Evaluating a gated screening approach for identifying risk in kindergarten mathematics.

The purpose of the present study was to examine the diagnostic accuracy of different universal screening approaches for identifying mathematics difficulties in kindergarteners. We used extant data from 2,010 kindergarten students from 23 schools across two states. First, we identified the diagnostic accuracy of two individual screeners: (a) a set of three curriculum-based measures (CBM) and (b) a diagnostic measure, the Number Sense Brief (NSB). Then, we determined the diagnostic accuracy of a gated screening approach considering both the CBM and NSB. The criterion measure was a norm-referenced mathematics achievement test. The results indicated that area under the curve values met or exceeded .80 for both individual screeners; however, the number of false positives was high. The gated screening approach yielded fewer false positives at the expense of increasing false negatives. Directions for future research and the practical implications of the results for screening in kindergarten mathematics are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Management of syncope in the Emergency Department: a European prospective cohort study (SEED).

BACKGROUND AND IMPORTANCE: In 2018, the European Society of Cardiology (ESC) produced syncope guidelines that for the first-time incorporated Emergency Department (ED) management. However, very little is known about the characteristics and management of this patient group across Europe. OBJECTIVES: To examine the prevalence, clinical presentation, assessment, investigation (ECG and laboratory testing), management and ESC and Canadian Syncope Risk Score (CSRS) categories of adult European ED patients presenting with transient loss of consciousness (TLOC, undifferentiated or suspected syncope). DESIGN: Prospective, multicentre, observational cohort study. SETTINGS AND PARTICIPANTS: Adults (≥18 years) presenting to European EDs with TLOC, either undifferentiated or thought to be of syncopal origin. MAIN RESULTS: Between 00:01 Monday, September 12th to 23:59 Sunday 25 September 2022, 952 patients presenting to 41 EDs in 14 European countries were enrolled from 98 301 ED presentations (n = 40 sites). Mean age (SD) was 60.7 (21.7) years and 487 participants were male (51.2%). In total, 379 (39.8%) were admitted to hospital and 573 (60.2%) were discharged. 271 (28.5%) were admitted to an observation unit first with 143 (52.8%) of these being admitted from this. 717 (75.3%) participants were high-risk according to ESC guidelines (and not suitable for discharge from ED) and 235 (24.7%) were low risk. Admission rate increased with increasing ESC high-risk factors; 1 ESC high-risk factor; n = 259 (27.2%, admission rate=34.7%), 2; 189 (19.9%; 38.6%), 3; 106 (11.1%, 54.7%, 4; 62 (6.5%, 60.4%), 5; 48 (5.0%, 67.9%, 6+; 53 (5.6%, 67.9%). Furthermore, 660 (69.3%), 250 (26.3%), 34 (3.5%) and 8 (0.8%) participants had a low, medium, high, and very high CSRS respectively with respective admission rates of 31.4%, 56.0%, 76.5% and 75.0%. Admission rates (19.3-88.9%), use of an observation/decision unit (0-100%), and percentage high-risk (64.8-88.9%) varies widely between countries. CONCLUSION: This European prospective cohort study reported a 1% prevalence of syncope in the ED. 4 in 10 patients are admitted to hospital although there is wide variation between country in syncope management. Three-quarters of patients have ESC high-risk characteristics with admission percentage rising with increasing ESC high-risk factors.

Proficiency With Number Concepts and Operations: Replicating the Efficacy of a First-Grade Mathematics Intervention.

Conceptual replications are part and parcel of education science. Methodologically rigorous conceptual replication studies permit researchers to test and strengthen the generalizability of a study's initial findings. The current conceptual replication sought to replicate the efficacy of a small-group, first-grade mathematics intervention with 240 first-grade students with mathematics difficulties in a new geographical region. Participating students were randomized into one of three conditions: (a) 2:1 mathematics intervention group, (b) 5:1 mathematics intervention group, or (c) business-as-usual instruction. Relative to the original study, findings from the replication varied. When comparing the treatment groups to the control, results suggested positive effects on all outcome measures, including a follow-up assessment administered one year later. However, differences between the two treatment groups based on group size were not found in the mathematics outcome measures. Both groups also received commensurate levels of observed instructional interactions. Implications for unpacking contextual differences between original research and their replications as well as using future research to explore the quantity and quality of instructional interactions as ways to explain variation in findings of group size are discussed.

