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ImportanceThe Centers for Disease Control and Prevention (CDC) released an opioid-prescribing guideline in March 2016. Little is known about the guideline’s potential effects on childhood cancer survivors, a population at high risk for pain.ObjectiveTo examine changes in opioid prescriptions and potential misuse/substance use disorders (SUD) among childhood cancer survivors and peers without cancer following the guideline release.Design, Setting, and ParticipantsIn this cohort study using the MarketScan Commercial Claims and Encounters Database, 8969 survivors who completed treatment for hematologic, central nervous system, bone, or gonadal cancers (aged ≤21 years at diagnosis) from 2009 to 2018 and 44 845 age-matched, sex-matched, and region-matched individuals without cancer were identified. With data aggregated based on the quarter-year of survivors’ treatment completion, interrupted time series analyses were conducted in this cohort study to estimate the immediate (level) change and change in time trend (trend change) for each outcome after the guideline release, accounting for autocorrelation. Data were analyzed from September 2021 to April 2022.ExposuresRelease of the CDC opioid-prescribing guideline.Main Outcomes and MeasuresOutcomes included any opioid prescription and any indicator for potential misuse/SUD within 1 year following completion of treatment.ResultsThis study included 8969 childhood cancer survivors (mean [SD] age, 13.7 [6.2] years old; 3814 [42.5%] female patients) and 44 845 peers without cancer (mean [SD] age, 13.7 [6.2] years old; 19 070 [42.5%] female patients). Before the guideline release, the opioid prescription rate (21.1% vs 7.2%) and rate of potential misuse/SUD (5.6% vs 1.9%) were higher among survivors than peers without cancer. After the guideline release, the trend in opioid prescription rate declined among survivors (trend change, −1.1 percentage points [ppt]; P P = .04; 95% CI, −4.2 to −0.1) and a decreasing trend (trend change, −0.4 ppt; P = .009; 95% CI, −0.6 to −0.1) in rate of potential misuse/SUD. Peers without cancer experienced decreasing trends in opioid prescription rate (trend change, −0.3 ppt; P P = .03; 95% CI, −0.1 to −0.01). By 2 years after the guideline release, relative reductions in opioid prescription rate and rate of potential misuse/SUD among survivors were 36.7% and 65.4%, respectively, with peers without cancer experiencing smaller reductions (15.9% and 29.9%).Conclusions and RelevanceIn this cohort study, the opioid prescription rate and rate of potential misuse/SUD declined among both survivors and peers without cancer following the CDC guideline release, with survivors experiencing greater reductions. More research is needed to understand the guideline’s potential effects on access to opioids required for pain control among childhood cancer survivors.

A production facility shutdown related to containment measures during the COVID-19 pandemic has resulted in a global shortage of iodinated contrast media. This article describes the strategies implemented at one large U.S. health system to maintain care continuity during the ongoing shortage. The strategies have included attempts to procure additional stock, repackage existing stock for use in larger numbers of patients, use noncontrast CT or alternative imaging modalities in place of contrast-enhanced CT, and collaborate with specialties outside of radiology to participate in conservation efforts. In addition, individual CT protocols underwent tailored modifications to use dual-energy technique and/or lower tube voltages, to allow lower contrast media doses with maintained visualization of tissue enhancement. The experiences during this period provide insights to facilitate long-term reductions in contrast media doses and ongoing CT protocol optimization after supplies return to normal levels. Critical throughout the efforts to mitigate the impact of the shortage have been system-level action, operational flexibility, and close communication by the health system's radiologists, technologists, physicists, pharmacists, and ordering providers.

