Investigating the Reading Profiles of Middle School Emergent Bilinguals with Significant Reading Comprehension Difficulties.

Purpose: This study investigated the reading profiles of middle school Spanish-speaking emergent bilinguals (EBs) with significantly below grade level reading comprehension and whether these profiles varied in their reading comprehension performance over time. Method: Latent profile analyses were used to classify Grade 6 and 7 Hispanic EBs (n = 340; 39% female) into subgroups based on their word reading and vocabulary knowledge. Growth models were then fit within each profile to evaluate reading comprehension performance over time. Results: Analyses revealed four latent profiles emerged: (a) very low word reading and low vocabulary (10%), (b) low word reading and low vocabulary (71%), (c) average word reading and low vocabulary (16%), and (d) high word reading and low vocabulary (3%). Subgroups varied in their reading comprehension initially and over one year. Students in the subgroup marked by very low word reading and low vocabulary showed the lowest reading comprehension performance initially; however, they also showed the greatest growth over one year. Conclusion: These findings suggest there is heterogeneity in the reading skill profiles of Spanish-speaking EBs with reading comprehension difficulties. They also underscore the prevalence of word reading difficulties among these students. These may be important factors to consider when developing interventions to prevent and remediate these difficulties.

Surface tension prevails over solute effect in organic-influenced cloud droplet activation.

The spontaneous growth of cloud condensation nuclei (CCN) into cloud droplets under supersaturated water vapour conditions is described by classic Köhler theory. This spontaneous activation of CCN depends on the interplay between the Raoult effect, whereby activation potential increases with decreasing water activity or increasing solute concentration, and the Kelvin effect, whereby activation potential decreases with decreasing droplet size or increases with decreasing surface tension, which is sensitive to surfactants. Surface tension lowering caused by organic surfactants, which diminishes the Kelvin effect, is expected to be negated by a concomitant reduction in the Raoult effect, driven by the displacement of surfactant molecules from the droplet bulk to the droplet-vapour interface. Here we present observational and theoretical evidence illustrating that, in ambient air, surface tension lowering can prevail over the reduction in the Raoult effect, leading to substantial increases in cloud droplet concentrations. We suggest that consideration of liquid-liquid phase separation, leading to complete or partial engulfing of a hygroscopic particle core by a hydrophobic organic-rich phase, can explain the lack of concomitant reduction of the Raoult effect, while maintaining substantial lowering of surface tension, even for partial surface coverage. Apart from the importance of particle size and composition in droplet activation, we show by observation and modelling that incorporation of phase-separation effects into activation thermodynamics can lead to a CCN number concentration that is up to ten times what is predicted by climate models, changing the properties of clouds. An adequate representation of the CCN activation process is essential to the prediction of clouds in climate models, and given the effect of clouds on the Earth's energy balance, improved prediction of aerosol-cloud-climate interactions is likely to result in improved assessments of future climate change.

The concept of holism applied in recent palliative care practice: A scoping review.

BACKGROUND: Whilst there is a sense of holism existing within palliative care practice, what is not clear is the extent to which holism, as applied in recent palliative care practice, has been adequately researched. Currently, no reviews on this topic were identified through systematic and scoping review registries. AIM: To identify and describe the available published evidence on the key features of holism and the core domains underpinning the application of holism in relation to recent palliative care practice. DESIGN: Scoping review using the Johanna Briggs Institute design. DATA SOURCES: MEDLINE, EMCARE, and CINAHL (Ovid), PsycINFO, SocINDEX, SCOPUS and Web of Science. (International, peer-reviewed, published papers in the English language from January 2010to December 2020). RESULTS: Five studies met inclusion criteria. Two studies used qualitative methods, one used mixed-methods, and two were randomised controlled trials. The research investigated (1) frameworks for holistic care and (2) assessment tools applied in palliative care settings. CONCLUSIONS: The results from the review led to identifying key features of palliative care that were presented as interconnected aspects of holistic care domains in both assessments and interventions. The literature revealed a focus on curative and biomedical approaches to disease management with holistic aspects acknowledged, but not in the forefront of core service delivery. Holism was generally conceptualised as an overarching theoretical framework to palliative care service provision and positioned as an adjunct to palliative models of care. These findings point to a gap in research that links the concept of holism to applied palliative care practices.

Visual attention and reading: A test of their relation across paradigms.

