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Twice-exceptionality (2e), broadly defined as the co-occurrence of a gift or talent and a disability, has been a part of the educational lexicon since the 1990s, although its empirical backing is limited. We conducted a comprehensive review of the empirical literature on 2e and created a simulation study of 2e. For the latter, we constructed population distribution functions that represent indicators of ability using a range of correlations and identification criteria guided by the reviewed literature. We observed the theoretical occurrence of 2e, even at its most relaxed definitions, to be much rarer than prevailing literature implies (probability = 0.148). As correlations and factor loadings increase, the prevalence estimates of 2e drop considerably. Our results demonstrated the need for a more informed, standardized, and quantifiable approach to the identification of individuals with 2e.

Despite a high dropout rate and poor educational and posteducational outcomes, limited evidence-based practices have been validated with students at the high school level who have emotional and behavioral problems. The purpose of this study was to evaluate the impact of a multitreatment, assessment-based intervention package. Participants were 647 high-school-age students with both emotional/behavioral problems and impairment in school functioning. Using a randomized controlled trial, the intervention group showed significantly fewer disruptions, measured using direct observation. No significant differences were found in directly observed engagement or on standardized measures. However, in general, interventions were implemented with low frequency. Dosage effects were examined for classroom interventions and a social skills intervention (Interpersonal Skills Group [ISG]). Results indicated a dosage effect for ISG, reflected in standardized measures. Although implementation was low, teachers and staff rated practices that they implemented highly favorably.

ObjectivesConcern has been raised in the rheumatology community regarding recent regulatory warnings that HCQ used in the coronavirus disease 2019 pandemic could cause acute psychiatric events. We aimed to study whether there is risk of incident depression, suicidal ideation or psychosis associated with HCQ as used for RA.MethodsWe performed a new-user cohort study using claims and electronic medical records from 10 sources and 3 countries (Germany, UK and USA). RA patients ≥18 years of age and initiating HCQ were compared with those initiating SSZ (active comparator) and followed up in the short (30 days) and long term (on treatment). Study outcomes included depression, suicide/suicidal ideation and hospitalization for psychosis. Propensity score stratification and calibration using negative control outcomes were used to address confounding. Cox models were fitted to estimate database-specific calibrated hazard ratios (HRs), with estimates pooled where I2

School engagement is an important predictor of graduation. One strategy to enhance student engagement is mentoring. Check & Connect is a structured mentoring program that has resulted in favorable outcomes for many students, including those with emotional and behavioral disorders. Effectiveness, however, depends on the quality of the mentor-mentee relationship. Although research has examined factors that increase relationship effectiveness, findings have been inconsistent. We explored the perceptions and correspondence of 166 high school students (i.e., mentees) with social, emotional, and/or behavioral challenges and their mentors about the mentoring relationship and variables that contribute to relationship quality. Results indicated that mentors and mentees rated the relationship favorably and their ratings correlated moderately. Mentor and mentee variables examined (gender, ethnicity/race, age) were not significant predictors of relationship quality; however, specific topics discussed during mentoring sessions for mentors (family, friends) and mentees (school, future plans) were significantly related to their perceptions of relationship quality.

ObjectiveTo investigate the use of repurposed and adjuvant drugs in patients admitted to hospital with covid-19 across three continents.DesignMultinational network cohort study.SettingHospital electronic health records from the United States, Spain, and China, and nationwide claims data from South Korea.Participants303 264 patients admitted to hospital with covid-19 from January 2020 to December 2020.Main outcome measuresPrescriptions or dispensations of any drug on or 30 days after the date of hospital admission for covid-19.ResultsOf the 303 264 patients included, 290 131 were from the US, 7599 from South Korea, 5230 from Spain, and 304 from China. 3455 drugs were identified. Common repurposed drugs were hydroxychloroquine (used in from