PURPOSE: Adolescents and young adults (AYAs) with cancer have high rates of hospital deaths. It is not clear if this reflects their preferences or barriers to dying at home. METHODS: Between December 2018 and January 2021, we conducted in-depth interviews with AYAs (age 12-39 years) with stage IV or recurrent cancer, family caregivers including bereaved caregivers, and clinicians of AYAs with cancer. Patients were asked about their priorities for care including location of death, caregivers were asked what was most important in the care of their AYA family member, and clinicians were asked to reflect on priorities identified through caring for AYAs. Directed content analysis was applied to interview data, and themes regarding location of death were developed. RESULTS: Eighty individuals (23 AYAs, 28 caregivers, and 29 clinicians) participated in interviews. Most AYAs and caregivers preferred a home death. However, some AYAs and caregivers opted for a hospital death to alleviate caregiver burden or protect siblings from the perceived trauma of witnessing a home death. Lack of adequate services to manage intractable symptoms at home and insufficient caregiver support led some AYAs/caregivers to opt for hospital death despite a preference for home death. Participants acknowledged the value of hospice while also pointing out its limitations in attaining a home death. CONCLUSION: Although most AYAs prefer to die at home, this preference is not always achieved. Robust home-based services for effective symptom management and caregiver support are needed to close the gap between preferred and actual location of death for AYAs.

Systematic prompting is a versatile evidence-based practice that can improve a range of outcomes for students with disabilities, but many teachers and paraeducators are not familiar with systematic prompting or may struggle with implementation. In this systematic review, the authors identified 28 articles that evaluated training practices for school practitioners implementing systematic prompting procedures in school settings. Fifteen studies focused on paraeducators and 13 on teachers, with an increased focus on paraeducators in more recently published studies. The authors found that a variety of training approaches were effective, and that all studies included two core strategies: didactic instruction and performance feedback. These two strategies represent only a subset of recommended practices from the broader staff training literature but may be sufficient for training basic practices like systematic prompting. Future research is needed to directly compare training approaches and identify the most efficient means for enabling educators to implement systematic prompting with fidelity.

For students with autism, recess is often a missed opportunity to develop social competence and relationships. Although interventions have been developed to promote interactions and social skills for students with average or above-average intellectual functioning, there has been less focus on students with autism who have below-average intellectual functioning or who meet the criteria for intellectual disability. In this single-case design study, we tested the efficacy of a combined peer-mediated and social skills instruction intervention on the interactions, play, and social skills of three students with autism who met their state's criteria for alternate assessment for students with significant cognitive disabilities. Social skills instruction featured video models that portrayed same-aged peers demonstrating individualized social skills on the playground. For all three students, there were substantial increases in interactions, play and social skills, and students and their peers provided positive feedback about the intervention.

PURPOSE To evaluate the clinical patterns of utilization of OncotypeDX Recurrence Score (RS) in early-stage, hormone receptor–positive, human epidermal growth factor receptor 2–negative breast cancer (BC) at an academic center with previously established internal reflex testing guidelines. METHODS RS testing in accordance with preexisting reflex criteria and predictors of utilization outside of reflex criteria were retrospectively analyzed for the years 2019-2021 in a quality improvement evaluation. Patients were grouped according to OncotypeDX testing within (cohort A) or outside (cohort B) of predefined criteria which included a cap at age older than 65 years. RESULTS Of 1,687 patients whose tumors had RS testing, 1,087 were in cohort A and 600 in cohort B. In cohort B, nearly half of patients were older than 65 years (n = 279; IQR, 67-72 years). For patients older than 65 years, those with RS testing were younger (median age: 69 v 73 years), with higher grade cancers (G2-3: 84.9% v 54.7%) and were more likely to be treated with chemotherapy (15.4% v 4.1%). Issues for implementation of RS testing in older patients were identified, including potential structural barriers related to the current policy on the reimbursements of genomic tests. CONCLUSION Internal guidelines may facilitate standardized utilization of the RS in early-BC. Our data suggest that clinicians preferred broader utilization of RS across the age spectrum, with therapeutically important consequences. Modifying the current policy for reimbursement of RS testing and in internal reflexive testing criteria for those older than 65 years is warranted.

