Midfoot Amputations as Adjuncts to Limb Preservation.

Midfoot amputations are viable options for limb preservation in cases of forefoot infection, diabetic ulcers, critical limb ischemia, trauma, or malignancy to avoid major lower-extremity amputation. Each level of midfoot amputation has limitations to consider including wound healing problems, soft-tissue contracture, or need for revisional amputations. However, some of these facets can be addressed perioperatively. Each midfoot amputation has benefits as viable options for limb and functional preservation and to avoid major limb amputation. There currently is no set guideline for level of midfoot amputation in patients with critical limb ischemia. Levels of amputation are determined by multiple factors including but not limited to degree of tissue loss, vascular status, the ability to preserve function, surgeon experience, and pertinent patient factors. This approach to limb salvage is best performed from a multi-disciplinary perspective.

Am I a good person? Academic correlates of explicit and implicit self-esteem during early childhood.

Implicit and explicit self-esteem are not commonly measured in the same children. Using a cross-sectional design, data from 354 Croatian children (184 girls) in Grade 1 (Mage = 7.55 years) and Grade 5 (Mage = 11.58 years) were collected in Spring 2019. All children completed explicit and implicit self-esteem measures; math and language grades were obtained. For the explicit measure, older children showed lower self-esteem than younger children, and girls showed lower self-esteem than boys. For the implicit measure, there were no age effects, and girls showed higher self-esteem than boys. Although both types of self-esteem were positively associated with academic achievement, implicit self-esteem was associated more strongly with language than with math achievement. Discussion is provided about why self-esteem relates to academic achievement during childhood.

Predictors of Time Spent in Special Education Among Students With Severe-to-Profound Hearing Loss.

OBJECTIVE: Determine if students with severe-to-profound hearing loss with cochlear implants (CIs) mainstream (transition to general education) more than students with hearing amplification at the population level. STUDY DESIGN: Cross-sectional secondary analysis of data from the National Center of Education Statistics. SETTING: Special education (SpEd) students in the United States who had severe to profound "hearing impairment" and were 6 to 16 years old at enrollment from 2000 to 2001. METHODS: We weighted the data to produce national estimates, performed multiple imputations for missingness, and built a multivariate linear regression model, which was cross-validated with a multivariate Poisson regression model. We used a theory-based approach to model-building using a directed acyclic graph to identify the minimally sufficient adjustment set of variables, which included school district urbanicity, student's age when they started SpEd, other disabilities, home language, and caregiver education. RESULTS: We identified 7267 students with CIs and 28,794 students with hearing amplification. CI users mainstreamed more than peers using hearing amplification during secondary school (40.29% less daily time in special education, p = .004) but not during primary school (9.19% less daily time in SpEd, p = .155). Additional significant predictors of mainstreaming varied between the primary and secondary school cohorts and included school district urbanicity and the student's age when they started SpEd. CONCLUSION: CI status predicts daily time spent in SpEd among a secondary school cohort. These findings do not establish causation. The National Center of Education Statistics should consider linking to clinical databases in future studies.

Sequential Prediction of Literacy Achievement for Specific Learning Disabilities Contrasting in Impaired Levels of Language in Grades 4 to 9.

Sequential regression was used to evaluate whether language-related working memory components uniquely predict reading and writing achievement beyond cognitive-linguistic translation for students in Grades 4 through 9 ( N = 103) with specific learning disabilities (SLDs) in subword handwriting (dysgraphia, n = 25), word reading and spelling (dyslexia, n = 60), or oral and written language (oral and written language learning disabilities, n = 18). That is, SLDs are defined on the basis of cascading level of language impairment (subword, word, and syntax/text). A five-block regression model sequentially predicted literacy achievement from cognitive-linguistic translation (Block 1); working memory components for word-form coding (Block 2), phonological and orthographic loops (Block 3), and supervisory focused or switching attention (Block 4); and SLD groups (Block 5). Results showed that cognitive-linguistic translation explained an average of 27% and 15% of the variance in reading and writing achievement, respectively, but working memory components explained an additional 39% and 27% of variance. Orthographic word-form coding uniquely predicted nearly every measure, whereas attention switching uniquely predicted only reading. Finally, differences in reading and writing persisted between dyslexia and dysgraphia, with dysgraphia higher, even after controlling for Block 1 to 4 predictors. Differences in literacy achievement between students with dyslexia and oral and written language learning disabilities were largely explained by the Block 1 predictors. Applications to identifying and teaching students with these SLDs are discussed.

