Expanding the Direct and Indirect Effects Model of Writing (DIEW): Reading-Writing Relations, and Dynamic Relations As a Function of Measurement/Dimensions of Written Composition.

Within the context of the Direct and Indirect Effects model of Writing, we examined a dynamic relations hypothesis, which contends that the relations of component skills, including reading comprehension, to written composition vary as a function of dimensions of written composition. Specifically, we investigated (a) whether higher order cognitive skills (i.e., inference, perspective taking, and monitoring) are differentially related to three dimensions of written composition-writing quality, writing productivity, and correctness in writing; (b) whether reading comprehension is differentially related to the three dimensions of written composition after accounting for oral language, cognition, and transcription skills; and whether reading comprehension mediates the relations of discourse oral language and lexical literacy to the three dimensions of written composition; and (c) whether total effects of oral language, cognition, transcription, and reading comprehension vary for the three dimensions of written composition. Structural equation model results from 350 English-speaking second graders showed that higher order cognitive skills were differentially related to the three dimensions of written composition. Reading comprehension was related only to writing quality, but not to writing productivity or correctness in writing; and reading comprehension differentially mediated the relations of discourse oral language and lexical literacy to writing quality. Total effects of language, cognition, transcription, and reading comprehension varied largely for the three dimensions of written composition. These results support the dynamic relation hypothesis, role of reading in writing, and the importance of accounting for dimensions of written composition in a theoretical model of writing.

Does Teacher Self-Efficacy Predict Writing Practices of Teachers of Deaf and Hard of Hearing Students?

Forty-four elementary grade teachers of deaf and hard of hearing students were surveyed about how they taught writing and their beliefs about writing. Beliefs about writing included their self-efficacy to teach writing, attitude toward writing, and epistemological beliefs about writing. These teachers from fifteen different states in the United States slightly agreed that they were efficacious writing teachers and they were slightly positive about their writing. They slightly agreed that learning to write involves effort and process, moderately disagreed that writing development is innate or fixed, slightly disagreed that knowledge about writing is certain, and were equally split about whether writing knowledge comes from authorities and experts. On average, teachers applied the twenty-two instructional writing practices surveyed at least once a month. They reported their students wrote weekly, and their writing was supported through goal setting, feedback, and prewriting activities. Writing instruction mostly focuses on teaching grammar and how to plan compositions. Teacher self-efficacy uniquely and statistically predicted reported teaching practices after attitude toward writing, and epistemological beliefs were first controlled. Recommendations for future research and implications for practice are presented.

Paediatric use of antibiotics in children with community acquired pneumonia: A survey from Da Nang, Vietnam.

AIM: To characterise paediatricians' antibiotic-prescribing behaviour when managing community acquired pneumonia. METHODS: We conducted a knowledge and attitudes survey of paediatric doctors practicing at a regional provincial hospital in central Vietnam over a 2-week period (from 12 December 2017 to 29 December 2017). RESULTS: Of 79 eligible paediatric doctors, 69 (87.3%) completed the questionnaire, of whom 65 (94.2%) thought that antibiotics were overused in Vietnam. Thirty-eight doctors (55.1%) indicated that they routinely hospitalised children with pneumonia to provide intravenous antibiotics. Most doctors reported discharging children with non-severe pneumonia after 5 days (76.9%) and those with severe pneumonia after 7-10 days (88.4%); older doctors generally continued intravenous antibiotics for longer. The two most important factors driving discharge decisions were clinical assessment (95.6%) and completion of the full course of intravenous antibiotics (80.0%). Antibiotic prescription was influenced by local guidelines (62.3%), drugs used before admission (50.0%) and the opinion of senior clinicians (37.7%). Most doctors believed antibiotic stewardship was necessary (98.6%) and that over-the-counter use of antibiotics should be restricted (97.1%). CONCLUSIONS: Paediatricians recognised an urgent need for more effective regulation and antibiotic stewardship in Vietnam. Routinely completing a full course of intravenous antibiotics leads to unnecessary and prolonged hospitalisation.

Cystic fibrosis newborn screening programs: implications of the CFTR variant spectrum in nonwhite patients.