Relations of visual attention to reading have long been hypothesized; however, findings in this literature are quite mixed. These relations have been investigated using several different visual attention paradigms and with variable controls for other competing reading-related processes. We extended current knowledge by evaluating four of the key visual attention paradigms used in this research-visual attention span, attention blink, visual search, and visuospatial attention-in a single study. We tested the relations of these to reading in 90 middle schoolers at high risk for reading difficulties while considering their effect in the context of known language predictors. Performance on visual-spatial, visual search, and attentional blink paradigms showed weak nonsignificant relations to reading. Visual attention span tasks showed robust relations to reading even when controlling for language, but only when stimuli were alphanumeric. Although further exploration of visual attention in relation to reading may be warranted, the robustness of this relationship appears to be questionable, particularly beyond methodological factors associated with the measurement of visual attention. Findings extend and refine our understanding of the contribution of attention to reading skill and raise questions about the mechanism by which visual attention is purported to affect reading.

When Treatment Adherence Matters: Interactions Among Treatment Adherence, Instructional Quality, and Student Characteristics on Reading Outcomes.

In this study, we examined the extent to which teachers' treatment adherence, instructional quality, and the interaction of these variables influenced eighth-grade students' content knowledge and reading comprehension. We examined treatment fidelity for students (n = 775) in classes randomly assigned to receive an evidence-based content area reading program called Promoting Adolescents' Comprehension of Text. Results indicate that teachers' instructional quality was a statistically significant, positive predictor of student content knowledge and reading comprehension performance, whereas teachers' treatment adherence was not. Statistically significant interactions between treatment adherence and instructional quality were present, such that teachers' treatment adherence had a stronger impact on student learning outcomes when their overall instructional quality was low. Moderator analyses also revealed that students' pretest performance and English learner status influenced the effects of treatment adherence and instructional quality on student outcomes. These findings help elucidate the conditions under which Promoting Adolescents' Comprehension of Text leads to improved outcomes, and more broadly, underscore the importance of carefully examining dimensions of treatment fidelity when testing the effects of treatment programs.

Hospital admission as a deprescribing triage point for patients discharged to Residential Aged Care Facilities.

BACKGROUND: Deprescribing may benefit older frail patients experiencing polypharmacy. We investigated the scope for deprescribing in acutely hospitalised patients and the long-term implications of continuation of medications that could potentially be deprescribed. METHODS: Acutely hospitalised patients (n = 170) discharged to Residential Aged Care Facilities, ≥75 years and receiving ≥5 regular medications were assessed during admission to determine eligibility for deprescribing of key drug classes, along with the actual incidence of deprescribing. The impact of continuation of nominated drug classes (anticoagulants, antidiabetics, antiplatelets, antipsychotics, benzodiazepines, proton pump inhibitors (PPIs), statins) on a combined endpoint (death/readmission) was determined. RESULTS: Hyperpolypharmacy (>10 regular medications) was common (49.4%) at admission. Varying rates of deprescribing occurred during hospitalisation for the nominated drug classes (8-53%), with considerable potential for further deprescribing (34-90%). PPI use was prevalent (56%) and 89.5% of these had no clear indication. Of the drug classes studied, only continued PPI use at discharge was associated with increased mortality/readmission at 1 year (hazard ratio 1.54, 95% confidence interval (1.06-2.26), P = 0.025), driven largely by readmission. CONCLUSION: There is considerable scope for acute hospitalisation to act as a triage point for deprescribing in older patients. PPIs in particular appeared overprescribed in this susceptible patient group, and this was associated with earlier readmission. Polypharmacy in older hospitalised patients should be targeted for possible deprescribing during hospitalisation, especially PPIs.

Sustained attention and behavioral ratings of attention in struggling readers.

Attention is correlated with reading, but the extent to which behavioral ratings and sustained attention relate to reading skills is unclear. We assessed 245 4th and 5th grade struggling readers (mean age = 10.3 years) on behavioral ratings of attention, sustained attention, and reading over a school year. Contributions of behavioral ratings and sustained attention were considered cross-sectionally and longitudinally in the context of other important predictors of reading. Results suggest that sustained measures and behavioral ratings assess distinct, yet overlapping, aspects of attention. Both types of attention accounted for unique variance in comprehension, but not word reading accuracy or fluency, when evaluated cross-sectionally. Results also support the role of behavioral ratings of attention in fluency and in comprehension growth. Findings suggest that multidimensional assessment of attention is useful when considering its relation to reading, and highlights the need to integrate conceptualizations of attention that arise from different theoretical approaches.

