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More than two-thirds of middle school students do not read proficiently. Research has shown that targeted interventions using explicit instruction methods can improve reading outcomes for struggling readers. A central feature of explicit instruction is the systematic implementation of instructional interactions, but it is not clear what specific instructional interaction practices lead to stronger outcomes for middle school readers. This study used a regression discontinuity design to compare the frequency and impact of instructional interactions experienced by eighth-grade students who received a targeted reading intervention (n = 1,461) with those who did not (n = 4,292). Results indicated that students who received intervention experienced far more instructional interactions with their teachers than did students who did not. However, the association between rates of interaction and student need in the intervention group was minimal, and the relationship between the rate of instructional interactions and reading growth was mixed. Implications for intervening with struggling students in the middle grades are discussed.
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Optimal care in nursing home (NH) settings requires effective team communication. Certified nursing assistants (CNAs) interact with nursing home residents frequently, but the extent to which CNAs feel their input is valued by other team members is not known. We conducted a cross-sectional study in which we administered a communication survey within 20 Utah nursing home facilities to 650 team members, including 124 nurses and 264 CNAs. Respondents used a 4-point scale to indicate the extent to which their input is valued by other team members when reporting their concerns about nursing home residents. We used a one-way ANOVA with a Bonferroni correction. When compared to nurses, CNAs felt less valued (CNA mean = 2.14, nurse mean = 3.24; p < 0.001) when reporting to physicians, and less valued (CNA mean = 1.66, nurse mean = 2.71; p < 0.001) when reporting to pharmacists. CNAs did not feel less valued than nurses (CNA mean = 3.43, nurse mean = 3.37; p = 0.25) when reporting to other nurses. Our findings demonstrate that CNAs feel their input is not valued outside of nursing, which could impact resident care. Additional research is needed to understand the reasons for this perception and to design educational interventions to improve the culture of communication in nursing home settings.
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Asistentes de Enfermería , Casas de Salud , Comunicación , Estudios Transversales , Humanos , Instituciones de Cuidados Especializados de EnfermeríaRESUMEN
Information transfers in long-term care (LTC) settings between and among providers, staff, residents, and family caregivers are often fragmented. In order to identify training needs to improve communication, a survey instrument was developed and refined to assess the self-efficacy of LTC staff in communicating with staff, providers, residents, and caregivers. This 11-item survey instrument, based on a literature review, covered four key concepts (mutual respect, recognizing and responding to sensory deficits, limited health literacy, and changes in condition) relevant to communicating health information in LTC settings. Ten content experts evaluated each survey item using a 4-point scale. The content validity of the survey was established by using the content validity index to assess results at the item and scale levels. All items scored 0.90 or greater and were retained. Future work should entail broad-scale validation and testing of this survey across the United States. By assessing the self-efficacy of LTC staff in communicating with the interprofessional team, leadership teams can design personalized interprofessional continuing education activities aimed at improving communication skills. [J Contin Educ Nurs. 2022;53(3):123-130.].
