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Testing a component model of reading comprehension in a randomized controlled trial, we evaluated the efficacy of 4 interventions that were designed to target components of language and metacognition that predict children's reading comprehension: vocabulary, listening comprehension, comprehension of literate language, academic knowledge, and comprehension monitoring. Third- and 4th-graders with language skills falling below age expectations participated (N = 645). Overall, the component interventions were only somewhat effective in improving the targeted skills, compared to a business-as-usual control (g ranged from -0.14 to 0.33), and no main effects were significant after correcting for multiple comparisons. Effects did not generalize to other language skills or to students' reading comprehension. Moreover, there were Child Characteristic × Treatment interaction effects. For example, the intervention designed to build sensorimotor mental representations was more effective for children with weaker vocabulary skills. Implications for component models of reading and interventions for children at risk of reading comprehension difficulties are discussed. [This article was published in "Scientific Studies of Reading" (EJ1188481).]

Background: Splitting apheresis platelet (PLT) units increase available inventory during shortages. The impact of prolonged storage in gas‐impermeable aliquot bags on PLT quality in vitro and transfusion outcomes in patients remains uncertain. Study Design and Methods: We assessed in vitro PLT quality and thromboelastography (TEG) in PLTs stored for 8 or 24 h in aliquot bags compared with baseline (T0). Retrospective assessment of response (PLT increment and corrected count increment (CCI)) was conducted among adults (≥18 years) transfused with split platelet units from January 2021 to June 2022. Results: No differences were observed in PLT and white blood cell (WBC) counts, mean platelet volume, or TEG parameters during storage, except for an increase in TEG R time (mean ± SD) at 24 h (6.1 ± 0.5 min) compared to T0 (4.4 ± 0.8 min), p = 0.0031 one‐way ANOVA. Eighty‐one patients were transfused 119 split units with a median [IQR] PLT yield of 2.1 × 1011[1.9 × 1011 to 2.3 × 1011] and storage duration of 1.6[0.7–9.1] h. The overall median PLT count increment was 6.0 × 103/uL and CCI was 5.0 × 103, correlating negatively with split unit storage duration (Spearman rho = −0.218, p = 0.017). Compared with split transfusions of pathogen‐reduced (PR) PLTs, non‐PR splits were associated with higher median platelet count increments (7.0 × 103/μL vs. 4.0 × 103/μL, p = 0.0263 Mann–Whitney U) and higher CCIs (6.5 × 103 vs. 3.9 × 103, p = 0.0116 Mann–Whitney U) despite no differences in PLT yields (2.1 × 1011/μL vs. 2.1 × 1011/μL). Discussion: Storing PLTs in aliquot bags for 8 or 24 h does not adversely affect their quality in vitro. Splitting apheresis PLTs are feasible for adult transfusions during shortages. It may be advisable to prioritize non‐PR PLTs for splitting given improved patient responses. [ABSTRACT FROM AUTHOR]

Background: Many children with sickle cell disease (SCD) who suffer a stroke receive chronic transfusion therapy (CTT) indefinitely; however, their adulthood neurologic outcomes have not been reported. Understanding these outcomes is critical to inform decisions regarding curative therapy in childhood. Study Design and Methods: In this retrospective study, we described a cohort of adults with SCD and a history of childhood stroke who received care at a single center and compared their outcomes with matched subjects without childhood stroke using chi2 and Mann–Whitney U tests. Results: Of 42 subjects with childhood stroke, all received CTT for secondary stroke prophylaxis. Five (11%) developed recurrent stroke. The rate of stroke was similar in subjects with and without childhood stroke (0.7 vs. 1.1 per 100 person·years, p =.63). Both cohorts exhibited evidence of iron overload (median ferritin 2227 vs. 1409 ng/dL, p =.10) and alloimmunization (45% vs. 45%, p = 1.0), despite receiving care in a comprehensive SCD program. Discussion: For adults with SCD who had a childhood stroke, our results suggest CTT returns the risk of stroke to that of age‐matched stroke naïve patients with SCD. [ABSTRACT FROM AUTHOR]