Multitiered Systems of Support, Adaptive Interventions, and SMART Designs.

This article introduces the special section on adaptive interventions and sequential multiple-assignment randomized trial (SMART) research designs. In addition to describing the two accompanying articles, we discuss features of adaptive interventions (AIs) and describe the use of SMART design to optimize AIs in the context of multitiered systems of support (MTSS) and integrated MTSS. AI is a treatment delivery model that explicitly specifies how information about individuals should be used to decide which treatment to provide in practice. Principles that apply to the design of AIs may help to more clearly operationalize MTSS-based programs, improve their implementation in school settings, and increase their efficacy when used according to evidence-based decision rules. A SMART is a research design for developing and optimizing MTSS-based programs. We provide a running example of a SMART design to optimize an MTSS-aligned AI that integrates academic and behavioral interventions.

Problem Behaviors and Response to Reading Intervention for Upper Elementary Students With Reading Difficulties.

This study investigated the extent to which problem behaviors were factors associated with response to a year-long multicomponent reading intervention for fourth- and fifth-grade students with reading difficulties. Students scoring ≤85 standard score on the Test of Silent Reading Efficiency and Comprehension (n = 108), a reading fluency and comprehension screener measure, were randomized to the researcher-provided treatment condition (n = 55) or the business-as-usual comparison condition (n = 53). Results indicated that problem behaviors were associated with lower reading comprehension outcomes. Findings also suggested that students with higher levels of overall problem behaviors and externalizing behaviors in the treatment condition outperformed similar students in the comparison condition on the Gates-MacGinitie Reading Test (p < .05). Future research is needed on how to best identify, develop, and adapt effective interventions for students with reading difficulties and problem behaviors within school-wide response to intervention frameworks.

Examining the Reading and Cognitive Profiles of Students With Significant Reading Comprehension Difficulties.

This study investigated the word reading and listening comprehension difficulties of fourth-grade students with significant reading comprehension deficits and the cognitive difficulties that underlie these weaknesses. Latent profile analysis was used to classify a sample of fourth-grade students (n = 446) who scored below the 16th percentile on a measure of reading comprehension into subgroups based on their performance in word reading (WR) and listening comprehension (LC). Three latent profiles emerged: (a) moderate deficits in both WR and LC of similar severity (91%), (b) severe deficit in WR paired with moderate LC deficit (5%), and (c) severe deficit in LC with moderate WR difficulties (4%). Analyses examining the associations between cognitive attributes and group membership indicated students with lower performance on cognitive predictors were more likely to be in a severe subgroup. Implications for educators targeting improved reading performance for upper elementary students with significant reading difficulties were discussed.

Potentially inappropriate medication use and related hospital admissions in aged care residents: The impact of dementia.

AIMS: To determine the prevalence of potentially inappropriate medication (PIM) use at hospital admission and discharge, and the contribution to hospital admission among residential aged care facility residents with and without dementia. METHODS: We conducted a secondary analysis using data from a multihospital prospective cohort study involving consecutively admitted older adults, aged 75 years or older, who were taking 5 or more medications prior to hospital admission and discharged to a residential aged care facility in South Australia. PIM use was identified using the 2015 Screening Tool for Older Persons' Prescription and 2019 Beers criteria. An expert panel of clinicians with geriatric medicine expertise evaluated the contribution of PIM to hospital admission. RESULTS: In total, 181 participants were included, the median age was 87.5 years and 54.7% were female. Ninety-one (50.3%) had a diagnosis of dementia. Participants with dementia had fewer PIMs, according to at least 1 of the 2 screening criteria, than those without dementia, at admission (dementia: 76 [83.5%] vs no dementia: 84 [93.3%], P = .04) and discharge (78 [85.7%] vs 83 [92.2%], P = .16). PIM use was causal or contributory to the admission in 28.1% of study participants (n = 45) who were taking at least 1 PIM at admission. CONCLUSIONS: Over 80% of acutely admitted older adults took PIMs at hospital admission and discharge and for over a quarter of these people the admissions were attributable to PIM use. Hospitalisation presents an opportunity for comprehensive medication reviews, and targeted interventions that enhance such a process could reduce PIM use and related harm.

Examining Factors Affecting Reading and Math Growth and Achievement Gaps in Grades 1-5: A Cohort-Sequential Longitudinal Approach.

