e-learning or are using e-learning but are facing financial constraints. (Contains 15 notes.)

Background: Comprehensive, enforced tobacco-free school (TFS) policies lead to significant reductions in youth tobacco use. North Carolina is the first state in the United States to develop a statewide mass media campaign to promote the adoption of and compliance with TFS policies. Methods: In order to guide campaign development, researchers conducted a literature review as well as interviews with 45 TFS-policy experts, stakeholders, and North Carolina legislators. The experts included state and national TFS researchers and advocates, and the majority of stakeholders were North Carolina school administrators and personnel selected because of their personal knowledge of and experience with TFS policy. Interviewees provided information on messages they believed would be most salient to highlight in the media campaign and the best type of people to appear in ads. Results: Recommended themes included (1) a positive message about TFS becoming the norm in the state, (2) experiences of school districts that had successfully passed TFS policies, (3) the importance of adult role modeling, and (4) personal stories from youth about the importance of TFS policy. Recommended people to appear in ads included youth and adults with a personal connection to and experience with TFS policy. Using these recommended themes and people, the TFS media campaign began in the fall of 2006. In the 8 months following the campaign launch, 9 additional school districts adopted TFS policies, increasing the total from 78 to 87 (out of 115) by June 2007. In July 2007, the North Carolina legislature passed legislation mandating that all school districts adopt TFS policies by August 2008. Conclusions: Media campaigns can serve as part of a comprehensive strategy to advance TFS policies. Other states should consider these results in designing and evaluating a media campaign to promote adoption of and compliance with TFS policies. (Contains 2 tables.)

The present study examined the prevalence, characteristics, beliefs, and demographic predictors of parent-child physical violence among South Asian, Middle Eastern, East Asian, and Latina women in the United States. Two hundred fifty-one college-educated women from a middle to high SES (South Asian/Middle Eastern, n = 93; East Asian, n = 72; Latina, n = 86) completed a self-report survey on childhood experiences and beliefs regarding physical abuse. Seventy-three percent of the South Asian and Middle Eastern sample, 65% of the East Asian sample, and 78% of the Latina sample reported experiencing at least one type of physical abuse. Significant differences in characteristics and perpetrators of abuse were found across groups. Demographic factors did not predict physical abuse. Experiencing physical abuse was the only predictor for acceptance of physical discipline and as a parental privilege or right across groups. Implications of alternate cultural models of family violence based on beliefs and exposure to violence are discussed.

An important resource for educators interested in incorporating material about mass media and race into their teaching might be academic research conducted in universities and media research organizations and published in academic journals. However, because certain forms of racial thinking "saturate" all forms of knowledge production in society, it is important for educators to be aware of race-related biases inherent in some of the research on media and race. Awareness of these biases should help educators as they read the research on media and race, sort through the growing literature on the topic, and make choices about how and with what effect information about media and race can be incorporated into their teaching. This essay reviews three biases apparent in some of the research investigating the relation between mass media and race. These biases will be illustrated with examples from recently published studies in journalism and mass communication academic journals. The three biases are related in important ways to the assumed normality of "Whiteness" that permeates U.S. society. Juxtaposed to Whiteness is the "Other," which is defined in the following sections in the context of discussing how the presumed differences between Whiteness and the Other generate social meaning, reinforce certain racial hierarchies, and effect the production of knowledge.

