Montessori education's impact on academic and nonacademic outcomes: A systematic review.

Background: Montessori education is the oldest and most widely implemented alternative education in the world, yet its effectiveness has not been clearly established. Objectives: The primary objective of this review was to examine the effectiveness of Montessori education in improving academic and nonacademic outcomes compared to traditional education. The secondary objectives were to determine the degree to which grade level, Montessori setting (public Montessori vs. private Montessori), random assignment, treatment duration, and length of follow-up measurements moderate the magnitude of Montessori effects. Search Methods: We searched for relevant studies in 19 academic databases, in a variety of sources known to publish gray literature, in Montessori-related journals, and in the references of studies retrieved through these searches. Our search included studies published during or before February 2020. The initial search was performed in March 2014 with a follow-up search in February 2020. Selection Criteria: We included articles that compared Montessori education to traditional education, contributed at least one effect size to an academic or nonacademic outcome, provided sufficient data to compute an effect size and its variance, and showed sufficient evidence of baseline equivalency-through random assignment or statistical adjustment-of Montessori and traditional education groups. Data Collection and Analysis: To synthesize the data, we used a cluster-robust variance estimation procedure, which takes into account statistical dependencies in the data. Otherwise, we used standard methodological procedures as specified in the Campbell Collaboration reporting and conduct standards. Main Results: Initial searches yielded 2012 articles, of which 173 were considered in detail to determine whether they met inclusion/exclusion criteria. Of these, 141 were excluded and 32 were included. These 32 studies yielded 204 effect sizes (113 academic and 91 nonacademic) across 132,249 data points. In the 32 studies that met minimum standards for inclusion, including evidence of baseline equivalence, there was evidence that Montessori education outperformed traditional education on a wide variety of academic and nonacademic outcomes. For academic outcomes, Hedges' g effect sizes, where positive values favor Montessori, ranged from 0.26 for general academic ability (with high quality evidence) to 0.06 for social studies. The quality of evidence for language (g = 0.17) and mathematics (g = 0.22) was also high. The effect size for a composite of all academic outcomes was 0.24. Science was the only academic outcome that was deemed to have low quality of evidence according to the GRADE approach. Effect sizes for nonacademic outcomes ranged from 0.41 for students' inner experience of school to 0.23 for social skills. Both of these outcomes were deemed as having low quality of evidence. Executive function (g = 0.36) and creativity (g = 0.26) had moderate quality of evidence. The effect size for a composite of all nonacademic outcomes was 0.33. Moderator analyses of the composite academic and nonacademic outcomes showed that Montessori education resulted in larger effect sizes for randomized studies compared to nonrandomized studies, for preschool and elementary settings compared to middle school or high school settings, and for private Montessori compared to public Montessori. Moderator analyses for treatment duration and duration from intervention to follow-up data collection were inconclusive. There was some evidence for a lack of small sample-size studies in favor of traditional education, which could be an indicator of publication bias. However, a sensitivity analysis indicated that the findings in favor of Montessori education were nonetheless robust. Authors' Conclusions: Montessori education has a meaningful and positive impact on child outcomes, both academic and nonacademic, relative to outcomes seen when using traditional educational methods.

Back to the future: Redefining "universal precautions" to include masking for all patient encounters.

Despite recent guidance from the Centers for Disease Control and Prevention (CDC) allowing institutions to relax in-facility masking strategies and due to our evolving understanding of respiratory pathogen transmission during the coronavirus disease 2019 (COVID-19) pandemic, we propose an updated standard for universal precautions in healthcare settings: permanently including universal masking in routine patient-care interactions. Such a practice prioritizes safety for patients, healthcare providers (HCPs), and visitors.

