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BackgroundCompliance to disease modifying therapy (DMT) is associated with a reduced risk of relapse, lower healthcare resource utilization, and improved health-related quality of life in patients with multiple sclerosis (MS). Our objective was to assess the compliance and discontinuation rates of fingolimod relative to other oral, injectable, and infusible DMTs available on the market at the time of the study in Canada in patients with relapsing-remitting MS (RRMS).Methods and findingsWe conducted a retrospective claims analysis. Patients with RRMS with ≥ 1 prescription for each DMT were included. Compliance (medication possession ratio of ≥ 80%) and discontinuation (gap > 30 days from the end of the index prescription) were calculated at the 6-, 12- and 24-month time points. Compliance with fingolimod at the 6-, 12- and 24-month time points was 75%, 75% and 70%, respectively; compared with DMF [70% (P < 0.001), 68% (P < 0.001), and 56% (P < 0.001), respectively], and BRACE [53% (P < 0.001), 47% (P < 0.001), and 35% (P < 0.001), respectively]. Compliance with fingolimod was comparable to teriflunomide at each time point, but was higher compared to natalizumab [70% versus 57% (P < 0.001)] at the 24-month time point. At the 6-, 12- and 24-month time points, patients on fingolimod had the lowest discontinuation rate (26%, 24%, and 29%, respectively) compared to BRACE [49% (P < 0.001), 44% (P < 0.001), and 57% (P < 0.001)], respectively], and natalizumab [33% (P < 0.001), 29% (P < 0.001), and 45% (P < 0.001), respectively], and was similar to teriflunomide (26%, 25%, and 31%, respectively).ConclusionsThe compliance rate in fingolimod treated patients at the 24 month time point was higher than that observed in natalizumab treated patients. The discontinuation rate was lower with fingolimod compared to other DMTs at all time points but was similar to teriflunomide.

This article describes a unit-length project involving students in the analysis of how public memory is shaped by multiple factors and functions persuasively to influence one's understanding of historical events. This project was designed for an upper-division undergraduate course in Rhetoric and Public Memory, but could be adapted for use in a Persuasion or Rhetorical Criticism course. In the Memory Mosaic project described here, student groups work together to assemble the key pieces of a public memory. They develop a critical framework for examining representations of public memory, engage in a collaborative rhetorical analysis of how that public memory operates persuasively to shape citizens, and synthesize the results of this analysis in a group presentation (alternatives include a group or individual papers, a collaborative video, or a blog with multiple contributors). This project focuses on public memory in the United States because American culture and history are familiar terrain for most students. Since collective memory depends significantly on shared experiences, the American context provides an important foundation for the course.

This qualitative study examines, from the perspective of the families, the transition process to employment or postsecondary education for adolescents with learning disabilities (LDs) and the interplay of the roles of parents, students with LDs, and teachers. Using a case study design, series of three in-depth interviews were conducted with five individuals with LDs and with their parents. Data were analyzed inductively. The findings indicate that the families all had informal transition plans; formal transition plans were not written. For four of the families, the transition process was successful and occurred in two phases spanning the elementary and secondary school years. In the first phase parents controlled the transition process, and during the second phase they transferred this responsibility to their children with LDs. Parents' high expectations and advocacy; students' hard work, self-determination and self-advocacy; and teachers' mentoring and support also contributed to the achievement of transition goals. Throughout the process parents, adolescents with LDs, and teachers worked collaboratively. In the fifth case, only the factor of parental advocacy was in place, and it was insufficient to bring about a successful transition for the adolescent with LDs.

Immigrants are also emigrants, possessing social ties that link them to people and places left behind. Although this duality is inherent to the migration process, researchers typically separate the study of emigration from that of immigration. Using new survey data on Latino immigrant social and political engagement in the sending and receiving society, we assess how political attitudes and national allegiance are shaped by social and political ties acquired at home and abroad. We find that immigrants’ home country social ties yield modest political consequences, whereas the more important influences sustaining connections to homeland polities stem from premigration political experiences. Both cross-border social ties and premigration political experiences reinforce homeland national identities. Furthermore, the acquisition of U.S. citizenship tends to corrode homeland attachments and Latino immigrants are more likely to shift political allegiance from home to host state once legal status is obtained.