Homozygous familial hypercholesterolemia (HoFH) is an autosomal co-dominant disorder characterized by extreme elevations in LDL-C and early onset ASCVD. Unfortunately, patients with HoFH generally experience poor LDL-C lowering with standard lipid-lowering therapy and rarely achieve LDL-C goals. Evinacumab is a monoclonal antibody administered by monthly IV infusion that binds angiopoietin-like 3 and when added to standard lipid-lowering therapies lowers LDL-C by ∼50% in clinical trials involving patients with HoFH. Real-world effectiveness and safety of evinacumab is unknown. Examine the safety and efficacy of evinacumab in the real-world treatment of patients with HoFH across multiple US academic medical centers. We performed retrospective chart review to assess safety and efficacy of evinacumab in patients with HoFH in clinical practice at six US academic medical centers. The primary efficacy endpoint was the percent change in LDL-C from baseline to first follow-up and to most recent follow-up after evinacumab initiation. Secondary efficacy endpoints were percent change in non-HDL-C, triglycerides, total cholesterol, HDL-C, and achievement of an LDL-C <70 mg/dL. Adverse events were recorded. Twenty-four patients (mean age 38 yrs; range 5-75) with HoFH were followed for a median of 48 weeks. Fifty percent were female, 16 (66.7%) had ASCVD, 21 (87.5%) on a statin, 20 (83.3%) on ezetimibe, 16 (66.7%) on PCSK9i, 6 (24%) on lomitapide, and 8 (33.3%) undergoing lipoprotein apheresis (Table 1). Significant reductions in LDL-C, non-HDL-C, total cholesterol, triglycerides, and HDL-C were observed both at first follow-up (4 weeks) and most recent follow-up (48 weeks) (p < 0.001 for all). Significantly more patients achieved LDL-C <70 mg/dL after evinacumab was added (Table 2, Figure). No serious adverse events occurred and evinacumab was generally well-tolerated. 9 patients (37.5%) reported side-effects which were generally mild. Side-effects led to discontinuation of therapy in 1 patient due to fatigue and back pain. Across six US academic medical centers, evinacumab was generally well-tolerated by patients with HoFH and lowered LDL-C by ∼50%, consistent with results from clinical trials. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore associations between allegations of malpractice and the severity of the alleged malpractice injury. The public-use data file of the National Practitioner Data Bank was used to identify 34,042 dentist malpractice reports from January 1, 2010, through December 31, 2020. Univariate descriptive analysis was conducted to identify frequencies of malpractice allegations when classified by the severity of the alleged malpractice injury, practitioner graduation year, and year of original report processing. Ordinal logistic regression analyses were conducted to explore associations between the malpractice allegation type and the severity of the alleged malpractice injury. A total of 15,183 valid reports were used in the analysis. Compared with treatment-related allegations, a surgery-related allegation proved 5.3 times more likely to result in minor permanent injury; a diagnosis-related allegation was 6.5 times more likely to result in significant permanent injury and 10.4 times more likely to result in major permanent injury; and an anesthesia-related allegation was 6.2 times more likely to result in major permanent injury. The confounding variable of graduation year proved significant with respect to major temporary and minor permanent injury. As the allegation group advanced from diagnosis-related to anesthesia-, treatment-, and surgery-related allegations, the odds of a higher severity of injury did not increase. Establishing a proper diagnosis and developing a treatment plan to manage the anticipated complications of the procedure to be performed are critical to a successful outcome. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic and related school closures may have disrupted school-related supports and services important to children's wellbeing. However, we lack national data about US children's wellbeing and family priorities for school-related services. We sought to determine 1) children's social-emotional wellbeing and 2) needs and priorities for school-based services in the 2021 2022 school year among a US sample of parents of school-aged children. METHODS: In June 2021, we surveyed 1504 parents of children enrolling in grades K-12 in the 2021-2022 school year participating in the Understanding America Study, a nationally representative probability-based Internet panel of families completing regular internet-based surveys (Response rate to this survey was 79.2%). Parents completed the Strengths and Difficulties Questionnaire and reported their needs for school-related services regarding "support getting healthcare", "mental wellness support", "food, housing, legal or transportation support", and "learning supports and enrichment." Weighted regressions examined associations among wellbeing, needs, and sociodemographic characteristics. RESULTS: Approximately one-quarter of children had deficits in hyperactivity (26.1%), one-third in peer problems (32.6%), and 40% in prosocial areas. Most parents (83.5%) reported a school-related need, with 77% reporting learning supports and enrichment needs and 57% reporting mental wellness needs. The highest priority needs were for tutoring, socialization, increased instructional time, coping with stress, and physical activity. CONCLUSIONS: US school children have high social-emotional and school-related needs. Investments in schools are urgently needed, particularly for learning supports and mental wellness, to meet the high demand for services and parents' priorities to support child health and wellbeing. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Despite extensive efforts, overall readmission rates at US children's hospitals have not materially declined over the past decade, raising questions about how to direct future efforts. Using measures of prevalence and performance variation we describe readmission rates by condition and identify priority conditions for future intervention. METHODS: Retrospective cohort study of 49 US children's hospitals in the Pediatric Health Information System in 2017. Conditions were classified using All Patients Refined Diagnosis Related Groups. 30-day unadjusted and risk-adjusted readmission rates were calculated for each hospital/condition using the Pediatric All Cause Readmission measure. We ranked the highest volume conditions by rate variation (RV, interquartile range divided by the median) for each condition across hospitals. RESULTS: The sample included 811,434 index hospitalizations with 50,196 (6.2%) 30-day readmissions. The RV across hospitals/conditions was between 0 and 2.8 (median = 0.7). Common reasons for admission had low RVs across hospitals, for example, bronchiolitis (readmission rate = 5.6%, RV = 0.4), seizure (readmission rate = 6.6%, RV = 0.3), and asthma (readmission rate = 3.1%, RV = 0.4). We identified 33 conditions with high variation in readmission rates across hospitals, which accounted for 18% of all discharges and 11% of all pediatric readmissions. These conditions may serve as candidates for future readmission reduction activities. CONCLUSIONS: Many common childhood conditions have little variation in readmission rates across children's hospitals, suggesting limited future improvement opportunities. Conditions with high rate variation may provide opportunities for quality improvement; however, these conditions account for a relatively small share of total discharges suggesting modest potential impacts on national rates. [ABSTRACT FROM AUTHOR]