Despite focused efforts, achievement gaps remain a problem in the America's education system, especially those between students from higher and lower income families. Continued work on reducing these gaps benefits from an understanding of students' reading and math growth from typical school instruction and how growth differs based on initial proficiency, grade, and demographic characteristics. Data from 5,900 students in Grades 1-5 tested in math and reading at six points across two years were analyzed using cohort-sequential latent growth curve models to determine longitudinal growth patterns. Results indicated that students with low initial proficiency grew more quickly than students with higher proficiency. However, after two school years their achievement remained below average and well below that of students with higher initial proficiency. Demographic characteristics had small but significant effects on initial score and growth rates.

Differential Co-Development of Vocabulary Knowledge and Reading Comprehension for Students with and without Learning Disabilities.

In this large-scale study of students from Title 1 schools (N = 14,773), we used multiple-group latent change score (LCS) modeling to investigate the developmental relations between vocabulary knowledge and reading comprehension in students with a school-identified learning disability (LD, n = 627) and typically developing students (n = 14,146). Students were tested for their vocabulary breadth and passage comprehension skills in Kindergarten through fourth grade. For typically developing students, there were bidirectional influences between their vocabulary knowledge and reading comprehension skills. There were no cross-lagged influences across constructs for students with an LD. We find evidence for a developmental delay, such that students with an LD had similar levels and gains in their vocabulary knowledge relative to typically developing students, but these students started much lower in their reading comprehension skills and did not catch up to their typically developing peers. We discuss the implications for children with learning disabilities and the development of their reading comprehension skills.

Examining Sources and Mechanisms of Reading Comprehension Difficulties: Comparing English Learners and Non-English Learners within the Simple View of Reading.

In the present study, we compared the extent to which linguistic comprehension (vocabulary and listening comprehension) and word reading explain reading comprehension differentially for English learners (ELs) and non-ELs with reading difficulties, and we investigated whether different mechanisms of reading comprehension failure exist for each group. Using the simple view of reading as our framework, we tested a model in which vocabulary exerts a direct effect on reading comprehension and indirect effects through listening comprehension and word reading. Results from a multigroup structural equation model with a sample of 446 struggling fourth-grade readers (n = 229 for ELs; n = 211 for non-ELs) demonstrated both similarities and differences in the sources and mechanisms of reading comprehension difficulties for ELs and non-ELs with reading problems. Word reading was an important source of reading comprehension difficulty for both groups. For non-ELs, the effect of word reading was larger than the effects of linguistic comprehension (vocabulary and listening comprehension combined); however, for ELs, the effects of linguistic comprehension were greater than the effect of word reading. Vocabulary had indirect effects via both listening comprehension and word reading for ELs, but it demonstrated a direct effect on reading comprehension for non-ELs. These results suggest that developing a range of linguistic comprehension skills (e.g., word-level and sentence-level language skills) may be important for ELs with reading comprehension difficulties in the upper-elementary grades.

How Initial Word Reading and Language Skills Affect Reading Comprehension Outcomes for Students With Reading Difficulties.

This study examined how differences in listening comprehension and word reading at the beginning of the school year influence changes in reading comprehension for English learners (ELs) with significant reading difficulties compared to non-ELs with significant reading difficulties. The study investigated heterogeneity in response to instruction among 400 struggling readers in fourth grade (n = 183 for non-EL; n = 217 for EL) who received an intensive reading intervention. At pretest, word reading, listening comprehension, and reading comprehension were measured, and at posttest, reading comprehension was measured again. Results from moderated multiple regression analyses showed a significant three-way interaction such that reading comprehension at posttest was higher for ELs than non-ELs with similar levels of low word reading but relatively higher levels of listening comprehension. However, non-ELs outperformed ELs with similar levels of relatively high word reading and average to high listening comprehension. The findings suggest that pre-intervention skill profiles may need to be interpreted differently for ELs and non-ELs with significant reading difficulties in relation to language and literacy outcomes.

Examining the Effects of Afterschool Reading Interventions for Upper Elementary Struggling Readers.

We examined the efficacy of an afterschool multicomponent reading intervention for third- through fifth-grade students with reading difficulties. A total of 419 students were identified for participation based on a 90 standard score or below on a screening measure of the Test of Silent Reading Efficiency and Comprehension. Participating students were randomly assigned to a business as usual comparison condition or one of two reading treatments. All treatment students received 30 min of computer-based instruction plus 30 min of small-group tutoring for four to five times per week. No statistically significant reading comprehension posttest group differences were identified (p > .05). The limitations of this study included high attrition and absenteeism. These findings extend those from a small sample of experimental studies examining afterschool reading interventions and provide initial evidence that more instruction, after school, may not yield the desired outcome of improved comprehension.

