Assessing oral reading fluency within and across grade levels: Development of equated test forms.

Deficits in oral reading fluency (ORF) impair reading comprehension and tend to persevere throughout schooling. Therefore, the assessment and monitoring of the students' performance in ORF across time should be routinely performed to guide the instruction and intervention. The goal of this work was to develop and validate a test of ORF for Portuguese students from grades 1 to 6 (TAF - Teste de Avaliação da Fluência) that includes specific test forms for each grade level with equated scores that allow comparison across multiple assessment points. In study 1 (N = 1166), the chained equipercentile equating method was performed to equate the test forms' scores horizontally and vertically. The tests of differences performed using the equated scores indicated that they were similar within the same grade level but increased significantly across grade levels. In study 2 (N = 549), reliability and validity evidence for the test forms was collected. Test-retest correlations were higher than .90, suggesting a high stability of the scores. Significant correlations between the TAF scores and the ones obtained in other reading tests, teachers' judgments, and school outcomes, were obtained, thus providing evidence of validity for the developed test forms. This instrument allows not only interindividual comparisons but also the assessment of intra-individual changes in ORF across time or as a result of intervention programs, while avoiding learning effects that arise when the same measure is administered multiple times.

Removal of veterinary antibiotics in constructed wetland microcosms - Response of bacterial communities.

This study aimed to evaluate the response of bacteria, in terms of microbial community structure, from constructed wetland (CW) microcosms exposed to two veterinary antibiotics, enrofloxacin (ENR) and ceftiofur (CEF), alone or in a mixture, identifying which bacterial groups were dominant in CWs substrate during livestock wastewater treatment. Wastewater, not-doped or doped with ENR and/or CEF (100 µg/L each), was treated during 18 one-week cycles. Systems showed removal percentages > 85% for the added antibiotics, showing also high removal percentages for nutrients and organic matter and confirming CWs systems were working properly. However, both time of exposure and presence of antibiotics influenced significantly CWs substrate bacterial community structure. Pyrosequencing results showed bacterial communities were dominated by phyla Proteobacteria (38-48%), Firmicutes (20-27%), Bacteroidetes (12-15%) and Actinobacteria (4-9%), and that their relative abundance was clearly affected by the presence of the antibiotics. Results suggest the applicability of CWs for the removal of veterinary antibiotics from livestock wastewaters and provide new knowledge about the bacteria within the system, which can potentially be involved in removal processes. This information could in the future be used to improve CWs removal rates of pharmaceuticals from livestock wastewaters.

The development of vocabulary and grammar: a longitudinal study of European Portuguese-speaking toddlers.

The goals of this study were to analyze the growth and stability of vocabulary, mean length of the three longest utterances (MLLUw), and sentence complexity in European Portuguese-speaking children aged 1;4-2;6, to explore differences in growth as a function of personal and family-related variables, and to investigate the inter-relationships among the three language dimensions. Fifty-one European Portuguese-speaking toddlers were longitudinally assessed at 1;4, 1;9, 2;1, and 2;6, through parent reports. Exponential growth models best described acquisition patterns during this period, but the vocabulary growth accelerated across the full age-range, whereas the growth of grammar dimensions accelerated mainly after 1;9. High variability was observed in the scores, but the toddlers' relative positions were mostly stable over time. Gender approached significance as a predictor of vocabulary growth. Maternal educational level did not predict the growth of any of the three language dimensions. Both vocabulary and MLLUw predicted sentence complexity.

Assessing reading comprehension with narrative and expository texts: Dimensionality and relationship with fluency, vocabulary and memory.

