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Little is known about the quality of the special educators who move schools, switch to general education, or leave teaching. In this study, the author examined if turnover (moving schools within a district, moving schools between districts, switching to general education, or leaving teaching in the state) was associated with two common indicators of teacher quality: value-added scores or teaching observation scores. On average, special educators' probability of leaving teaching in the state declined as their value-added score increased, after accounting for the characteristics of teachers, their students, and their schools. Observation scores were similarly negatively associated with leaving and with moving within or between districts. Eight percent of special educators switched to general education positions, and the probability of switching was not associated with teachers' value-added or observation scores. The author discusses the implications for ensuring schools retain effective special educators while noting the limitations of current measures of special educator quality used in practice.

Drawing on eight waves of the Schools and Staffing Survey and the National Teacher and Principal Survey, we used a difference-in-differences research design to examine special education teachers' (SETs) responses to No Child Left Behind (NCLB) and the subsequent reauthorization of the Individuals with Disabilities Education Act (IDEA). IDEA was associated with decreases in the proportion of SETs with special education as a field of study and graduate degrees, an increase in co-teaching, and a decrease in the proportion of SETs working in a resource delivery model, with no evidence that NCLB influenced these outcomes. Little consistent evidence was found to indicate these federal policies influenced SETs' job attitudes (e.g., job satisfaction). We identified differences in these associations based on school poverty status and grade level. These findings help to better understand the status and challenges of the current SET workforce and the unintended consequences of federal reform policies.

Response to intervention (RTI) is a method for providing academic support to students and for identifying specific learning disabilities (SLDs). Using interrupted time series and hazard models, we examined if statewide RTI adoption in the U.S. state of Tennessee was associated with changes in rates of SLD and first-time SLD identification in elementary schools, and if these associations varied across student groups. Response to intervention was associated with an initial decline in the percentage of students with SLD in the state that continued over time, with larger decreases for students who were Black or economically disadvantaged. Response to intervention was associated with a 61% average decrease in the odds of first-time SLD identification by third grade (about a 0.006 change in the predicted probability), with greater declines for students who were Black or economically disadvantaged. We discuss these results in the context of disproportionality in special education and the need for research examining whether declines in SLD were due to improved academic outcomes, as opposed to delays in identification.

Multitiered systems for supporting students' behavior in schools rely on teachers using generally effective classroom management strategies, such as Tier 1 practices. However, few tools exist to easily assess classwide Tier 1 practices. In this brief report, we describe one potential tool, the Classroom Atmosphere Rating Scale--Brief (CARS-B) and assess the properties of the tool using item response theory and multilevel models. We found that most items on the CARS-B had acceptable discriminations and difficulty estimates. Teachers' CARS-B latent scores were positively associated with student group on-task. We discuss potential changes to the CARS-B and its use in research and practice.

BackgroundLiver tumors are rare in children with histologic heterogeneity that makes diagnosis challenging. Systematic histopathological review, performed as part of collaborative therapeutic protocols, identified relevant histologic subtypes that are important to distinguish. The Children's Hepatic tumors International Collaboration (CHIC) was established to study pediatric liver tumors on a global scale and led to establishment of a provisional consensus classification for use in international clinical trials. The current study is the validation of this initial classification and first large-scale application by international expert reviewers.ProcedureThe CHIC initiative includes data from 1605 children treated on eight multicenter hepatoblastoma (HB) trials. Review of 605 available tumors was performed by seven expert pathologists from three consortia (US, EU, Japan). Cases with discordant diagnoses were collectively reviewed to reach a final consensus diagnosis.ResultsOf 599 cases with sufficient material for review, 570 (95.2%) were classified as HB by all consortia, and 29 (4.8%) as non-HB, which included "hepatocellular neoplasm, NOS" and malignant rhabdoid tumors. 453 of 570 HBs were classified as epithelial by final consensus. Some patterns (i.e., small cell undifferentiated, macrotrabecular, cholangioblastic) were selectively identified by reviewers from different consortia. All consortia identified a similar number of mixed epithelial-mesenchymal HB.ConclusionsThis study represents the first large-scale application and validation of the pediatric malignant hepatocellular tumors consensus classification. It is a valuable resource to train future generations of investigators on accurate diagnosis of these rare tumors and provides a framework for further international collaborative studies and refinement of the current classification of pediatric liver tumors.

