How Can We Support Online Learning for Elementary Students? Perceptions and Experiences of Award-Winning K-6 Teachers.

K-12 online learning can be advantageous in a variety of circumstances, including inclement weather days and emergency remote teaching. With the lessons learned from the COVID-19 pandemic, many K-12 districts may consider ways to incorporate online learning into their regular school plans after they resume face-to-face instruction. However, the most challenges to online learning seemed to take place at the elementary level. This brings up an important question: What should elementary online teaching and learning look like? We examined six award-winning K-6 teachers' perspectives on and experiences with online instruction and practices for elementary students. The teachers suggested that online instruction to support elementary students' learning should be (a) organized, (b) engaging, and (c) interactive. Teachers also suggested that developmentally appropriate use of technology and parental involvement may foster elementary students' online learning experiences.

Seropositive anti-MOG antibody-associated acute disseminated encephalomyelitis (ADEM): a sequelae of Mycoplasma pneumoniae infection.

Acute disseminated encephalomyelitis (ADEM) is a demyelinating, autoimmune disease of the central nervous system (CNS). It causes motor and sensory deficits, altered mental status and other neurological symptoms. Though rarely fatal, it has been associated with residual motor and neurocognitive deficits. Our case consisted of a 4-year-old girl who presented with fatigue and unsteady gait after a respiratory illness. During her hospital course, she became progressively weaker and experienced seizures. Imaging showed sections of demyelination in the CNS, and appropriate treatment was started. Additional labs resulted in positive Mycoplasma pneumoniae serum serology. Antimyelin oligodendrocyte glycoprotein (anti-MOG) antibodies were also found, which is a risk factor for relapsing, multiphasic ADEM. To our knowledge, this is the first case of anti-MOG antibody-associated ADEM due to M. pneumoniae infection. Our patient has made a complete recovery. The parents only report slightly increased fatigue and irritability.

How well do patients understand written instructions?: health literacy assessment in rural and urban rheumatology outpatients.

The aim of this study was to assess health literacy (word recognition and comprehension) in patients at a rural rheumatology practice and to compare this to health literacy levels in patients from an urban rheumatology practice.Inclusion criteria for this cross-sectional study were as follows: ≥18-year-old patients at a rural rheumatology practice (Mid-North Coast Arthritis Clinic, Coffs Harbour, Australia) and an urban Sydney rheumatology practice (Combined Rheumatology Practice, Kogarah, Australia). Exclusion criteria were as follows: ill-health precluding participation; poor vision/hearing, non-English primary language. Word recognition was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). Comprehension was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). Practical comprehension and numeracy were assessed by asking patients to follow prescribing instructions for 5 common rheumatology medications.At the rural practice (Mid-North Coast Arthritis Clinic), 124/160 patients agreed to participate (F:M 83:41, mean age 60.3 ±â€Š12.2) whereas the corresponding number at the urban practice (Combined Rheumatology Practice) was 99/119 (F:M 69:30, mean age 60.7 ±â€Š17.5). Urban patients were more likely to be born overseas, speak another language at home, and be employed. There was no difference in REALM or TOFHLA scores between the 2 sites, and so data were pooled. REALM scores indicated 15% (33/223) of patients had a reading level ≤Grade 8 whereas 8% (18/223) had marginal or inadequate functional health literacy as assessed by the TOFHLA. Dosing instructions for ibuprofen and methotrexate were incorrectly understood by 32% (72/223) and 21% (46/223) of patients, respectively.Up to 15% of rural and urban patients had low health literacy and <1/3 of patients incorrectly followed dosing instructions for common rheumatology drugs.There was no significant difference in word recognition, functional health literacy, and numeracy between rural and urban rheumatology patients.

Rickettsial and ehrlichial infections.

Rickettsial diseases represent a clinically homogeneous group of infections characterized by fever, headache myalgias, variable presence of a rash, and a broad spectrum of neurological manifestations. Epidemiological information including time of year, geography, history of arthropod exposure, and animal contact gives important clues to the diagnosis, and should be actively elicited. Abnormalities in hematological indices of liver function tests should also increase suspicion for illness. Delay in initiation of doxycycline therapy while awaiting laboratory confirmation of infection has been associated with progressive neurological impairment and death. Clinicians should maintain a low threshold to initiate empiric therapy for rickettsial diseases in any patient with neurological findings and compatible exposures, signs, or laboratories, as these syndromes represent readily treatable causes of neurological dysfunction.

Diagnostic challenges of central nervous system tuberculosis.

Central nervous system tuberculosis (TB) was identified in 20 cases of unexplained encephalitis referred to the California Encephalitis Project. Atypical features (encephalitic symptoms, rapid onset, age) and diagnostic challenges (insensitive cerebrospinal fluid [CSF] TB PCR result, elevated CSF glucose levels in patients with diabetes, negative result for tuberculin skin test) complicated diagnosis.

Pediatric encephalitis: what is the role of Mycoplasma pneumoniae?

BACKGROUND: Encephalitis is a complex, debilitating, and sometimes fatal neurologic condition to which children are especially prone. Mycoplasma pneumoniae, a common respiratory pathogen, has been implicated as an etiology of encephalitis. Evidence for recent or acute M. pneumoniae infection has been demonstrated in limited studies of both pediatric and adult patients with encephalitis. PATIENTS AND METHODS: Unexplained encephalitis cases are referred to the California Encephalitis Project for diagnostic testing. Serum, cerebrospinal fluid, and respiratory specimens are tested by polymerase chain reaction and serology methods for the presence of multiple pathogens, including M. pneumoniae. M. pneumonia-associated cases of encephalitis were compared with other bacterial agents, herpes simplex virus 1, and enterovirus. RESULTS: Of 1988 patients referred to the California Encephalitis Project, evidence of acute M. pneumoniae infection was found in 111 patients, of which 84 (76%) were pediatric patients. Eighty percent of the 84 patients were positive for M. pneumoniae by serology alone. Cerebrospinal fluid polymerase chain reaction for M. pneumoniae was rarely positive (2%). Patients with M. pneumoniae-associated pediatric encephalitis were a median of 11 years old, progressed rapidly (median: 2 days from onset to hospitalization), and were often in the ICU (55%). Symptoms included fever (70%), lethargy (68%), and altered consciousness (58%). Gastrointestinal (45%) and respiratory (44%) symptoms were less common. Compared with patients with other bacterial as well as viral agents, patients with M. pneumoniae-associated encephalitis had fewer seizures and less-severe hospital courses. CONCLUSIONS: M. pneumoniae is the most common agent implicated in the California Encephalitis Project. Patients with M. pneumoniae-associated encephalitis are predominantly pediatric, and their presentations are clinically similar to enterovirus encephalitis, although they frequently require intensive care with prolonged hospitalizations. Given that M. pneumoniae infection is found more than any other pathogen, increased emphasis should be placed on elucidating the role and mechanism of M. pneumoniae in encephalitis.

Anti-galactocerebroside testing in Mycoplasma pneumoniae-associated encephalitis.

Mycoplasma pneumoniae (Mp) is the most frequently identified pathogen in the California Encephalitis Project, but the role and mechanism of Mp is unclear. Since auto-antibodies to anti-galactocerebroside (anti-GalC) have been reported in patients with evidence of acute Mp infection of the central nervous system (CNS), serum and cerebrospinal fluid (CSF) samples from 26 patients with evidence of Mp were tested for anti-GalC antibodies. Anti-GalC antibody was found in the CSF of only eight (31%) of 21 Mp patients indicating that CSF anti-GalC antibody is not a specific marker for Mp CNS disease.