Mothers With Perceived Insufficient Milk: Preliminary Evidence of Home Interventions to Boost Mother-Infant Interactions.

Perceived insufficient milk (PIM) is the primary reason for breastfeeding discontinuation globally. This study evaluated the short-term impact of mother-infant interactions through home interventions designed to overcome PIM as a result of the infant's behavior, delivered to 14 dyads of breastfeeding mothers and their full-term singleton infants. A single group, three-occasion prepost design was used. Mother-infant interactions were measured by the Nursing Child Assessment Feeding Scale (NCAFS) at 6, 13, and 27 days postpartum. There were significantly increased mother-infant interactions during intervention. Specifically, significant growth over the intervention occurred for mother's sensitivity to cues, cognitive growth fostering, infant's clarity of cues, and responsiveness to caregiver. The NCAFS total score was also significantly improved. Although modifications are required, the three home intervention sessions showed promise in improving mother-infant interactions during breastfeeding. Further investigation using a randomized experimental design is warranted.

Checking Equity: Why Differential Item Functioning Analysis Should Be a Routine Part of Developing Conceptual Assessments.

We provide a tutorial on differential item functioning (DIF) analysis, an analytic method useful for identifying potentially biased items in assessments. After explaining a number of methodological approaches, we test for gender bias in two scenarios that demonstrate why DIF analysis is crucial for developing assessments, particularly because simply comparing two groups' total scores can lead to incorrect conclusions about test fairness. First, a significant difference between groups on total scores can exist even when items are not biased, as we illustrate with data collected during the validation of the Homeostasis Concept Inventory. Second, item bias can exist even when the two groups have exactly the same distribution of total scores, as we illustrate with a simulated data set. We also present a brief overview of how DIF analysis has been used in the biology education literature to illustrate the way DIF items need to be reevaluated by content experts to determine whether they should be revised or removed from the assessment. Finally, we conclude by arguing that DIF analysis should be used routinely to evaluate items in developing conceptual assessments. These steps will ensure more equitable-and therefore more valid-scores from conceptual assessments.

Pilot test of a home-based program to prevent perceived insufficient milk.

PROBLEM: Although the World Health Organization and American Academy of Pediatrics recommend exclusive breastfeeding for the first six months, only 22% of U.S. mothers do so. Mothers' perceived insufficient milk (PIM) is the primary reason for breastfeeding discontinuation globally. There are two changeable causes of PIM: (1) mothers' misinterpretation of their infant's behavior, and (2) mothers' lack of confidence in their ability to breastfeed. AIM: The purpose of this study was to evaluate the short-term effect of a home-based intervention designed to prevent and/or reduce PIM. METHODS: A mixed-methods, single-group, pretest-midtest-posttest design was used for evaluating a home-based breastfeeding program. The program was implemented during three 1.0- to 1.5-h home intervention sessions at 6, 13, and 27 days postpartum, delivered to 14 dyads of breastfeeding mothers and their full-term singleton infants. FINDINGS: We found significant increases over time in mothers' sensitivity to infant behavior and breastfeeding self-efficacy as well as significant decreased attribution of infant crying to PIM. Exit interviews indicated that the program was accepted by participating mothers. DISCUSSION: This is the first intervention study that has directly targeted the causes of PIM. The home-based intervention has the potential to add to maternal competencies both in correctly assessing their infants' behavior, thereby preventing erroneous attribution of infant behavior to PIM, as well as simultaneously bolstering maternal confidence in breastfeeding skills. CONCLUSION: By building maternal competencies, the home-based intervention has a longer-range potential to prevent breastfeeding discontinuation. Further evaluation is warranted.