Teachers may have affective responses to teaching students with emotional/behavioral disorders (EBD) that influence their effectiveness. We used latent profile analysis to examine the burnout profiles of 102 K-Grade 6 general education and special education teachers who had students with or at risk for EBD in their classrooms. We then examined if profile membership varied by teacher type (special education vs. general education) and if profile membership was related to teachers' directly observed classroom management skills. Our results suggest that teachers exhibit three burnout profiles: "flourishing," "buffered," and "struggling"; that profile membership did not vary by teacher type; and that burnout profiles were related to teachers' classroom management skills. These findings suggest teachers may need differential supports when working with students who have EBD and provide directions for future research regarding the association between teacher affect and classroom instruction.

Growing numbers of students are educated in charter schools, including students with disabilities (SWD). Prior research suggests that charter schools educate a smaller percentage of SWD than traditional public schools, leading to a special education gap between sectors. We used data from a large urban district to examine how choice, mobility, and special education classification influenced the special education gap with descriptive statistics, gap decomposition, and causal analyses relying on a randomized component of school assignment. The driver of the gap was parental choice, with parents of SWD less often choosing charter schools. Enrolling in a charter school had no effect on the probability that a student was newly identified for special education services, but increased the probability that a student was deidentified for special education services. We discuss potential mechanisms underlying these results, with attention to factors that shape parental choice, and future research needed to understand parental choices.

The incidence and biochemical consequences of rare tumor subtypes are often hard to study. Fibrolamellar liver cancer (FLC) is a rare malignancy affecting adolescents and young adults. To better characterize the incidence and biochemical consequences of this disease, we combined a comprehensive analysis of the electronic medical record and national payer data and found that FLC incidence is likely five to eight times higher than previous estimates. By employing unsupervised learning on clinical laboratory data from patients with hyperammonemia, we find that FLC-associated hyperammonemia mirrors metabolic dysregulation in urea cycle disorders. Our findings demonstrate that advanced computational analysis of rich clinical datasets can provide key clinical and biochemical insights into rare cancers.

School administrators make decisions that directly affect the educational context in which teachers work and students learn. In this commentary, we argue that addressing the burnout of individual special educators without attending to school working conditions may do little to improve teachers' burnout and the outcomes of students with emotional/behavioral disorders (EBD). We review the literature regarding the importance of working conditions, specifically collegial supports, workload and time pressure, professional development and in-service training, and safety, for teachers' affect and career decisions, and literature showing how administrators' choices are related to working conditions. Students with EBD are served within schools, not just by special educators acting independently and alone. Improving implementation of evidence-based practices for students with EBD through addressing teacher burnout requires attention to the broader school system and the ways in which administrators make choices that support or constrain the abilities of the teachers within their schools.

We used five waves of nationally representative data over 16 years from the Schools and Staffing Survey, National Teacher Principal Survey, and Teacher Follow-up Survey to descriptively examine how the roles, responsibilities, preparation, and supports for special educators have changed over time. We then used regression to investigate how these variables were associated with special educator attrition. This information is essential to ensure teacher education adequately prepares special educators for the contexts in which they work. We identified some changes in special educators' work environment, including substantially increased use of team teaching. Our results indicated special educator attrition declined from 2000 to 2012, and this decline was primarily driven by reductions in movement between schools. Regression analysis provided little insight into the variables associated with this decline, suggesting a need for future research.