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Comunicación , Relaciones Interpersonales , Cuidados a Largo Plazo , Atención a la Salud , Personal de Salud , Humanos , Grupo de Atención al Paciente , Instituciones Residenciales , Autoeficacia , Encuestas y Cuestionarios , Estados UnidosRESUMEN
BACKGROUND: During the COVID-19 pandemic, universities transitioned to primarily online delivery, and it is important to understand what implications the transition back to in-person activities may have on spread of SARS-CoV-2 in the student population. The specific aim of our study was to provide insights into the effect of timetabling decisions on the spread of SARS-CoV-2 in a population of undergraduate engineering students. METHODS: We developed an agent-based modelling simulation that used a Canadian first-year undergraduate engineering program with an enrolment of 180 students in 5 courses of 12.7 weeks in length. Each course involved 150 minutes of lectures and 110 minutes of tutorials or laboratories per week. We considered several online and in-person timetabling scenarios with different scheduling frequencies and section sizes, in combination with surveillance and testing interventions. The study was conducted from May 1 to Aug. 31, 2021. RESULTS: When timetabling interventions were applied, we found a reduction in the mean number of students who were infected and that a containment of widespread outbreaks could be achieved. Timetables with online lectures and small (1/6 class capacity) tutorial or laboratory sections reduced the mean number of students who were infected by 83% and reduced the risk of large outbreaks that occurred with in-person lectures. We also found that spread of SARS-CoV-2 was less sensitive to class size than to contact frequency when a biweekly timetable was implemented (i.e., alternating online and in-person sections on a biweekly basis). Including a contact-tracing policy and randomized testing to the timetabling interventions helped to contain the spread of SARS-CoV-2 further. Vaccination coverage had the largest effect on reducing the number of students who were infected. INTERPRETATION: Our modelling showed that by taking advantage of timetabling opportunities and applying appropriate interventions (contact tracing, randomized testing and vaccination), SARS-CoV-2 infections may be averted and disruptions (case isolations) reduced. However, given the emergence of SARS-CoV-2 variants, transitions from online to in-person classes should proceed cautiously from small biweekly classes, for example, to manage risk.
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COVID-19/prevención & control , Toma de Decisiones en la Organización , Ingeniería/educación , Control de Infecciones/métodos , Universidades , Adulto , COVID-19/epidemiología , Canadá , Humanos , Estudiantes , Factores de Tiempo , Universidades/organización & administración , Adulto JovenRESUMEN
BACKGROUND: Musicians are known to be at risk for developing hearing sensitivity and hearing-related problems given their occupational exposure to high-level sound. Among options for hearing conservation, earplugs are an effective and inexpensive choice. Adoption rates for musicians' earplugs remains consistently low, however, given concerns about the impact of hearing protection on their own performance as well as concerns that the resultant music will be a negative experience for listeners. In fact, few studies have (1) examined musicians' attitudes about using hearing protection while performing themselves and (2) determined whether music played by musicians wearing hearing protection sounds different to listeners. PURPOSE: The purposes of this study were (1) to evaluate how wearing musicians' earplugs affected musicians' perception of their performance while they were playing, and (2) to examine whether listeners can distinguish a difference between music recorded by musicians playing with and without earplugs. RESEARCH DESIGN: Experiment 1: student musicians were recorded playing under two conditions (with and without wearing earplugs) and then were surveyed about their experience. Experiment 2: musically experienced and naïve listeners were presented with musical samples played by musicians with and without earplugs in an ABX format. Listeners responded by indicating whether the third stimulus (X) was conditionally identical to the first (A) or second stimulus (B). RESULTS: Experiment 1: while performing, musicians always preferred the no earplugs condition. The majority, however, rated the overall experience of playing with earplugs as generally positive. Experiment 2: listeners were unable to hear a difference between the two recordings. DISCUSSION: In this experiment, musicians rated their experience playing without hearing protection more favorably than their experience playing with hearing protection, but most musicians rated their experience with hearing protection as generally positive. The inability of listeners to distinguish a difference in music played with and without hearing protection suggests that the listening experience may not be adversely impacted by hearing protection worn by the performers. CONCLUSION: Earplugs are an inexpensive, noninvasive strategy for hearing conservation for musicians, and this study indicates that barriers to wearing hearing protection might be less problematic than previously reported.
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Pérdida Auditiva Provocada por Ruido , Música , Dispositivos de Protección de los Oídos , Audición , Pérdida Auditiva Provocada por Ruido/prevención & control , Pruebas Auditivas , HumanosRESUMEN
Opportunities for practice play a critical role in learning complex behaviors. In the context of explicit mathematics instruction, practice facilitates systematic opportunities for students with mathematics difficulties (MD) to learn new mathematics content and apply such knowledge and skills to novel mathematics problems. This study explored whether there is an optimal amount of student practice that teachers should provide in core mathematics instruction to maximize the mathematics achievement of kindergarten students with MD, a so called "Goldilocks effect," as opposed to simply "more is better." Results from observation data collected in a large-scale efficacy trial supported the latter rather than the former. Specifically, we found that three individual practice opportunities for every explicit teacher demonstration of mathematical content was associated with increased mathematics achievement for students with MD relative to fewer practice opportunities. Implications for facilitating frequent student practice opportunities during core mathematics instruction and designing professional development for teachers who work with students with MD are discussed.