Accumulating evidence suggests that assessment-informed personalized instruction, tailored to students' individual skills and abilities, is more effective than more one-size-fits-all approaches. In this study, we evaluate the efficacy of Individualizing Student Instruction in Mathematics (ISI-Math) compared to Reading (ISI-Reading) where classrooms were randomly assigned to ISI-Math or ISI-Reading. The literature on child characteristics X instruction or skill X treatment interaction effects point to the complexities of tailoring instruction for individual students who present with constellations of skills. Second graders received mathematics instruction in small flexible learning groups based on their assessed learning needs. Results of the study (n=32 teachers, 370 students) revealed significant treatment effects on standardized mathematics assessments. With effect sizes (d) of 0.41-0.60, we show that we can significantly improve 2nd graders' mathematics achievement, including for children living in poverty, by using assessment data to individualize the mathematics instruction they receive. The instructional regime, ISI-Math, was implemented by regular classroom teachers and it led to about a 4-month achievement advantage on standardized mathematics tests when compared to students in control classrooms. These results were realized within one school year. Moreover, treatment effects were the same regardless of school-level poverty and students' gender, initial mathematics or vocabulary scores.

With national focus on reading and math achievement, science and social studies have received less instructional time. Yet, accumulating evidence suggests that content knowledge is an important predictor of proficient reading. Starting with a design study, we developed Content Area Literacy Instruction (CALI), as an individualized (or personalized) instructional program for kindergarteners through fourth graders to build science and social studies knowledge. We developed CALI to be implemented in general education classrooms, over multiple iterations (n=230 students), using principles of design-based implementation research. The aims were to develop CALI as a usable and feasible instructional program that would, potentially, improve science and social studies knowledge, and could be implemented during the literacy block without negatively affecting students' reading gains (i.e., no opportunity cost). We then evaluated the efficacy of CALI in a randomized controlled field trial with 418 students in kindergarten through fourth grade. Results reveal that CALI demonstrates promise as a useable and feasible instructional individualized general education program, and is efficacious in improving social studies (d=2.2) and science (d=2.1) knowledge, with some evidence of improving oral and reading comprehension skills (d=.125).

With national focus on reading and math achievement, science and social studies have received less instructional time. Yet, accumulating evidence suggests that content knowledge is an important predictor of proficient reading. Starting with a design study, we developed Content Area Literacy Instruction (CALI), as an individualized (or personalized) instructional program for kindergarteners through fourth graders to build science and social studies knowledge. We developed CALI to be implemented in general education classrooms, over multiple iterations (n=230 students), using principles of design-based implementation research. The aims were to develop CALI as a usable and feasible instructional program that would, potentially, improve science and social studies knowledge, and could be implemented during the literacy block without negatively affecting students' reading gains (i.e., no opportunity cost). We then evaluated the efficacy of CALI in a randomized controlled field trial with 418 students in kindergarten through fourth grade. Results reveal that CALI demonstrates promise as a useable and feasible instructional individualized general education program, and is efficacious in improving social studies (d=2.2) and science (d=2.1) knowledge, with some evidence of improving oral and reading comprehension skills (d=.125).

To investigate whether child × instruction effects contribute to mathematics gains in first grade, we conducted a cluster randomized controlled trial with 454 (205 treatment; 249 control) students in 28 classrooms. Classrooms were randomly assigned to implement Math Peer Assisted Learning Strategies (Math PALS) to supplement Saxon Math or Saxon Math alone. Teachers received professional development on either Math PALS (treatment) or individualized reading instruction (control). Intent-to-treat and treatment-on-the-treated results revealed no significant difference between the Math PALS and control groups in student mathematics gains. However, Math PALS effectiveness varied with initial math skills. Based on modeled results of the continuous fall math score, students who scored at the 75th percentile of the sample demonstrated significantly stronger mathematics outcomes compared with the treated control group; there was no significant treatment effect for students at the 50th percentile. For students with lower initial math skills (modeled at the 25th percentile of the sample), the effect of the treatment was negative. Students with lower initial mathematics skills made greater gains in the control group (Saxon Math alone) versus the Math PALS group.

