An exploration of the relationship between phonological and phonics knowledge, and self-efficacy for teaching.

The purpose of the present study was to survey trainee teachers to find out if there was a relationship between phonological and phonics content knowledge, perceived proficiency in this knowledge, and feelings of self-efficacy as teachers. Participants were 51 undergraduate international teacher trainees from Malaysia studying in a 4-year university program to teach English as another language. They completed a phonological and phonics knowledge survey as well as a short questionnaire relating to self-efficacy for teaching. The survey results showed, similar to previous studies of the linguistic knowledge of teachers and teacher trainees, difficulties with phonological and phonics knowledge. Students who thought they were proficient in phonological and phonics knowledge were higher in phonological knowledge but not in phonics scores than were students who thought they were less proficient. The results for teaching self-efficacy showed that students with higher phonological knowledge had higher levels of external teaching self-efficacy in that they tended to disagree that factors outside their control made it difficult for some pupils to succeed. This suggests that higher levels of phonological knowledge gives prospective teachers more self-belief in their ability to help all their pupils.

Integrated care as a means to improve primary care delivery for adults and adolescents in the developing world: a critical analysis of Integrated Management of Adolescent and Adult Illness (IMAI).

BACKGROUND: More than three decades after the 1978 Declaration of Alma-Ata enshrined the goal of 'health for all', high-quality primary care services remain undelivered to the great majority of the world's poor. This failure to effectively reach the most vulnerable populations has been, in part, a failure to develop and implement appropriate and effective primary care delivery models. This paper examines a root cause of these failures, namely that the inability to achieve clear and practical consensus around the scope and aims of primary care may be contributing to ongoing operational inertia. The present work also examines integrated models of care as a strategy to move beyond conceptual dissonance in primary care and toward implementation. Finally, this paper examines the strengths and weaknesses of a particular model, the World Health Organization's Integrated Management of Adolescent and Adult Illness (IMAI), and its potential as a guidepost toward improving the quality of primary care delivery in poor settings. DISCUSSION: Integration and integrated care may be an important approach in establishing a new paradigm of primary care delivery, though overall, current evidence is mixed. However, a number of successful specific examples illustrate the potential for clinical and service integration to positively impact patient care in primary care settings. One example deserving of further examination is the IMAI, developed by the World Health Organization as an operational model that integrates discrete vertical interventions into a comprehensive delivery system encompassing triage and screening, basic acute and chronic disease care, basic prevention and treatment services, and follow-up and referral guidelines. IMAI is an integrated model delivered at a single point-of-care using a standard approach to each patient based on the universal patient history and physical examination. The evidence base on IMAI is currently weak, but whether or not IMAI itself ultimately proves useful in advancing primary care delivery, it is these principles that should serve as the basis for developing a standard of integrated primary care delivery for adults and adolescents that can serve as the foundation for ongoing quality improvement. SUMMARY: As integrated primary care is the standard of care in the developed world, so too must we move toward implementing integrated models of primary care delivery in poorer settings. Models such as IMAI are an important first step in this evolution. A robust and sustained commitment to innovation, research and quality improvement will be required if integrated primary care delivery is to become a reality in developing world.

Cost of inaction: a framework to estimate the economic cost of missing a patient with tuberculosis in the Indian context.

OBJECTIVES: To estimate the economic impact of failure to find and treat tuberculosis disease and prevent tuberculosis infection from progressing to active disease. DESIGN: Estimating the economic cost of not finding and treating a patient suffering from tuberculosis. SETTING: Estimation methodology is developed in the Indian context, as informed by local costs and reported tuberculosis epidemiology. PARTICIPANTS: No individual participants were included. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure is the total cost of patients with drug-susceptible and drug-resistant tuberculosis who are and are not found and treated by tuberculosis programmes, including costs for medications, lost productivity, healthcare services and furthered transmission. We calculate the economic burdens by varying the number of individuals a person sick with tuberculosis infects (10 or 15 people) and the risk of progression to tuberculosis disease if infected (5 or 8%). The secondary outcome measure is the amount saved by finding a patient early or who would not have otherwise been found. All costs are presented in US dollars (exchange rate: 72 Indian rupees/1 US$). RESULTS: By finding and treating a patient early before furthered transmission occurs-or stopping progression of tuberculosis infection to tuberculosis disease with preventive therapy-the Indian health system can save US$5502 to US$15 825 and US$5846 to US$25 575, for each individual with drug-susceptible and drug-resistant tuberculosis, respectively, across scenarios. CONCLUSIONS: These estimates provide crude, lower bounds for the potential costs of not appropriately diagnosing and treating a single patient with active tuberculosis in a timely manner, or preventing a patient with tuberculosis infection from progressing to active disease. The actual financial burden on society is far higher than estimated using this simple, short-term cost-effective analyses. Our results highlight the limitations of tuberculosis costing models to date, and demonstrate the importance of accounting for airborne transmission of tuberculosis.

