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Despite substantial cross-national interest in remedial programming as a way to support low-achieving students, evidence of its effectiveness is rare, particularly in low-income and/or crisis-affected contexts. In this article, we present experimental evidence of the impact of a remedial tutoring program on academic outcomes from a two-level randomized trial of two treatments in Niger: school randomization testing the impact of skill-targeted SEL activities and within-school student-level randomization testing the impact of access to remedial tutoring. We find that tutoring for 4 h per week improves students' literacy and Math outcomes, and the addition of skill-targeted SEL activities positively impacts school grades above and beyond access to tutoring alone. These findings suggest the potential value of remedial tutoring to supplement formal schooling in low-income and/or conflict-affected contexts. They also suggest increased attention to implementation strategies, as access alone was insufficient for students to attain grade-level competencies.

Introduction: African-Americans are more likely than Caucasians to access healthcare through the emergency department (ED); however, the reasons behind this pattern are unclear. The objective is to investigate the effect of race, insurance, socioeconomic status, and perceived health on the preference for ED use.Methods: This is a prospective study at a tertiary care ED from June to July 2009. Patients were surveyed to capture demographics, healthcare utilization, and baseline health status. The primary outcome of interest was patient-reported routine place of healthcare. Other outcomes included frequency of ED visits in the previous 6 months, barriers to primary care and patient perception of health using select questions from the Medical Outcomes Study Short Form 36 (SF-36).Results: Two hundred and ninety-two patients completed the survey of whom 58% were African-American and 44% were uninsured. African-Americans were equally likely to report 3 or more visits to the ED, but more likely to state a preference for the ED for their usual place of care (24% vs. 13%, p < 0.01). No significant differences between groups were found for barriers to primary care, including insurance. African-Americans less often reported comorbidities or hospitalization within the previous 6 months (23% vs. 34%, p = 0.04). On logistic regression modeling, African-Americans were more than 2 times as likely to select the ED as their usual place of healthcare (OR 2.24, 95% CI 1.22 - 4.08). Conclusion: African-Americans, independent of health insurance, are more likely than Caucasians to designate the ED as their routine place of healthcare. [West J Emerg Med. 2012;13(5):410-415.]

Understanding the mechanisms that produce cellular cytotoxicity is fundamental in the field of toxicology. Cytotoxic stimuli can include organic toxins such as hemorrhagic snake venom, which can lead to secondary complications such as the development of necrotic tissue and profuse scarring. These clinical manifestations mimic cytotoxic responses induce by other organic compounds such as organic acids. We used hemorrhagic snake venom and human embryonic kidney cells (HEK 293T) as a model system to better understand the cellular responses involved in venom induced cytotoxicity. Cells stimulated with Crotalus atrox (CA) (western diamondback) venom for 4 or 10 h demonstrated significant cytotoxicity. Results from 2′,7′‐Dichlorodihydrofluorescein diacetate (H2DCF‐DA) assays determine CA venom stimulation induces a robust production of reactive oxygen species (ROS) over a 3‐h time course. In contrast, pretreatment with polyethylene glycol (PEG)‐catalase or N‐acetyl cysteine (NAC) prior to CA venom stimulation significantly blunted H2DCFDA fluorescence fold changes and showed greater cytoprotective effects than cells stimulated with CA venom alone. Pre‐ incubating HEK293T cells with the NADPH oxidase (NOX) pan‐inhibitor VAS2870 prior venom stimulation significantly minimized the venom‐induced oxidative burst at early timepoints (≤2 h). Collectively, our experiments show that pre‐application of antioxidants reduces CA venom induce cellular toxicity. This result highlights the importance of ROS in the early stages of cytotoxicity and suggests muting ROS production in noxious injuries may increase positive clinical outcomes. Understanding the mechanisms that produce cellular cytotoxicity is fundamental in the field of toxicology. We used hemorrhagic snake venom as a model system to better understand cytotoxicity from noxious stimuli. Cell stimulated with CA venom showed a robust production of reactive oxygen species (ROS). The pre‐application of antioxidants reduced CA venom‐induced ROS and cellular toxicity This result highlights the importance of ROS in the early stages of cytotoxicity and suggests muting ROS production in noxious injuries may increase positive clinical outcomes. [ABSTRACT FROM AUTHOR]

Isolates of the fire blight pathogen Erwinia amylovora with high-level resistance to Oxytetracycline (minimal inhibitory concentration [MIC] > 100 µg/ml) and to streptomycin (MIC > 100 µg/ml) were recovered from four commercial pear orchards in California between 2018 and 2020. The two representative Oxytetracycline- and streptomycin-resistant (OxyTcR-SmR) sttains 32-10 and 33-1 were as virulent as the antibiotic susceptible strain 13-1 in causing blossom blight of pear and were recovered more than 50% of the time 7 days after co-inoculation to pear flowers with strain 13-1. In the field, inoculation of strain 32-10 to pear flowers that were pretreated with Oxytetracycline at 200 µg/ml did not reduce disease compared with an untreated control. Four OxyTcR-SmR strains were subjected to draft genome sequencing to identify the genetic determinants of antibiotic resistance and their location. A 43.6-kb IncX plasmid, designated pX11-7, was detected in each of the four strains, and this plasmid encoded the tetracycline-resistance gene tetB and the streptomycin-resistance gene pair strAB within a large putatively mobile genetic element consisting of the transposon Tn10 that had inserted within the streptomycin-resistance transposon Tn60S2. We also determined that pX11-7 was conjugative and was transferred at a rate that was 104 to 105 higher into an E. amylovora strain isolated in California compared with an E. amylovora strain that was isolated in Michigan. The occurrence of high levels of resistance to both Oxytetracycline and streptomycin in E. amylovora strains from commercial pear orchards in California significantly limits the options for blossom blight management in these locations. [ABSTRACT FROM AUTHOR]