The Molecular Pathology Section, Cleveland Clinic (Cleveland, OH), has undergone enhancement of its testing portfolio and processes. An Excel 2013- and paper-based data-management system was replaced with a commercially available laboratory information-management system (LIMS) software application, a separate bioinformatics platform, customized test-interpretation applications, a dedicated sample-accessioning service, and a results-releasing software application. The customized LIMS solution manages complex workflows, large-scale data packets, and process automation. A customized approach was required because, in a survey of commercially available off-the-shelf software products, none met the diverse and complex needs of this molecular diagnostics service. The project utilized the expertise of clinical laboratorians, pathologists, genetics counselors, bioinformaticians, and systems analysts in partnering with software-engineering consultants to design and implement a solution. Concurrently, Agile software-building best practices were formulated, which may be emulated for scalable and cost-effective laboratory-authored software.

PurposeThe purpose of this paper is to explore antecedents of helping behaviors among nurses using a social exchange framework. The paper reports an investigation into the effects of reciprocity, perceived coworker efficacy and stress on active and passive helping behaviors.Design/methodology/approachTo test hypotheses, the authors performed random coefficient modeling on Mplus with data from 155 full-time nurses.FindingsNurses were willing to help coworkers regardless of perceived reciprocity levels in the relationship. Rather, their perceptions of the coworker's efficacy and previous behavior predicted helping.Originality/valueThis manuscript contributes to the literature in a number of ways. First, it provides empirical evidence that individuals will suppress or ignore reciprocity norms during an interdependent task. This lends credence to the idea that social exchanges may need to be examined in light of other variables or at other levels of analysis. Second, it demonstrates that investment behaviors (i.e. helping) can and do occur in exchange relationships despite low reciprocity. Overall, the data suggest that individuals are willing to maintain relationships despite a lack of returns.

Aim/Purpose: This study examines the impact of transitioning from in-person classrooms to remote online business education and provides analysis of key factors impacting course and instructor ratings as well as strategies for higher education institutions to provide engaging instruction. Background: “Zoom”ing into teaching and moving out of traditional classrooms during the COVID-19 pandemic has been a path full of twists and has impacted student perceptions of courses as well as instructors. One challenge has been to make the quality of synchronous online instruction perceived by students as positive as classroom-delivered ones. Methodology: We analyze primary data collected in the course evaluation process from Business & Accounting students over six semesters between Fall 2019 to Spring 2022, covering pre-pandemic instruction in the classroom and the conversion to virtual instruction via Zoom. A total of 1782 observations for 38 courses were examined using mean comparison, regression and correlation analyses, and pairwise comparisons. Contribution: We provide insights from the evaluation of those instructors who were able to make their Zoom-delivered courses perceived by students as equivalent or better than room-delivered ones. Specifically, clear presentation, stimulating delivery, providing feedback and encouraging discussion were positively correlated with successful online classes. Findings: We find that there is a clear downward shift in course and instructor ratings as the change to synchronous online delivery was made. However, in the Spring of 2022, even though instructors and students were still not completely back in the classroom, both instructor and course ratings moved back closer to the pre-pandemic levels. The parameters associated with instructor ratings, such as providing feedback, clear presentations, stimulating sessions, and encouraging discussion, showed similar downward fluctuations. Also, aspects related to course content were affected by the transition to online modality, including training on critical thinking quantitative analysis, research and writing abilities, and overall usefulness of the content. Moore’s model of Transactional Distance helps explain these changes. Recommendations for Practitioners: We recommend that practitioners allow sufficient time for students and faculty to learn through online instruction delivery and supply training for both populations in adapting to learning in this delivery mode. Recommendation for Researchers: The disruption in higher education caused by COVID-19 has provided a wealth of information on the pluses and minuses of online delivery. Careful inspection of trends can help provide guidance to higher education leaders. Impact on Society: One of the many changes the COVID-19 pandemic brought was the opportunity to try alternate ways of connecting and learning. This study shows how this experience can be used to guide the future of higher education. Future Research: Further research is needed to explore the in-depth reactions of students and faculty to the switch from classroom to online delivery, to explore whether these findings can be more broadly applied to other subjects and other types of universities.