A costing framework to compare tuberculosis infection tests.

OBJECTIVE: To develop a framework to estimate the practical costs incurred from, and programmatic impact related to, tuberculosis (TB) infection testing-tuberculin skin tests (TST) versus interferon gamma release assay (IGRA)-in a densely populated high-burden TB area. METHODS: We developed a seven-step framework that can be tailored to individual TB programmes seeking to compare TB infection (TBI) diagnostics to inform decision-making. We present methodology to estimate (1) the prevalence of TBI, (2) true and false positives and negatives for each test, (3) the cost of test administration, (4) the cost of false negatives, (5) the cost of treating all that test positive, (6) the per-test cost incurred due to treatment and misdiagnosis and (7) the threshold at which laboratory infrastructure investments for IGRA are outweighed by system-wide savings incurred due to IGRA utilisation. We then applied this framework in a densely populated, peri-urban district in Lima, Peru with high rates of Bacillus Calmette-Guérin (BCG) vaccination. FINDINGS: The lower sensitivity of TST compared with IGRA is a major cost driver, leading to health system and societal costs due to misdiagnosis. Additionally, patient and staff productivity costs were greater for TST because it requires two patient visits compared with only one for IGRA testing. When the framework was applied to the Lima setting, we estimate that IGRA-associated benefits outweigh infrastructural costs after performing 672 tests. CONCLUSIONS: Given global shortages of TST and concerns about costs of IGRA testing and laboratory capacity building, this costing framework can provide public health officials and TB programmes guidance for decision-making about TBI testing locally. This framework was designed to be adaptable for use in different settings with available data. Diagnostics that increase accuracy or mitigate time to treatment should be thought of as an investment instead of an expenditure.

ROAD: The Road Event Awareness Dataset for Autonomous Driving.

Humans drive in a holistic fashion which entails, in particular, understanding dynamic road events and their evolution. Injecting these capabilities in autonomous vehicles can thus take situational awareness and decision making closer to human-level performance. To this purpose, we introduce the ROad event Awareness Dataset (ROAD) for Autonomous Driving, to our knowledge the first of its kind. ROAD is designed to test an autonomous vehicle's ability to detect road events, defined as triplets composed by an active agent, the action(s) it performs and the corresponding scene locations. ROAD comprises videos originally from the Oxford RobotCar Dataset, annotated with bounding boxes showing the location in the image plane of each road event. We benchmark various detection tasks, proposing as a baseline a new incremental algorithm for online road event awareness termed 3D-RetinaNet. We also report the performance on the ROAD tasks of Slowfast and YOLOv5 detectors, as well as that of the winners of the ICCV2021 ROAD challenge, which highlight the challenges faced by situation awareness in autonomous driving. ROAD is designed to allow scholars to investigate exciting tasks such as complex (road) activity detection, future event anticipation and continual learning. The dataset is available at https://github.com/gurkirt/road-dataset; the baseline can be found at https://github.com/gurkirt/3D-RetinaNet.

The Expression and Function of Metastases Associated Lung Adenocarcinoma Transcript-1 Long Non-Coding RNA in Subchondral Bone and Osteoblasts from Patients with Osteoarthritis.