PURPOSE: Cystic fibrosis newborn screening (CFNBS) has been offered across the United States since 2010. However, as compared with white patients with CF, CFTR variant identification in nonwhite populations remains inequitable. Utilizing the recent characterization of the nonwhite CF variant spectrum, we examined the effectiveness of current CFNBS molecular panels in identifying affected nonwhite newborns. METHODS: Based on a cross-sectional evaluation of genotyping data from the CF Foundation Patient Registry that compared 3,496 nonwhite with 22,206 white CF patients, the current CFNBS algorithms used in the 50 states and the District of Columbia were analyzed. We assessed the percentage of CF patients of Hispanic, African, Asian, and Native American heritage who would not be identified by the molecular panels most commonly used. RESULTS: Compared with whites, variant detection was significantly lower in Hispanic, black, and Asian newborns (P ≤ 0.0001 each), as well as in Native American newborns (P values ranged from 0.001 to 0.0003), for the most common CFNBS panels. CONCLUSION: This study provides a perspective on the applicability of current panels to a diverse population and enables CFNBS programs to consider more inclusive test approaches to facilitate diagnosis, timely clinical intervention, and enhanced prognosis for CF patients of nonwhite and mixed ethnicities.Genet Med 19 1, 36-44.

An Evaluation of Alternative Markers to Guide Initiation of Anti-retroviral Therapy in HIV-Infected Children in Settings where CD4 Assays are not Available.

OBJECTIVES: In settings where CD4 testing is not available, alternative markers to start paediatric anti-retroviral therapy (ART) could be used. A comprehensive evaluation of these markers has not been performed. METHODS: Prospective cross-sectional study of HIV-infected Malawian children not eligible for ART based on clinical criteria. Associations between CD4 and alternative markers [haemoglobin, total lymphocyte count (TLC), serum albumin, thrombocytes and growth parameters] were analysed, and accuracy of existing and new cut-offs were evaluated. RESULTS: In all, 417 children were enrolled. Of 261 children aged ≥5 years, 155 (59%) qualified to start ART using CD4. In this group, only TLC was associated with CD4 (p < 0.001). Sensitivity for TLC was 21% (95% CI: 15-29%), using World Health Organization cut-offs. Improved cut-offs increased sensitivity to 73% (95% CI: 65-80%), specificity 62% (95% CI: 52-72%). CONCLUSION: Clinical staging alone is an unreliable strategy to start ART in children. TLC is the only alternative marker for CD4, cut-offs need to be revised though.

A Blueprint to Address Research Gaps in the Development of Biomarkers for Pediatric Tuberculosis.

Childhood tuberculosis contributes significantly to the global tuberculosis disease burden but remains challenging to diagnose due to inadequate methods of pathogen detection in paucibacillary pediatric samples and lack of a child-specific host biomarker to identify disease. Accurately diagnosing tuberculosis in children is required to improve case detection, surveillance, healthcare delivery, and effective advocacy. In May 2014, the National Institutes of Health convened a workshop including researchers in the field to delineate priorities to address this research gap. This blueprint describes the consensus from the workshop, identifies critical research steps to advance this field, and aims to catalyze efforts toward harmonization and collaboration in this area.

The Writing Performance of Elementary Students Receiving Strategic and Interactive Writing Instruction.

Strategic and Interactive Writing Instruction (SIWI) has led to improved writing and language outcomes among deaf and hard of hearing (DHH) middle grades students. The purpose of this study was to examine the effects of SIWI on the written expression of DHH elementary students across recount/personal narrative, information report, and persuasive genres. Five multiple-probe case studies demonstrate a relationship between implementation of SIWI and improvements in genre-related writing performance. The effect of instruction was most immediately demonstrated with information reports and persuasive writing, whereas several sessions of recount instruction were needed for students to satisfy performance criteria. Additionally, pre- and post-data from a larger group of students (N = 31) were compared. Wilcoxon signed-rank test statistics were statistically significant for each genre with medium to high effect sizes. Data suggest SIWI as a promising practice with elementary students, and comments regarding further development and research are provided.

Do Special and General Education Teachers' Mindset Theories About the Malleability of Writing and Intelligence Predict Their Writing Practices?