Previous findings demonstrate peer support arrangements improve academic and social outcomes for secondary students with severe disabilities, but further research is needed to determine (a) the degree to which this practice would benefit younger students, (b) the impact on student independence, and (c) how teachers can best support paraeducator implementation. In this multiple-probe-across-participants design study, a teacher trained five paraeducators to facilitate peer support arrangements with four elementary students with multiple disabilities who were eligible for alternate assessment. We identified functional relationships between teacher training and paraeducator implementation and between peer support arrangements and peer interactions. Interactions increased to levels similar to those of peers without disabilities. Students decreased their reliance on paraeducators for classroom routines when peers provided support. These findings show that the effectiveness of peer support arrangements extends to elementary students with multiple disabilities and replicate initial evidence for a promising model of teacher-implemented training for paraeducators.

Objective:Physical activity (PA) is a known benefit to older adults with diabetes; however, the determinants of PA are less well studied in this population. Applying the World Health Organization’s International Classification of Functioning, Disability and Health (ICF), a well-established biopsychosocial framework, we explored PA participation among older adult with type 2 diabetes.Method:Using data from the Health and Retirement Study and the RAND Center for the Study of Aging (N = 2,016; mean age = 73.19; SD = 6.16), we conducted hierarchical stepwise regression analysis to evaluate the relative contribution of different biopsychosocial predictors to PA – namely, body functions and structure, activity and participation, personal, and environmental factors.Results:Altogether, biopsychosocial factors accounted for 20% of the variance in PA participation. Of the personal factors, high extraversion and low neuroticism explained approximately 54% of the variance in PA among the older adults – beyond sociodemographics. Low body mass index, reduced pain, reduced depression, and higher cognitive functioning also had good explanatory power (25% of explained variance), whereas activity participation and environment did not (10% each).Conclusion:Aligning care with components of the ICF will help to ensure a focus on person-centric practices and, in turn, optimize participation outcomes such as PA.

Childhood cancer causes significant physical and emotional stress. Patients and families benefit from palliative care (PC) to reduce symptom burden, improve quality of life, and enhance family-centered care. We evaluated palliative opportunities across leukemia/lymphoma (LL), solid tumors (ST), and central nervous system (CNS) tumor groups.A priori, nine palliative opportunities were defined: disease progression/relapse, hematopoietic stem cell transplant, phase 1 trial enrollment, admission for severe symptoms, social concerns or end-of-life (EOL) care, intensive care admission, do-not-resuscitate (DNR) status, and hospice enrollment. A single-center retrospective review was completed on 0-18-year olds with cancer who died from January 1, 2012 to November 30, 2017. Demographic, disease, and treatment data were collected. Descriptive statistics were performed. Opportunities were evaluated from diagnosis to death and across disease groups.Included patients (n = 296) had LL (n = 87), ST (n = 114), or CNS tumors (n = 95). Palliative opportunities were more frequent in patients with ST (median 8) and CNS tumors (median 7) versus LL (median 5, p = .0005). While patients with ST had more progression/relapse opportunities (p .0001), patients with CNS tumors had more EOL opportunities (p .0001), earlier PC consultation, DNR status, and hospice enrollment. Palliative opportunities increased toward the EOL in all diseases (p .0001). PC was consulted in 108 (36%) patients: LL (48%), ST (30%), and CNS (34%, p = .02).All children with cancer incur many events warranting PC support. Patients with ST and CNS tumors had more palliative opportunities than LL, yet received less subspecialty PC. Understanding palliative opportunities within each disease group can guide PC utilization to ease patient and family stress.