Reading comprehension assessment should rely on valid instruments that enable adequate conclusions to be taken regarding students' reading comprehension performance. In this article, two studies were conducted to collect validity evidence for the vertically scaled forms of two Tests of Reading Comprehension for Portuguese elementary school students in the second to fourth grades, one with narrative texts (TRC-n) and another with expository ones (TRC-e). Two samples of 950 and 990 students participated in Study 1, the study of the dimensionality of the TRC-n and TRC-e forms, respectively. Confirmatory factor analyses provided evidence of an acceptable fit for the one-factor solution for all test forms. Study 2 included 218 students to collect criterion-related validity. The scores obtained in each of the test forms were significantly correlated with the ones obtained in other reading comprehension measures and with the results obtained in oral reading fluency, vocabulary and working memory tests. Evidence suggests that the test forms are valid measures of reading comprehension.

Light-NBI to identify high-risk phenotypes for gastric adenocarcinoma: do we still need biopsies?

OBJECTIVE: Early diagnosis of gastric cancer may be achieved through surveillance of patients with extensive gastric intestinal metaplasia (eGIM). However, diagnosis of eGIM generally implies histology. We aimed at determining the accuracy of high-resolution endoscopy with light-narrow band imaging (NBI) to assess the presence of eGIM on a per-patient basis. MATERIAL AND METHODS: Prospective cohort of 60 patients divided into two groups: derivation cohort (n = 25) to evaluate the reliability and validity, and a real-time validation group (n = 35). In the derivation group, six endoscopists with two levels of expertise were asked to estimate the grade of GIM based in endoscopic images (white light endoscopy, light-NBI and amplification/near focus). In the real-time validation set, experienced endoscopists were asked to similarly record their real-time optical diagnosis. Histology was then considered as the gold standard. RESULTS: In the derivation group diagnosis accuracy was 60% with WLE (non-expert 59% vs. 61% experts), increasing to 73% after NBI magnification (non-expert 63% vs. 83% expert, p < 0.05). Moreover, proportion of agreement with histology was 83%, with a correct diagnosis of eGIM in 87% for experienced observers. In the real-time group experts obtained 89% global diagnostic accuracy correctly identifying 91% of the eGIM. The sensitivity, specificity, LR + and LR- of real-time endoscopic diagnosis of eGIM was 0.92 (CI95%:0.67-0.99), 0.96 (0.79-0.99), 21.1 (3.08-144) and 0.09 (0.013-0.57). CONCLUSION: For the first time the reliability of high-resolution endoscopy with light-NBI for extension of GIM is described. Our results suggest that more than 90% of individuals at risk could be identified without the need for biopsies, simplifying the current recommendations.

Well-being and academic achievement in secondary school pupils: The unique effects of burnout and engagement.

The main goal of this study was to examine the relationship among burnout, engagement, well-being, and academic performance in Portuguese secondary school pupils. The existence of gender related differences in these relationships was also investigated. The sample was composed of 489 pupils who attended an academic track at secondary school. Results of multi-group structural equation modelling indicated that higher levels of cynicism towards studies were associated with lower academic achievement. Exhaustion was not uniquely related to the adolescents' academic achievement or well-being. However, higher levels of engagement, namely dedication and vigour, were related to higher levels of well-being. Moreover, vigour was also uniquely associated with academic achievement. The results were similar for boys and girls. Implications for intervention and future research are discussed.

Ultrasound-assisted technique for challenging jejunostomy balloon-tube replacements.

The authors present a case of a 38-year-old man with a 4-hour history of accidental removal of a jejunostomy balloon-tube replacement (PEG-18-BRT-S, Cook Medical Inc., Bloomington, USA). The patient had undergone a direct percutaneous endoscopic jejunostomy (DPEJ) ten months ago, before chemoradiotherapy treatment for an esophageal squamous-cell carcinoma (uT3N2cM0). His past medical condition included alcoholic liver disease and distal gastrectomy from a life-threatening duodenal bleeding ulcer.

Balloon overtube-assisted stenting in difficult upper and lower gastrointestinal locations using a modified over-the-wire technique.