Sharp decline in rates of community respiratory viral detection among patients at the National Institutes of Health Clinical Center during the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVES: To analyze the frequency and rates of community respiratory virus infections detected in patients at the National Institutes of Health Clinical Center (NIHCC) between January 2015 and March 2021, comparing the trends before and during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: We conducted a retrospective study comparing frequency and rates of community respiratory viruses detected in NIHCC patients between January 2015 and March 2021. Test results from nasopharyngeal swabs and washes, bronchoalveolar lavages, and bronchial washes were included in this study. Results from viral-challenge studies and repeated positives were excluded. A quantitative data analysis was completed using cross tabulations. Comparisons were performed using mixed models, applying the Dunnett correction for multiplicity. RESULTS: Frequency of all respiratory pathogens declined from an annual range of 0.88%-1.97% between January 2015 and March 2020 to 0.29% between April 2020 and March 2021. Individual viral pathogens declined sharply in frequency during the same period, with no cases of influenza A/B orparainfluenza and 1 case of respiratory syncytial virus (RSV). Rhino/enterovirusdetection continued, but with a substantially lower frequency of 4.27% between April 2020 and March 2021, compared with an annual range of 8.65%-18.28% between January 2015 and March 2020. CONCLUSIONS: The decrease in viral respiratory infections detected in NIHCC patients during the pandemic was likely due to the layered COVID-19 prevention and mitigation measures implemented in the community and the hospital. Hospitals should consider continuing the use of nonpharmaceutical interventions in the future to prevent nosocomial transmission of respiratory viruses during times of high community viral load.

Management of Unique Pneumonias Seen in the Intensive Care Unit.

Infection of the lower respiratory tract is a potentially severe or life-threatening illness. Taking the right steps to recognize, identify, and treat pneumonia is critical to improving patient outcomes. An awareness of the diversity of potential infectious causes, the local endemic flora and resistance patterns, as well as testing strategies to differentiate causes of pneumonia is essential to providing the best patient outcomes. Understanding surveillance definitions allow intensivists to become partners in reducing hospital-associated infections and improving quality of care.

Experience with voluntary severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing of asymptomatic staff at the National Institutes of Health for one year.

Voluntary asymptomatic severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing was provided by the NIH Clinical Center over 1 year. Among 105,927 tests, 0.2% were positive. Among eligible staff, 79% participated with variable frequency and 61% of positive individuals had symptoms at the time of testing. Saliva specimen collection was chosen as an option less frequently than midturbinate collection.

Multisociety statement on coronavirus disease 2019 (COVID-19) vaccination as a condition of employment for healthcare personnel.

This consensus statement by the Society for Healthcare Epidemiology of America (SHEA) and the Society for Post-Acute and Long-Term Care Medicine (AMDA), the Association for Professionals in Epidemiology and Infection Control (APIC), the HIV Medicine Association (HIVMA), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP) recommends that coronavirus disease 2019 (COVID-19) vaccination should be a condition of employment for all healthcare personnel in facilities in the United States. Exemptions from this policy apply to those with medical contraindications to all COVID-19 vaccines available in the United States and other exemptions as specified by federal or state law. The consensus statement also supports COVID-19 vaccination of nonemployees functioning at a healthcare facility (eg, students, contract workers, volunteers, etc).

Pooled Saliva Specimens for SARS-CoV-2 Testing.

We evaluated saliva (SAL) specimens for SARS-CoV-2 reverse transcriptase PCR (RT-PCR) testing by comparison of 459 prospectively paired nasopharyngeal (NP) or midturbinate (MT) swabs from 449 individuals with the aim of using saliva for asymptomatic screening. Samples were collected in a drive-through car line for symptomatic individuals (n = 380) and in the emergency department (ED) (n = 69). The percentages of positive and negative agreement of saliva compared to nasopharyngeal swab were 81.1% (95% confidence interval [CI], 65.8% to 90.5%) and 99.8% (95% CI, 98.7% to 100%), respectively. The percent positive agreement increased to 90.0% (95% CI, 74.4% to 96.5%) when considering only samples with moderate to high viral load (cycle threshold [CT ] for the NP, ≤34). Pools of five saliva specimens were also evaluated on three platforms, bioMérieux NucliSENS easyMAG with ABI 7500Fast (CDC assay), Hologic Panther Fusion, and Roche Cobas 6800. The average loss of signal upon pooling was 2 to 3 CT values across the platforms. The sensitivities of detecting a positive specimen in a pool compared with testing individually were 94%, 90%, and 94% for the CDC 2019-nCoV real-time RT-PCR, Panther Fusion SARS-CoV-2 assay, and Cobas SARS-CoV-2 test, respectively, with decreased sample detection trending with lower viral load. We conclude that although pooled saliva testing, as collected in this study, is not quite as sensitive as NP/MT testing, saliva testing is adequate to detect individuals with higher viral loads in an asymptomatic screening program, does not require swabs or viral transport medium for collection, and may help to improve voluntary screening compliance for those individuals averse to various forms of nasal collections.