IntroductionTo evaluate whether outpatient insulin treatment, hemoglobin A1c (HbA1c), glucose on admission, or glycemic control during hospitalization is associated with SARS-CoV-2 (COVID-19) illness severity or mortality in hospitalized patients with diabetes mellitus (DM) in a geographical region with low COVID-19 prevalence.Research design and methodsA single-center retrospective study of patients hospitalized with COVID-19 from January 1 through August 31, 2020 to evaluate whether outpatient insulin use, HbA1c, glucose on admission, or average glucose during admission was associated with intensive care unit (ICU) admission, mechanical ventilation (ventilator) requirement, or mortality.ResultsAmong 111 patients with DM, 48 (43.2%) were on outpatient insulin and the average HbA1c was 8.1% (65 mmol/mol). The average glucose on admission was 187.0±102.94 mg/dL and the average glucose during hospitalization was 173.4±39.8 mg/dL. Use of outpatient insulin, level of HbA1c, glucose on admission, or average glucose during hospitalization was not associated with ICU admission, ventilator requirement, or mortality among patients with COVID-19 and DM.ConclusionsOur findings in a region with relatively low COVID-19 prevalence suggest that neither outpatient glycemic control, glucose on admission, or inpatient glycemic control is predictive of illness severity or mortality in patients with DM hospitalized with COVID-19.

Comorbid conditions appear to be common among individuals hospitalised with coronavirus disease 2019 (COVID-19) but estimates of prevalence vary and little is known about the prior medication use of patients. Here, we describe the characteristics of adults hospitalised with COVID-19 and compare them with influenza patients. We include 34,128 (US: 8362, South Korea: 7341, Spain: 18,425) COVID-19 patients, summarising between 4811 and 11,643 unique aggregate characteristics. COVID-19 patients have been majority male in the US and Spain, but predominantly female in South Korea. Age profiles vary across data sources. Compared to 84,585 individuals hospitalised with influenza in 2014-19, COVID-19 patients have more typically been male, younger, and with fewer comorbidities and lower medication use. While protecting groups vulnerable to influenza is likely a useful starting point in the response to COVID-19, strategies will likely need to be broadened to reflect the particular characteristics of individuals being hospitalised with COVID-19.

Research examining effective reading interventions for students with reading difficulties in the upper elementary grades is limited relative to the information available for the early elementary grades. In the current study, we examined the effects of a multicomponent reading intervention for students with reading comprehension difficulties. We used a partially nested analysis with latent variables to adequately match the design of the study and provide the necessary precision of intervention effects. We examined the effects of the intervention on students' latent word reading, latent vocabulary, and latent reading comprehension. In addition, we examined whether these effects differed for students of varying levels of reading or English language proficiency. Findings indicated the treatment significantly outperformed the comparison on reading comprehension (Effect Size = 0.38), but no overall group differences were noted on word reading or vocabulary. Students' initial word reading scores moderated this effect. Reading comprehension effects were similar for English learner and non-English learner students.

Home language experiences are important for children's development of language and literacy. However, the home language context is complex, especially for Spanish-speaking children in the United States. A child's use of Spanish or English likely ranges along a continuum, influenced by preferences of particular people involved, such as parents, siblings, or friends. Moreover, there are likely differences across social contexts represented by the classroom--teachers, educational programs, and economic situations--which could be important to understand. The current article tests confirmatory empirical models for Spanish versus English language use in the homes of 1,115 Spanish-speaking children and how this use relates to home learning activities and kindergarten children's language and literacy skills. The results show that although overall balance of family language use relates to home language and literacy activities as well as children's kindergarten language and literacy skills, language use by individual family members is also related to some home learning activities and children's skills.

OpenMx is free, full-featured, open source, structural equation modeling (SEM) software. OpenMx runs within the "R" statistical programming environment on Windows, Mac OS-X, and Linux computers. The rationale for developing OpenMx is discussed along with the philosophy behind the user interface. The OpenMx data structures are introduced--these novel structures define the user interface framework and provide new opportunities for model specification. Two short example scripts for the specification and fitting of a confirmatory factor model are next presented. We end with an abbreviated list of modeling applications available in OpenMx 1.0 and a discussion of directions for future development.

This study of 1,338 Spanish-speaking 1st graders examined contextual effects of bilingual programs on reading comprehension and the effect of language of instruction within these contexts. The study included 128 classrooms in 32 schools located in border Texas and in urban Texas and California. These classrooms used either English immersion or Spanish maintenance bilingual programs. Detailed observations of teachers' instructional language were made, sampled within the year. The analyses allowed classroom-level differences to be separated from student-level differences, and for Spanish and English passage comprehension to be considered simultaneously. While mean differences between programs were reduced for English passage comprehension, maintenance programs still outperformed immersion programs in Spanish. Results also indicated large program and locale covariance differences at the classroom level, implying important differences in how these programs operate in these locales. (Contains 6 tables, 3 figures, and 1 footnote.)