In this series of four patients, some modifications of the standard over-the-wire (OTW) technique for stent deployment using the balloon overtube normally used in single-balloon enteroscopy are presented. This modified technique allowed the use of OTW stents in patients where there were difficulties that meant the standard technique was unsuccessful. For each patient, the authors describe different small novel adaptations of this modified technique that enabled self-expanding metal stents (SEMSs) and biodegradable stents to be successfully deployed in different gastrointestinal locations. Moreover, in one patient the stent was placed without fluoroscopic guidance.

Obscure gastrointestinal bleeding: Which factors are associated with positive capsule endoscopy findings?

BACKGROUND: Capsule endoscopy is a first line examination to evaluate obscure gastrointestinal bleeding. The identification of factors associated with the detection of lesions by capsule endoscopy could improve resource utilization and patient selection. OBJECTIVES: To identify factors associated with positive capsule endoscopy findings in patients with obscure gastrointestinal bleeding. METHODS: Retrospective, single-center study, including 203 patients (214 capsule endoscopy procedures) submitted to capsule endoscopy in the setting of obscure gastrointestinal bleeding. Type of obscure gastrointestinal bleeding, number of units of packed red blood cells transfused, type of positive finding, number of endoscopy studies performed prior to capsule endoscopy, comorbidities, medication and Charlson index were evaluated. Overt bleeding was subdivided into ongoing and previous gastrointestinal bleeding. Only lesions with high hemorrhagic potential (P2) were classified as positive findings. RESULTS: The mean age was 62.2 years and 59.7% of patients were female. Most patients were referred for occult gastrointestinal bleeding (64.5%), while 35.5% were referred for overt gastrointestinal bleeding (63.2% previous-overt gastrointestinal bleeding). The most frequent positive findings included ulcers/ erosions (34%) and angioectasias (32%). In univariate analysis, the identification of positive findings was significantly higher in those with ongoing-overt bleeding (p < 0.001), advanced age (p =0.003), increasing number of pre-capsule endoscopies (p < 0.001), increasing transfusion requirements (p < 0.001), moderate/severe renal disease (p = 0.009) and antiplatelet drugs (p = 0.021) and NSAID intake (p = 0.005). In multivariate analysis, positive findings were significantly higher only in those with ongoing-overt bleeding (odds ratio [OR] 18.68, 95% confidence interval [CI] 3.98-85.6, p < 0.001), higher transfusion requirements (OR 1.23, 95% CI 1.1-1.4, p < 0.001) and NSAID intake (OR 5.9, 95% CI 2.1-17.3, p = 0.001). CONCLUSIONS: Capsule endoscopy should be used early in obscure gastrointestinal bleeding. Ongoing-overt bleeding, higher transfusion requirements and NSAIDs intake were associated with positive findings on capsule endoscopy.

What is the long-term outcome of a negative capsule endoscopy in patients with obscure gastrointestinal bleeding?

BACKGROUND AND AIMS: There are contradictory findings regarding long-term outcome in patients with obscure gastrointestinal bleeding and negative capsule endoscopy. Factors associated with rebleeding after a negative videocapsule are not entirely known. OBJECTIVE: The aim of this study was to compare the rebleeding rate between negative and positive capsule endoscopy patients and to identify predictive factors for rebleeding in patients with negative findings. MATERIAL AND METHODS: Consecutive patients with obscure gastrointestinal bleeding referred to a single center over a period of 5 years were identified. After exclusion of patients with a follow time < 6 months, 173 patients were included. Clinical information was retrospectively collected from medical records. Rebleeding was defined as evidence of melena/hematochezia, a drop in hemoglobin of ≥ 2 g/dL, or the need for transfusion 30 days after the index episode. RESULTS: The mean age was 61.7 years and 60% were female. The median follow up time was 27 months. Most patients were referred for occult gastrointestinal bleeding (67.1%) while 32.9% were referred for overt bleeding. More than 50% of the patients had negative capsule endoscopy. The rebleeding rate in negative capsule endoscopy is 16%, with a mean follow-up time of 25.8 months and is significantly lower than positive capsule endoscopy (16% vs. 30.2%, p = 0.02). Rebleeding after negative capsule endoscopy is higher in patients who need more transfusions of packet red blood cells before capsule endoscopy (3.0 vs. 0.9, p = 0.024) and have overt bleeding (46% vs. 13.9%, p = 0.03). In 53% of these patients, rebleeding occurs > 12 months after a negative capsule endoscopy. CONCLUSIONS: Patients with obscure gastrointestinal bleeding and a negative capsule endoscopy had a significantly lower rebleeding rate and can be safely followed. However, a higher transfusion of red blood cells previous to capsule endoscopy and an overt bleeding are associated with a higher rebleeding. So, it is reasonable to consider that these patients may benefit of at least one year of follow-up.