Young people living with an autism spectrum disorder (ASD) have less access to sports and physicalactivity. Even when they do, the instructors do not always have the training to include them adequately.This study aimed to identify barriers that young people with ASD may face and strategies to overcomethese barriers. In order to meet the objectives of the study, semi-structured interviews were conductedwith young people, parents, and caregivers. Then, a qualitative analysis of the interviews has allowedthe identification of three types of barriers: related to ASD, related to the physical and socialenvironments, and related to the physical activity itself. Three categories of coping strategies have alsobeen identified by the participants. In order to help reduce the barriers, one should focus on the socialenvironment, the activity, and communication strategies. This study confirms previous research andshows that there are effective ways to intervene with young people living with ASD in order to optimizetheir integration in sports and physical activity and that it can be done with little resources.

Emerging foodborne pathogens present a threat to public health. It is now recognized that several foodborne pathogens originate from wildlife as demonstrated by recent global disease outbreaks. Zoonotic spillover events are closely related to the ubiquity of parasitic, bacterial, and viral pathogens present within human and animal populations and their surrounding environment. Foodborne diseases have economic and international trade impacts, incentivizing effective wildlife disease management. In North America, there are no food safety standards for handling and consumption of free-ranging game meat. Game meat consumption continues to rise in North America; however, this growing practice could place recreational hunters and game meat consumers at increased risk of foodborne diseases. Recreational hunters should follow effective game meat food hygiene practices from harvest to storage and consumption. Here, we provide a synthesis review that evaluates the ecological and epidemiological drivers of foodborne disease risk in North American hunter populations that are associated with the harvest and consumption of terrestrial mammal game meat. We anticipate this work could serve as a foundation of preventive measures that mitigate foodborne disease transmission between free-ranging mammalian and human populations.

The redox state of the cell can be affected by many cellular conditions. In this study we show that detectable reactive oxygen species (ROS) are also generated in response to DNA damage by the chromatin remodeling factor and monoamine oxidase LSD1/KDM1A. This raised the possibility that the localized generation of hydrogen peroxide produced by LSD1 may affect the function of proximally located DNA repair proteins. The two major pathways for repair of DNA double-strand breaks (DSBs) are homologous recombination (HR) and non-homologous end joining (NHEJ). Cells were exposed to low levels of ectopic H2O2, DNA breaks generated by laser light, and recruitment kinetics of NHEJ protein Ku80 to DNA damage sites determined. Ku80 recruitment to damage sites was significantly decreased in cells pretreated with H2O2 while HR end binding protein Nbs1 was increased. This suggests that the DNA repair pathway choice has the potential to be modulated by the local redox state. This has implications for chemotherapeutic approaches involving generating DNA damage to target actively dividing cancer cells, which may be more or less effective dependent on the redox state of the targeted cells and the predominant repair pathway required to repair the type of DNA damage generated.

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Background: Statin therapy (ST) has been associated with improved outcomes from sepsis. Our objective was to systematically review the association between established ST and outcomes of patients with community-acquired pneumonia (CAP) that is severe enough to require hospitalisation. Methods: Two meta-analyses were conducted following a search of articles published before 31st January 2013. After exclusions, seven studies were included to assess the effects of statins on 30-day mortality from CAP, and eight studies were included to assess the effects of statins on the development of CAP. Endpoints were a reduction in the risk of 30-day mortality or risk of developing CAP. Results: A reduction in the risk of 30-day mortality from CAP was identified in patients established on ST (pooled odds ratio [OR]: 0.70, 95% confidence interval [CI]: 0.65-0.76; adjusted OR: 0.58, 95% CI: 0.47-0.69). The pooled OR for risk of developing CAP in patients with and without established ST was 1.01 (95% CI: 0.98-1.04). Conclusion: There appears to be weak evidence to suggest a potential benefit of established ST. It is associated with a reduced risk of 30-day mortality in patients subsequently hospitalised with CAP. Further evidence is required, but ST could be considered as a means of reducing the risk of mortality from pneumonia.

