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Background Body-mass index (BMI) and blood pressure (BP) levels are rising in sub-Saharan African cities, particularly among women. However, there is very limited information on how much they vary within cities, which could inform targeted and equitable health policies. Our study aimed to analyse spatial variations in BMI and BP for adult women at the small area level in the city of Accra, Ghana. Methods and findings We combined a representative survey of adult women's health in Accra, Ghana (2008 to 2009) with a 10% random sample of the national census (2010). We applied a hierarchical model with a spatial term to estimate the associations of BMI and systolic blood pressure (SBP) and diastolic blood pressure (DBP) with demographic, socioeconomic, behavioural, and environmental factors. We then used the model to estimate BMI and BP for all women in the census in Accra and calculated mean BMI, SBP, and DBP for each enumeration area (EA). BMI and/or BP were positively associated with age, ethnicity (Ga), being currently married, and religion (Muslim) as their 95% credible intervals (95% CrIs) did not include zero, while BP was also negatively associated with literacy and physical activity. BMI and BP had opposite associations with socioeconomic status (SES) and alcohol consumption. In 2010, 26% of women aged 18 and older had obesity (BMI [greater than or equal to] 30 kg/m.sup.2 ), and 21% had uncontrolled hypertension (SBP [greater than or equal to] 140 and/or DBP [greater than or equal to] 90 mm Hg). The differences in mean BMI and BP between EAs at the 10th and 90th percentiles were 2.7 kg/m.sup.2 (BMI) and in BP 7.9 mm Hg (SBP) and 4.8 mm Hg (DBP). BMI was generally higher in the more affluent eastern parts of Accra, and BP was higher in the western part of the city. A limitation of our study was that the 2010 census dataset used for predicting small area variations is potentially outdated; the results should be updated when the next census data are available, to the contemporary population, and changes over time should be evaluated. Conclusions We observed that variation of BMI and BP across neighbourhoods within Accra was almost as large as variation across countries among women globally. Localised measures are needed to address this unequal public health challenge in Accra., Author(s): Sierra N. Clark 1,2, James E. Bennett 1,2, Raphael E. Arku 3, Allan G. Hill 4, Günther Fink 5, Richard M. Adanu 6, Richard B. Biritwum 7, Rudolph Darko [...]

In most school systems in the United States, interscholastic sporting events and other extracurricular activities help bring people together while enhancing opportunities for students to become integral parts of their communities. Because of the important role that extracurricular activities, especially sports, play in the lives of students, schools, and communities, litigation has addressed the extent to which a particular portion of the student population, children with disabilities, are entitled to accommodations affording them opportunities to participate in these school-sponsored events. Virtually identical language in Section 504 of the Rehabilitation Act and the Americans with Disabilities Act (ADA) requires school officials in programs receiving federal financial assistance to make individualized determinations in granting reasonable accommodations for students who are otherwise qualified to participate in extracurricular activities. Since courts generally have not required educators to include extracurricular activities in the individualized education programs of students who are covered by the Individuals with Disabilities Education Act (2005), this article focuses on the two laws that have generated most of the controversies: (1) Section 504; and (2) the ADA.

Measuring the strength of different reproductive barriers across species pairs is key to reveal the mechanisms that have led to evolutionary radiations. Here we study a genus of miniature plants, Argyroderma , which comprises 11 species restricted to a single plain of the Southern African desert. We measure different reproductive barriers to understand how species boundaries are maintained in this genus. Our results show that reproductive isolation is almost complete between all species pairs and relies on three pre-mating barriers: geographic isolation operating at spatial scales of c. 10 km, phenological isolation in flowering time, and habitat isolation operating at spatial scales of just a few metres, which is thought to be due to contrasting edaphic preferences between species. In comparison, post-mating isolation arising before seed formation is weak and does not restrict gene flow much between species. Interestingly, the high levels of both geographic and habitat isolation that we have measured between Argyroderma species might be due to their miniature size, which leads to restricted gene flow across space and to adaptation to spatially restricted micro-habitats. [ABSTRACT FROM AUTHOR]

This is a collaborative autoethnographic account of two educators' experience teaching undergraduate students a course that integrates and activates service-learning principles before, during, and after the pandemic. It is a narrative of the circumstances and problems encountered, how they addressed these issues, and how they addressed problems, resolved issues, and improved learning outcomes. The study also discussed outcomes resulting from the steps they undertook and explored how they want to develop and enhance their courses moving forward. In discussing their experiences, they realized that the pandemic allowed them to reflect on their teaching philosophy and pedagogy, which led to improving their teaching practices. They believe that these improvements led to better learning outcomes. Furthermore, sharing experiences led to discussing unique perspectives on issues and problems, providing insight on how to solve problems, resolve issues, and improve learning outcomes. [ABSTRACT FROM AUTHOR]

A major expense associated with litigating disputes under the Individuals with Disabilities Education Act (IDEA) is the right of parents who succeed in suits against their school boards to recover attorney fees. Yet until recently, boards were generally unable to recover attorney fees from parents even when they succeeded in demonstrating that they met IDEA mandates. In one of the more significant changes affecting the cost of delivering special education, the IDEA now allows school boards to recover attorney fees if they can convince courts that parental suits were unreasonable. In light of the significance of statutory language allowing school boards to recover fees, this article reviews the IDEA's key features and accompanying case law addressing attorney fees. It then briefly reflects on the meaning of the attorney fees provisions for school business officials and other education leaders who are responsible for overseeing school board finances.