Effects of Emergent Literacy Interventions for Preschoolers With Autism Spectrum Disorder.

Combining data from a series of three planned, consecutive independent randomized controlled trials (RCTs), the present study investigates two literacy interventions for preschool children with autism spectrum disorder (ASD). For the first cohort, children were randomized to interactive book reading treatment (IBR)or a business-as-usual (BAU) control condition; in Cohort 2, children were randomized to phonological awareness treatment (PA)or BAU; in Cohort 3, children were randomized to IBR or PA. Both treatments were implemented weekly in the classroom from November to May. Combined across cohorts, data from n =47 IBR, n =42 PA, and n =44 BAU students from 57 classrooms in 8 districts were available for analysis. Model results showed that IBR had significantly greater pretest-posttest gains than the sample mean on expressive vocabulary and listening comprehension (d*=0.29 and 0.30), whereas PA had significantly greater phonological awareness gains (d*=0.39).

Interventions that Enhance Breastfeeding Initiation, Duration, and Exclusivity: A Systematic Review.

OBJECTIVE: The purpose of this review was to evaluate breastfeeding interventions trialed to date and recommend directions for future needs in breastfeeding research. METHODS: A literature review was conducted using PubMed, CINAHL Plus, and PsycINFO databases to identify studies that evaluated efficacy or effectiveness of breastfeeding interventions on breastfeeding initiation, duration, or exclusivity as a primary, secondary, or tertiary outcome. Combinations of search terms included breastfeeding, feeding behavior, prenatal/patient education, health promotion, social support, perinatal/prenatal/intrapartum/postnatal care, and postpartum period. RESULTS: Six studies were included in this review, using PRISMA guidelines. Acquisition of knowledge and skills, emotional support by healthcare providers, and self-efficacy over maternal confidence in her ability to breastfeed were factors the intervention studies relied on to affect breastfeeding practices. Although these factors were addressed in the studies, breastfeeding mothers had difficulty transferring what they gained from interventions into their real-life breastfeeding practices as evidenced by the highest drop-off rate of exclusive breastfeeding in the early postpartum. CONCLUSIONS: There were conceptual limitations to the reviewed studies: (1) lack of understanding of maternal perception of infant behavior and (2) perceived insufficient milk as a remaining primary reason for breastfeeding discontinuation. There were methodological limitations: (1) lack of theory-based interventions and (2) lack of intervention fidelity. Future studies involving breastfeeding should focus on the causes of the problems driven by theory-based interventions integrated with intervention fidelity.

Contributions of Morphological Skill to Children's Essay Writing.

Morphological skills have previously been found to reliably predict reading skill, including word reading, vocabulary, and comprehension. However, less is known about how morphological skills might contribute to writing skill, aside from its well-documented role in the development of spelling. This correlational study examines whether morphological skill, as measured by a sentence generation task tapping both derivational morphology and meta-syntactic skills, predicts performance on a standardized essay writing task for fifth- and eighth-grade U.S. students (N = 233), after controlling for grade level, comprehension, and writing fluency. Multilevel analyses indicated that morphological skill and writing fluency were each uniquely predictive of essay quality, and this finding was consistent regardless of whether accurate spelling was required in the morphological task. Our results suggest that morphological skills play an important role in writing, as has been previously documented in reading and spelling.

Immunosenescence and pneumococcal disease: an imbalance in host-pathogen interactions.

