Virtual Patient/Family Communication in the Acute Care Setting.

Patient and family-centered care strategies see patients and families as valuable healthcare team members and are therefore treated as essential clinical partners to achieve safe, high-quality care. Traditionally, hospitals have relied on physical presence as the primary strategy for including families in shared decision-making. During COVID-19, widespread visitor restrictions removed this primary strategy. Hospitals rapidly deployed virtual communication tools to address the challenges visitor restrictions created. The rapid deployment produced benefits and unintended consequences, especially for the healthcare providers. Through a series of qualitative interviews with family members and healthcare providers, consistent themes were identified and mapped to the sociotechnical model. This project identified barriers to adoption and proposed corresponding success criteria. Although the project focused on implementing virtual communication in the context of the COVID-19 pandemic, virtual communication strategies can likely support family-centered care goals outside of the pandemic context.

High genetic load without purging in caribou, a diverse species at risk.

High intra-specific genetic diversity is associated with adaptive potential, which is key for resilience to global change. However, high variation may also support deleterious alleles through genetic load, thereby increasing the risk of inbreeding depression if population sizes decrease. Purging of deleterious variation has been demonstrated in some threatened species. However, less is known about the costs of declines and inbreeding in species with large population sizes and high genetic diversity even though this encompasses many species globally that are expected to undergo population declines. Caribou is a species of ecological and cultural significance in North America with a wide distribution supporting extensive phenotypic variation but with some populations undergoing significant declines resulting in their at-risk status in Canada. We assessed intra-specific genetic variation, adaptive divergence, inbreeding, and genetic load across populations with different demographic histories using an annotated chromosome-scale reference genome and 66 whole-genome sequences. We found high genetic diversity and nine phylogenomic lineages across the continent with adaptive diversification of genes, but also high genetic load among lineages. We found highly divergent levels of inbreeding across individuals, including the loss of alleles by drift but not increased purging in inbred individuals, which had more homozygous deleterious alleles. We also found comparable frequencies of homozygous deleterious alleles between lineages regardless of nucleotide diversity. Thus, further inbreeding may need to be mitigated through conservation efforts. Our results highlight the "double-edged sword" of genetic diversity that may be representative of other species atrisk affected by anthropogenic activities.

Predictive Validity of Curriculum-Embedded Measures on Outcomes of Kindergarteners Identified as At Risk for Reading Difficulty.

This study examined the predictive validity of formative assessments embedded in a Tier 2 intervention curriculum for kindergarten students identified as at risk for reading difficulty. We examined when (i.e., months during the school year) measures could predict reading outcomes gathered at the end of kindergarten and whether the predictive validity of measures changed across the kindergarten year. Participants consisted of 137 kindergarten students whose reading development was assessed four times from October to February. Measures aligned with content taught in the curriculum and assessed a range of phonologic, alphabetic, and word-reading skills. Results from structural equation modeling indicate that 36.3% to 65.2% of the variance was explained on the latent decoding outcome and 62.0% to 86.8% on the latent phonological outcome across the four time points. Furthermore, the predictive validity of specific skills increased over the kindergarten year, with more complicated tasks (e.g., word segmentation) becoming more predictive at subsequent measurement occasions. Results suggest that curriculum-embedded measures may be viable tools for assessing and predicting reading performance.

Examining the effects of linking student performance and progression in a tier 2 kindergarten reading intervention.

Despite the emerging evidence base on response to intervention, there is limited research regarding how to effectively use progress-monitoring data to adjust instruction for students in Tier 2 intervention. In this study, we analyzed extant data from a series of randomized experimental studies of a kindergarten supplemental reading intervention to determine whether linking performance on formative assessments to curriculum progression improved kindergarten reading outcomes over standard implementation. We were interested in whether specific progression adjustments would enhance the effects of supplemental reading intervention. Growth-mixture modeling using data from kindergarteners (n = 136) whose intervention progression (e.g. repeat lessons, skip lessons) was adjusted every 4 weeks based on mastery data identified four latent classes characterized by unique profiles of curriculum progression adjustments. Multilevel analyses comparing the performance of students in the four classes with that of propensity matched groups whose intervention was not adjusted (n = 101) indicated positive effects of curriculum progression for (a) students whose formative assessment performance exceeded 90% and received early and sustained lesson acceleration and (b) students who initially performed below 70% on assessments and who repeated early lessons and progressed to conventional implementation. Effects of curriculum adjustments for the two smallest groups were less clear.

Assessing spelling in kindergarten: further comparison of scoring metrics and their relation to reading skills.

Early reading and spelling development share foundational skills, yet spelling assessment is underutilized in evaluating early reading. This study extended research comparing the degree to which methods for scoring spelling skills at the end of kindergarten were associated with reading skills measured at the same time as well as at the end of first grade. Five strategies for scoring spelling responses were compared: totaling the number of words spelled correctly, totaling the number of correct letter sounds, totaling the number of correct letter sequences, using a rubric for scoring invented spellings, and calculating the Spelling Sensitivity Score (Masterson & Apel, 2010b). Students (N=287) who were identified at kindergarten entry as at risk for reading difficulty and who had received supplemental reading intervention were administered a standardized spelling assessment in the spring of kindergarten, and measures of phonological awareness, decoding, word recognition, and reading fluency were administered concurrently and at the end of first grade. The five spelling scoring metrics were similar in their strong relations with factors summarizing reading subskills (phonological awareness, decoding, and word reading) on a concurrent basis. Furthermore, when predicting first-grade reading skills based on spring-of-kindergarten performance, spelling scores from all five metrics explained unique variance over the autoregressive effects of kindergarten word identification. The practical advantages of using a brief spelling assessment for early reading evaluation and the relative tradeoffs of each scoring metric are discussed.