Background: Hemolytic disease of the fetus and newborn (HDFN) is caused by maternal alloantibody‐mediated destruction of fetal/neonatal red blood cells (RBCs). While the pathophysiology has been well‐characterized, the clinical and laboratory monitoring practices are inconsistent. Methods: We surveyed 103 US institutions to characterize laboratory testing practices for individuals with fetuses at risk of HDFN. Questions included antibody testing and titration methodologies, the use of critical titers, paternal and cell‐free fetal DNA testing, and result reporting and documentation practices. Results: The response rate was 44% (45/103). Most respondents (96%, 43/45) assess maternal antibody titers, primarily using conventional tube‐based methods only (79%, 34/43). Among respondents, 51% (23/45) rescreen all individuals for antibodies in the third trimester, and 60% (27/45) perform paternal RBC antigen testing. A minority (27%, 12/45) utilize cell‐free fetal DNA (cffDNA) testing to predict fetal antigen status. Maternal antibody titers are performed even when the fetus is not considered to be at risk of HDFN based on cffDNA or paternal RBC antigen testing at 23% (10/43) of sites that assess titers. Discussion: There is heterogeneity across US institutions regarding the testing, monitoring, and reporting practices for pregnant individuals with fetuses at risk of HDFN, including the use of antibody titers in screening and monitoring programs, the use of paternal RBC antigen testing and cffDNA, and documentation of fetal antigen results. Standardization of laboratory testing protocols and closer collaboration between the blood bank and transfusion medicine service and the obstetric/maternal‐fetal medicine service are needed. [ABSTRACT FROM AUTHOR]

The Association for the Advancement of Blood and Biotherapies (AABB) Clinical Transfusion Medicine Committee (CTMC) provides evidence-based guidance on safe and effective transfusion practices. Key developments in transfusion medicine in 2023 include findings on red blood cell transfusion strategies for myocardial infarction, updated RBC transfusion guidelines, and the impact of donor sex on transfusion outcomes. Additionally, studies on infectious diseases, blood donor screening, and collections, as well as patient blood management (PBM) metrics and effectiveness, were highlighted. The document also covers advances in hemostasis, hemoglobinopathies, immunohematology, genomics, pediatrics, apheresis, and biotherapies, including the FDA approval of gene therapies for sickle cell disease. Lastly, the text addresses healthcare disparities and diversity, equity, and inclusion (DEI) issues, such as racial disparities in postoperative transfusion outcomes and gender and racial inequity among editorial positions. [Extracted from the article]

Background: The data to support chronic automated red cell exchange (RCE) in sickle cell disease (SCD) outside of stroke prevention, is limited, especially in adults. Study Design and Methods: A retrospective analysis was conducted of patients with SCD who were referred for chronic RCE at our institution over a 10‐year period. Data that were evaluated included patient demographics, referral indications, and procedural details (e.g., vascular access, adverse events, etc.). In a subanalysis, the number of annual acute care encounters during 3 years of chronic RCE was compared with that in the year preceding the first RCE. Results: A total of 164 patients were referred for chronic RCE: median age was 28 years (interquartile range [IQR] = 22–36) at referral and 60% were female. Seventy (42.6%) were naïve to chronic transfusion (simple or RCE) prior to referral. The leading indications for referral were refractory pain (73/164, 44.5%) and iron overload (57/164, 34.7%). A total of 5090 procedures occurred during the study period (median = 19, IQR = 5–45). Of the 138 patients who had central vascular access, 8 (6%) and 16 (12%) had ≥1 central‐line‐related thrombosis and/or infection, respectively. Of those who were not RBC alloimmunized at initiation of RCE, 12/105 (11.4%) developed new antibodies during chronic RCE. In those 30 patients who were adherent to therapy for 3 years, there was no significant difference in acute care encounters following initiation of RCE. Conclusion: Prospective clinical trials are needed to determine which patients are most likely to benefit from chronic RCE and refine selection accordingly. See editorial on page 1385–1387, in this issue [ABSTRACT FROM AUTHOR]