Seventy-five general and 65 special education teachers working in the same 65 elementary schools in 12 different U.S. school districts were surveyed about their mindsets concerning the malleability of writing and intelligence as well as their practices for teaching writing. All teachers taught writing to one or more fourth-grade students receiving special education services, including students with learning disabilities. Both general and special education teachers typically held a growth mindset toward the malleability of writing and intelligence. Collectively, these teachers' mindsets predicted writing frequency (i.e., frequency of students' writing) and how often they taught writing skills and processes once variance due to teachers' preparation, efficacy to teach writing, teaching experience, and type of teacher was first controlled. The observed relationships between teachers' mindsets and reported practices for teaching writing were not mediated by type of teacher (i.e., general or special education). General and special education teachers did not differ in writing frequency for three types of writing collectively (narrative, informative, and persuasive) or how frequently they made 18 adaptations for teaching writing collectively, but general education teachers reported teaching writing skills and processes more often than their special education counterparts. Recommendations for future research and implications for practice are presented.

Improved detection of cystic fibrosis by the California Newborn Screening Program for all races and ethnicities.

BACKGROUND: Newborn screening (NBS) for cystic fibrosis (CF) is universal in the United States. Protocols vary but include an immunoreactive trypsinogen (IRT) level and CFTR variant panel. California CF NBS has a 3-step screening: IRT level, variant panel, and CFTR sequencing if only one variant identified on panel. METHODS: This was a cohort study of infants with CF born in California (2007-2021) to examine racial and ethnic differences in having a false-negative NBS result for CF and at which step the false-negative occurred. We examined how different CFTR variant panels would improve detection of variants by race and ethnicity: original 39-variant panel, current 75-variant panel, and all 402 disease-causing CFTR variants in the CFTR2 database. RESULTS: Of the 912 infants born in California with CF, 84 had a false-negative result: 38 due to low IRT level and 46 with a high IRT value (but incomplete variant detection). Asian (OR 6.3) and Black infants (OR 2.5) were more likely to have a false-negative screening result than non-Hispanic white infants. The majority of false-negative screening (but CF diagnosis) cases among American Indian/Native Alaskan and non-Hispanic White infants were due to low IRT levels. The majority of Asian and Hispanic infants with false-negative screening had no variants detected. Detection of two CFTR variants was improved with the 75-variant panel in Black, Hispanic, and non-Hispanic White infants and with the 402-variant panel in Black, Hispanic, non-Hispanic White, and other race infants. CONCLUSIONS: Larger CFTR panels in NBS improved the detection of CF in all races and ethnicities.

Scaling up interventions to achieve global tuberculosis control: progress and new developments.

Tuberculosis is still one of the most important causes of death worldwide. The 2010 Lancet tuberculosis series provided a comprehensive overview of global control efforts and challenges. In this update we review recent progress. With improved control efforts, the world and most regions are on track to achieve the Millennium Development Goal of decreasing tuberculosis incidence by 2015, and the Stop TB Partnership target of halving 1990 mortality rates by 2015; the exception is Africa. Despite these advances, full scale-up of tuberculosis and HIV collaborative activities remains challenging and emerging drug-resistant tuberculosis is a major threat. Recognition of the effect that non-communicable diseases--such as smoking-related lung disease, diet-related diabetes mellitus, and alcohol and drug misuse--have on individual vulnerability, as well as the contribution of poor living conditions to community vulnerability, shows the need for multidisciplinary approaches. Several new diagnostic tests are being introduced in endemic countries and for the first time in 40 years a coordinated portfolio of promising new tuberculosis drugs exists. However, none of these advances offer easy solutions. Achievement of international tuberculosis control targets and maintenance of these gains needs optimum national health policies and services, with ongoing investment into new approaches and strategies. Despite growing funding in recent years, a serious shortfall persists. International and national financial uncertainty places gains at serious risk. Perseverance and renewed commitment are needed to achieve global control of tuberculosis, and ultimately, its elimination.

Association between preterm delivery and pre-pregnancy body mass (BMI), exercise and sleep during pregnancy among working women in Southern California.