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Discalculia , Matemática/educación , Práctica Psicológica , Enseñanza , Adulto , Preescolar , Discalculia/rehabilitación , Femenino , Humanos , Masculino , ObservaciónRESUMEN
Few published studies have examined the relationship between exercise during pregnancy, quality of life (QOL), and postpartum depressive symptoms in healthy pregnant women. A prospective cohort of 578 healthy pregnant women were followed during their pregnancy through 6 months postpartum. Levels of self-reported exercise and QOL before, during, and following pregnancy were assessed using standardized questionnaires during each trimester of pregnancy and 6 months postpartum. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) at 28 weeks gestation and 6 weeks postpartum. Participants were classified as having "sufficient exercise" if they achieved at least 150 min of exercise per week. Sufficient exercisers reported significantly higher ratings on most domains of QOL during each trimester of pregnancy and in the postpartum follow-up, compared with insufficient exercisers. There were no significant between-group differences in depressive symptoms. In examining the impact of exercise during each trimester, active women who became sedentary during their third trimester demonstrated a decline in their QOL. Achieving recommended levels of exercise during pregnancy was associated with higher QOL during pregnancy and the postpartum in healthy pregnant women. Decreasing the amount of exercise during pregnancy was associated with reduced QOL. These results suggest that it may be important for health care professionals to counsel healthy pregnant women about both the benefits of being physically active during pregnancy, and to provide guidance on how to remain physically active during a healthy pregnancy.
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Depresión Posparto/epidemiología , Depresión/epidemiología , Ejercicio Físico/psicología , Trimestres del Embarazo/psicología , Calidad de Vida/psicología , Adolescente , Adulto , Depresión/psicología , Depresión Posparto/psicología , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Estudios Prospectivos , Adulto JovenRESUMEN
Regular physical activity has been shown to improve pregnancy outcomes. We sought to identify barriers to exercise during the first trimester of pregnancy. Five hundred forty-nine pregnant women in their first trimester rated barriers to exercise on a scale of 1 (not a barrier) to 5 (a huge barrier) and recorded physical activity (minutes/week). Women were placed into one of three classifications, nonexercisers (zero exercise), infrequent exercisers (<150 minutes/week), or exercisers (≥150 minutes/week). The greatest barriers (mean) were nausea/fatigue (3.0) and lack of time (2.6). Exercisers reported significantly lower barrier levels. Nausea/fatigue was a greater barrier for nonexercisers compared to exercisers (3.6 vs 2.8, p < .001). Focusing education and interventions on these barriers may help pregnant women achieve healthy exercise levels.
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OBJECTIVE: We describe a novel way to calculate estimated blood loss (EBL) using an intraoperative pictographic tool in gynecologic surgery. METHODS: A pictographic tool to estimate sponge saturation was developed to calculate EBL during surgery. A prospective cohort of women 18 years or older undergoing benign vaginal hysterectomy with planned adnexal surgery at Mayo Clinic were consented for use of the pictographic tool. Demographic, preoperative, intraoperative, and postoperative data were abstracted. Estimated blood loss was compared among surgeons, anesthesia providers, and the pictographic tool and then correlated with change in hemoglobin. RESULTS: Eighty-one patients met inclusion with mean age of 45.3 ± 8.7 years. Successful vaginal hysterectomy was achieved in all patients with successful completion of planned adnexectomy in 69 (85.2%). Mean EBL among surgeons, anesthesia providers, and pictographic estimates, respectively, was as follows: 199.4 ± 81.9 mL, 195.5 ± 152.2 mL, and 288.5 ± 186.6 mL, with concordance correlation coefficients for surgeons and anesthesia providers versus pictographic tool of 0.40 (95% confidence interval, 0.29-0.51) and 0.68 (95% confidence interval, 0.57-0.79), respectively. The mean postoperative change in hemoglobin was -1.8 g/dL; there were no postoperative transfusions. Change in hemoglobin was more correlated with blood loss estimates from surgeons (r = -0.31, P = 0.008) and anesthesia providers (r = -0.37, P = 0.003) than the pictographic tool (r = -0.19, P = 0.11). CONCLUSIONS: Use of a pictographic tool to objectively estimate blood loss demonstrated significant overestimations compared with both anesthesia providers' and surgeons' estimates because the pictographic tool was less correlated with postoperative change in hemoglobin than anesthesia provider and surgeon estimates.