The current study evaluated the relation between Spanish and English vocabulary. Whereas previously reported correlations have revealed strong differences among types of vocabulary measures used and the ages of the students tested, no prior study had used a multilevel model to control for classroom-level differences. The current study used multiple measures of vocabulary--picture vocabulary and narrative production tasks--in multilevel models of 1,300 Spanish-speaking students in 247 kindergarten and 1st-grade classrooms in English immersion and bilingual transitional programs. The current results highlight the need to separate classroom effects from student effects, since for vocabulary measures, student-level correlations were strongly biased toward zero when classroom-level correlations were opposite in direction from student-level correlations. Most important, the current results support a strong distinction between types of vocabulary measure (e.g., picture vs. narrative) and suggest sizable influence of instruction for questions of bilingual performance. (Contains 3 figures and 5 tables.)

This study investigated the efficacy of a package of accommodations for poor readers in Grade 7. Students with and without word reading disabilities were randomly assigned to take an experimental version of a high-stakes reading comprehension test in 1 of 3 formats: (a) standard administration, (b) read aloud accommodations with 1-day administration, or (c) read aloud accommodations with 2-day administration. The significant condition effect and nonsignificant group by condition interaction suggested that accommodations helped both poor and average readers. However, the accommodation effect in average readers stemmed from low performance in the nonaccommodated experimental condition that was not apparent when the same students previously took the state-administered test. The 2-day administration was more effective than the 1-day administration. (Contains 3 tables and 2 figures.)

Cognitive ability and behavioral adaptability are distinct, yet related, constructs that can impact childhood development. Both are often reduced in deaf children of hearing parents who do not provide sufficient language and communication access. Additionally, parental depression is commonly observed due to parent-child communication difficulties that can lead to parents' feelings of inadequacy and frustration. We sought to assess whether adaptive behavior in deaf children was associated with nonverbal intelligence and parental depression. Parents of precochlear implant patients seen for neuropsychological assessment were administered the Parenting Stress Index and Vineland Behavior Adaptive Scales to obtain measures of parental distress and child's behavioral adaptability. Precochlear implant patients' cognitive functioning was assessed via the Mullen Scales of Early Learning or the Leiter International Performance Scale-Revised, depending on the child's age at the time of testing. Regardless of age or neurological status, the deaf child's adaptive behavior consistently showed a strong relationship with intelligence. Moderate correlation between parental depression and the child's adaptive behavior was observed only in the younger group. The relationship between parental depression and communication subscale was moderated by intelligence for deaf children without neurological complications. The findings provide important implications for promoting family-centered interventions with early communication and language development.

The construct validity of English and Spanish phonological awareness (PA) tasks was examined with a sample of 812 kindergarten children from 71 transitional bilingual education program classrooms located in 3 different types of geographic regions in California and Texas. Tasks of PA, including blending nonwords, segmenting words, and phoneme elision, were measured in Spanish and in English and analyzed via multilevel confirmatory factor analysis at the task level. Results showed that the PA tasks defined a unitary construct at both the student and classroom levels in each language. English and Spanish PA factors were related to each other (.93 and .83 at the student and classroom levels, respectively) as well as to word reading, both within languages (correlations estimated between .74 and .93) and across languages (correlations estimated between .47 and .79). Although the PA constructs were statistically separable in each language, the high correlation between Spanish and English PA indicates considerable overlap in these abilities.

Ordered latent class analysis (OLCA) can be used to approximate unidimensional latent distributions. The main objective of this study is to evaluate the method of OLCA in detecting non-normality of an unobserved continuous variable (i.e., a common factor) used to explain the covariation between dichotomous item-level responses. Using simulation, we compared a model in which probabilities of class membership were estimated to a restricted submodel in which class memberships were fixed to normal Gauss-Hermite quadrature values. Our results indicate that the likelihood ratio statistic follows a predictable chi-square distribution for a wide range of sample sizes (N = 500-12,000) and test instrument characteristics, and has reasonable power to detect non-normality in cases of moderate effect sizes. Furthermore, under situations of large sample sizes, large numbers of items, or centrally located item difficulties, simulations suggest that it may be possible to describe the shape of latent trait distributions. Application to data on the symptoms of major depression, assessed in the National Comorbidity Survey, suggests that the latent trait does not depart from normality in men but does so to a small but significant extent in women.