Adolescents and young adults (AYAs) with advanced cancer identify normalcy as an important component of quality end-of-life care. We sought to define domains of normalcy and identify ways in which clinicians facilitate or hinder normalcy during advanced cancer care.This was a secondary analysis of a qualitative study that aimed to identify priority domains for end-of-life care. Content analysis of semi-structured interviews among AYAs aged 12-39 years with advanced cancer, caregivers, and clinicians was used to evaluate transcripts. Coded excerpts were reviewed to identify themes related to normalcy.Participants included 23 AYAs with advanced cancer, 28 caregivers, and 29 clinicians. Participants identified five domains of normalcy including relationships, activities, career/school, milestones, and appearance. AYAs and caregivers identified that clinicians facilitate normalcy through exploration of these domains with AYAs, allowing flexibility in care plans, identification of short-term and long-term goals across normalcy domains, and recognizing losses of normalcy that occur during cancer care.AYAs with cancer experience multiple threats to normalcy during advanced cancer care. Clinicians can attend to normalcy and improve AYA quality of life by acknowledging these losses through ongoing discussions on how best to support domains of normalcy and by reinforcing AYA identities beyond a cancer diagnosis.

The SARS-CoV-2 genome has mutated during the coronavirus disease 2019 (COVID-19) pandemic. Some of these mutations have impacted the performance of nucleic acid amplification tests like PCR, which are commonly used as diagnostic tools to detect an infection.

PURPOSE Pediatric palliative care (PPC) improves quality of life for children and adolescents with cancer. Little is known about disparities between different racial and ethnic groups in the frequency and timing of PPC referrals. We evaluated the impact of race and ethnicity on the frequency and timing of PPC referral after initiation of an embedded PPO clinic where no formal consultation triggers exist. METHODS Patients with cancer between 0 and 25 years at diagnosis who experienced a high-risk event between July 2015 and June 2018 were eligible. Demographic, disease, and PPC information were obtained. Descriptive statistics and logistic regression were used to assess likelihood of receiving PPC services by race/ethnicity. RESULTS Of 426 patients who experienced a high-risk event, 48% were non-Hispanic White, 31% were non-Hispanic Black, 15% were Hispanic of any race, and 4% were non-Hispanic Asian. No significant differences were found between race/ethnicity and age at diagnosis/death, sex, and diagnosis. PPC consultation (p = 0.03) differed by race. Non-Hispanic Black patients were 1.7 times more likely than non-Hispanic White patients to receive PPC after adjustment (p = 0.01). White patients spent less days in the hospital in the last 90 days of life (3.0 days) compared with Black (8.0), Asian (12.5), or Hispanic patients (14.0, p = 0.009) CONCLUSION: Disparities exist in patients receiving pediatric oncology and PPC services. Cultural tendencies as well as unconscious and cultural biases may affect PPC referral by race and ethnicity. Better understanding of cultural tendencies and biases may improve end-of-life outcomes for children and young adults with cancer.

Background Clinical laboratories routinely use formalin-fixed paraffin-embedded (FFPE) tissue or cell block cytology samples in oncology panel sequencing to identify mutations that can predict patient response to targeted therapy. To understand the technical error due to FFPE processing, a robustly characterized diploid cell line was used to create FFPE samples with four different pre-tissue processing formalin fixation times. A total of 96 FFPE sections were then distributed to different laboratories for targeted sequencing analysis by four oncopanels, and variants resulting from technical error were identified. Results Tissue sections that fail more frequently show low cellularity, lower than recommended library preparation DNA input, or target sequencing depth. Importantly, sections from block surfaces are more likely to show FFPE-specific errors, akin to “edge effects” seen in histology, while the inner samples display no quality degradation related to fixation time. Conclusions To assure reliable results, we recommend avoiding the block surface portion and restricting mutation detection to genomic regions of high confidence.