What is the long term safety of a negative capsule endoscopy in patients with obscure gastrointestinal bleeding?

BACKGROUND AND AIMS: There are contradictory findings regarding long-term outcome in patients with obscure gastrointestinal bleeding and negative capsule endoscopy. Factors associated with rebleeding after a negative videocapsule are not entirely known. OBJECTIVE: The aim of this study was to compare the rebleeding rate between negative and positive capsule endoscopy patients and to identify predictive factors for rebleeding in patients with negative findings. MATERIAL AND METHODS: Consecutive patients with obscure gastrointestinal bleeding referred to a single center over a period of 5 years were identified. After exclusion of patients with a follow time < 6 months, 173 patients were included. Clinical information was retrospectively collected from medical records. Rebleeding was defined as evidence of melena/hematochezia, a drop in hemoglobin of ≥ 2 g/dL, or the need for transfusion 30 days after the index episode. RESULTS: The mean age was 61.7 years and 60% were female. The median follow up time was 27 months. Most patients were referred for occult gastrointestinal bleeding (67.1%) while 32.9% were referred for overt bleeding. More than 50% of the patients had negative capsule endoscopy. The rebleeding rate in negative capsule endoscopy is 16%, with a mean follow-up time of 25.8 months and is significantly lower than positive capsule endoscopy (16% vs. 30.2%, p = 0.02). Rebleeding after negative capsule endoscopy is higher in patients who need more transfusions of packet red blood cells before capsule endoscopy (3.0 vs. 0.9, p = 0.024) and have overt bleeding (46% vs. 13.9%, p = 0.03). In 53% of these patients, rebleeding occurs > 12 months after a negative capsule endoscopy. CONCLUSIONS: Patients with obscure gastrointestinal bleeding and a negative capsule endoscopy had a significantly lower rebleeding rate and can be safely followed. However, a higher transfusion of red blood cells previous to capsule endoscopy and an overt bleeding are associated with a higher rebleeding. So, it is reasonable to consider that these patients may benefit of at least one year of follow-up.

Initial experience with fecal microbiota transplantation in Clostridium difficile infection - transplant protocol and preliminary results.

BACKGROUND AND AIMS: Clostridium difficile infection (CDI) constitutes an important cause of antibiotic-associated diarrhea. Recurrence after first-line treatment with antibiotics is high and fecal microbiota transplantation (FMT) may be effective for refractory and recurrent CDI. This series aims to describe the efficacy of FMT in the treatment of refractory and recurrent CDI. METHODS: A prospectively recorded single-centre case series of patients with persistent or recurrent CDI treated with FMT between June 2014 and March 2015 was analyzed. Primary and secondary outcomes were defined as resolution of diarrhea without recurrence of CDI within 2 months after one or more FMT, respectively. A descriptive analysis was performed. RESULTS: 8 FMT were performed in 6 patients, 3 with refractory CDI and 3 with recurrent CDI. The median age of recipients was 71 years and 66.7% were women. One FMT was delivered through colonoscopy and the remaining 87.5% through esophagogastroduodenoscopy. One upper FMT was excluded due to recurrence of CDI after antibiotic exposure for a respiratory infection. The overall cure rate of FMT was total with lower route and 83.3% with upper route. Primary cure rate was achieved in 83.3% of patients and secondary cure rate was achieved in all patients. Median time to resolution of diarrhea after FMT was 1 day and no complications were reported during follow-up. CONCLUSION: FMT appears to constitute a safe and effective approach in the management of refractory and recurrent CDI. Difference between primary and secondary cure rates may result of insufficient restoration of intestinal microbiota with a single FMT.