Endometriosis is a leading cause of pain and infertility affecting millions of women globally. Herein, we characterize variation in DNA methylation (DNAm) and its association with menstrual cycle phase, endometriosis, and genetic variants through analysis of genotype data and methylation in endometrial samples from 984 deeply-phenotyped participants. We estimate that 15.4% of the variation in endometriosis is captured by DNAm and identify significant differences in DNAm profiles associated with stage III/IV endometriosis, endometriosis sub-phenotypes and menstrual cycle phase, including opening of the window for embryo implantation. Menstrual cycle phase was a major source of DNAm variation suggesting cellular and hormonally-driven changes across the cycle can regulate genes and pathways responsible for endometrial physiology and function. DNAm quantitative trait locus (mQTL) analysis identified 118,185 independent cis-mQTLs including 51 associated with risk of endometriosis, highlighting candidate genes contributing to disease risk. Our work provides functional evidence for epigenetic targets contributing to endometriosis risk and pathogenesis. Data generated serve as a valuable resource for understanding tissue-specific effects of methylation on endometrial biology in health and disease.

Small cell undifferentiated (SCU) histology and alpha-fetoprotein (AFP) levels below 100 ng/mL have been reported as poor prognostic factors in hepatoblastoma (HB); subsequent studies reported SMARCB1 mutations in some SCU HBs confirming the diagnosis of rhabdoid tumor. The Children's Hepatic tumors International Collaboration (CHIC) database was queried for patients with HB who had AFP levels less than 100 ng/mL at diagnosis or were historically diagnosed as SCU HBs. Seventy-three of 1605 patients in the CHIC database were originally identified as SCU HB, HB with SCU component, or HB with low AFP levels. Upon retrospective review, they were re-classified as rhabdoid tumors (n = 11), HB with SCU component (n = 41), and HB with low AFP (n = 14). Seven were excluded for erroneously low AFP levels. Overall survival was 0% for patients with rhabdoid tumors, 76% for patients with HB with SCU component, and 64% for patients with HB with AFP less than 100 ng/mL. Patients with HB with SCU component or low AFP should be assessed for SMARCB1 mutations and, if confirmed, treated as rhabdoid tumors. When rhabdoid tumors are excluded, the presence of SCU component and low AFP at diagnosis were not associated with poor prognosis in patients diagnosed with HB.

As the field moves toward adaptive and individualized behavior intervention, it is important to identify and consider relevant student characteristics as potential levers (i.e., critical factors) for improving intervention effectiveness. Motivated by previous findings suggesting that behavioral profiles and teachers' perceptions of students with problem behavior vary by student gender, we evaluated gender differences in teacher ratings and direct observations of classroom problem behavior for elementary students with or at risk of emotional and behavioral disorder (EBD; N = 352). We found significant gender differences for teacher ratings of problem behavior, social skills, and academic competence. However, we did not find significant differences between male and female students on direct observation measures of behavior or reading skills. These findings provide evidence suggesting that student gender may be a critical factor in addressing classroom problem behavior. Future work in this area will help guide researchers and practitioners in considering how student gender and related teachers' perceptions may inform intervention selection and implementation for students with or at risk of EBD.

Background & aimsHepatoblastoma (HB) and hepatocellular carcinoma (HCC) are the predominant liver cancers in children, though their respective treatment options and associated outcomes differ dramatically. Risk stratification using a combination of clinical, histological, and molecular parameters can improve treatment selection, but it is particularly challenging for tumors with mixed histological features, including those in the recently created hepatocellular neoplasm not otherwise specified (HCN NOS) provisional category. We aimed to perform the first molecular characterization of clinically annotated cases of HCN NOS.MethodsWe tested whether these histological features are associated with genetic alterations, cancer gene dysregulation, and outcomes. Namely, we compared the molecular features of HCN NOS, including copy number alterations, mutations, and gene expression profiles, with those in other pediatric hepatocellular neoplasms, including HBs and HCCs, as well as HBs demonstrating focal atypia or pleomorphism (HB FPAs), and HBs diagnosed in older children (>8).ResultsMolecular profiles of HCN NOS and HB FPAs revealed common underlying biological features that were previously observed in HCCs. Consequently, we designated these tumor types collectively as HBs with HCC features (HBCs). These tumors were associated with high mutation rates (∼3 somatic mutations/Mb) and were enriched with mutations and alterations in key cancer genes and pathways. In addition, recurrent large-scale chromosomal gains, including gains of chromosomal arms 2q (80%), 6p (70%), and 20p (70%), were observed. Overall, HBCs were associated with poor clinical outcomes.ConclusionsOur study indicates that histological features seen in HBCs are associated with combined molecular features of HB and HCC, that HBCs are associated with poor outcomes irrespective of patient age, and that transplanted patients are more likely to have good outcomes than those treated with chemotherapy and surgery alone. These findings highlight the importance of molecular testing and early therapeutic intervention for aggressive childhood hepatocellular neoplasms.Lay summaryWe molecularly characterized a class of histologically aggressive childhood liver cancers and showed that these tumors are clinically aggressive and that their observed histological features are associated with underlying recurrent molecular features. We proposed a diagnostic algorithm to identify these cancers using a combination of histological and molecular features, and our analysis suggested that these cancers may benefit from specialized treatment strategies that may differ from treatment guidelines for other childhood liver cancers.