Transfusion of blood products is a necessary part of successful delivery of myelosuppressive regimens in pediatric cancer. There is a paucity of literature characterizing outcomes or management of pediatric patients with cancer when transfusion is declined.The objective of this paper is to describe the clinical characteristics, care, and outcomes of patients with cancer at risk for declining transfusion.A retrospective cohort of patients aged 0-21 years with cancer managed at Children's Healthcare of Atlanta between 2006 and 2020 and with ICD-9 codes indicating risk of "transfusion refusal" or Jehovah's witness (JW) religion was identified. Demographics, disease, and management were abstracted. Descriptive statistics were performed to examine associations with transfusion receipt. Among 35 eligible patients identified as at risk for declining transfusion, 89% had primary guardians who identified as JW, and 45.7% identified as Black, non-Hispanic. Only 40% of guardians actively declined transfusion. Transfusion recipients had significantly lower hemoglobin (g/dl) and platelet counts (1000/μl) at initial presentation (9.6 vs. 11.9, p .002 and 116.0 vs. 406.5, p = .001, respectively) and at nadir (5.9 vs. 8.7, p .001 and ≤ 10 vs. 154, p .001, respectively) than non-recipients. Legal intervention was required in 36.4% of those who ultimately received a transfusion.Among pediatric cancer patients whose medical record initially indicated a preference for no transfusion, 60% of guardians accepted blood products when prescribed for oncology care. Guidelines for systematic management and transfusion sparing approaches are needed to honor guardian's preferences when possible yet while maintaining equitable cancer outcomes in this population.

Context The osteoblast-derived polypeptide, osteocalcin (OC), has been associated with lower risk of type 2 diabetes and metabolic syndrome (MetS) in several epidemiological studies. Animal studies have indicated the undercarboxylated form of OC (ucOC) drives its association with metabolic outcomes. Objective We compared associations of ucOC and carboxylated OC (cOC) with MetS and its components in older men. Methods A cross-sectional analysis of 2575 men aged ≥70 years and older resident in Perth, Western Australia. ucOC was assayed using a hydroxyapatite-binding method, and cOC calculated by subtracting ucOC from total OC. Main outcome measures were MetS and its components. Results Both lower serum ucOC and cOC levels, and the proportion of cOC (%cOC) were associated with less favorable metabolic parameters (higher waist circumference, triglyceride, glucose, blood pressure, and lower high-density lipoprotein cholesterol), whereas inverse associations were found with %ucOC. Men in the lowest quintile of ucOC had higher risk of MetS compared to men in the highest quintile (Q1 ≤ 7.7 vs Q5 > 13.8 ng/mL; OR = 2.4; 95% CI, 1.8-3.2). Men in the lowest quintile of cOC had higher risk of MetS compared to those in the highest quintile (≤ 5.8 vs > 13.0 ng/mL; OR = 2.4; 95% CI, 1.8-3.2). Conclusion Lower concentrations of serum ucOC or cOC were associated with less favorable metabolic parameters and a higher risk of MetS. In contrast, a lower proportion of ucOC was associated with better metabolic parameters and lower MetS risk. Further research is warranted to determine whether ucOC and cOC are suitable biomarkers for cardiometabolic risk in men.

Paraeducators play an important role in the education of students with significant disabilities. They can best contribute to improving student outcomes when they are skilled in using evidence-based practices. Tiered training is a practical and promising solution for how teachers can train teams of paraeducators to use evidence-based practices. Like a Response to Intervention (RTI) model for students, tiered staff training involves providing initial training for groups of paraeducators, monitoring their performance, and then providing follow-up coaching to only the paraeducators who need extra support. In this article, each step of tiered training is described with examples. This step-by-step guide is informed by a series of research studies in which tiered training was tested with more than 60 paraeducators who serve students with significant disabilities in public schools.

Background: Integrated pediatric palliative oncology (PPO) outpatient models are emerging to assist oncologists, children, and families throughout their course with cancer. Significant time is devo...