• Non-statin lipid-lowering therapies reduce residual ASCVD risk. • Utilization of non-statin therapies is low for secondary prevention. • There has been limited uptake of non-statin therapies in the last several years. • Increasing use of these therapies is paramount to improving the treatment gap. Nearly two-thirds of individuals with atherosclerotic cardiovascular disease (ASCVD) do not reach target low-density lipoprotein cholesterol despite statin therapy. Three novel lipid-lowering therapies have proven to further reduce ASCVD beyond statins, including: ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), and icosapent ethyl. This study evaluated the use of these three agents in 728,423 individuals with ASCVD from 89 US health systems from 01/2018 through 03/2021 using the electronic health record. As of 2021, only 6.0% of ASCVD patients were on ezetimibe, 1.6% were on a PCSK9i, and 1.3% on icosapent ethyl, with utilization only marginally increasing over the study period. Addressing the underutilization of non-statin lipid-lowering therapy for secondary prevention is a critical step in improving the treatment gap of patients with residual risk of ASCVD. [ABSTRACT FROM AUTHOR]

Background: A key strategy to eliminate tuberculosis (TB) in the United States is to increase latent tuberculosis infection (LTBI) screening, testing, and treatment among non-US-born Asian populations. Purpose: The purpose was to increase LTBI screening, testing, and treatment at a community clinic. Methods: Retrospective baseline LTBI data were retrieved through electronic medical record review. Interventions included adoption of standardized TB risk assessment, training providers to use shorter LTBI treatment regimens, and use of a care coordinator. Chart abstraction to examine outcomes was conducted postintervention at 4 months. Results: In 2017, only 3 patients (7%) with LTBI were started on treatment. At 4 months postintervention, 28 (72%) patients with LTBI were started on treatment, of which 27 (96%) were placed on 3- to 4-month regimens. Conclusions: Training for providers and changes to clinic workflow, including use of a care coordinator, can help increase LTBI screening, testing, and treatment in community clinics. [ABSTRACT FROM AUTHOR]

Peptic ulcer disease (PUD) is more prevalent in cirrhotic patients and it has been associated with poor outcomes. However, there are no population-based studies from the United States (U.S.) that have investigated this association. Our study aims to estimate the incidence trends, predictors, and outcomes PUD patients with underlying cirrhosis. We analyzed Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project (HCUP) data for years 2002–2014. Adult hospitalizations due to PUD were identified by previously validated ICD-9-CM codes as the primary diagnosis. Cirrhosis was also identified with presence of ICD-9-CM codes in secondary diagnosis fields. We analyzed trends and predictors of PUD in cirrhotic patients and utilized multivariate regression models to estimate the impact of cirrhosis on PUD outcomes. Between the years 2002–2014, there were 1,433,270 adult hospitalizations with a primary diagnosis of PUD, out of which 70,007 (4.88%) had cirrhosis as a concurrent diagnosis. There was a significant increase in the proportion of hospitalizations with a concurrent diagnosis of cirrhosis, from 3.9% in 2002 to 6.6% in 2014 (p < 0.001). In an adjusted multivariable analysis, in-hospital mortality was significantly higher in hospitalizations of PUD with cirrhosis (odd ratio [OR] 1.78; 95% confidence interval [CI] 1.63–1.97; P < 0.001), however, there was no difference in the discharge to facility (OR 1.00; 95%CI 0.94 − 1.07; P = 0.81). Moreover, length of stay (LOS) was also higher (6 days vs. 4 days, P < 0.001) among PUD with cirrhosis. Increasing age and comorbidities were associated with higher odds of in-hospital mortality among PUD patients with cirrhosis. Our study shows that there is an increased hospital burden as well as poor outcomes in terms of higher in-hospital mortality among hospitalized PUD patients with cirrhosis. Further studies are warranted for better risk stratification and improvement of outcomes. [ABSTRACT FROM AUTHOR]

Human Reliability Program (HRP) is a set of procedures, protocols, and the corresponding performance of activities to support and sustain the secure and safe operation of a facility. Our review indicated that HRP is referred to by various names, such as, Personnel Reliability Program (PRP), Trustworthiness Program, and Fitness for Duty Program, with PRP being the most common amongst them. A brief description of the evolution of HRP and its components for Finland, Japan, Jordan, Nigeria, Russia, US, and UK is provided. Details of the Trustworthiness Program by the International Atomic Energy Agency are also provided. Most of the HRPs have similar components and implementation steps with few variations, and they all have identical objectives. Even though a structured HRP may not exist in Indian civil nuclear energy facilities, an account of various HRP components practiced in India is discussed. The HRP review provided should help security practitioners and academics. [ABSTRACT FROM AUTHOR]