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Le vieillissement de la population exige de renouveler les façons de penser l’aménagement des milieux de vie pour renforcer le bien-être des aînés. Plusieurs études ont démontré que le loisir contribue à l’amélioration de la qualité de vie des aînés. À cet effet, le milieu municipal est appelé à jouer un rôle important dans l’offre de loisir destinée à ce groupe. Cet article présente les résultats d’un sondage mené en 2015 à Montréal auprès de 464 répondants âgés de 50 ans et plus. Ils démontrent l’importance accordée par les aînés aux pratiques de loisir libres et aux espaces extérieurs multifonctionnels. Ces résultats révèlent également des disparités physiques et socioéconomiques marquées dans la population sondée. Cette enquête met ultimement en lumière le fait que l’action municipale semble davantage être conçue comme facilitatrice pour la mise en place de projets par et pour les aînés que comme simple pourvoyeuse d’activités.

Renal and lung fibrosis was characterized by the accumulation of collagen-immunoreactive mesenchymal cells expressing the intermediate filament protein nestin. The present study tested the hypothesis that nestin expression was increased in the hypertrophied/fibrotic left ventricle of suprarenal abdominal aorta constricted adult male Sprague-Dawley rats and induced in ventricular fibroblasts by pro-fibrotic peptide growth factors. Nestin protein levels were upregulated in the pressure-overloaded left ventricle and expression positively correlated with the rise of mean arterial pressure. In sham and pressure-overloaded hearts, nestin immunoreactivity was detected in collagen type I(+)-and CD31(+)-cells identified in the interstitium and perivascular region whereas staining was absent in smooth muscle α-actin(+)-cells. A significantly greater number of collagen type I(+)-cells co-expressing nestin was identified in the left ventricle of pressure-overloaded rats. Moreover, an accumulation of nestin(+)-cells lacking collagen, CD31 and smooth muscle α-actin staining was selectively observed at the adventitial region of predominantly large calibre blood vessels in the hypertrophied/fibrotic left ventricle. Angiotensin II and TGF-β1 stimulation of ventricular fibroblasts increased nestin protein levels via phosphatidylinositol 3-kinase- and protein kinase C/SMAD3-dependent pathways, respectively. CD31/eNOS(+)-rat cardiac microvascular endothelial cells synthesized/secreted collagen type I, expressed prolyl 4-hydroxylase and TGF-β1 induced nestin expression. The selective accumulation of adventitial nestin(+)-cells highlighted a novel feature of large vessel remodelling in the pressure-overloaded heart and increased appearance of collagen type I/nestin(+)-cells may reflect an activated phenotype of ventricular fibroblasts. CD31/collagen/nestin(+)-interstitial cells could represent displaced endothelial cells displaying an unmasked mesenchymal phenotype, albeit contribution to the reactive fibrotic response of the pressure-overloaded heart remains unknown.

The purpose of this qualitative study was to examine the educational advocacy experiences of 36 adoptive parents of adolescents and young adults with fetal alcohol spectrum disorder (FASD). The participants responded to a questionnaire and 29 of them also engaged in an in-depth individual interview. Data were analysed inductively. Emerging from the data were four dimensions of advocacy: awareness, information seeking, presenting the case and monitoring. It was also found that the Internet was an essential tool for parents to seek information and support from others, and that in some cases advocacy was a means for parents to obtain respect from educators and programmes and services for their children. (Contains 2 tables.)