Background Despite favorable prognoses, pediatric patients with hematologic malignancies experience significant challenges that may lead to diminished quality of life or family stress. They are less likely to receive subspecialty palliative care (PC) consultation and often undergo intensive end‐of‐life (EOL) care. We examined “palliative opportunities,” or events when the integration of PC would have the greatest impact, present during a patient's hematologic malignancy course and relevant associations. Methods A single‐center retrospective review was conducted on patients aged 0–18 years with a hematologic malignancy who died between 1/1/12 and 11/30/17. Demographic, disease, and treatment data were collected. A priori, nine palliative opportunity categories were defined. Descriptive statistics were performed. Palliative opportunities were evaluated over temporal quartiles from diagnosis to death. Timing and rationale of pediatric PC consultation were evaluated. Results Patients (n = 92) had a median of 5.0 (interquartile range [IQR] 6.0) palliative opportunities, incurring 522 total opportunities, increasing toward the EOL. Number and type of opportunities did not differ by demographics. PC consultation was most common in patients with lymphoid leukemia (50.9%, 28/55) and myeloid leukemia (48.5%, 16/33) versus lymphoma (0%, 0/4, p = 0.14). Forty‐four of ninety‐two patients (47.8%) received PC consultation a median of 1.8 months (IQR 4.1) prior to death. Receipt of PC was associated with transplant status (p = 0.0018) and a higher number of prior palliative opportunities (p = 0.0005); 70.3% (367/522) of palliative opportunities occurred without PC. Conclusion Patients with hematologic malignancies experience many opportunities warranting PC support. Identifying opportunities for ideal timing of PC involvement may benefit patients with hematologic cancers and their caregivers., Palliative opportunities are events throughout a child's course with cancer that warrant additional palliative care support. Children with hematologic malignancies experienced a median of five palliative opportunities throughout their course, which increase toward death, yet received palliative care consultation only 47% of the time.

Video prompting (VP) is an evidence-based practice, but few studies have included teachers and paraeducators as implementers. We adopted one of the single-case designs (multiple probe design) to evaluate the effectiveness of teacher and paraeducator-implemented VP on vocational skills for four high school students with significant intellectual and developmental disabilities. Experimental effects were demonstrated for all four students, but only two students met the mastery criterion. Individualized adaptations (i.e., priming, more frequent reinforcement) enabled two students to make further progress. The two students who met the mastery criterion maintained their performance after 2 weeks. These findings add to growing evidence that teachers and practitioners can effectively implement VP and suggest that individualized adaptations may be needed for some students with significant disabilities.

The success of teachers is tied to their effectiveness in managing student behavior. In this meta-analysis, we identified 49 single-case-design studies that evaluated the effectiveness of teacher training on their implementation of behavioral support strategies. Training was most often provided in a one-on-one format ( n = 18) and included ongoing coaching ( n = 20). Thirty-three of the 49 designs met What Works Clearinghouse standards with or without reservations. The overall between-case standardized mean difference effect size was d = 1.50. We analyzed and grouped teacher- and student-level outcomes as a result of training into five domains: (a) teacher-delivered praise ( d = 1.94), (b) teacher desirable behavior (e.g., treatment fidelity; d = 1.22), (c) teacher undesirable behavior (e.g., reprimands; d = 0.87), (d) student desirable behavior ( d = 1.88), and (e) student undesirable behavior ( d = 1.22). Across all studies, the combined nonoverlap of all pairs scores ranged from 0.37 to 1.0 ( M = 0.866). We discuss future areas of research as well as implications for teacher training in behavioral support implementation.

While overall survival has improved significantly for children with cancer over the past 75 years, cancer remains the leading cause of death from disease among children and adolescents. Further, despite the many advances in medical and nursing care, children with cancer still experience significant physical and emotional suffering over the course of their illness, especially at the end of life (EOL). Children endure significant rates of high-intensity medical interventions (e.g., intubation, intensive care unit admission) at the EOL despite many parents, adolescents, and young adult patients identifying home as their preferred location of death. Hospice care has the potential to ease suffering at the EOL and facilitate home deaths, and yet, most children still die in acute care settings without hospice care. Numerous barriers prevent timely enrollment in hospice among children with cancer who are in the EOL period. This report describes the development and testing of a palliative care/EOL communication intervention designed to overcome some of these barriers and subsequently improve EOL outcomes (i.e., earlier hospice enrollment, less use of high-intensity medical interventions, reduced pain and suffering) among children with cancer and their parents (i.e., less emotional distress and uncertainty, improved hope and healthcare satisfaction).