Metastasis Associated Lung Adenocarcinoma Transcript-1 (MALAT1) is implicated in regulating the inflammatory response and in the pathology of several chronic inflammatory diseases, including osteoarthritis (OA). The purpose of this study was to examine the relationship between OA subchondral bone expression of MALAT1 with parameters of joint health and biomarkers of joint inflammation, and to determine its functional role in human OA osteoblasts. Subchondral bone and blood were collected from hip and knee OA patients (n = 17) and bone only from neck of femur fracture patients (n = 6) undergoing joint replacement surgery. Cytokines were determined by multiplex assays and ELISA, and gene expression by qPCR. MALAT1 loss of function was performed in OA patient osteoblasts using locked nucleic acids. The osteoblast transcriptome was analysed by RNASeq and pathway analysis. Bone expression of MALAT1 positively correlated to serum DKK1 and galectin-1 concentrations, and in OA patient osteoblasts was induced in response to IL-1ß stimulation. Osteoblasts depleted of MALAT1 exhibited differential expression (>1.5 fold change) of 155 genes, including PTGS2. Both basal and IL-1ß-mediated PGE2 secretion was greater in MALAT1 depleted osteoblasts. The induction of MALAT1 in human OA osteoblasts upon inflammatory challenge and its modulation of PGE2 production suggests that MALAT1 may play a role in regulating inflammation in OA subchondral bone.

Closing delivery gaps in the treatment of tuberculosis infection: Lessons from implementation research in Peru.

BACKGROUND: Targeted testing and treatment of TB infection to prevent disease is a pillar of TB elimination. Despite recent global commitments to greatly expand access to preventive treatment for TB infection, there remains a lack of research on how best to expand preventive treatment programs in settings with high TB burdens. METHODS: We conducted implementation research in Lima, Peru, around a multifaceted intervention to deliver TB preventive treatment to close contacts of all ages, health care workers, and people in congregate settings. Key interventions included use of the interferon gamma release assay (IGRA), specialist support for generalist physicians at primary-level health facilities, and treatment support by community health workers. We applied a convergent mixed methods approach to evaluate feasibility and acceptability based on a care cascade framework. FINDINGS: During April 2019-January 2020, we enrolled 1,002 household contacts, 148 non-household contacts, 107 residents and staff of congregate settings, and 357 health care workers. Cumulative completion of the TB preventive care cascade was 34% for contacts <5 years old, 28% for contacts 5-19 years old, 18% for contacts ≥20 years old, 0% for people in congregate settings, and 4% of health care workers. IGRA testing was acceptable to adults exposed to TB. Preventive treatment was acceptable to contacts, but less acceptable to physicians, who frequently had doubts about prescribing preventive treatment for adults. Community-based treatment support was both acceptable and feasible, and periodic home-visits or calls were identified as facilitators of adherence. CONCLUSIONS: We attempted to close the gap in TB preventive treatment in Peru by expanding preventive services to adult contacts and other risk groups. While suboptimal, care cascade completion for adult contacts was consistent with what has been observed in high-income settings. The major losses in the care cascade occurred in completing evaluations and having doctors prescribe preventive treatment.

Identifying barriers and facilitators to implementation of community-based tuberculosis active case finding with mobile X-ray units in Lima, Peru: a RE-AIM evaluation.

OBJECTIVES: Identify barriers and facilitators to integrating community tuberculosis screening with mobile X-ray units into a health system. METHODS: Reach, effectiveness, adoption, implementation and maintenance evaluation. SETTING: 3-district region of Lima, Peru. PARTICIPANTS: 63 899 people attended the mobile units from 7 February 2019 to 6 February 2020. INTERVENTIONS: Participants were screened by chest radiography, which was scored for abnormality by computer-aided detection. People with abnormal X-rays were evaluated clinically and by GeneXpert MTB/RIF (Xpert) sputum testing. People diagnosed with tuberculosis at the mobile unit were accompanied to health facilities for treatment initiation. PRIMARY AND SECONDARY OUTCOME MEASURES: Reach was defined as the percentage of the population of the three-district region that attended the mobile units. Effectiveness was defined as the change in tuberculosis case notifications over a historical baseline. Key implementation fidelity indicators were the percentages of people who had chest radiography performed, were evaluated clinically, had sputum samples collected, had valid Xpert results and initiated treatment. RESULTS: The intervention reached 6% of the target population and was associated with an 11% (95% CI 6 to 16) increase in quarterly case notifications, adjusting for the increasing trend in notifications over the previous 3 years. Implementation indicators for screening, sputum collection and Xpert testing procedures all exceeded 85%. Only 82% of people diagnosed with tuberculosis at the mobile units received treatment; people with negative or trace Xpert results were less likely to receive treatment. Suboptimal treatment initiation was driven by health facility doctors' lack of familiarity with Xpert and lack of confidence in diagnoses made at the mobile unit. CONCLUSION: Mobile X-ray units were a feasible and effective strategy to extend tuberculosis diagnostic services into communities and improve early case detection. Effective deployment however requires advance coordination among stakeholders and targeted provider training to ensure that people diagnosed with tuberculosis by new modalities receive prompt treatment.