The effects and interactions of student, teacher, and setting variables on reading outcomes for kindergartners receiving supplemental reading intervention.

This exploratory study examined the influences of student, teacher, and setting characteristics on kindergarteners' early reading outcomes and investigated whether those relations were moderated by type of intervention. Participants included 206 kindergarteners identified as at risk for reading difficulties and randomly assigned to one of two supplemental interventions: (a) an experimental explicit, systematic, code-based program or (b) their schools' typical kindergarten reading intervention. Results from separate multilevel structural equation models indicated that among student variables, entry-level alphabet knowledge was positively associated with phonemic and decoding outcomes in both conditions. Entry-level rapid automatized naming also positively influenced decoding outcomes in both conditions. However, its effect on phonemic outcomes was statistically significant only among children in the typical practice comparison condition. Regarding teacher variables, the quality of instruction was associated with significantly higher decoding outcomes in the typical reading intervention condition but had no statistically significant influence on phonemic outcomes in either condition. Among setting variables, instruction in smaller group sizes was associated with better phonemic outcomes in the comparison condition but had no statistically significant influence on outcomes of children in the intervention group. Mode of delivery (i.e., pullout vs. in class) had no statistically significant influence on either outcome variable.

Indexing response to intervention: a longitudinal study of reading risk from kindergarten through third grade.

In this study, response to intervention and stability of reading performance of 41 kindergarten children identified as at risk of reading difficulty were evaluated from kindergarten through third grade. All students were assessed in the fall of each academic year to evaluate need for intervention, and students who fell below the 30th percentile on criterion measures received small-group supplemental intervention. Measures included a combination of commercial normative referenced measures and specific skill and construct measures to assess growth or change in reading risk status relative to 30th percentile benchmarks. Results indicated that consistent with the findings of prior research involving students with comparable entry-level performance, the majority of children identified as at risk in the beginning of kindergarten responded early and positively to intervention. On average, absolute performance levels at the end of kindergarten positioned students for trajectories of later reading performance that exceeded the 50th percentile on the majority of measures. Moreover, changes in risk status that occurred early were generally sustained over time. Only oral reading fluency performance failed to exceed the 30th percentile for the majority of students.

Attributes of effective and efficient kindergarten reading intervention: an examination of instructional time and design specificity.

A randomized experimental design with three levels of intervention was used to compare the effects of beginning reading interventions on early phonemic, decoding, and spelling outcomes of 96 kindergartners identified as at risk for reading difficulty. The three instructional interventions varied systematically along two dimensions--time and design of instruction specificity--and consisted of (a) 30 min with high design specificity (30/H), (b) 15 min with high design specificity plus 15 min of non-code-based instruction (15/H+15), and (c) a commercial comparison condition that reflected 30 min of moderate design specificity instruction (30/M). With the exception of the second 15 min of the 15/H+15 condition, all instruction focused on phonemic, alphabetic, and orthographic skills and strategies. Students were randomly assigned to one of the three interventions and received 108 thirty-minute sessions of small-group instruction as a supplement to their typical half-day kindergarten experience. Planned comparisons indicated findings of statistical and practical significance that varied according to measure and students' entry-level performance. The results are discussed in terms of the pedagogical precision needed to design and provide effective and efficient instruction for students who are most at risk.

Beginning reading intervention as inoculation or insulin: first-grade reading performance of strong responders to kindergarten intervention.

This study examined the first-grade reading progress of children who participated in an intensive beginning reading intervention in kindergarten. Specifically, the study investigated whether kindergarten intervention could prevent first-grade reading difficulties, or produce an "inoculation" effect, for some children under certain instructional conditions. Participants included children at risk for developing reading difficulties who received a 7-month beginning reading intervention in kindergarten. In October of first grade, 59 children who had achieved criterion levels on measures of phonological awareness and alphabetic knowledge were randomly assigned to one of two types of first-grade reading instruction: (a) code-based classroom instruction and a supplemental maintenance intervention, or (b) only code-based classroom instruction. February posttest measures assessed oral reading fluency, word reading, nonword reading, and comprehension. Between-group analyses indicated that instructional groups did not differ on any posttest measure. The students' absolute levels of achievement were compared to national and local normative samples. These results indicated that between 75% and 100% of students in both conditions attained posttest levels and demonstrated growth comparable to their average-achieving peers. These results support the hypothesis that strong responders to kindergarten intervention can experience an inoculation effect through the middle of first grade with research-validated classroom reading instruction.

Improving beginning reading instruction and intervention for students with LD: reconciling "all" with "each".

We begin with an examination of the tensions that exist between educational efforts that target the needs of all students and efforts that target the needs of individual students with disabilities. Next, we provide reasons why, in beginning reading, a schoolwide system designed to teach all students to read can also support individualized and flexible instruction designed to teach each student to read. Finally, we describe a schoolwide beginning reading model that includes a schoolwide framework or infrastructure that supports comprehensive and coordinated reading goals, assessment, and instruction for all students integrated with ongoing progress monitoring and instructional adjustments that allow for differentiated and individualized instruction for each student, including students with disabilities.