Causal Mediation in Educational Intervention Studies.

Understanding the factors that mediate the effect of educational or behavioral intervention is critical to advancing both research and practice. When properly implemented, mediators add depth to the results of intervention research, indicating why a program works, highlighting ways to enhance its effectiveness, and revealing the elements that are essential to successful implementation. However, many researchers find mediation a difficult topic and struggle to implement it properly in statistical models of effects from between-groups randomized studies. In an effort to bring clarity to the topic of mediation and encourage its use where appropriate, this article lays out the requirements for evidence of a causal-mediated effect. An example of a randomized trial of an intervention targeting self-regulation and student behavior is used to illustrate the process of conceptualizing and testing for mediation of treatment effects. Statistical considerations also are addressed.

A Century of Progress: Reading Interventions for Students in Grades 4-12, 1914-2014.

The history of research on interventions for struggling readers in Grades 4 through 12 dates back to 19th-century case studies of seemingly intelligent children who were unable to learn to read. Physicians, psychologists, educators, and others were determined to help them. In the process, they launched a century of research on a wide variety of approaches to reading intervention. As shown in this systematic narrative review, much has changed over time in the conceptualization of reading interventions and the methods used to determine their efficacy in improving outcomes for struggling readers. Building on the knowledge gathered over the past 100 years, researchers and practitioners are well-poised to continue to make progress in developing and testing reading interventions over the next 100 years.

Changes in Warfarin Sensitivity During Decompensated Heart Failure and Chronic Obstructive Pulmonary Disease.

BACKGROUND: Heart failure (HF) has been associated with an elevated international normalized ratio (INR) in patients on warfarin. OBJECTIVES: Compare warfarin sensitivity during hospital admission for HF exacerbation and chronic obstructive pulmonary disease (COPD) exacerbation with admissions unrelated to HF or COPD (controls) as well as during disease stability. METHODS: We conducted a case-controlled observational study. Patients admitted to a tertiary teaching hospital for HF exacerbation (n = 37), COPD exacerbation (n = 26), and admissions unrelated to HF or COPD (controls, n = 60) were included. Warfarin sensitivity (INR per daily mg dose of warfarin) at admission was compared to periods of disease stability and also compared between the 3 groups. RESULTS: The increase in warfarin sensitivity at admission was 94% for HF patients (P < 0.0001), 59% for COPD (P = 0.003) patients, and 24% for controls (P = 0.002). HF patients with New York Heart Association (NYHA) class 3 and 4 and NYHA class 1 and 2 experienced changes in warfarin sensitivity of 125% (P = 0.006) and 50% (P = 0.13) at admission. HF patients had higher warfarin sensitivity at admission (mean = 1.62 [SD = 1.27]) compared to the control group (0.91 [0.52], P < 0.0001) and COPD group (1.03 [0.79], P = 0.04). and required greater intervention with vitamin K than controls (14% vs 0%, P = 0.007). CONCLUSION: HF and COPD patients were more sensitive to warfarin during disease exacerbation, with HF exacerbation having the largest impact, resulting in clinically significant management implications.

The Impact of Intensive Reading Intervention on Level of Attention in Middle School Students.

The purpose of the study was to estimate the impact of reading intervention on ratings of student attention over time. We used extant data from a longitudinal randomized study of a response-based reading intervention to fit a multiple-indicator, multilevel growth model. The sample at randomization was 54% male, 18% limited English proficient, 85% eligible for free or reduced-price lunch, 58% African American, and 32% Hispanic. Reading ability was measured by using the Woodcock-Johnson III Tests of Achievement. Attention was measured by using the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale. Findings indicate that intensive, response-based reading intervention over 3 years improved reading achievement and behavioral attention in middle school struggling readers, with treatment directly affecting reading, which in turn influenced attention. In the business-as-usual condition, there was no relation between improved reading and attention. The results are consistent with a correlated liabilities model of comorbidity. The results do not align with the inattention-as-cause hypothesis, which predicts that reading intervention should not affect attention. The findings do not support, but do not necessarily preclude, the phenocopy hypothesis. The results are especially pertinent for older students who may be inattentive partly because of years of struggling with reading.