Introduction: Autoimmune encephalitis (AE) comprises a heterogeneous group of autoantibody‐mediated disorders targeting the brain parenchyma. Therapeutic plasma exchange (TPE), one of several first‐line therapies for AE, is often initiated when AE is suspected, albeit prior to an established diagnosis. We sought to characterize the role of TPE in the treatment of suspected AE. Methods: A single‐center, retrospective analysis was performed of adults (≥18 years) who underwent at least one TPE procedure for "suspected AE." The following parameters were extracted and evaluated descriptively: clinicopathologic characteristics, treatment course, TPE‐related adverse events, outcomes (e.g., modified Rankin scale [mRS]), and diagnosis once investigation was complete. Results: A total of 37 patients (median age 56 years, range 28–77 years, 62.2% male) were evaluated. Autoimmune antibody testing was positive in serum for 43.2% (n = 16) and cerebrospinal fluid for 29.7% (n = 11). Patients underwent a median of five TPE procedures (range 3–16), with 97.3% (n = 36) via a central line and 21.6% (n = 8) requiring at least one unit of plasma as replacement fluid. Fifteen patients (40.5%) experienced at least one TPE‐related adverse event. Compared with mRS at admission, the mRS at discharge was improved in 21.6% (n = 8), unchanged in 59.5% (n = 22), or worse in 18.9% (n = 7). Final diagnosis of AE was determined to be definite in 48.6% (n = 18), probable in 8.1% (n = 3) and possible in 27.0% (n = 10). Six (16.2%) patients were ultimately determined to have an alternate etiology. Conclusion: Empiric TPE for suspected AE is generally well‐tolerated. However, its efficacy remains uncertain in the absence of controlled trials, particularly in the setting of seronegative disease. [ABSTRACT FROM AUTHOR]

Background: Washing red blood cell (RBC) units mitigates severe allergic transfusion reactions. However, washing reduces the time to expiration and the effective dose. Automated washing is time‐ and labor‐intensive. A shortage of cell processor tubing sets prompted review of medical necessity for washed RBC for patients previously thought to require washing. Study Design and Methods: A single‐center, retrospective study investigated discontinuing wash RBC protocols in chronically transfused adults. In select patients with prior requirements for washing, due to a history of allergic transfusion reactions, trials of unwashed transfusions were performed. Patient demographic, clinical, laboratory, and transfusion data were compiled. The per‐unit washing cost was the sum of the tubing set, saline, and technical labor costs. Results: Fifteen patients (median age 34 years interquartile range [IQR] 23–53 years, 46.7% female) were evaluated. These patients had been transfused with a median of 531 washed RBC units (IQR 244–1066) per patient over 12 years (IQR 5–18 years), most commonly for recurrent, non‐severe allergic reactions. There were no transfusion reactions with unwashed RBCs aside from one patient with one episode of pruritus and another with recurrent pruritus, which was typical even with washed RBC. We decreased the mean number of washed RBC units per month by 72.9% (104 ± 10 vs. 28.2 ± 25.2; p <.0001) and saved US $100.25 per RBC unit. Conclusion: Washing of RBCs may be safely reconsidered in chronically transfused patients without a history of anaphylaxis. Washing should be implemented judiciously due to potential lack of necessity and logistical/operational challenges. [ABSTRACT FROM AUTHOR]

Background: Red blood cell (RBC) transfusion remains a major treatment for sickle cell disease (SCD). Patients with SCD have a high prevalence of renal impairment and cardiorespiratory disease, conferring risk of transfusion‐associated circulatory overload (TACO). Study Design and Methods: We describe an approach, titled euvolemic automated transfusion (EAT), to transfuse SCD patients with severe anemia who are at risk of TACO. In EAT, plasmapheresis is performed using donor RBCs, rather than albumin or plasma, as replacement fluid. Euvolemia is maintained. A retrospective analysis was conducted of patients with SCD who underwent EAT at our institution over a 10‐year period, to evaluate the efficacy and safety of EAT. Results: Eleven SCD patients underwent 109 EAT procedures (1–59 procedures per patient). The median age was 42 years (IQR = [30–49]) and 82% (n = 9) were female. Most (82%; n = 9) patients had severe chronic kidney disease and 55% (n = 6) had heart failure. One (9%) patient had a history of life‐threatening TACO. Mean pre‐ and post‐procedure Hct values were 19.8% (SD ± 1.6%) and 29.1% (SD ± 1.4%), respectively. The average Hct increment was 3.2% per RBC unit. Only two EAT‐related complications were recorded during the 109 procedures: central line‐associated infection and citrate toxicity (muscle cramping). EAT used an average of two RBC units less than that projected for standard automated RBC exchange. Conclusion: Our findings suggest that EAT is safe and effective to treat patients with SCD and severe anemia, who are at risk for TACO. EAT requires fewer RBC units compared to automated RBC exchange. [ABSTRACT FROM AUTHOR]