Subspecialty exposure during residency can influence the future pursuit of fellowship training. In this study, we compared the trends in strabismus surgical experience reported by graduating ophthalmology residents in the United States with other categories of ophthalmic surgery. Over the 10-year period (2010-2019), there was a decline in the total number of strabismus procedures performed during residency by ophthalmology residents graduating in a given year (1.4 fewer cases per year; 95% CI, 1.1-1.6 [ P < 0.001]). Although several surgical categories experienced a decrease in cases performed in the assistant role, strabismus surgery was the only category with a decrease in cases performed in the surgeon role (0.4 fewer cases per year; 95% CI, 0.3–0.5 [ P < 0.001]).▪ [ABSTRACT FROM AUTHOR]

Background: Physicians' professional networks are an important source of new medical information and have been shown to influence the adoption of new treatments, but it is unknown how physician networks impact the de-adoption of harmful practices.Methods: We analyzed changes in physicians' use of dronedarone after the PALLAS trial (Palbociclib Collaborative Adjuvant Study; November 2011) showed that dronedarone increased the risk of death from cardiovascular events among patients with permanent atrial fibrillation. Deidentified administrative claims from the OptumLabs Data Warehouse were combined with physicians' demographic information from the Doximity database and publicly available data on physicians' patient-sharing relationships compiled by the Centers for Medicare and Medicaid Services. We used a linear probability model with an interrupted linear time trend specification to model the impact of the PALLAS trial on physicians' dronedarone usage between 2009 and 2014.Results: Before the PALLAS trial, the use of dronedarone was increasing by 0.22 percentage points per quarter (95% CI, 0.19-0.25) in our Medicare Advantage sample (N=343 429 patient-quarter observations) and 0.63 percentage points per quarter (95% CI, 0.52-0.75) in our commercially insured sample (N=44 402 patient-quarter observations). After the PALLAS trial and subsequent United States Food and Drug Administration black box warning, physicians in the Medicare Advantage sample with an above-median number of network connections to other physicians decreased their quarterly usage of dronedarone by 0.12 percentage points more per quarter (95% CI, -0.20 to -0.04; P=0.031) than physicians with equal to or below the median number of network connections. Similar patterns existed in the commercially insured sample (P=0.0318).Conclusions: After controlling for a wide range of patient, physician, and geographic characteristics, physicians with a greater number of network connections were faster de-adopters of dronedarone for patients with permanent atrial fibrillation after the PALLAS trial and subsequent United States Food and Drug Administration black box warning detailed the harmfulness of dronedarone for these patients. Policies for improving physicians' responsiveness to new medical information should consider utilizing the influence of these important professional network relationships. [ABSTRACT FROM AUTHOR]

Background: Over the past decade, biopharmaceutical companies have been progressively establishing global frameworks across their capabilities. It is well recognized that the Medical Information (MI) department is a key externally facing function that needs to maintain a consistent focus on optimizing its capabilities of addressing product medical inquiries worldwide. Methods: In the United States, a consortium named Pha rma C ollaboration for T ransparent M edical I nformation, phactMI, a collaboration of pharmaceutical company MI departments dedicated to supporting health care professionals in their commitment to provide quality patient care, has provided a forum to benchmark and share best practices across the companies. In May 2017, phactMI conducted a survey inclusive of 25 biopharmaceutical companies to gain insight into the globalization of respective MI departments and relevant trends. Results: We found increased trends in various aspects of globalization across large, mid, and small size companies, and identified key drivers for success. Overall, 16 of the 25 companies had globalized their MI department, 5 had only partially globalized, and the remaining 4 had not globalized. Conclusion: The findings of this survey will further help inform the MI community as to globalization approaches for a successful outcome. [ABSTRACT FROM AUTHOR]

Importance: Depression is associated with increased inflammation, which may precede its onset, especially in older people. Some preclinical data suggest potential antidepressant effects of aspirin, supported by limited observational data suggesting lower rates of depression in individuals treated with aspirin. There currently appears to be no evidence-based pharmacotherapies for the primary prevention of depression.Objective: To determine whether low-dose aspirin (100 mg) reduces the risk of depression in healthy older adults.Design, Setting, and Participants: This double-blinded, placebo-controlled randomized clinical trial was a substudy of the Aspirin in Reducing Events in the Elderly (ASPREE) trial, which examined if aspirin increased healthy life span, defined as survival free of dementia and disability. The prespecified secondary outcome was depression. Individuals of all races/ethnicities older than 70 years in Australia, as well as white individuals older than 70 years and black and Hispanic individuals older than 65 years in the United States, were included.Interventions: Participants were randomized to aspirin (100 mg daily) or placebo, with a median (interquartile range) follow-up of 4.7 (3.5-5.6) years.Main Outcomes and Measures: The primary outcome was a proxy measure of major depressive disorder defined as a score of 8 or more on the Center for Epidemiologic Studies Depression 10-item (CES-D-10) scale.Results: Of the 19 114 participants enrolled in the trial, 9525 received aspirin and 9589 received a placebo. The mean (SD) age was 75.2 (4.0) years in the aspirin group and 75.1 (4.5) years in the placebo group; 9531 (56.4%) were women. Participants' demographics and clinical characteristics at baseline were similar between groups. A total of 79 886 annual CES-D-10 measurements were taken, with a mean of 4.2 measurements per participant. There were no significant differences at annual visits in the proportions of CES-D-10 scores of 8 or more between the aspirin and placebo groups. The incidence rate of new CES-D-10 scores of 8 or more was 70.4 events per 1000 person-years in the aspirin group and 69.1 in the placebo group (hazard ratio, 1.02 [95% CI, 0.96-1.08]; P = .54).Conclusions and Relevance: Low-dose aspirin did not prevent depression in this large-scale study of otherwise healthy older adults.Trial Registration: ClinicalTrials.gov Identifier: NCT01038583. [ABSTRACT FROM AUTHOR]