According to the Individuals with Disabilities Education Act (IDEA), once students with disabilities receive educational placements, school officials cannot unilaterally change their settings. When officials wish to change the placements of students with disabilities for any reason, they must not only notify their parents of their intent to do so in writing, they must also afford them opportunities either to participate in making decisions involving their children or to object to those with which they disagree. Under what is known as the status quo or stay-put provision, the IDEA mandates that while administrative hearings or judicial proceedings that parents filed to challenge proposed changes by school officials are pending, students must remain in their "then-current placements" unless the parties agree otherwise. The purpose of the status quo provision is to provide educational stability and consistency ("Gabel ex rel. L.G. v. Board of Education of the Hyde Park Central School District 2005"). In light of the lack of judicial clarity about when school boards must incur the typically unbudgeted cost of unilateral parental placements of students in private schools, the authors examine the key provision from the IDEA's regulations regarding who should pay for unilateral placements along with case law on point, then reflect on what this means for school business officials, other education leaders, and school boards.

When school boards fail to provide the free appropriate public education (FAPE) guaranteed in the Individuals with Disabilities Education Act (IDEA), students with disabilities and their parents can be compensated in various ways. One of the more common remedies is to reimburse parents for tuition and other costs they may have incurred in obtaining special-education and related services privately. In spite of numerous cases on the issue of tuition reimbursement and an IDEA amendment that delineates conditions under which parents can be reimbursed for private school tuition, litigation in this area continues. In "Forest Grove School District v. T.A." (2008), the Supreme Court handed down its third pronouncement on tuition reimbursement, this time addressing whether a parent who places a child with a disability in a private school is entitled to tuition reimbursement if the child has never attended a public school. The Court held that students are not barred categorically from receiving private school reimbursement simply because they did not receive public school services first. Although critics of "Forest Grove" may argue that it will result in a significant increase in unilateral private school placements, resulting in tens of thousands of unexpected and unbudgeted expenditures, the reality is not so grim. As in the past, to be reimbursed, parents will have to show that school boards failed to provide a FAPE and that their unilateral placements in private schools provided an appropriate education for their children.

Students with disabilities are entitled to a free appropriate public education (FAPE) under the Individuals with Disabilities Education Act (IDEA). If school officials fail to provide students with a FAPE, the courts may grant appropriate relief. Courts often direct educators to provide students with disabilities with a FAPE and to compensate parents for expenses associated with obtaining the services that their children lost, such as tuition. Courts have also granted awards of compensatory educational services to students whose parents were unable to pay for placements in advance. Judicial awards of compensatory services have extended students' eligibility for years after they graduated or reached the maximum age of eligibility under the IDEA or state laws, have included extra services during academic terms, and have added services during vacation periods. Moreover, as reflected by a case from Georgia, "Draper v. Atlanta Independent School System" (2008), the Eleventh Circuit affirmed that a school board had to place a student in a private school since officials failed to provide him with a FAPE. In light of "Draper", this article reviews compensatory services awards. The first section reviews the types of compensatory services awards that courts have granted, while the second analyzes the Eleventh Circuit's judgment in "Draper". The final substantive section offers suggestions for school business officials and other education leaders who must plan and budget for such awards. The article rounds out with a brief conclusion.

The estimated prevalence of hepatitis C virus (HCV) infection in the US is 1.8 %. Data are limited on the clinical profile of the disease at first presentation and dynamic follow-up of ALT level, especially in publicly-funded patients. This information is critical for optimal management of these patients. The present study is aimed to assess the clinical profiles of chronic hepatitis C (CHC) at first presentation and clinical implication of dynamic follow-up of ALT level in a county medical center setting. A total of 294 patients were selected from the population consecutively evaluated in the Hepatitis Clinic at Los Angeles County-USC Medical Center between Jan. 1990 and Dec. 1998. Ethnicity of the patients was Hispanics-49.0%, Caucasian-28.6%, African American-13.6%, and Asian-8.8%. Risk factors were identifiable in 84.0% of patients, and injection drug use (IDU) represented the leading risk factor for HCV acquisition (47.4%). History of alcoholism was present in 39.1%. The initial clinical diagnoses were chronic hepatitis 76.9%; compensated cirrhosis 20.4%; and decompensated cirrhosis 2.7%. Elevation of ALT, alpha fetoprotein (AFP), ferritin, and anti-nuclear antibody (ANA) titer were seen in 219/294 (74.5%), 60/194 (30.9%), 20/83 (24.1%), and 35/97 (36.1%) patients, respectively. Anti-HBc (total) test was positive in 65/129 (50.5%) patients. The presence of cirrhosis was significantly associated with age greater than 55 years at entry, female gender, non-African American ethnicity, history of transfusion, lower level of albumin and elevated level of AFP. Longitudinal observation of ALT changes in 178 patients who had neither evidence of cirrhosis at entry nor received interferon treatment showed persistently normal, intermittently or persistently elevated ALT level in 15.2%, 38.3%, and 46.6% patients, respectively. The frequency of developing clinical evidence of cirrhosis during follow-up was significantly higher in patients with persistently (16.0%) or intermittently (7.0%) elevated ALT than that in patients with persistently normal ALT (4.0%). In conclusion, the present study analyzed the clinical profiles of CHC, assessed risk factors for developing cirrhosis, and demonstrated the clinical value of dynamic follow-up of ALT level in a cohort of publicly-funded patients. These data have major implications in designing optimal strategies for disease management, antiviral therapy, and screening for hepatocellular carcinoma in patients with CHC.