Insights into paediatric tube feeding dependence: A Speech-language pathology perspective.

Purpose: To explore possible factors contributing to paediatric tube feeding dependency from the speech-language pathology perspective. Tube feeding dependency can have serious repercussions for children and their families with failed or slow weaning/transitioning from tube to oral feeding, more likely after the age of five.Method: A mixed methods approach was conducted. During the first quantitative phase, an online national survey of speech-language pathologists (SLPs) from the health and non-health sectors was carried out followed by interviews with a subset of the respondents. Forty-three SLPs completed the survey. In the second qualitative phase, 10 participants from the survey were interviewed in depth as to their opinions about why tube dependency occurs. Survey data from phase one were analysed using descriptive statistics and chi square comparisons. Interview data were categorised using thematic analysis. Findings from both methodologies were combined to report the results.Result: Two interlinking meta-themes were identified from the combined data sets. These were: (1) Medicalisation of tube fed children in infancy as a root cause of tube feeding dependency and (2) Fragmentation of the tube fed child's continuity of care. The specific results indicated several possible reasons for tube feeding dependency including medical emphasis on weight gain, prolonged nasogastric tube feeding and waiting too long for transition from tube to oral feeding. A lack of integrated care and clinician confidence in non-health settings also appeared to be a factor contributing to tube feeding dependency.Conclusion: Early and ongoing biomedical focus on weight gain affected long-term goals for transitioning leading, subsequently, to tube feeding becoming normalised by school age.

Vaspin promotes insulin sensitivity of elderly muscle and is upregulated in obesity.

Adipokines have emerged as central mediators of insulin sensitivity and metabolism, in part due to the known association of obesity with metabolic syndrome disorders such as type 2 diabetes. Recent studies in rodents have identified the novel adipokine vaspin, as playing a protective role in inflammatory metabolic diseases by functioning to promote insulin sensitivity during metabolic stress. However, at present the skeletal muscle and adipose tissue expression of vaspin in humans is poorly characterised. Furthermore, the functional role of vaspin in skeletal muscle insulin sensitivity has not been studied. Since skeletal muscle is the major tissue for insulin-stimulated glucose uptake understanding the functional role of vaspin in human muscle insulin signalling is critical in determining its role in glucose homeostasis. The objective of this study was to profile the skeletal muscle and subcutaneous adipose tissue expression of vaspin in humans of varying adiposity and to determine the functional role of vaspin in mediating insulin signalling and glucose uptake in human skeletal muscle. Our data shows that vaspin is secreted from both human subcutaneous adipose tissue and skeletal muscle, and is more highly expressed in obese older individuals compared to lean older individuals. Furthermore, we demonstrate that vaspin induces activation of the PI3K/AKT axis, independent of insulin receptor activation, promotes GLUT4 expression and translocation and sensitises older obese human skeletal muscle to insulin-mediated glucose uptake.

The Multiple Mini-Interview: A Possible Solution to Problems Associated with the Interview Processes for a Selected Entry Allied Health Program.

BACKGROUND: Concerns have been raised about the effectiveness of traditional semi-structured interviews in selected entry allied health programs in terms of whether they give applicants the best opportunity to demonstrate their personal qualities and whether the process itself is overly intimidating and impersonal. This in turn raises questions about the reliability and validity of interviews. In this study, a possible alternative process was examined, the multiple mini-interview (MMI). The study investigated the MMI's perceived acceptability for use by a speech-language pathology program. METHODS: The MMI was administered prior to the beginning of the academic year. The study involved 43 applicants and 5 faculty members. On completion of the MMI, participants were invited to complete an optional questionnaire about their perceptions of the process. CONCLUSIONS: Overall, applicants indicated that they found the MMI process to be fair, simple, and non-threatening. The faculty members who interviewed the students also indicated that the process was fairer than the traditional interview, easier for them to manage because they could focus on one specific aspect of the interview process, and gave them an opportunity to meet all of the applicants.