Online Patient-Reported Outcome Measure Engagement Is Dependent on Demographics and Locality: Findings From an Observational Cohort.

OBJECTIVE: Online patient-reported outcome measures (PROMs) enable remote collection of perceptions of health status, function, and well-being. We aimed to explore patterns of PROM completion in patients with early inflammatory arthritis (EIA) recruited to the National Early Inflammatory Arthritis Audit (NEIAA). METHODS: NEIAA is an observational cohort study design; we included adults from this cohort with a new diagnosis of EIA from May 2018 to March 2020. The primary outcome was PROM completion at baseline, 3 months, and 12 months. Mixed effects logistic regression and spatial regression models were used to identify associations between demographics (age, gender, ethnicity, deprivation, smoking, and comorbidity), clinical commissioning groups, and PROM completion. RESULTS: Eleven thousand nine hundred eighty-six patients with EIA were included, of whom 5331 (44.5%) completed at least 1 PROM. Patients from ethnic minority backgrounds were less likely to return a PROM (adjusted odds ratio [aOR] 0.57, 95% CI 0.48-0.66). Greater deprivation (aOR 0.73, 95% CI 0.64-0.83), male gender (aOR 0.86, 95% CI 0.78-0.94), higher comorbidity burden (aOR 0.95, 95% CI 0.91-0.99), and current smoker status (aOR 0.73, 95% CI 0.64-0.82) also reduced odds of PROM completion. Spatial analysis identified 2 regions with high (North of England) and low (Southeast of England) PROM completion. CONCLUSION: We define key patient characteristics (including ethnicity) that influence PROM engagement using a national clinical audit. We observed an association between locality and PROM completion, with varying response rates across regions of England. Completion rates could benefit from targeted education for these groups.

Online non-technical skills faculty training.

BACKGROUND: The Medical Students Non-Technical Skills (Medi-StuNTS) system is a behavioural marker system (BMS) designed to identify and debrief non-technical skills (NTS) for medical students during immersive simulation. Educators must be adequately trained in using the BMS. This study aimed to design and implement an online platform to deliver a faculty development course on using Medi-StuNTS and evaluate the feasibility of this platform in training faculty to identify and debrief NTS. APPROACH: The online platform was developed by faculty with expertise in NTS, based on guidance for faculty training programme requirements and the multimodal model for online education. Content was arranged in modules, using presentations, videos of simulation scenarios and interactive discussion boards. EVALUATION: Fifteen participants completed the course and feedback over a two-month period. A feedback form was completed to assess feasibility, based on a feasibility framework. The areas of focus were acceptability, demand, implementation, practicality, adaptation, integration, expansion and limited efficacy. Feedback indicated that the course shows promise in improving the ability of faculty to identify and debrief NTS. IMPLICATIONS: The platform was successfully developed and implemented and was able to reach a national audience due to its online nature. Specific strengths include increased flexibility and accessibility compared to in-person training. Feasibility assessment suggests that this newly developed online platform can work as an effective method for faculty development in order to increase skills in identifying and debriefing NTS using Medi-StuNTS. Future work will focus on expansion of the online platform and dissemination to an international audience.

Examining Interactions Across Instructional Tiers: Do Features of Tier 1 Predict Student Responsiveness to Tier 2 Mathematics Intervention?