This manuscript reports on data collected as part of a larger research study designed to investigate factors that facilitate the integration of children with hearing loss into mainstream environments. Aspects of communicative, academic, and social functioning for 43 adolescents and young adults were examined using questionnaires. In addition, standardized assessments of communication, academic competence, and self-perception were administered to a subset of 24 participants. The results indicate that participants with hearing loss who had participated in a listening and spoken language program in childhood, and had continued to receive support services in school, were able to function effectively within mainstream school and community environments. The participants in this study performed at average or above-average levels on measures of communication, academic achievement, and self-perception compared to their peers with typical hearing. (Contains 6 tables and 7 figures.)

This research examined the advocacy experiences of 16 parents of adolescents and young adults who had been assessed as intellectually gifted. The purpose was to determine the applicability of the four dimensions of advocacy to their experiences (awareness, information seeking, presenting the case, and monitoring). Participants responded to a questionnaire and 14 also participated in individual interviews. The parents advocated individually to have their own children identified as intellectually gifted, to have them placed in specific programs, and, in the case of a dual diagnosis, to have accommodations written in the Individual Education Plans. It was also found that their experiences could be categorized according to the dimensions of advocacy and that there was a process involving a series of key events that triggered activities associated with each dimension. (Contains 3 tables.)

This study examines the relationship between the reported career intentions and perceptions of preparedness of graduating secondary teachers in Quebec, across a two-year period, in an effort to identify factors which contribute to growing attrition rates among beginning teachers. The study reveals that those beginning teachers most concerned with their lack of preparation in the areas of classroom management and assessment of students' learning are more likely to consider leaving the profession. While evidence suggests that beginning teachers do develop increasing confidence in terms of classroom management in their second year of teaching, their challenges with effectively assessing student learning endure through the first two years of teaching. Findings from this mixed method study suggest that both initial teacher education and employers have a shared responsibility to give greater attention to the ways in which teachers are introduced to and have experience with strategies for the assessment of student learning.

Previous studies have shown that blind subjects may outperform the sighted on certain tactile discrimination tasks. We recently showed that blind subjects outperformed the sighted in a haptic 2D-angle discrimination task. The purpose of this study was to compare the performance of the same blind (n = 16) and sighted (n = 17, G1) subjects in three tactile discrimination tasks dependent solely on cutaneous inputs from the fingertip of the index finger, D2. A second group of sighted subjects (n = 30, G2) were also tested. Texture discrimination thresholds were 0.62 (G1)-0.80 mm (G2) for the sighted subjects, and 0.64 mm for the blind (standard, 2 mm spatial period). Grating orientation thresholds were 0.99 (G1)-1.12 mm (G2) for the sighted subjects, and 0.96 mm for the blind. Finally, vibrotactile frequency discrimination thresholds (100 Hz standard) were 19.5 (G2) and 20.0 Hz (G1) for the sighted, and 16.5 Hz for the blind subjects. There were no significant differences in performance between the blind and the sighted subjects for the grating orientation or vibrotactile frequency discrimination tasks. In contrast, blind subjects outperformed the sighted for the texture discrimination task (G2 only), possibly reflecting the fact that the raised dot surfaces were similar to the dots forming Braille characters (all were fluent Braille readers). (Contains 3 figures.)

This study examines the early neurodevelopmental function of infants and preschool children who have chronic kidney disease (CKD). Fifteen patients with CKD are compared to a healthy control group using the "Mullen Scales of Early Learning" (MSEL) and the "Vineland Adaptive Behavior Scale" (VABS). Multivariate analysis reveals significant differences between the CKD and control groups on both MSEL (p less than 0.01) and VABS (p less than 0.001) composite scales, with the group with CKD obtaining lower scores on both composites. A higher proportion of children with CKD meet federal eligibility criteria for early cognitive delay, but similar proportions are found across adaptive behaviors. Disease severity is positively correlated to cognitive and adaptive functioning such that lower scores are associated with less renal function (MSEL r = 0.62, p less than 0.001; VABS r = 0.70, p less than 0.001). Suggestions are made in regard to special education assessment and service provision. (Contains 2 tables.)