The article uses confirmatory factor analysis (CFA) as a template to explain didactically multilevel structural equation models (ML-SEM) and to demonstrate the equivalence of general mixed-effects models and ML-SEM. An intuitively appealing graphical representation of complex ML-SEMs is introduced that succinctly describes the underlying model and its assumptions. The use of definition variables (i.e., observed variables used to fix model parameters to individual specific data values) is extended to the case of ML-SEMs for clustered data with random slopes. Empirical examples of multilevel CFA and ML-SEM with random slopes are provided along with scripts for fitting such models in SAS Proc Mixed, Mplus, and Mx. Methodological issues regarding estimation of complex ML-SEMs and the evaluation of model fit are discussed. Further potential applications of ML-SEMs are explored.

Background: Cutaneous metastases in pancreatic cancer (PC) are rare. Herein, we evaluate the clinical, genomic, and other descriptors of patients with PC and cutaneous metastases. Methods: Institutional databases were queried, and clinical history, demographics, PC cutaneous metastasis details, and overall survival (OS) from cutaneous metastasis diagnosis were abstracted. OS was estimated using Kaplan–Meier methods. Results: Forty patients were identified, and median age (Q1–Q3, IQR) of PC diagnosis was 66.0 (59.3–72.3, 12.9) years. Most patients had Stage IV disease at diagnosis (n = 26, 65%). The most common location of the primary tumor was the tail of the pancreas (n = 17, 43%). The most common cutaneous metastasis site was the abdomen (n = 31, 78%), with umbilical lesions occurring in 74% (n = 23) of abdominal lesions. The median OS (95% CI) was 11.4 months (7.0, 20.4). Twenty‐three patients had umbilical metastases (58%), and 17 patients had non‐umbilical metastases (43%). The median OS (95% CI) was 13.7 (7.0, 28.7) months in patients with umbilical metastases and 8.9 (4.1, Not reached) months in patients with non‐umbilical metastases (p = 0.1). Sixteen of 40 (40%) patients underwent somatic testing, and findings were consistent with known profiles. Germline testing in 12 (30%) patients identified pathogenic variants in patients: CHEK2, BRCA1, and ATM. Conclusion: Cutaneous metastases from PC most frequently arise from a pancreas tail primary site and most frequently occur in the umbilicus. Cutaneous metastases may generally be categorized as umbilical or non‐umbilical metastases. [ABSTRACT FROM AUTHOR]

Investigated models relating coping efficacy, coping efforts, and psychological problems of children of divorce. Structural equation model supported coping efficacy as mediating between active coping, avoiding coping, and psychological problems. Prospective longitudinal model supported coping efficacy as mediating between active coping and internalizing problems. Individual growth curve model supported coping efficacy as mediating between active coping and psychological problems. (Author/KB)

First and second graders (n=285) received one of three types of classroom reading programs: (1) direct instruction in letter-sound correspondence; (2) less direct instruction in sound-spelling patterns; and (3) implicit instructions in the alphabetic code while reading connected text. Results show advantages of reading programs that emphasize explicit instruction in the alphabetic principle. (SLD)

Examines effectiveness of three different reading interventions in reading disabled second and third graders. Compares growth in phonological and orthographic processing and word reading. Finds the most significant mediator of intervention effects was initial differences in phonological and orthographic processing skills. Concludes that synthetic phonics facilitates skill in phonological analysis relative to analytic phonics and sight-word methods, but it does not transfer to gains in reading. Discusses implications. (RS)