Special education teacher shortages result in unqualified teachers working with students who have disabilities. Past research has focused on national shortages and the number of special education teachers in schools, but fewer studies have examined the number of new special education program completers, an important aspect of the potential special educator pipeline. In this study, we used publicly available data to examine long- and short-term trends in the number of program completers, if these trends were related to the number of students with disabilities over time, and if trends varied by state. Using graphs and multilevel modeling, we found that trends in the special education teacher pipeline varied dramatically by state, that national averages might be substantially influenced by large states, and that trends in recent years suggest a decline in special education program completers. We discuss the implications of these findings for ensuring that all students with disabilities have access to teachers with special education training.

Students with disabilities are served by both special and general educators, yet teachers often feel unprepared to meet the needs of these students in their classrooms. Using data from a nationally representative survey, we examined the sufficiency of teachers' access to supports available for meeting the needs of students with high-incidence disabilities, their access to development opportunities, and the sources teachers used to access interventions. We explored differences in teachers' experiences by grade band, service delivery model, and teacher preparation model. We found teachers of students with disabilities rated the sufficiency of access to supports between somewhat insufficient and somewhat sufficient, with the lowest ratings for planning/release time and training and information. Teachers reported greater rates of access to collaboration than professional development. Colleagues were sources for resources related to academic interventions and administrators were sources for nonacademic intervention resources. There were few significant differences in these results by teacher characteristics.

Many teachers struggle with the classroom management skills necessary to support students with disabilities. Teacher evaluation is a potential method for supporting teachers' use of classroom management strategies. The authors evaluate the extent to which classroom management was included in state teacher evaluation rubrics and the types of classroom management topics that were included in the rubrics. They find that while one fifth of standards and indicators were related to classroom management, there was large variability across states. Rubrics that included classroom management focused on proactive strategies, but often did not include specific evidence-based practices that could help teachers improve their classroom management skills. Very few rubrics included any focus on how to address student misbehavior. In light of these findings, the authors provide a discussion of the importance of including high-quality standards and indicators about classroom management to support teachers of students with disabilities.

Federal policies have aimed to improve access to grade-level curriculum for students with disabilities (SWD). Current conceptualizations of access posit that it is evidenced by students' academic outcomes. In a meta-analysis of 180 effect sizes from 23 studies, we examined access as outcomes by estimating the size of the gap in reading achievement between students with and without disabilities. Findings indicated that SWDs performed 1.17 standard deviations, or more than 3 years, below typically developing peers. The reading gap varied by disability label but not by other student and assessment characteristics. We discuss implications for access to grade-level curriculum and potential reasons for why the achievement gap is so large despite existing policies.

Abstract Endometriosis is a leading cause of pain and infertility affecting millions of women globally. Herein, we characterize variation in DNA methylation (DNAm) and its association with menstrual cycle phase, endometriosis, and genetic variants through analysis of genotype data and methylation in endometrial samples from 984 deeply-phenotyped participants. We estimate that 15.4% of the variation in endometriosis is captured by DNAm and identify significant differences in DNAm profiles associated with stage III/IV endometriosis, endometriosis sub-phenotypes and menstrual cycle phase, including opening of the window for embryo implantation. Menstrual cycle phase was a major source of DNAm variation suggesting cellular and hormonally-driven changes across the cycle can regulate genes and pathways responsible for endometrial physiology and function. DNAm quantitative trait locus (mQTL) analysis identified 118,185 independent cis-mQTLs including 51 associated with risk of endometriosis, highlighting candidate genes contributing to disease risk. Our work provides functional evidence for epigenetic targets contributing to endometriosis risk and pathogenesis. Data generated serve as a valuable resource for understanding tissue-specific effects of methylation on endometrial biology in health and disease.