The purpose of this qualitative study was to examine the educational and employment experiences of 10 adults who had recently been diagnosed as having a learning disability. Seven of the participants eventually obtained a high school diploma or the equivalent and they all had held a variety of entry-level jobs. The participants felt that having an undiagnosed learning disability had negatively affected their past, present, and future educational and employment opportunities. The importance of a caring adult to advocate on behalf of at-risk students and a set of goals, skills, and abilities that should be developed while in school emerged from the findings. (Contains 3 tables.)

From its inception, a primary goal of public education has been to develop self-discipline among students, best seen as them exhibiting socially and morally responsible behavior. This goal coincides with another important educational imperative, as well as an alternative meaning of the term "discipline": to correct misbehavior to create and maintain a safe and orderly environment that is conducive to learning. "Self-discipline" refers to assuming social and moral responsibility for one's own actions, and doing so under one's own volition (i.e., not solely out of fear of punishment or to gain external rewards). By fostering self-discipline, educators develop students who understand and appreciate the difference between right and wrong, assume responsibility for their actions, recognize the importance of cooperative relationships, and show genuine care and interest in others. This article presents several tips for fostering self-discipline among students. (Contains 7 online resources.)

The purpose of this study was to examine persistence in school among students with Foetal Alcohol Spectrum Disorder (FASD) from the perspectives of the students themselves and their parents. Tinto's (1975, 1997) Student Integration Model (SIM) provided the theoretical framework for this research. This model involves an interplay between (1) background characteristics and attributes affecting the level of goal commitment, (2) level of academic integration, and (3) level of social integration into the institution that determine whether or not a student will graduate. The findings showed limited support for Tinto's SIM and that parental advocacy is strongly linked with persistence among adolescents with FASD. A new model showing the parents' role in encouraging persistence through their actions at home and advocacy at the schools is presented. (Contains 1 table and 1 figure.)

This article examines identity and the experiences of being a role model among graduates of a Native Teacher Education Program (NTEP). It also studies how the NTEP supported the participants' development as role models. Central findings focus attention on their leadership experiences, questions about their ability to be a role model, and the benefits and disadvantages of being a role model. It was also found that the NTEP provided the context for the participants to reconstruct their identity to include being a role model. Three stages of becoming a role model are described.

Background: This study examined persistence in high school among students with Fetal Alcohol Spectrum Disorder (FASD) from the perspective of the adolescents themselves. Tinto's (1975, 1997) Student Integration Model (SIM) provided the theoretical framework for the research. This model consists of three factors: background characteristics, academic integration, and social integration. Method: A collective case study method involving 8 adolescents with FASD from Canada and the United States was used. Results: Although the students did not meet the usual academic standards and had acquaintances rather than friends, they perceived themselves as academically and socially successful. It was shown that persistence occurred largely because of the strong support of, and advocacy by, the adoptive parents. Conclusions: Parental advocacy is an environmental factor that may protect adolescents with FASD from dropping out of high school.

Fetal Alcohol Spectrum Disorder (FASD) is a term that encompasses the various neurodevelopmental disorders experienced by individuals with prenatal alcohol exposure. FASD incorporates the terms Fetal Alcohol Syndrome (FAS), Fetal Alcohol Effects (FAE), and Alcohol-Related Neurodevelopmental Disorder (ARND). Early studies showed that students with FASD had disrupted high school experiences that included suspensions and expulsions, and that they eventually dropped out of school. However, findings from a more recent study, which was conducted by the authors, demonstrated that in the right environment, students with FASD can graduate from high school. Sixteen adolescents and young adults from the United States and Canada participated in the authors' qualitative study that also involved 37 parents of children with FASD. The purpose of the study was to examine the educational experiences of individuals with FASD, with a view to determining what factors related to their persistence in high school. The adolescents and young adults in the study discussed the behaviors of their worst and best teachers and offered tips on how best to teach students with FASD. (Contains 1 table and 7 resources.)