Lexical access and phonological decoding in adult dyslexic subtypes.

Lexical access and phonological decoding were tested in 100 normal adult readers and 21 adult dyslexic individuals. Within the dyslexic sample, 11 dysphonetic dyslexic and 10 dyseidetic dyslexic participants were classified on the basis of spelling patterns. In the 1st experiment, adult dyseidetic readers showed a marked deficit on the lexical-access decision task in comparison with adult dysphonetic readers. In the 2nd experiment, the phonological-decoding decision task did not separate the subtypes. A lexical-access deficit in adult dyseidetic dyslexia cannot be explained in terms of a developmental delay. A phonological-decoding deficit in adult dyseidetic dyslexia may be explained by increased involvement of the lexical procedure in phonological assembly under an analogy strategy.

The effect of phonics-enhanced Big Book reading on the language and literacy skills of 6-year-old pupils of different reading ability attending lower SES schools.

The purpose of this study was to improve the literacy achievement of lower socioeconomic status (SES) children by combining explicit phonics with Big Book reading. Big Book reading is a component of the text-centered (or book reading) approach used in New Zealand schools. It involves the teacher in reading an enlarged book to children and demonstrating how to use semantic, syntactic, and grapho-phonic cues to learn to read. There has been little research, however, to find out whether the effectiveness of Big Book reading is enhanced by adding explicit phonics. In this study, a group of 96 second graders from three lower SES primary schools in New Zealand were taught in 24 small groups of four, tracked into three different reading ability levels. All pupils were randomly assigned to one of four treatment conditions: a control group who received math instruction, Big Book reading enhanced with phonics (BB/EP), Big Book reading on its own, and Phonics on its own. The results showed that the BB/EP group made significantly better progress than the Big Book and Phonics groups in word reading, reading comprehension, spelling, and phonemic awareness. In reading accuracy, the BB/EP and Big Book groups scored similarly. In basic decoding skills the BB/EP and Phonics groups scored similarly. The combined instruction, compared with Big Book reading and phonics, appeared to have no comparative disadvantages and considerable advantages. The present findings could be a model for New Zealand and other countries in their efforts to increase the literacy achievement of disadvantaged pupils.

Prevalence of human papillomavirus in oropharyngeal and nonoropharyngeal head and neck cancer--systematic review and meta-analysis of trends by time and region.

BACKGROUND: Little information has been reported on regional and time trends of human papillomavirus (HPV) prevalence rates of oropharyngeal cancer (OPC) and non-OPC. METHODS: The study consisted of a systematic review and meta-analysis using random effects logistic regression models. RESULTS: Overall HPV prevalence in OPC (47.7%; 95% confidence interval [CI], 42.9-52.5%) increased significantly over time: from 40.5% (95% CI, 35.1-46.1) before 2000, to 64.3% (95% CI, 56.7-71.3) between 2000 and 2004, and 72.2% (95% CI, 52.9-85.7) between 2005 and 2009 (p < .001). Prevalence increased significantly in North America and Europe, and the significant gap between them that existed before 2000 (50.7% vs 35.3%, respectively, p = .008) has now disappeared (69.7% vs 73.1%, respectively, p = .8). Prevalence in non-OPC (21.8%; 95% CI, 18.9-25.1%) has not increased over time (p = .97). CONCLUSIONS: The sharp increase in the proportion of HPV-positive OPC over the last decade has occurred at a faster rate in Europe compared with that in North America. In contrast, the relatively low prevalence of HPV in non-OPC remains unchanged.

Intraoperative sigmoidoscopy in gynecologic surgery.

Intraoperative sigmoidoscopy is underused by the majority of practicing gynecologists and is not widely taught in obstetrics and gynecology training programs. In this report, a step-by-step approach is provided in order to perform sigmoidoscopy. Indications for use, along with various intraoperative applications, are discussed. Results from our center's experience with its use during laparoscopic treatment of adhesions, endometriosis, and associated disease of the bowel also are provided. Intraoperative sigmoidoscopy is a safe and efficacious procedure that can aid in the evaluation and treatment of pelvic pathology and facilitate identification and management of bowel injuries. It should be considered a valuable adjunct when such cases are encountered by gynecologic and pelvic surgeons.