High-quality Tier 1 instruction is frequently conceptualized as the "foundation" for other tiers of intervention within multitiered systems of support (MTSS) models. However, the vast majority of Tier 2 intervention studies do not account for Tier 1 variables when examining intervention effectiveness. The purpose of this study was to examine Tier 1 predictors, or "quality indicators," of differential responsiveness to Tier 2 mathematics intervention. Data were drawn from a large-scale data set where all teachers taught the Early Learning in Mathematics (Tier 1) core program across the academic year, and a subset of students were selected for the ROOTS (Tier 2) mathematics intervention. We examined the following Tier 1 variables: (a) classroom-level mathematics gains, (b) Tier 1 fidelity of implementation, (c) Tier 1 classroom management and instructional support, and (d) class size. Response to Tier 2 intervention was not significantly predicted by any of the Tier 1 variables examined; however, the pattern of Hedges' g effect sizes suggested that students with higher quality of Tier 1 instruction tended to benefit less from the Tier 2 ROOTS intervention. Results are discussed in the context of implications for research and practice.

Can this data be saved? Techniques for high motion in resting state scans of first grade children.

Motion remains a significant technical hurdle in fMRI studies of young children. Our aim was to develop a straightforward and effective method for obtaining and preprocessing resting state data from a high-motion pediatric cohort. This approach combines real-time monitoring of head motion with a preprocessing pipeline that uses volume censoring and concatenation alongside independent component analysis based denoising. We evaluated this method using a sample of 108 first grade children (age 6-8) enrolled in a longitudinal study of math development. Data quality was assessed by analyzing the correlation between participant head motion and two key metrics for resting state data, temporal signal-to-noise and functional connectivity. These correlations should be minimal in the absence of noise-related artifacts. We compared these data quality indicators using several censoring thresholds to determine the necessary degree of censoring. Volume censoring was highly effective at removing motion-corrupted volumes and ICA denoising removed much of the remaining motion artifact. With the censoring threshold set to exclude volumes that exceeded a framewise displacement of 0.3 mm, preprocessed data met rigorous standards for data quality while retaining a large majority of subjects (83 % of participants). Overall, results show it is possible to obtain usable resting-state data despite extreme motion in a group of young, untrained subjects.

Sharpening, focusing, and developing: A study of change in nonsymbolic number comparison skills and math achievement in 1st grade.

Children's ability to discriminate nonsymbolic number (e.g., the number of items in a set) is a commonly studied predictor of later math skills. Number discrimination improves throughout development, but what drives this improvement is unclear. Competing theories suggest that it may be due to a sharpening numerical representation or an improved ability to pay attention to number and filter out non-numerical information. We investigate this issue by studying change in children's performance (N = 65) on a nonsymbolic number comparison task, where children decide which of two dot arrays has more dots, from the middle to the end of 1st grade (mean age at time 1 = 6.85 years old). In this task, visual properties of the dot arrays such as surface area are either congruent (the more numerous array has more surface area) or incongruent. Children rely more on executive functions during incongruent trials, so improvements in each congruency condition provide information about the underlying cognitive mechanisms. We found that accuracy rates increased similarly for both conditions, indicating a sharpening sense of numerical magnitude, not simply improved attention to the numerical task dimension. Symbolic number skills predicted change in congruent trials, but executive function did not predict change in either condition. No factor predicted change in math achievement. Together, these findings suggest that nonsymbolic number processing undergoes development related to existing symbolic number skills, development that appears not to be driving math gains during this period. Children's ability to discriminate nonsymbolic number improves throughout development. Competing theories suggest improvement due to sharpening magnitude representations or changes in attention and inhibition. The current study investigates change in nonsymbolic number comparison performance during first grade and whether symbolic number skills, math skills, or executive function predict change. Children's performance increased across visual control conditions (i.e., congruent or incongruent with number) suggesting an overall sharpening of number processing. Symbolic number skills predicted change in nonsymbolic number comparison performance.

Using Direct Observation to Document "Practice-Based Evidence" of Evidence-Based Mathematics Instruction.