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Anexos Uterinos/cirugía , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Histerectomía Vaginal/efectos adversos , Cuidados Intraoperatorios/métodos , Adulto , Técnicas de Apoyo para la Decisión , Femenino , Humanos , Persona de Mediana Edad , Tempo Operativo , Fotograbar , Estudios Prospectivos , Tapones Quirúrgicos de GazaAsunto(s)
Antiinflamatorios no Esteroideos/administración & dosificación , Anticarcinógenos/administración & dosificación , Aspirina/administración & dosificación , Neoplasias Gastrointestinales/prevención & control , Anciano , Ensayos Clínicos como Asunto , Neoplasias del Colon/prevención & control , Congresos como Asunto , Neoplasias Esofágicas/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Gástricas/prevención & controlRESUMEN
This article presents findings of an efficacy trial examining the effect of a multitiered instruction and intervention model on first grade at-risk students' reading outcomes. Schools (N = 16) were randomly assigned to the treatment or control condition. In the fall of Grade 1, students were assigned to an instructional tier on the basis of Stanford Achievement Test-10th Edition scores (31st percentile and above = Tier 1; from the 10th to the 30th percentile = Tier 2). In both conditions, students identified as at risk (i.e., Tier 2; n = 267) received 90 min of whole group instruction (Tier 1) and an additional 30 min of daily small group intervention (Tier 2). In the treatment condition, teachers were trained to enhance core reading instruction by making instruction more explicit and increasing practice opportunities for students in Tier 1. In addition, at-risk readers were provided an additional 30-min daily small group intervention with content that was highly aligned with the Tier 1 core reading program. Results indicate significant, positive effects of the intervention on students' decoding and first semester fluent reading and potentially positive effects on reading comprehension and total reading achievement.
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Dislexia/rehabilitación , Intervención Educativa Precoz/métodos , Evaluación de Resultado en la Atención de Salud , Lectura , Niño , Femenino , Humanos , MasculinoAsunto(s)
Electrónica , Salud Pública , Productos de Tabaco/efectos adversos , Contaminación por Humo de Tabaco/efectos adversos , Dispositivos para Dejar de Fumar Tabaco , Uso de Tabaco/efectos adversos , Uso de Tabaco/epidemiología , Ensayos Clínicos como Asunto , Europa (Continente)/epidemiología , Humanos , Nueva Zelanda/epidemiología , Salud Pública/tendencias , Fumar/efectos adversos , Fumar/epidemiología , Cese del Hábito de Fumar/métodos , Industria del Tabaco , Uso de Tabaco/prevención & control , Dispositivos para Dejar de Fumar Tabaco/efectos adversos , Dispositivos para Dejar de Fumar Tabaco/estadística & datos numéricos , Estados Unidos/epidemiología , United States Food and Drug AdministrationRESUMEN
RATIONALE: Severe sepsis and septic shock are leading causes of intensive care unit (ICU) admission, morbidity, and mortality. The effect of compliance with sepsis management guidelines on outcomes is unclear. OBJECTIVES: To assess the effect on mortality of compliance with a severe sepsis and septic shock management bundle. METHODS: Observational study of a severe sepsis and septic shock bundle as part of a quality improvement project in 18 ICUs in 11 hospitals in Utah and Idaho. MEASUREMENTS AND MAIN RESULTS: Among 4,329 adult subjects with severe sepsis or septic shock admitted to study ICUs from the emergency department between January 2004 and December 2010, hospital mortality was 12.1%, declining from 21.2% in 2004 to 8.7% in 2010. All-or-none total bundle compliance increased from 4.9-73.4% simultaneously. Mortality declined from 21.7% in 2004 to 9.7% in 2010 among subjects noncompliant with one or more bundle element. Regression models adjusting for age, severity of illness, and comorbidities identified an association between mortality and compliance with each of inotropes and red cell transfusions, glucocorticoids, and lung-protective ventilation. Compliance with early resuscitation elements during the first 3 hours after emergency department admission caused ineligibility, through lower subsequent severity of illness, for these later bundle elements. CONCLUSIONS: Total severe sepsis and septic shock bundle compliances increased substantially and were associated with a marked reduction in hospital mortality after adjustment for age, severity of illness, and comorbidities in a multicenter ICU cohort. Early resuscitation bundle element compliance predicted ineligibility for subsequent bundle elements.