Background Methods for identifying gene fusion events, such as fluorescence in situ hybridization (FISH), immunohistochemistry (IHC), and transcriptome analysis, are either single gene approaches or require bioinformatics expertise not generally available in clinical laboratories. We analytically validated a customized next-generation sequencing (NGS) panel targeting fusion events in 34 genes involving soft-tissue sarcomas. Methods Specimens included 87 formalin-fixed paraffin-embedded (FFPE) tissues with known gene fusion status. Isolated total nucleic acid was used to identify fusion events at the RNA level. The potential fusions were targeted by gene-specific primers, followed by primer extension and nested PCR to enrich for fusion candidates with subsequent bioinformatics analysis. Results The study generated results using the following quality metrics for fusion detection: (a) ≥100 ng total nucleic acid, (b) RNA average unique start sites per gene-specific primer control ≥10, (c) quantitative PCR assessing input RNA quality had a crossing point Conclusions The test validation study demonstrated analytical sensitivity of 98.7% and analytical specificity of 90.0%. The NGS-based panel generated highly concordant results compared to alternative testing methods.

The Problem. Everything we know and understand about flexible work arrangements (FWAs) revolves around extant research exploring the effects and effectiveness of FWAs based on samples in which organizations and/or employees freely adopted their use. In a post COVID-19 world, organizations implemented FWAs and employees who may not have been prepared for or desired such arrangements. This has resulted in implementing FWAs in situations where the job, culture, or person does not “support” FWAs. The Solution. We suggest the economic uncertainty of the ongoing COVID-19 pandemic should shift Human Resource Development (HRD) attention to managing the organizational climate of work and work expectations, specifically with regard to FWAs. We discuss how HRD practitioners can help, specifically by preparing managers for enhanced communication and feedback, as well as through supporting employee development via proactive job crafting, to better prepare managers and workers to accept and flourish in FWAs both short and long term. The Stakeholders. The stakeholders for this article include decision-makers in organizations interested in driving success through long-term initiatives rooted in developing human capital. In addition, this article should resonate with HRD professionals interested in working with managers and employees to systematically build sustainable FWA systems.

Purpose This study aims to document the emotions experienced by women achieving high levels of organizational success and investigate what differences, if any, existed between C-Suite women in the West* and China** in this regard. Design/methodology/approach In total, 105 senior female leaders in Mainland China and the West participated in an in-depth electronic survey about their leadership journeys. Findings The emotional associations with the pathway to high-level positions were generally positive with gratitude, hope, excitement and pride standing out, but Western female leaders were significantly more likely to express fear and feeling overwhelmed than their counterparts, whereas significantly more Chinese female leaders reported feeling inadequate than the Western women. The Chinese sample reported directionally more positive emotions than Western ones. The Chinese women cited curiosity, joy and relief, but Western female leaders made no mention of these emotions in their leadership journeys. Originality/value Little has been published on the emotions that women experience on their way to very high-level positions. Many of these studies used other people’s perceptions of female leaders to understand their reactions to the biases and challenges facing them. This study elicited direct responses from female organizational leaders. Research comparing the journeys of Western and Chinese C-Suite women is limited. These results can be useful for educators and human resource professionals in supporting female career advancement in Mainland China and the West.

The social distancing mandate, implemented in response to the coronavirus disease 2019 (COVID-19) global pandemic, has guided many schools to deliver instruction via distance learning. Among the many challenges generated by this delivery system is the need for school mental health services, including school suicide prevention and intervention, to be conducted remotely. After briefly discussing the magnitude of the problem of youth suicide and how the COVID-19 pandemic has likely increased risk for youth suicidal ideation and behaviors, this article provides guidance on how school systems can prepare for and conduct suicide risk assessments in distance learning environments.

Existing literature on counterproductive work behaviors (CWBs) has focused on the influence that interpersonal and organizational factors have on predicting said behavior. However, more recent stud...