Implementation of evidence-based practices (EBPs) is paramount to students' development of mathematics proficiency. This study investigated "practice-based evidence" of interventionists' actual use of explicit mathematics instruction, a well-established EBP. Specifically, this study analyzed direct observation data collected in a federally funded efficacy trial involving a Tier 2 first-grade mathematics intervention to examine whether the quantity and quality of explicit mathematics instruction was associated with the mathematics outcomes of 470 first-grade students with or at risk for mathematics learning disabilities. Associations between group-level pretreatment skill levels and the quality and quantity of explicit mathematics instructional practices used in the intervention were also explored. Findings suggested significant associations between positive gains in student mathematics outcomes and (a) lower rates of incorrectly answered mathematics-focused questions, and (b) the rate in which interventionists delivered group-level practice opportunities and offered academic feedback. Significant associations were also found between initial student mathematics performance and rates of student errors and the quality of explicit instruction. Implications for using direct observation to document enacted EBPs are discussed.

Kindergarteners at Risk for Severe Mathematics Difficulties: Investigating Tipping Points of Core Mathematics Instruction.

A concerning number of students enter kindergarten facing an intractable variation of mathematics difficulties (MD). This study investigated the impact of an explicit, core kindergarten mathematics program on the mathematical outcomes of kindergartners who demonstrated risk for severe MD at kindergarten entry and examined whether these students improved from a category of high MD risk (i.e., <10th percentile) to a lower risk of MD (i.e., norm-referenced performance at or above the 10th, 20th, 30th, and 40th percentiles) between the fall and spring of kindergarten. Differential response to the program based on the classroom-level proportion of students with severe MD was also explored. A total of 795 kindergarteners with severe MD from 122 classrooms were included in the analyses. Results suggested students with severe MD in treatment classrooms improved from fall to spring at a greater rate than their control peers. Treatment students also demonstrated higher rates of improvement from below the 10th percentile to a performance at or above the 20th, 30th, and 40th percentiles across the school year. No evidence of differential efficacy of the program by the classroom-level proportion of students with severe MD was found. Implications for using explicit mathematics programs to thwart the onset of severe MD among academically vulnerable students are discussed.

Exploring the utility of assessing early mathematics intervention response via embedded assessment.

The provision of high-quality early mathematics instruction and intervention is critical to ensure that all students are on track for academic success. Given this, identifying and utilizing assessments that can enable the detection of nonresponse to mathematics instruction is a critical aspect of early intervention. To this end, the current study explored the extent to which there were distinct patterns of performance on embedded assessments for intervention participants within the context of a large-scale randomized control trial of the ROOTS intervention. This study also examined how performance on embedded assessments was associated with pretest mathematics scores and residual gains on mathematics measures, and how those associations differed based on (a) the point in the intervention when students demonstrated difficulty, and (b) intervention intensity. Findings from this study suggest that participants fell into 4 distinct performance categories and performance classifications were associated with pretest measures and gains in mathematics achievement. Study results also highlight the potential relevance of instructional intensity and timely monitoring of student performance. Implications for intervention and instructional planning in the context of tiered instructional delivery models are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Fluidal pyroclasts reveal the intensity of peralkaline rhyolite pumice cone eruptions.

Peralkaline rhyolites are medium to low viscosity, volatile-rich magmas typically associated with rift zones and extensional settings. The dynamics of peralkaline rhyolite eruptions remain elusive with no direct observations recorded, significantly hindering the assessment of hazard and risk. Here we describe uniquely-preserved, fluidal-shaped pyroclasts found within pumice cone deposits at Aluto, a peralkaline rhyolite caldera in the Main Ethiopian Rift. We use a combination of field-observations, geochemistry, X-ray computed microtomography (XCT) and thermal-modelling to investigate how these pyroclasts are formed. We find that they deform during flight and, depending on size, quench prior to deposition or continue to inflate then quench in-situ. These findings reveal important characteristics of the eruptions that gave rise to them: that despite the relatively low viscosity of these magmas, and similarities to basaltic scoria-cone deposits, moderate to intense, unstable, eruption columns are developed; meaning that such eruptions can generate extensive tephra-fall and pyroclastic density currents.