Little is known about modifiable lifestyle factors beyond quitting smoking that could prevent preterm delivery (PTD, <37 weeks gestation). We examined the individual and joint associations of pre-pregnancy BMI, second trimester exercise and sleep on PTD. We conducted a nested, population-based case-control study interviewing postpartum 344 cases delivering at <37 weeks, as identified by clinical estimate of gestational age from prenatal screening records, and 698 term controls, excluding term low birthweight. Eligible women participated in California's statewide Prenatal Screening Program, worked during pregnancy, and delivered a singleton birth in Southern California in 2002-2003. Modeled separately, moderate (odds ratio [OR] = 0.90; 95% confidence interval [CI] = 0.84-0.96--per hour/week) and vigorous (OR = 0.67; 95% CI = 0.46-0.98 for yes vs. no) exercise during the second trimester were associated with a reduced odds of PTD, and sleep duration was not (OR = 1.09, 95% CI = 0.80-1.48 for <7 h; OR = 0.88, 95% CI = 0.57-1.48 for >8 h vs. 7-8 h). When sleep and exercise variables were modeled together along with pre-pregnancy BMI, only moderate exercise (OR = 0.91; 95% CI 0.85-0.98) continued to be associated with reduced odds of PTD. The benefits of moderate exercise appeared strongest for women with BMI greater than 24 kg/m(2) (OR = 0.85; 95% CI = 0.79-0.93) and weakened with decreasing BMI. No other interactions were found. Moderate exercise is associated with reduced PTD, particularly for women with BMI above the normal range. The results are of public health relevance given that these risk factors are potentially modifiable both pre-conceptionally and during pregnancy and rates of PTD are still high in the United States.

Special and General Education Teachers' Beliefs About Writing and Writing Instruction.

Seventy-six general education and 67 special education teachers working in the same 66 elementary schools were surveyed about their beliefs about writing. Each teacher taught writing to one or more fourth-grade students receiving special education services, including students with learning disabilities. Survey findings indicated that general education teachers believed that they were better prepared to teach writing than special education teachers, and they were more positive about their own efforts to learn to teach writing. General education teachers also held more positive attitudes about teaching writing and their own capabilities as a writer than their special education counterparts. Furthermore, general educators were more likely than special educators to indicate that writing developed through effort and process, and less likely to think that writing knowledge came from experts. Beliefs about adequacy of preparation to teach writing predicted teachers' beliefs about their level of knowledge to teach writing, efficacy to overcome students' writing difficulties, and attitudes toward teaching writing. Recommendations for future research and implications for practice are presented.

The Long-Term Effects of the COVID-19 Pandemic on Children's Writing: a Follow-up Replication Study.

The COVID-19 pandemic and the move by governments worldwide to cancel in-class instruction and move to emergency remote instruction in March and April of 2020 created an unprecedented disruption in children's education. As the COVID-19 pandemic took form and continued to impact education in the following 2020/2021 academic year, multiple concerns were raised about possible negative effects on students' learning. The current longitudinal replication study examined this proposition for second-grade students in Norway. In a previous investigation (Skar et al. Journal of Educational Psychology 114:1553-1566, 2022), we found that scores for quality of writing, handwriting fluency, and attitude toward writing of first-grade children tested immediately after emergency remote instruction ended in the Spring of 2020 (During COVID-19 cohort) were lower than the scores of first-grade students from the same schools tested a year earlier before the start of the pandemic (Before COVID-19 cohort). In the present study, we compared the scores for the During COVID-19 cohort (333 girls, 308 boys) on these same writing measures 1 year later at the end of second grade to a During COVID-19 cohort of second-graders (888 girls, 780 boys) from the same schools tested 2 years earlier before the start of the pandemic. The initial negative impact of the COVID-19 pandemic on first-grade students' writing observed by Skar et al. (Journal of Educational Psychology 114:1553-1566, 2022) was no longer evident 1 year later at the end of second grade in the current study.

Understanding the interplay between text quality, writing self-efficacy and writing anxiety in learners with and without migration background.