Background: Medical malpractice occurs when a hospital or health-care provider through negligent act or omission results in an injury to a patient. More than 50% of otolaryngologists have faced at least 1 claim, with rhinology being the most litigated subspecialty. This study aims to analyze medical litigation trends in Rhinology from 2000 to 2017 in the United States. Methods: The Westlaw database was reviewed from 2000 to 2017. Data were compiled on the demographics of the plaintiffs, procedures, nature of damages, legal allegations, and the use of expert witnesses, physician demographics/practice characteristics, verdicts, indemnities, and county/state of case. Results: There were 75 cases that met inclusion criteria after review of 125 cases. Majority of cases went to trial over settlement (80%) and were found in the Northeast region of the United States (36%). Most common cited legal allegations were improper performance and failure to follow standard of care. The most common nature of injuries were eye injury (29%) and intracranial complications (27%). The highest payouts were for progression of disease followed by intracranial injury. Of the 75 total cases analyzed, 37 (49.3%) used expert witnesses. When an expert witness was used at trial, the verdict statistically favored the defendant (62.5%). Conclusions: Our analysis reveals the importance of meticulous surgical techniques and thorough preoperative evaluations. [ABSTRACT FROM AUTHOR]

Community transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) in the United States on February 26, 2020, and the rapid spread that followed forced patients, providers, payors, and policy makers to adapt to an unprecedented, nearly instant, and enormous demand for virtual care. Although few US ophthalmology practices incorporated telemedicine prior to COVID-19, its use has now become the norm. Regarding the use of synchronous patient-to-provider virtual visits (SPPVV) in pediatric ophthalmology, we have pooled our collective experience at three academic practices across the country to describe initial workflows, technology solutions, use cases, and barriers to care. [ABSTRACT FROM AUTHOR]

The antiplatelet landscape for the secondary prevention of ischemic stroke has changed significantly over the past decade. Poststroke dual antiplatelet regimens are becoming increasingly routine as supported by recent literature and guideline recommendations. Dual antiplatelet therapy after stroke generally consists of aspirin and clopidogrel and is considered in the short term after stroke in select populations including those with mild stroke or transient ischemic attack and in patients with severe intracranial atherosclerosis. When initiating dual antiplatelet therapy, factors that may increase a patient's risk of bleeding must be weighed against the patient's risk of future ischemic events. This review focuses on antiplatelet medications available in the United States with the aim to provide a summary of the available literature on poststroke dual antiplatelet therapy, pharmacological nuances of the agents, and reversal of antiplatelets in the setting of intracerebral hemorrhage. [ABSTRACT FROM AUTHOR]

Accurately identifying English-language learner (ELL) students who also need special education services has long been a problem for educators. Historically, English-learners were overrepresented in special education, but litigation and civil rights complaints have, in more recent years, led to an equally troubling problem with identifying too few ELLs with legitimate special education needs, or not providing services to them in a timely manner. National research done within the last decade, including a 2003 study commissioned by the U.S. Department of Education, found that overidentification occurred more commonly in districts with small numbers of ELLs (fewer than 99 such students), and underidentification was more common in districts with larger ELL populations. More recent data, however, seem to suggest that underidentification might be the larger issue on a national level: In 2009-2010, English-learners comprised 9.7 percent of students enrolled in public schools, but made up 8.3 percent of public school students being served under the Individuals with Disabilities Education Act, according to the National Center for Education Statistics. And by 2030, English-learners will comprise an estimated 40 percent of the American student population. The heart of the problem, educators and researchers say, is discerning whether students are simply struggling with acquiring English or truly have disabilities that are impeding their progress. It's a challenge that the Education Department is trying to help districts tackle, starting off by commissioning an exploratory study of a half-dozen districts that will document, in detail, the procedures and techniques that educators are using to identify English-learners for special education. Among students with disabilities, "there seems to be evidence in some areas of overrepresentation of English-learners, and in some areas of underrepresentation of English-learners." Educators say that it is often hard to validly identify students and disentangle the disability from the language problems. One of the difficulties is that so many of the assessment and evaluation tools for determining whether students have disabilities are intended for students who speak a single language, usually English, and who are proficient in it.