Respiratory infections are among the most important causes of morbidity and mortality from infectious diseases worldwide. The most common causative bacterium, Streptococcus pneumoniae, frequently colonises the upper respiratory tract, where it resides mostly asymptomatically. Occasionally, however, S pneumoniae can cause severe disease such as pneumonia. Local host immunity is essential to control colonising pathogens by preventing overgrowth, spread, and invasion. However, age-related immune deficits in elderly people, known as immunosenescence, might contribute to increased disease burden. We review present knowledge about immunosenescence in the respiratory tract against Gram-positive bacteria, particularly S pneumoniae. We discuss the possible underdetection of pneumococcal colonisation in elderly people, and suggest changes to present surveillance methods to improve understanding of the relation between colonisation and disease. We conclude that present knowledge about alteration of host-pathogen interactions by immunosenescence in the respiratory tract is insufficient, and that research is needed to enable improved measures for prevention.

Bioinformatics education in high school: implications for promoting science, technology, engineering, and mathematics careers.

We investigated the effects of our Bio-ITEST teacher professional development model and bioinformatics curricula on cognitive traits (awareness, engagement, self-efficacy, and relevance) in high school teachers and students that are known to accompany a developing interest in science, technology, engineering, and mathematics (STEM) careers. The program included best practices in adult education and diverse resources to empower teachers to integrate STEM career information into their classrooms. The introductory unit, Using Bioinformatics: Genetic Testing, uses bioinformatics to teach basic concepts in genetics and molecular biology, and the advanced unit, Using Bioinformatics: Genetic Research, utilizes bioinformatics to study evolution and support student research with DNA barcoding. Pre-post surveys demonstrated significant growth (n = 24) among teachers in their preparation to teach the curricula and infuse career awareness into their classes, and these gains were sustained through the end of the academic year. Introductory unit students (n = 289) showed significant gains in awareness, relevance, and self-efficacy. While these students did not show significant gains in engagement, advanced unit students (n = 41) showed gains in all four cognitive areas. Lessons learned during Bio-ITEST are explored in the context of recommendations for other programs that wish to increase student interest in STEM careers.

Effectiveness of paraeducator-supplemented individual instruction: beyond basic decoding skills.

A total of 46 children in Grades 2 and 3 with low word-level skills were randomly assigned to 1 of 2 groups that received supplemental phonics-based reading instruction. One group received intervention October through March (21.5 hours), and one group served as a control from October through March and later received intervention March through May (17.5 hours). Paraeducators trained in a standard treatment protocol provided individual instruction for 30 min per day, 4 days per week. At the March posttest, the early treatment (ET; n = 23) group outperformed the controls (late treatment, LT; n = 20) on reading accuracy and passage fluency. Across both groups, second graders outperformed third graders on these same measures. At the 3-month follow-up, the ET group showed no evidence of decline in reading accuracy, passage fluency, or words spelled; however, 3rd-grade ET students had significantly higher spelling skills compared to 2nd graders. The LT group demonstrated significant growth during their intervention in reading accuracy and spelling, but not passage fluency. When we compared the ET and LT groups on their gains per instructional hour, we found that the ET group made significantly greater gains than the LT group across all 3 measures. The results support the value of paraeducator-supplemented reading instruction for students below grade level in word identification and reading fluency.

Relative effectiveness of reading practice or word-level instruction in supplemental tutoring: how text matters.

In this quasi-experimental study, which is part of a series of investigations on supplemental reading tutoring variations, the relative effectiveness of more intense decoding instruction or text reading practice was examined. Fifty-seven first-grade students scoring in the lowest quartile for reading skills received either classroom reading instruction or one of two treatments: tutoring in word study with text reading practice, or word study tutoring alone. Individual instruction was provided by trained paraprofessional tutors. At the end of first grade, treatment students significantly outperformed their nontutored peers on measures of reading accuracy, reading comprehension, reading efficiency, passage reading fluency, and spelling. Differential treatment effects on passage reading fluency are examined, taking into consideration pretest skill levels and text reading practice characteristics.