Student Practice Opportunities in Core Mathematics Instruction: Exploring for a Goldilocks Effect for Kindergartners With Mathematics Difficulties.

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.

Examining the Impact of Group Size on the Treatment Intensity of a Tier 2 Mathematics Intervention Within a Systematic Framework of Replication.

Group size and treatment intensity are understudied topics in mathematics intervention research. This study examined whether the treatment intensity and overall intervention effects of an empirically validated Tier 2 mathematics intervention varied between intervention groups with 2:1 and 5:1 student-teacher ratios. Student practice opportunities and the quality of explicit instruction served as treatment intensity metrics. A total of 465 kindergarten students with mathematics difficulties from 136 intervention groups participated. Results suggested comparable performances between the 2:1 and 5:1 intervention groups on six outcome measures. Observation data indicated that student practice differed by group size. Students in the 5:1 groups received more opportunities to practice with their peers, while students in the 2:1 groups participated in more frequent and higher quality individualized practice opportunities. Implications in terms of delivering Tier 2 interventions in small-group formats and engaging at-risk learners in meaningful practice opportunities are discussed.

Investigating the incremental validity of cognitive variables in early mathematics screening.

The purpose of this study was to investigate the incremental validity of a set of domain general cognitive measures added to a traditional screening battery of early numeracy measures. The sample consisted of 458 kindergarten students of whom 285 were designated as severely at-risk for mathematics difficulty. Hierarchical multiple regression results indicated that Wechsler Abbreviated Scales of Intelligence (WASI) Matrix Reasoning and Vocabulary subtests, and Digit Span Forward and Backward measures explained a small, but unique portion of the variance in kindergarten students' mathematics performance on the Test of Early Mathematics Ability-Third Edition (TEMA-3) when controlling for Early Numeracy Curriculum Based Measurement (EN-CBM) screening measures (R² change = .01). Furthermore, the incremental validity of the domain general cognitive measures was relatively stronger for the severely at-risk sample. We discuss results from the study in light of instructional decision-making and note the findings do not justify adding domain general cognitive assessments to mathematics screening batteries. (PsycINFO Database Record

Management of bacterial postoperative endophthalmitis and the role of vitrectomy.

Management of postoperative bacterial endophthalmitis was explored in the Endophthalmitis Vitrectomy Study37 in 1995, which has underpinned the core protocols in treatment ever since. While surgical techniques have continued to evolve, little has changed in the overall clinical management as no further large randomized controlled trials have taken place. We review the literature addressing the incidence of endophthalmitis, pathogens, antibiotic therapies, and the role of vitrectomy. We suggest an update to management protocols based on available evidence. While vitreous culture remains the gold standard for diagnosis, new techniques allow bacterial identification after antibiotic administration, so injection should be initiated immediately. Current antibiotic regimes are comprehensive and do not need changing. Intravitreal antibiotics should not be repeated at 48 hours after initial treatment. Vitrectomy should be considered instead if the clinical picture is not improving.

Examining the Efficacy of a Tier 2 Kindergarten Mathematics Intervention.

This study examined the efficacy of a Tier 2 kindergarten mathematics intervention program, ROOTS, focused on developing whole number understanding for students at risk in mathematics. A total of 29 classrooms were randomly assigned to treatment (ROOTS) or control (standard district practices) conditions. Measures of mathematics achievement were collected at pretest and posttest. Treatment and control students did not differ on mathematics assessments at pretest. Gain scores of at-risk intervention students were significantly greater than those of control peers, and the gains of at-risk treatment students were greater than the gains of peers not at risk, effectively reducing the achievement gap. Implications for Tier 2 mathematics instruction in a response to intervention (RtI) model are discussed.