[Whipple's Disease: retrospective analysis of twelve cases and review of the literature]. / Doença de Whipple: análisis retrospectivo de doce casos e revisión de la literature.

BACKGROUND: Whipple's disease is a rare and chronic bacterial disease with multiorganic involvement. Although there is no valid estimate of its actual prevalence, only about 1,000 cases have been reported. OBJECTIVE: To describe the demographic, clinical, laboratory, endoscopic and pathologic features, type of treatment used, its duration and response. METHODS: Based on the duodenal histology, we identified twelve cases of Whipple's disease in the Hospital Centre of Vila Nova de Gaia, between 1997 and 2010. RESULTS. Nine patients (75%) were male and the mean age at diagnosis was 58 years. All patients experienced at least one gastrointestinal and general symptom. Arthralgia were reported in four patients (33%) and occurred on average six years before the onset of gastrointestinal and general symptoms. In 10 patients the initial treatment was trimethoprim-sulfamethoxazole. The initial treatment duration was one year in 8 cases (80%). Seven patients (70%) had a symptomatic resolution between the third and sixth months of antibiotic therapy, as well as an endoscopic and histological improvement. Even in these patients, there was maintenance of periodic acid-Schiff positive macrophages, although in small number and with a more diffuse distribution. Gastrointestinal symptoms predominated in cases of clinical relapse. CONCLUSIONS: The gastrointestinal and general symptoms as well as the arthralgia were the predominant manifestations. The majority of patients showed clinical and endoscopic improvement in response to treatment with trimethoprim-sulfamethoxazole. However, in these cases periodic acid-Schiff positive macrophages can remain for years. Thus, in the absence of clinical deterioration, the presence of these structures is not indicative ofactive disease.

Carcinogenic Risk from Lead and Cadmium Contaminating Cow Milk and Soya Beverage Brands Available in the Portuguese Market.

Our previous work demonstrated the presence of lead (Pb) and cadmium (Cd) contamination in cow milk (CM) and soy beverages (SBs) in Portugal. These metals share carcinogenic mechanisms, suggesting at least additive effects. Our goals were to assess carcinogenic risks from Pb and Cd intake detected in various CM and SB brands on the Portuguese market and to determine the relative contributions of Pb and Cd. Furthermore, we modeled different consumption scenarios for various age/body weight groups to estimate cumulative Excess Lifetime Carcinogenic Risk (ELCR). ELCR was computed by multiplying chronic daily intake by a cancer slope factor for each metal, with an ELCR > 1 × 10-4 indicating carcinogenic risk. Five CM and three SB brands posed cancer risks in children, with the highest values at 1.75 × 10-4 and 9.12 × 10-5, respectively; Pb had mean relative contributions of 87.8 ± 3.1% in CM and 54.9 ± 12.1% in SB. Carcinogenic risks were observed for children, adolescents, and adults in several CM or SB consumption scenarios, albeit at levels above typical Portuguese intakes. Strict monitoring of metal levels, such as Pb and Cd, is advised because CM is a component of many foods, including baby food.

Biliary self-expandable metallic stent using single balloon enteroscopy assisted ERCP--overcoming limitations of current accessories.

Device assisted enteroscopy (DAE) techniques have been recently developed for the diagnosis and treatment of small bowel diseases. These techniques can also be used to perform endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomies. The main difficulties with DAE-ERCP are related to type of surgery, to the different dimensions and lack of frontal view of the enteroscope and to the resulting limitations with the use of standard accessories, resulting in the need of dedicated accessory devices. Although most ERCP techniques have been successfully performed with DAE-ERCP, biliary self-expandable metallic stents (SEMS) have not yet been used, as dedicated biliary SEMS for the enteroscope are lacking. The authors present a case report showing a new method to place standard biliary trough-the-scope SEMS with DAE-ERCP, using a different technique of stent deployment.