Writing presents considerable challenges to students' motivation. Yet there is a dearth of studies assessing the role of affect and motivation in writing performance for students with migration backgrounds (MB), who often underachieve in writing. Our study addressed this research gap by investigating the interplay between writing self-efficacy, writing anxiety, and text quality in 208 secondary students with and without MB using Response Surface Analyses. The data showed comparable levels of self-efficacy and, notably, lower writing anxiety levels among students with MB despite lower writing achievements. In the full sample, we observed positive correlations between self-efficacy and text quality and negative correlations between writing anxiety and text quality. When modeling efficacy and anxiety measures and their interplay to predict text quality, self-efficacy measures continued to account for statistically detectable unique variance in text quality, whereas writing anxiety did not. However, students with MB demonstrated differing interplay patterns, with less efficacious students with MB showing positive relations between writing anxiety and text quality.

Efficacy for writing self-regulation, attitude toward writing, and quality of second grade students' writing.

Motivational beliefs, such as writing self-efficacy and attitude toward writing, are believed to foster or hinder writing by influencing if one chooses to write, how much effort is committed to writing, and what cognitive resources writers apply. In the current study, we examined self-efficacy for writing self-regulation and attitude toward writing of 2,124 Grade 2 Norwegian students (1,069 girls; 1,055 boys). We investigated if there were differences in each of these beliefs between girls and boys and students who differed in their language status (Norwegian first language, Norwegian and another language both first language, or language other than Norwegian first language). We further tested if each of these writing motivational beliefs made statistically unique contributions to predicting the quality of students' writing. In each of these analyses, we controlled for variance related to individual- and school factors. Girls were more positive about writing than boys, and they were confident about their abilities to self-regulate writing. Students with Norwegian and another language both as first language ("bilingual" students) had a more positive attitude toward writing than the other two language groups. Efficacy for writing self-regulation and attitude toward writing both made statistically significant unique contributions to predicting the quality of students writing, although these two writing beliefs collectively accounted for just 2% of the variance in writing quality scores once individual- and school-factors were controlled. Recommendations for future research and implications of the finding are discussed.

A latent scale model to minimize subjectivity in the analysis of visual rating data for the National Turfgrass Evaluation Program.

Introduction: Traditional evaluation procedure in National Turfgrass Evaluation Program (NTEP) relies on visually assessing replicated turf plots at multiple testing locations. This process yields ordinal data; however, statistical models that falsely assume these to be interval or ratio data have almost exclusively been applied in the subsequent analysis. This practice raises concerns about procedural subjectivity, preventing objective comparisons of cultivars across different test locations. It may also lead to serious errors, such as increased false alarms, failures to detect effects, and even inversions of differences among groups. Methods: We reviewed this problem, identified sources of subjectivity, and presented a model-based approach to minimize subjectivity, allowing objective comparisons of cultivars across different locations and better monitoring of the evaluation procedure. We demonstrate how to fit the described model in a Bayesian framework with Stan, using datasets on overall turf quality ratings from the 2017 NTEP Kentucky bluegrass trials at seven testing locations. Results: Compared with the existing method, ours allows the estimation of additional parameters, i.e., category thresholds, rating severity, and within-field spatial variations, and provides better separation of cultivar means and more realistic standard deviations. Discussion: To implement the proposed model, additional information on rater identification, trial layout, rating date is needed. Given the model assumptions, we recommend small trials to reduce rater fatigue. For large trials, ratings can be conducted for each replication on multiple occasions instead of all at once. To minimize subjectivity, multiple raters are required. We also proposed new ideas on temporal analysis, incorporating existing knowledge of turfgrass.

Writing knowledge, practices, efficacy, interests, attitudes, and beliefs of deaf education teachers: a randomized controlled trial.

Writing teachers play an extraordinarily important role in their students' writing development. Teachers' motivational beliefs, such as attitudes toward writing, perceptions of their efficacy to teach writing, or preparation to use evidence-based instructional practices, impact their writing instruction, which directly affects the advancement of students' writing skills. Deaf writers are a subpopulation of writers who may face discriminatory beliefs toward their writing development stemming from ableism, audism, or linguicism. Deaf education teachers may doubt their abilities to teach bilingual/multilingual students or teach deaf students experiencing language deprivation. The current study investigates whether deaf education teachers' beliefs can be fostered through an intensive one-year professional development (PD) program designed specifically for deaf education teachers. In this randomized controlled trial, we examine the extent to which the participation of deaf education teachers in specialized PD and subsequent writing instruction implementation (n = 26) impacts their pedagogical content knowledge, use of evidence-based practices for teaching writing, interest, attitudes, efficacy in teaching writing, and epistemological beliefs about writing compared to teachers in a business as usual condition (n = 24). Pre-post regression analyses indicate statistically significant group differences (with the treatment group scoring higher) on all variables except attitude and some epistemological beliefs. We speculate that specialized, sustained PD paired with supported implementation of writing instruction and ongoing teacher reflection are contributing factors to changes in teachers' motivational beliefs.