We examined the association between the percentage of students with disabilities (SWD) in general education teachers' classes and their likelihood of turnover, investigating potential internal and external resources (certification, experience, preparation, classroom management, and working conditions) as moderators and disaggregating types of teacher mobility. Before accounting for other variables, the percentage of SWD, and the percentage of students with most specific disabilities, in teachers' classes were positively associated with moving within and moving between districts. These associations were not significant after accounting for student, teacher, and school characteristics. We identified a negative association between leaving teaching in the state and the percentage of SWD in teachers' classes, even after accounting for other variables. Dual-certification and instructional leadership moderated some of these associations. Results suggest that future research is needed to identify the supports teachers have access to when they teach higher percentages of SWD.

Background: While the majority of reproductive-aged females will experience pelvic pain during their lives, biological mechanisms underlying pelvic pain are not well understood. We investigated associations between pelvic pain symptoms and oxidative stress among people with and without surgically-confirmed endometriosis. Methods: Using an enzyme-linked immunosorbent assay, we measured 8-Hydroxy-2’-deoxyguanosine (8-OHdG) in urine samples and corrected for creatinine levels in 434 surgically-confirmed endometriosis participants compared to 605 participants never diagnosed with endometriosis. At enrollment, participants reported details of their pelvic pain symptoms. Linear regression was used to compute geometric mean (GM) creatinine-corrected 8-OHdG levels with 95% confidence intervals (CI) among all participants and those with and without endometriosis separately, adjusting for potential confounders. Interactions by surgically-confirmed endometriosis status were tested by Wald statistics. Results: No trends in 8-OHdG were observed among those with or without endometriosis for severity or frequency of dysmenorrhea, acyclic pelvic pain, dyspareunia or pain with bowel movements. Among endometriosis participants, lower 8-OHdG levels were observed for participants with any white, blue/black, or brown lesions (GM=76.7 versus 82.9 ng/mg; p=0.10), which was primarily driven by lower levels of 8-OHdG for any blue/black lesions (GM=72.8 versus 81.6 ng/mg; p=0.05). Conclusion: While no associations were observed between 8-OHdG and pelvic pain symptoms, future research is needed to assess how other pathways of oxidative damage, e.g. through proteins or lipids, may affect endometriosis-associated symptoms. Additionally, further research is needed to understand differences in oxidative stress among endometriosis lesion sub-phenotypes.

Abstract Background Pediatric interventional oncology (PIO) is a growing field intended to provide additional or alternative treatment options for pediatric patients with benign or malignant tumors. Large series of patients treated uniformly and subjected to rigorous endpoints for efficacy are not available. Methods We designed a collaborative initiative to capture data from pediatric patients with benign and malignant tumors who underwent a therapeutic interventional radiology procedure. Modified Response Evaluation Criteria in Solid Tumors (mRECIST) was utilized as a measure of radiologic response and data were collected regarding improvement in pain and functional endpoints. Cumulative incidence of progressive disease was calculated using both the treated site and the patient as the analytic unit. Findings Forty patients, 16 with malignant tumors and 24 with benign tumors, underwent a total of 88 procedures. Cryo‐ and radiofrequency ablation were the most frequently utilized techniques for both cohorts of patients. A complete or partial response, or prolonged disease stability, were achieved in approximately 40% of patients with malignant tumors and 60% of patients with benign tumors. No patients had progressive disease as their best response. Resolution of pain and improved mobility with return‐to‐baseline activity were demonstrated across patients from both cohorts. Only minor complications were experienced. Interpretation Interventional radiology‐guided interventions can serve as an alternative or complementary approach to the treatment of benign and malignant tumors in pediatric patients. Prospective, multi‐institutional trials are required to adequately study utility, treatment endpoints, and durability of response.