Do not attempt cardiopulmonary resuscitation (DNACPR) orders: a systematic review of the barriers and facilitators of decision-making and implementation.

UNLABELLED: Most people who die in hospital do so with a DNACPR order in place, these orders are the focus of considerable debate. AIM: To identify factors, facilitators and barriers involved in DNACPR decision-making and implementation. METHODS: All study designs and interventions were eligible for inclusion. Studies were appraised guided by CASP tools. A qualitative analysis was undertaken. DATA SOURCES: Included electronic databases: Medline, Embase, ASSIA, Cochrane library, CINAHL, PsycINFO, Web of Science, the King's Fund Library and scanning reference lists of included studies. RESULTS: Four key themes were identified: Considering the decision - by senior physicians, nursing staff, patients and relatives. Key triggers included older age, co-morbidities, adverse prognostic factors, quality of life and the likelihood of success of CPR. Discussing the decision - levels, and combinations, of physician and nursing skills, patient understanding and family involvement produced various outcomes. Implementing the decision - the lack of clear documentation resulted in a breakdown in communications within health teams. Staff knowledge and support of guidelines and local policies varied. Consequences of a DNACPR decision - inadequate understanding by staff resulted in suboptimal care, and incorrect withdrawal of treatment. CONCLUSION: Significant variability was identified in DNACPR decision-making and implementation. The evidence base is weak but the absence of evidence does not indicate an absence of good practice. Issues are complex, and dependent on a number of factors. Misunderstandings and poor discussions can be overcome such as with an overall care plan to facilitate discussions and reduce negative impact of DNACPR orders on aspects of patient care.

Quantification of tissue shrinkage in canine small intestinal specimens after resection and fixation.

The aim of this study was to quantify the longitudinal shrinkage of canine small intestinal specimens after resection and fixation in 10% formalin. Samples were obtained from 12 clinically normal dogs of medium to large breed via ventral midline coeliotomy and enterectomy. The length of each sample was measured before excision, immediately after excision, and after 24 h in 10% formalin. The results were interpreted with the use of single-sample t-tests of the average changes; P-values of less than 0.01 were considered significant. The samples indicated a significant decrease in length after resection and fixation. The mean shrinkage from the pre-excision state was 28.3% immediately after excision (P < 0.0001) and 26.3% after 24 h of fixation (P < 0.0001). There was a small but not significant increase in the length of the specimens between the 2nd and 3rd measurement points. Quantification of the longitudinal shrinkage of resected intestinal specimens may improve interpretation of the distance of surgical margins from abnormal tissue in histopathology reports and allow investigation of the margins required for the clearance of specific tumors.

L'objectif de la présente étude était de quantifier le rétrécissement longitudinal de spécimens de petit intestin de chiens après résection et fixation dans de la formaline 10 %. Des échantillons ont été obtenus de 12 chiens cliniquement normaux de race moyenne à large via entérectomie et céliotomie via la ligne blanche ventrale. La longueur de chaque échantillon a été mesurée avant excision, immédiatement après l'excision, et après 24 h dans 10 % de formaline. Les résultats des changements moyens ont été interprétés au moyen de test de t pour échantillon unique; les valeurs de P inférieures à 0,01 étaient considérées significatives. Les échantillons ont montré une diminution significative de leur longueur après la résection et la fixation. Le rétrécissement moyen par rapport à l'état pré-excision était de 28,3 % immédiatement après l'excision (P < 0,0001) et 26,3 % après 24 h de fixation (P < 0,0001). Il y avait une légère, mais non significative, augmentation de la longueur des spécimens entre la 2e et la 3e mesure. La quantification du rétrécissement longitudinal des spécimens d'intestin réséqués pourrait améliorer l'interprétation de la distance des marges chirurgicales de tissus anormaux dans les rapports d'histopathologie et permettre l'étude des marges requises pour l'enlèvement de tumeurs spécifiques.(Traduit par Docteur Serge Messier).