Background: Intrauterine transfusion (IUT) is an invasive but critical and potentially life‐saving intervention for severe fetal anemia with demonstrated improvement in outcomes. The fetus is vulnerable to hemodynamic alterations and transfusion‐related adverse events; therefore, special consideration must be given to blood component selection and modification. There is widespread IUT practice variability, and existing guidance primarily relies on expert opinion and single center experiences. Study Design and Methods: Experts in Maternal Fetal Medicine, Pediatric Hematology, and Transfusion Medicine from centers across the United States, collectively performing about 120 IUT annually, offer a multidisciplinary perspective on the performance of IUT and preparation of blood components. This perspective includes strategies for identifying an at‐risk fetus, communicating between disciplines, determining the necessary blood volume, selecting and processing blood components, documenting the procedure in medical record, and managing the neonate. Results: Identifying an at‐risk fetus relies on review of the clinical history, non‐invasive monitoring, and laboratory evaluation. We recommend the use of relatively fresh, group O, cytomegalovirus‐safe, freshly irradiated, red blood cells (RBC) that are Hemoglobin S negative and antigen‐negative for any maternal antibody, if indicated. These RBC units should be concentrated to remove additives and increase the hematocrit thus minimizing fluctuations in fetal volume status. The units intended for IUT should be labeled clearly and the documentation of transfusion differentiated in the maternal medical record. Discussion: An awareness of the technical, logistical, and regulatory considerations for IUT performance will facilitate improved communication and patient care, especially when rare units of RBC are required. [ABSTRACT FROM AUTHOR]

Too many children fail to learn how to read proficiently with serious consequences for their overall well-being and long-term success in school. This may be because providing effective instruction is more complex than many of the current models of reading instruction portray; there are Child Characteristic x Instruction (CXI) interactions. Here we present efficacy results for a randomized control field trial of the Individualizing Student Instruction (ISI) intervention, which relies on dynamic system forecasting intervention models to recommend amounts of reading instruction for each student, taking into account CXI interactions that consider his or her vocabulary and reading skills. The study, conducted in seven schools with 25 teachers and 396 first graders, revealed that students in the ISI intervention classrooms demonstrated significantly greater reading skill gains by spring than did students in control classrooms. Plus, they were more likely to receive differentiated reading instruction based on CXI interaction guided recommended amounts than were students in control classrooms. The precision with which students received the recommended amounts of each type of literacy instruction, the distance from recommendation, also predicted reading outcomes. (Contains 7 figures and 6 tables.)

There is accumulating correlational evidence that the effect of specific types of reading instruction depends on children's initial language and literacy skills, called child characteristics x instruction (CxI) interactions. There is, however, no experimental evidence beyond first grade. This randomized control study examined whether CxI interactions might present an underlying and predictable mechanism for explaining individual differences in how students respond to third-grade classroom literacy instruction. To this end, we designed and tested an instructional intervention (Individualizing Student Instruction [ISI]). Teachers (n = 33) and their students (n = 448) were randomly assigned to the ISI intervention or a vocabulary intervention, which was not individualized. Teachers in both conditions received professional development. Videotaped classroom observations conducted in the fall, winter, and spring documented the instruction that each student in the classroom received. Teachers in the ISI group were more likely to provide differentiated literacy instruction that considered CxI interactions than were the teachers in the vocabulary group. Students in the ISI intervention made greater gains on a standardized assessment of reading comprehension than did students in the vocabulary intervention. Results indicate that CxI interactions likely contribute to students' varying response to literacy instruction with regard to their reading comprehension achievement and that the association between students' profile of language and literacy skills and recommended instruction is nonlinear and dependent on a number of factors. Hence, dynamic and complex theories about classroom instruction and environment impacts on student learning appear to be warranted and should inform more effective literacy instruction in third grade. (Contains 1 note, 9 tables, and 4 figures.)