Unlike traditional high school athletic teams, Unified Sports teams are designed to immerse students with intellectual disabilities in a facet of school culture that has largely eluded them. Nationwide, more than 2,000 schools in 42 states have the teams, where the ideal is for about half the athletes on each team to be students with intellectual disabilities, such as Down syndrome, and the rest partner athletes who play alongside them. Unified Sports was created by the Special Olympics more than 20 years ago, but the program has had a recent surge in popularity, the organization reports, in part because of a broader effort to foster an inclusive culture that extends beyond the gymnasium or the playing field called Project Unify. Since that program was established in 2008, the U.S. Department of Education has devoted more than $30 million to it. About 22,000 students across the country are involved in Unified Sports teams, and Special Olympics estimates that 20 times that number have been touched in some way by the program's offshoots.

A new report finding that black and Hispanic students are far more likely to be kicked out of school when they break the rules adds to a growing chorus of concern over the discipline policies being used in K-12 schools. Over the past two years, an increasing number of reports and initiatives have pointed out problems with 'zero tolerance" policies and other school discipline practices that some see as overly harsh or that seem to unfairly target students from some racial, gender, and ethnic groups. New data showing that black and Hispanic pupils are more likely to be expelled adds to a growing critique on school discipline. The mounting data and criticism prompted U.S. Secretary of Education Arne Duncan in July to share plans he and U.S. Attorney General Eric Holder have to reshape discipline policies that end up pushing children into the juvenile-justice system for crimes and rule-breaking on campus, keeping them from pursuing an education. And the Education Department's office for civil rights is developing guidance to help ensure that school discipline policies and practices comply with the civil rights laws the agency enforces.

The author reports on the U.S. Department of Agriculture's plan to look closely at whether the food-service-management companies running many school cafeterias are passing along all the discounts and rebates they receive from their suppliers to the districts that hire them. The plan to probe companies will begin in August, said Alison Decker, a lawyer in the USDA's office of inspector general. It was triggered in part by a settlement between the New York state attorney general and Sodexo, one of several large companies in the business of running school cafeterias. Last July, Sodexo, a French company with its U.S. headquarters in Gaithersburg, Maryland, agreed to pay $20 million to resolve allegations that it had over charged 21 school districts and the State University of New York system for some of the food provided to students. That settlement prompted U.S. Rep. Rosa L. DeLauro, D-Conn., to write to Secretary of Agriculture Tom Vilsack last September, urging a broader audit. The Agriculture Department's office of inspector general has notified the USDA of its plans for an audit, but it hasn't said which companies and districts will be involved, Ms. Decker said. The biggest providers of school food-management services are Sodexo, Philadelphia-based Aramark, and Chartwells, based in Charlotte, North Carolina.

Purpose The purpose of this paper is to illustrate the ways in which attention to programmatic vision and coherence – rather than foci on individual courses – might advance the work of justice-oriented, critical English education in important ways. The authors propose that consciously attending to the work of English education on the programmatic level can better enable English educators to cultivate democracy-sustaining dispositions in preservice teachers. Using Grossman et al.’s (2008) definition of “programmatic coherence”, the authors illustrate how one interdepartmental partnership is working to create a shared programmatic vision for English education.Design/methodology/approach Drawing on Cornel West’s call for the development of a three-piece democratic armor – Socratic questioning, prophetic witness and tragicomic hope – the authors describe their programmatic vision for cultivating democracy-sustaining dispositions in preservice teachers. They show how this shared vision constitutes the foundation for the organization, purpose and sequence of the four-semester cohort program. Finally, the authors describe how this vision helps facilitate meaningful and purposeful symbiosis between field experiences and university coursework.Findings In an effort to promote replicability regarding programmatic coherence, the authors share structural aspects of their program as well as pose generative questions for colleagues who are interested in approaching the work of critical, democratic English education from the programmatic level.Originality/value Addressing the challenges of teacher preparation – especially in this polarized and pitched historical moment – requires shifting the focus from individual courses to a more expansive view that might enable English educators to consider how courses within a program might collectively advance a particular vision of critical and democratic English education. [ABSTRACT FROM AUTHOR]