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Adhesión a Directriz/estadística & datos numéricos , Sepsis/terapia , Choque Séptico/terapia , Anciano , Cardiotónicos/uso terapéutico , Transfusión de Eritrocitos/métodos , Transfusión de Eritrocitos/estadística & datos numéricos , Femenino , Glucocorticoides/uso terapéutico , Mortalidad Hospitalaria , Humanos , Idaho , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Respiración Artificial/estadística & datos numéricos , Resucitación/métodos , Resucitación/estadística & datos numéricos , Resultado del Tratamiento , UtahRESUMEN
Spermatogenesis is a complex process reliant upon interactions between germ cells (GC) and supporting somatic cells. Testicular Sertoli cells (SC) support GCs during maturation through physical attachment, the provision of nutrients, and protection from immunological attack. This role is facilitated by an active cytoskeleton of parallel microtubule arrays that permit transport of nutrients to GCs, as well as translocation of spermatids through the seminiferous epithelium during maturation. It is well established that chemical perturbation of SC microtubule remodelling leads to premature GC exfoliation demonstrating that microtubule remodelling is an essential component of male fertility, yet the genes responsible for this process remain unknown. Using a random ENU mutagenesis approach, we have identified a novel mouse line displaying male-specific infertility, due to a point mutation in the highly conserved ATPase domain of the novel KATANIN p60-related microtubule severing protein Katanin p60 subunit A-like1 (KATNAL1). We demonstrate that Katnal1 is expressed in testicular Sertoli cells (SC) from 15.5 days post-coitum (dpc) and that, consistent with chemical disruption models, loss of function of KATNAL1 leads to male-specific infertility through disruption of SC microtubule dynamics and premature exfoliation of spermatids from the seminiferous epithelium. The identification of KATNAL1 as an essential regulator of male fertility provides a significant novel entry point into advancing our understanding of how SC microtubule dynamics promotes male fertility. Such information will have resonance both for future treatment of male fertility and the development of non-hormonal male contraceptives.
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Adenosina Trifosfatasas/genética , Infertilidad Masculina/genética , Células de Sertoli , Espermatogénesis/genética , Adenosina Trifosfatasas/metabolismo , Animales , Línea Celular Tumoral , Mapeo Cromosómico , Expresión Génica , Células Germinativas/citología , Células Germinativas/metabolismo , Humanos , Katanina , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Mutantes , Microtúbulos/genética , Microtúbulos/metabolismo , Mutagénesis , Fenotipo , Polimorfismo de Nucleótido Simple , Epitelio Seminífero/metabolismo , Epitelio Seminífero/patología , Células de Sertoli/citología , Células de Sertoli/metabolismo , Espermátides/metabolismo , Espermátides/patologíaAsunto(s)
Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/etiología , Enfermedad Crónica/prevención & control , Estilo de Vida , Obesidad/complicaciones , Consumo de Bebidas Alcohólicas/efectos adversos , Índice de Masa Corporal , Grasas de la Dieta/administración & dosificación , Ejercicio Físico , Fatiga/prevención & control , Femenino , Humanos , Carne/efectos adversos , Posmenopausia , Calidad de Vida , Medición de Riesgo , Factores de Riesgo , Conducta de Reducción del Riesgo , Prevención Secundaria , Conducta Sedentaria , Sobrevivientes/psicología , Sobrevivientes/estadística & datos numéricos , Pérdida de PesoRESUMEN
This qualitative study explores African American clergy's perspectives on pastoral care and pastoral counseling. Interviews were conducted with 18 African American clergy of diverse ages, locales, and educational levels who were recruited from a southern state. Two major themes emerged from the data: (a) Shepherding the Flock and (b) Distinguishable Concepts with Different Meaning and Functions. Implications for social work practice and research are addressed.