Artificial intelligence in medical referrals triage based on Clinical Prioritization Criteria.

The clinical prioritisation criteria (CPC) are a clinical decision support tool that ensures patients referred for public specialist outpatient services to Queensland Health are assessed according to their clinical urgency. Medical referrals are manually triaged and prioritised into three categories by the associated health service before appointments are booked. We have developed a method using artificial intelligence to automate the process of categorizing medical referrals based on clinical prioritization criteria (CPC) guidelines. Using machine learning techniques, we have created a tool that can assist clinicians in sorting through the substantial number of referrals they receive each year, leading to more efficient use of clinical specialists' time and improved access to healthcare for patients. Our research included analyzing 17,378 ENT referrals from two hospitals in Queensland between 2019 and 2022. Our results show a level of agreement between referral categories and generated predictions of 53.8%.

A longitudinal intervention study of the effects of increasing amount of meaningful writing across grades 1 and 2.

The current study examined the effectiveness of a writing is caught approach with young developing writers in Norway. This method is based on the premise that writing competence is acquired naturally through real use in meaningful contexts. Our longitudinal randomized control trial study tested this proposition by examining if increasing first grade students' opportunities to write in various genres for different purposes and for a range of audiences over a two-year time period improved the quality of their writing, handwriting fluency, and attitude towards writing. The study included data from 942 students (50.1% girls) in 26 schools randomly assigned to the experimental treatment, and 743 students (50.6% girls) in 25 schools randomly assigned to the business-as-usual (BAU) control condition. Across Grades 1 and 2, experimental teachers were asked to supplement their typical writing instruction by implementing 40 writing activities designed to increase students' purposeful writing. Increasing experimental students' writing over the two-year period did not result in statistically detectable differences in the writing quality, handwriting fluency, and attitude towards writing of students in the experimental and BAU control conditions. These findings did not provide support for the effectiveness of the writing is caught approach. Implications for theory, research, and practiced are discussed.

Shadow of a Pandemic: Persistence of Prenatal SARS-CoV-2 Antibodies in Newborn Blood Spots.

To investigate COVID-19 surveillance among pregnant women, the California Genetic Disease Screening Program conducted a screening performance and seroprevalence evaluation of maternal SARS-CoV-2 antibodies detected in banked newborn dried blood spots (DBS). We obtained seropositive results for 2890 newborn DBS from cohorts in 2020 and 2021 using Enable Bioscience's Antibody Detection by Agglutination-PCR (ADAP) assay for SARS-CoV-2 antibodies. To infer maternal infection, we linked 312 women with a known laboratory-confirmed COVID-19 episode with their newborn's DBS SARS-CoV02 antibody result. Among 2890 newborns, we detected 453 (15.7%) with SARS-CoV-2 antibodies in their DBS. Monthly snapshot statewide seroprevalence among neonates was 12.2% (95% CI 10.3-14.1%, n =1156) in December 2020 and 33.3% (95% CI 29.1-37.4%, n = 26) in March 2021. The longest time recorded from COVID-19 infection to a seropositive neonatal result was 11.7 months among the 312 mothers who had an available SARS-CoV-2 PCR test result. Approximately 94% (153/163) of DBS were seropositive when a known maternal infection occurred earlier than 19 days before birth. The estimated relative sensitivity of DBS to identify prevalent maternal infection was 85.1%, specificity 98.5% and PPV 99.2% (n = 312); the sensitivity was lowest during the December 2021 surge when many infections occurred within 19 days of birth. Fifty pre-pandemic specimens (100% seronegative) and 23 twin-pair results (100% concordant) support an intrinsic specificity and PPV of ADAP approaching 100%. Maternal infection surveillance is limited by a time lag prior to delivery, especially during pandemic surges.