Background: Cardiac implantable electronic device infections have been on the rise. A high-risk population is that with renal disease, especially dialysis. We aimed to assess procedural profiles and clinical outcomes of transvenous lead extraction for cardiac implantable electronic device infection based on renal disease status.Methods and Results: In 1420 consecutive patients undergoing transvenous lead extraction of infected cardiac implantable electronic devices (1996-2012), we assessed procedural profiles and clinical outcomes in 3 groups: normal renal function (group 1, n=1159), renal dysfunction not requiring dialysis (group 2, n=163), and dialysis (group 3, n=98). A total of 3182 infected leads were extracted. Dialysis patients had shorter lead dwell times and were less likely to require transvenous lead extraction tools but as likely to require femoral workstations. There were higher overall rates of procedure-related complications in dialysis patients (12% versus ≈6% in nondialysis) with no difference in the major complication rates (P=not significant). Complete procedural success rates were 94%, 96%, and 94% in groups 1, 2, and 3, respectively (P=not significant). There were 4 intraprocedural deaths in group 1 versus none in groups 2 and 3. Mortality rates were significantly higher in dialysis patients both at 1 and 6 months (P<0.0001 for both). In multivariable analyses, dialysis status was independently associated with increased mortality risk at 1 and 6 months. Other factors associated with mortality were lead material retention, functional (New York Heart Association) class, and occurrence of procedural complications.Conclusions: In patients with cardiac implantable electronic device infection, dialysis status did not seem to add complexity to transvenous lead extraction but was independently associated with increased mortality at 1 and 6 months. [ABSTRACT FROM AUTHOR]

Background: Since United States Food and Drug Administration approval in 2005, the short-term safety and efficacy of thoracic endovascular aortic repair (TEVAR) have been established. However, longer-term follow-up data remain lacking. The objective of this study is to report 6-year outcomes of TEVAR in clinical practice. Methods: A prospective cohort review was performed of all patients undergoing TEVAR at a single referral institution between March 2005 and May 2011. Rates of reintervention were noted. Overall and aortic-specific survival were determined using Kaplan-Meier methods. Log-rank tests were used to compare survival between groups. Results: During the study interval, 332 TEVAR procedures were performed in 297 patients. Reintervention was required after 12% of procedures at a mean of 8 ± 14 months after initial TEVAR and was higher in the initial tercile of patients (15.0% vs 9.9%). The 6-year freedom from reintervention was 84%. Type I endoleak was the most common cause of reintervention (5%). Six-year overall survival was 54%, and aorta-specific survival was 92%. Long-term survival was significantly lower than that of an age- and sex-matched United States population (p < 0.001). Survival was similar between patients requiring a reintervention vs those not (p = 0.26). Survival was different based on indication for TEVAR (p = 0.007), and patients with degenerative aneurysms had the lowest survival (47% at 6 years). Cardiopulmonary pathologies were the most common cause of death (27 of 93 total deaths). Conclusions: Long-term aortic-related survival after TEVAR is high, and the need for reintervention is infrequent. However, overall long-term survival is low, particularly for patients with degenerative aneurysms, and additional work is needed to identify patients unlikely to derive a survival benefit from TEVAR. [ABSTRACT FROM AUTHOR]

Background: Despite increasing awareness regarding evidence-based guidelines, considerable gaps exist for heart failure (HF) quality of care at teaching hospitals (TH) and nonteaching hospitals (NTH). We analyzed data from Get With The Guidelines (GWTG)-HF to compare the rates and trends of guideline-recommended care at TH and NTH for patients with HF.Method and Results: Baseline patient characteristics, performance measures, and in-hospital outcomes were compared between 197 187 HF patients admitted to TH and 106 924 patients admitted to NTH between 2005 and 2014. Patients treated in TH were younger and were more likely to be black and uninsured. Defect-free care (defined as 100% compliance with performance measures) was similar in both group of hospitals (crude rates: 88% at TH versus 86% at NTH, adjusted odds ratio 0.99, 95% confidence interval 0.73-1.34) as were individual performance measures: discharge instruction, documentation of ejection fraction, use of angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists, use of β-blocker, and smoking cessation counseling. During the study period, there was improvement in adherence with performance measures over time, with no significant difference at TH (adjusted odds ratio 1.20, 95% confidence interval 1.11-1.30; P<0.01) and NTH (adjusted odds ratio 1.09, 95% confidence interval 1.02-1.17; P=0.01; interaction P value 0.07).Conclusions: Data from the GWTG-HF program suggest that there was improving and comparable adherence with HF performance measures and use of guideline-recommended therapies irrespective of hospital teaching status. [ABSTRACT FROM AUTHOR]