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Actitud , Negro o Afroamericano , Clero , Cuidado Pastoral , Servicio Social , Adulto , Anciano , Humanos , Kentucky , Masculino , Persona de Mediana Edad , Rol Profesional , Protestantismo , Investigación Cualitativa , Derivación y ConsultaAsunto(s)
Neuroblastoma/diagnóstico , Neuroblastoma/terapia , Factores de Edad , Antineoplásicos/uso terapéutico , Vacunas contra el Cáncer/uso terapéutico , Niño , Ensayos Clínicos como Asunto , Terapia Combinada , Humanos , Neuroblastoma/tratamiento farmacológico , Neuroblastoma/epidemiología , Neuroblastoma/genética , Neuroblastoma/inmunología , Neuroblastoma/patología , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Tasa de Supervivencia , Estados Unidos/epidemiologíaAsunto(s)
Anticarcinógenos/uso terapéutico , Inhibidores de la Aromatasa/uso terapéutico , Neoplasias de la Mama/genética , Neoplasias de la Mama/prevención & control , Difosfonatos/uso terapéutico , Heterocigoto , Moduladores Selectivos de los Receptores de Estrógeno/uso terapéutico , Anticarcinógenos/farmacología , Ensayos Clínicos como Asunto , Femenino , Genes BRCA1 , Genes BRCA2 , Humanos , Mastectomía , Mutación , Ovariectomía , Poli(ADP-Ribosa) Polimerasa-1 , Inhibidores de Poli(ADP-Ribosa) Polimerasas , Clorhidrato de Raloxifeno/uso terapéutico , Medición de Riesgo , Factores de Riesgo , Tamoxifeno/uso terapéuticoRESUMEN
AIMS: The vascular type of Ehlers-Danlos syndrome (EDS IV) is an autosomal-dominant disorder characterized by thin translucent skin and extensive bruising. Patients with EDS IV have reduced life expectancy (median 45-50 years) due to spontaneous rupture of arteries (particularly large arteries) or bowel. EDS IV results from mutation of the COL3A1 gene, which encodes the pro-α(1) chains of type III collagen that is secreted into the extracellular matrix, e.g. by smooth muscle cells. A mouse model of EDS IV produced by targeted ablation of Col3a1 has been of limited use as only 10% of homozygous animals survive to adulthood, whereas heterozygous animals do not die from arterial rupture. We report a novel, exploitable model of EDS IV in a spontaneously generated mouse line. METHODS AND RESULTS: Mice were identified by predisposition to sudden, unexpected death from dissection of the thoracic aorta. Aortic dissection inheritance was autosomal-dominant, presented at an early age (median, 6 weeks) with incomplete penetrance, and had a similar sex ratio bias as EDS IV (2:1, male:female). Molecular genetic analysis demonstrated that the causal mutation is a spontaneous 185 kb deletion, including the promoter region and exons 1-39, of the Col3a1 gene. As in EDS IV, aortic dissection was not associated with elevated blood pressure, aneurysm formation, or infection, but may result from aberrant collagen fibrillogenesis within the aortic wall. CONCLUSION: This novel, exploitable mouse line that faithfully models the vascular aspects of human EDS IV provides an important new tool for advancing understanding of EDS IV and of aortic dissection in general.