Metals in Cow Milk and Soy Beverages: Is There a Concern?

Nowadays, there is an increased consumption of plant-based protein beverages like soy beverages (SBs) as substitutes for cow milk (CM). Both accumulate toxic metals like lead (Pb), cadmium (Cd), and manganese (Mn), which, although essential, are neurotoxic at high levels. Metals can also perturb the normal development of children. This work aimed to evaluate these metal concentrations in CM and SB purchased on the Portuguese market. After validation of the method, linearity of calibration curves, work range, detection and quantification limits, and selectivity, metals were determined in 14 CM and 14 SB brands using atomic absorption spectrometry. The values were compared between CM and SB and with permissible limit values. Soy beverages had significantly (p < 0.05) higher concentrations of Cd (5.6 ± 4.2 µg/L) and Mn (117.4 ± 30.3) µg/L) than CM (2.15 ± 1.84 µg/L and 5.93 ± 1.21 µg/L, respectively); the Pb concentrations in CM (19.3 ± 12.1 µg/L) were not significantly (p > 0.05) higher than in SB (13.4 ± 9.6 µg/L). These values were similar to other studies and close to but under permissible limit values. Nevertheless, due to the toxicity and bioaccumulation of metals, the fact that these foods are routinely ingested by all ages, mainly children, and represent key ingredients in many processed foods, including baby foods, we suggest strict surveying of metal levels in CM and SBs.

Reading, linguistic, and metacognitive skills: are they reciprocally related past the first school years?

Empirical research has systematically demonstrated the predictive role of reading, linguistic and metacognitive skills on reading comprehension performance. The study of the directionality of these relations and their relative contribution in the more advanced grades of primary school is an important aim for reading research, with practical implications for educational contexts. These issues are of particular relevance in semitransparent orthographies such as European Portuguese, as there is empirical evidence that these relations change over time. The goal of this study was to examine the longitudinal relations between oral reading fluency, listening comprehension, vocabulary, reading strategy use and reading comprehension in Portuguese students across grades 4 to 6. For this purpose, reciprocal-causation models with cross-lagged paths were tested using Mplus. The sample included 110 students who completed at least two assessment time points. The results indicated that there is a reciprocal relation between listening comprehension and reading comprehension, as well as between vocabulary and reading comprehension, in every grade. Oral reading fluency was a significant predictor of reading comprehension across grades 4-6, but the opposite relation was not verified. Reading strategy use in grade 5 was predicted by reading comprehension in grade 4. The results are discussed considering previous studies and their potential impact on psychoeducational practice and research. Limitations of the study and guidelines for future research are pointed out.

An Intervention in Reading Disabilities Using a Digital Tool During the COVID-19 Pandemic.

In the last decade, ICT-based interventions for developing reading skills in children with reading disabilities have become increasingly popular. This study had three goals: (a) to assess the existence of gains in word reading, oral reading fluency and listening comprehension after a Tier 2 intervention using the digital tool "I'm still learning," which was delivered partially in a remote modality during the COVID-19 pandemic; (b) to investigate whether the gains depended on the students' gender, the number of sessions attended and the interventionist; and (c) to investigate parents' perceptions about the suitability and perceived effects of the intervention. A single group design with pre-test and post-test was used. The intervention was delivered to second graders (N = 81) flagged as being at-risk for reading disabilities in a universal screening. The analyses showed significant gains in all three outcome variables after the intervention. The gains did not depend on students' gender, number of intervention sessions attended or interventionist. Parents' perceptions of the remote intervention were positive. The study findings highlight the potentialities of using technology-based interventions to foster reading skills and suggest that these may be especially useful during lockdowns.