Employee and stockholder of Amgen Inc. Amgen Inc. Current ACC/AHA dyslipidemia guidelines recommend initiating non-statin therapies such as PCSK9 inhibitors in very high risk (VHR) patients with atherosclerotic cardiovascular disease (ASCVD) who do not reach the threshold of 70 mg/dL with statins alone. Patients with a recent myocardial infarction (MI) (in the past 12 months) constitute a subset of VHR patients who have a significantly higher risk of subsequent cardiovascular (CV) events (CVE) in the months and years following the event. This study aimed to estimate the clinical and economic impact of early initiation of evolocumab after an MI from a US perspective. A published evolocumab partitioned survival model was used to simulate a cohort of 100,000 ASCVD patients with a recent MI and LDL-C above 100 mg/dL. CVE rates for non-fatal events (MI and stroke) and CV death were estimated using the US Prognos LDL-C database and NHANES with National Vital Statistics data, respectively. Treatment effect was modelled using the LDL-C percentage reduction and CVE rate ratios per mmol/L observed in the FOURIER trial. CVE costs were estimated from a US database representing healthcare claims from 2018 through 2020. We modelled the impact, over a 2-year time horizon, of early initiation of evolocumab (<10 days after the MI) compared to standard of care (SoC) of statins ± ezetimibe alone and compared to initiating evolocumab between 3 to 9 months after the MI. Early initiation of evolocumab in the simulated cohort of patients with a recent MI avoided a total of 5,356 CVE, corresponding to CVE cost savings of $310 million over the following 2 years, compared to treating patients with SoC alone. Treating patients with evolocumab early after the MI, in comparison to starting treatment at 3, 6 and 9 months after the MI, led to the avoidance of 1,150; 2,013; and 2,876 CVE with associated CVE cost savings of $67, $116,and $166 million, respectively. Our model shows that the earliest initiation of evolocumab after an MI has the highest potential to decrease the predicted number of CVE substantially, resulting in significant CVE cost savings compared to a later initiation of evolocumab or treatment with SoC alone. These results underscore the value of early initiation of intensive lipid-lowering therapy in VHR ASCVD patients, especially in patients with a recent MI. [ABSTRACT FROM AUTHOR]

Objective: The epidemiology of circulatory shock after spontaneous intracerebral hemorrhage (ICH) is unknown. We sought to determine its incidence, risk factors, and effect on case-fatality. Design: Retrospective multi-center cohort study. Setting: 83 ICUs in the United States from 2003- 2008. Patients: Subjects with ICH >17 years of age admitted to an ICU. Shock was defined as sustained systolic blood pressure <90 mmHg for ≥1 hour despite vasopressors. Interventions: None. Measurements and results: A total of 4,192 ICH patients. Median age was 67 yrs (IQR 54-77), 2221 (53%) were male, and 3030 (75%) were white. Median APACHE-II score was 15 (interquartile. range [IQR] 11-21) and Glasgow Coma Scale (GCS) was 11 (IQR 6-14). Incidence of shock after ICH was 5% (212/4192). Case-fatality was 72% among shock vs. 30% without shock (p<0.0001). In multi-variable analysis the following were associated with increased case-fatality: age (OR 1.01, 95%CI:1.01-1.02), DNR status (OR 1.8, 95%CI:1.3-2.6), GCS<8 (OR 11.4, 95%CI:8.4- 15.4), GCS 8-12 (OR 2.1, 95%CI:1.5-2.9), mechanical ventilation (OR 2.0, 95%CI:1.6-2.5), organ dysfunction (OR 1.7, 95%CI:1.4-2.0), spontaneous hypothermia (OR 7.3, 95%CI:2.8-19.3), APACHE ≥15 (OR 2.9, 95%CI:2.2-3.7), and shock (OR 1.9, 95%CI:1.2-3.0). EVD placement was associated with survival (OR 0.8, 95%CI:0.6-0.9). Conclusion: Circulatory shock after ICH is rare and associated with increased case-fatality. [ABSTRACT FROM AUTHOR]

Scholars and commentators heavily criticize the current federal sentencing system for over-incarceration, racial disparities in outcomes, and a lack of procedural protections for criminal defendants. This Article focuses on a procedural protection recently revived by the Supreme Court's 2004 decision in Crawford v. Washington: the Confrontation Clause of the Sixth Amendment. Though Crawford only addressed the Clause's application during trial, the case and its reasoning have important implications for today's federal sentencing regime under the Federal Sentencing Guidelines. Though the Supreme Court has yet to directly address the issue, I argue that lower courts incorrectly interpret an old, pre-Crawford case to read the confrontation right out of federal sentencing. Given the underlying philosophy, goals, and process of sentencing today, the argument to apply confrontation rights has never been stronger. Using never-before-reported U.S. Sentencing Commission data and federal sentencing transcripts, I show that important facts in Pre-Sentence Reports ("PSRs") are routinely disputed and inadequately resolved during sentencing. My analysis also reveals a meaningful lack of uniformity among federal districts and judges-a common theme in sentencing scholarship-in their willingness to change findings of fact in PSRs that impact defendants' final sentences. I propose a workable solution to satisfy constitutional confrontation rights at federal sentencing. Specifically, confrontation rights should apply when: (a) a defendant disputes a fact in the PSR after pleading or conviction; (b) the fact is related to a possible significant upward enhancement from the base offense level (not just an upward departure from the statutory maximum); and (c) a testimonial statement is the primary source of that fact. This effort is a small step toward ensuring the Constitution does not abandon defendants when they need it most. [ABSTRACT FROM AUTHOR]