Potassium hydroxide (KOH) preparation is an underutilized modality in the diagnosis of mycotic keratitis. We have earlier shown its utility in the diagnosis of Nocardia and Acanthamoeba keratitis. The aim of this study was (i) to evaluate the sensitivity, specificity and predictive value of KOH preparation, and (ii) to compare its efficacy with other methods of corneal scraping examination, for the diagnosis of mycotic keratitis. The study was conducted in two phases. In phase I, randomized corneal scrapings were examined by KOH, Gram′s stain, and lactophenol cotton blue (LPCB) in 91 infectious keratitis subjects. In phase II, 53 corneal scrapings were stained with KOH and calcofluor white (CFW), and viewed with bright field (KOH) and fluorescence (CFW) microscopy. The KOH and CFW readings were recorded by an observer masked to the clinical findings and culture results. Nineteen scrapings were examined by two masked observers. In 22 culture positive fungal keratitis patients in phase I, the sensitivity of KOH, Gram′s stain, and LPCB methods was 100%, 86.4%, and 77.3%, respectively. In phase II, the specificities of KOH and CFW were identical (83.8%), while the sensitivities were 81.2% and 93.7%, respectively (p = 0.59), in 16 culture positive mycotic keratitis patients. There was no significant difference between the negative and positive predictive values of KOH and CFW. Furthermore, no significant interobserver variability was found in the specificity and sensitivity. The KOH method compares well with other microscopy methods in the diagnosis of keratomycosis and has a definite place in the armamentarium of diagnostic techniques.

A didactic on latent growth curve modeling for ordinal outcomes is presented. The conceptual aspects of modeling growth with ordinal variables and the notion of threshold invariance are illustrated graphically using a hypothetical example. The ordinal growth model is described in terms of 3 nested models: (a) multivariate normality of the underlying continuous latent variables (y-sub(t)) and its relationship with the observed ordinal response pattern (Y-sub(t)), (b) threshold invariance over time, and (c) growth model for the continuous latent variable on a common scale. Algebraic implications of the model restrictions are derived, and practical aspects of fitting ordinal growth models are discussed with the help of an empirical example and MX script (M. C. Neale, S. M. Boker, G. Xie, & H. H. Maes, 1999). The necessary conditions for the identification of growth models with ordinal data and the methodological implications of the model of threshold invariance are discussed.

Purpose: The use of vaginal immobilization balloons placed into the vagina for immobilization of tandem and ovoid (T+O) applicator during high-dose-rate (HDR) brachytherapy delivery has been used at our institution, and seems to have improved our patient comfort, decreased procedure time, and minimized applicator misplacement. We aimed to show that these balloons, while originally marketed for single-day use, are safe and maintain applicator positioning/dosimetry when left in situ overnight for treatment delivery on sequential days. Material and methods: Forty-two paired computed tomography (CT) scans from thirteen patients who underwent T+O HDR treatments on sequential days with vaginal immobilization balloons in situ overnight were retrospectively compared to calculate mean change of balloon volumes and balloon/T+O distance to bony landmarks. Dosimetric planning was retroactively performed on day 2 using CT scan of each pair, and the change in estimated radiation delivery to the bladder and rectum was compared. Results: No statistically significant overnight changes were found in balloon volumes or anterior balloon positioning. The posterior balloon shifted –0.29 ±0.46 cm (p = 0.03) to the anterior public symphysis and 0.32 ±0.50 cm (p = 0.01) to the right femoral head. The tandem shifted 0.37 ±0.39 cm (p = 0.002) to the pubic symphysis. There was no significant difference found in radiation delivered to the bladder or rectum between the paired scans. Conclusions: This study showed minimal change in balloon volumes, balloons/T+O positioning, or in radiation dose to bladder and rectum when the applicator remained overnight. These findings support that inflatable vaginal immobilization balloons remaining in situ overnight for additional HDR T+O treatments on sequential days, is safe and provides stable dosimetry. [ABSTRACT FROM AUTHOR]

Meta-accuracy and perceptions of reciprocity can be measured by covariances between latent variables in two social relations models examining perception and meta-perception. We propose a single unified model called the Perception-Meta-Perception Social Relations Model (PM-SRM). This model simultaneously estimates all possible parameters to provide a more complete understanding of the relationships between perception and meta-perception. We describe the components of the PM-SRM and present two pedagogical examples with code, openly available on https://osf.io/4ag5m. Using a new package in R (xxM), we estimated the model using multilevel structural equation modeling which provides an approachable and flexib.e framework for evaluating the PM-SRM. Further, we discuss possible expansions to the PM-SRM which can explore novel and exciting hypotheses. [ABSTRACT FROM AUTHOR]

The article provide an overview of correctable visual impairment (CVI) in related disciplines and the importance of understanding CVI and corrective options in dermatology. Topics include resources needed for dermatologists concerning ophthalmologic wellness and key warning signs of visual acuity deficits and other ocular complications; and reduced professional productivity, and individuals with uncorrected presbyopia with increase in difficulty performing demanding near vision tasks.