The Relationship of Special Education Teacher Performance on Observation Instruments With Student Outcomes.

In this study, we examined the relationship of special education teachers' performance on the Recognizing Effective Special Education Teachers (RESET) Explicit Instruction observation protocol with student growth on academic measures. Special education teachers provided video-recorded observations of three instructional lessons along with data from standardized, curriculum-based academic measures at the beginning, middle, and end of the school year for the students in the instructional group. Teachers' lessons were evaluated by external, trained raters. Data were analyzed using many-faceted Rasch measurement (MFRM), correlation, and multiple regression. Teacher performance on the overall protocol did not account for statistically significant variance in student growth beyond that of students' beginning of the year academic performance. Teacher performance on an abbreviated protocol comprised of items that had average or higher item difficulties on the MFRM analysis accounted for an additional 4.5% of variance beyond that of beginning of the year student performance. Implications for further research are discussed.

Concomitant chest trauma and traumatic brain injury, biomarkers correlate with worse outcomes.

BACKGROUND: Clinical data are lacking on the influence of chest trauma on the secondary injury process after traumatic brain injury (TBI), with some data suggesting that multiple trauma may worsens brain injury. Blunt chest trauma and TBI represent the two major single injury entities with the highest risk of complications and are potential biomarker targets. METHODS: Trauma patients with severe TBI were enrolled. Serum biomarker levels were obtained every 6 hours for 72 hours. Baseline, 6 hours and 24 hours CT head scans were evaluated. Neurologic worsening was defined as increased contusions, ischemia, compression of basal cisterns, and/or midline shift. The TBI patients with chest injury (Abbreviated Injury Scale chest score ≥1) and those without chest injury were compared. Wilcoxon rank sum test, univariate logistic regression and receiver operating characteristic were reported. RESULTS: Fifty-seven patients. Mean age of 40.5 years. Median motor Glasgow Coma Scale score at admission and 24 hours was 3 (interquartile range, 1-5) and 5 (interquartile range, 3-5). Of the patients enrolled, 12.2% patients underwent craniotomy within 6 hours from the time of admission and 22.8% within 12 hours. Patients with chest trauma, 24.5% had a chest Abbreviated Injury Scale score of 3 or greater, and 73.6% sustained blunt chest trauma. Stratifying TBI patients with and without chest injury revealed higher mean levels of IL-4, IL-5, IL-8, and IL-10 and lower mean IFN-γ and IL-7 levels in patient with chest injury. IL-7 levels adjusted for chest injury predicted neurological worsening with area under the receiver operating characteristic of 0.59 (p value = 0.011). The TBI and chest trauma patients' IL-4 and neuron-specific enolase levels were predictive of mortality (area under the receiver operating characteristic of 0.67 and 0.63, p = 0.0001, 0.003), respectively. CONCLUSION: Utilizing biomarkers for early identification of patients with TBI and chest trauma has the capability of modifying adverse factors affecting morbidity and mortality in this subset of TBI patients. LEVEL OF EVIDENCE: Level III.

IgG4-Related Hypophysitis: Case Report and Literature Review.

IgG4-related hypophysitis is a rare, inflammatory process of the pituitary that mimics more commonly seen pituitary tumors. We report a case of IgG4-related hypophysitis in a 16-year-old female with diabetes insipidus who was found to have IgG4-related hypophysitis based on tissue diagnosis. This entity has not been previously described in a pediatric patient. Recognition of certain inflammatory processes of the pituitary may lead to alternative means of diagnosis and medical management without a biopsy.

Development of a standardized Intranet database of formulation records for nonsterile compounding, Part 2.

In part 1 of this series, we outlined the rationale behind the development of a centralized electronic database used to maintain nonsterile compounding formulation records in the Mission Health System, which is a union of several independent hospitals and satellite and regional pharmacies that form the cornerstone of advanced medical care in several areas of western North Carolina. Hospital providers in many healthcare systems require compounded formulations to meet the needs of their patients (in particular, pediatric patients). Before a centralized electronic compounding database was implemented in the Mission Health System, each satellite or regional pharmacy affiliated with that system had a specific set of formulation records, but no standardized format for those records existed. In this article, we describe the quality control, database platform selection, description, implementation, and execution of our intranet database system, which is designed to maintain, manage, and disseminate nonsterile compounding formulation records in the hospitals and affiliated pharmacies of the Mission Health System. The objectives of that project were to standardize nonsterile compounding formulation records, create a centralized computerized database that would increase healthcare staff members' access to formulation records, establish beyond-use dates based on published stability studies, improve quality control, reduce the potential for medication errors related to compounding medications, and (ultimately) improve patient safety.

People with mobility impairments: Physical activity and quality of participation.

BACKGROUND: we sought to describe the characteristics of physical activity levels, health, community integration, and social participation of people with mobility impairments. METHODS: based on responses to a participation survey, respondents, located primarily in the Midwestern United States, were divided into 3 physical activity groups: high, low, and inactive. We chose a purposeful sample of 604 people with mobility limitations who had a diagnosis of spinal cord injury, multiple sclerosis, cerebral palsy, stroke, or poliomyelitis. The Participation Survey/Mobility (PARTS/M) was used to measure participation in 6 domains and 20 different activities, the Physical Activity and Health Status (SF-36) was used to measure health and quality of life, and the Reintegration to Normal Living Index (RNL) was used to measure integration into the community. RESULTS: people with mobility impairments who were identified as having a high level of physical activity reported greater participation, better health, and a higher level of reintegration to normal community living compared with participants who described their physical activity level as low or inactive. CONCLUSION: positive health status and superior community participation were found in a high physical activity group compared with low active or inactive groups of people with mobility impairments and limitations.

Real-time fluorescence monitoring of tryptic digestion in proteomics.

Ensuring that proteolytic digestions are complete before submitting samples for downstream proteomic analyses is important, as failure or partial digestion can waste valuable instrument time and make results difficult to interpret. Conversely, overdigestion can also be problematic, such as when removing affinity tags from recombinant proteins or using nonspecific proteases. The techniques of HPLC, circular dichroism, SDS-PAGE, and MS have each been used to assess protein digestion. These techniques are slow, may require expensive instrumentation, can be inaccurate, and/or are unsuitable for real-time monitoring. Epicocconone is a natural fluorophore that reacts reversibly with proteins to form a highly fluorescent adduct and has previously been used to quantify proteins in 1D and 2D gels and in solution. Here, we describe a new method for the real-time monitoring of protein digestion based on epicocconone. This unique in situ fluorescent assay can tracelessly follow proteolysis of samples, at low microgram levels, destined for proteomics analysis or purification.