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Timely incision and drainage (ID) is first line management for anorectal abscesses. We aimed to define current practices in anorectal abscess management and identify factors associated with abscess recurrence and fistula formation.Index episodes of anorectal abscesses treated with ID in 2014-2018 at a multi-hospital healthcare system were included. Association with one-year abscess recurrence or fistula formation was evaluated using Cox proportional hazard regression. Fistulae were captured only among patients without fistulae at the index operation.A total of 458 patients met study criteria. One-year rate of abscess recurrence or fistula formation was 20.3%. When compared to bedside procedures, drainage in the operating room was associated with a reduced risk of either recurrence or fistula formation (aHR 0.20 [95%CI 0.114-0.367]).Improved exposure and patient comfort in the operating room may allow more complete drainage contributing to decreased rates of abscess recurrence or fistula formation.

Purpose: Surgery is a major risk factor for chronic opioid use among patients who had not recently been prescribed opioids. This study identifies the rate of, and risk factors for, persistent opioid use following laparoscopic cholecystectomy and open inguinal hernia repair in patients not recently prescribed opioids. Methods: This retrospective population-based cohort study included all patients who had not been prescribed opioids in the 6 months prior to undergoing open inguinal hernia repair or laparoscopic cholecystectomy from January 2013 to July 2016 in Ontario. Opioid prescription was identified from the provincial Narcotics Monitoring System and data were obtained from the Institute for Clinical Evaluative Sciences. The primary outcome was persistent opioid use after surgery (3, 6, 9 and 12 months). Associated risk factors and prescribing patterns were also examined. Results: Among the 90,326 patients in the study cohort, 80% filled an opioid prescription after surgery, with 11%, 9%, 5% and 1% filling a prescription at 3, 6, 9 and 12 months, respectively. Significant variability was identified in the type of opioid prescribed (41% codeine, 31% oxycodone, 18% tramadol) and in regional prescribing patterns (mean prescription/region range, 135–225 oral morphine equivalents). Predictors of continued opioid use included age, female gender, lower income quintile and being operated on by less experienced surgeons. Conclusion: Most patients who undergo elective cholecystectomy and hernia repair will fill a prescription for an opioid after surgery, and many will continue to fill opioid prescriptions for considerably longer than clinically anticipated. There is important variability in opioid type, regional prescribing patterns and risk factors that identify strategic targets to reduce the opioid burden in this patient population.

The present study examined the extent to which adaptive feedback and just-in-time writing strategy instruction improved the quality of high school students’ persuasive essays in the context of the Writing Pal (W-Pal). W-Pal is a technology-based writing tool that integrates automated writing evaluation into an intelligent tutoring system. Students wrote a pretest essay, engaged with W-Pal’s adaptive instruction over the course of four training sessions, and then completed a posttest essay. For each training session, W-Pal differentiated strategy instruction for each student based on specific weaknesses in the initial training essays prior to providing the opportunity to revise. The results indicated that essay quality improved overall from pretest to posttest with respect to holistic quality, as well as several specific dimensions of essay quality, particularly for students with lower literacy skills. Moreover, students’ scores on some of the training essays improved from the initial to revised version on the dimensions of essay quality that were targeted by instruction, whereas scores did not improve on the dimensions that were not targeted by instruction. Overall, the results suggest that W-Pal’s adaptive strategy instruction can improve the quality of students’ essays overall, as well as more specific dimensions of essay quality.

Background and Objectives Both rapid technological changes and (self-)ageism are pervasive challenges of the 21st century, potentially affecting older adults’ everyday functioning, health, and well-being. This systematic literature review aimed to synthesize scholarly evidence to determine the associations between everyday information and communication technology (EICT) usage and (self-)ageism as well as potential moderators. Research Design and Methods A systematic search was performed in 8 academic databases, covering the time frame from January 1995 to January 2021. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a total of 15 articles met the inclusion criteria and were involved in the analysis. The standardized National Heart, Lung, and Blood Institute’s quality assessment tools were used for risk bias. Results Several studies demonstrated significant associations between EICT usage and stereotype embodiment (n = 8), stereotype threat (n = 2), and age discrimination (n = 3). Age (group), gender, and motivation were examined as potential moderators. Discussion and Implications This review provides initial evidence on the associations between (self-)ageism and EICT usage. It highlights the importance of positive subjective aging perceptions for active EICT usage in older adults, but also emphasizes the detrimental consequences of ageism in EICT learning settings and technology design on older persons’ willingness and ability to use EICT. Further ecologically valid and methodologically sound research is needed to better understand both the nature and direction of the association between EICT usage and (self-)ageism.

Background Multidisciplinary conference presentation may provide recommendations for diagnosis, monitoring and treatment for patients with inflammatory bowel disease. Methods A prospective observational study was completed evaluating if case presentation resulted in a direct change in management for patients presented over a 2-year period in a tertiary Canadian centre. Change in management was defined as hospital admission, surgery or surgical referral, start/change in biologic therapy or other medication or initiation of parenteral nutrition. Secondary outcomes included the involvement of specialists and other referrals. Data were analyzed using frequencies and means with standard deviations. Results In 63 multidisciplinary conferences, 181 patients were presented, of whom 136 patients met the inclusion criteria of inflammatory bowel disease (Crohn’s n = 45, ulcerative colitis n = 88, undifferentiated n = 3). The majority were outpatient cases 110 (81%). Indications included 71 (52%) patients presented for IBD management with diagnosis > 1 year, 37 (27%) with an acute IBD flare in a chronic patient (>1 year since diagnosis) and 24 (18%) with new diagnosis of IBD. Change in management was recommended in 35 (26%) patients. The most common change was referral to surgery in 17 (13%), surgery in 12 (9%) or change in biologic therapy 11 (8%). Compliance with the recommendations was 85%. There was frequent specialist involvement in case discussions (gastroenterologist 100%, surgeon 60%, radiologist 68% and pathologist 32%). Conclusions Presentation of complex inflammatory bowel disease cases at multidisciplinary conference leads to a direct change in treatment in one quarter of cases, with surgical referral as the most frequent outcome.

Reduced nigrostriatal uptake on N-(3-fluoropropyl)-2β-carbomethoxy-3β-(4-[123I]iodophenyl) nortropane (123I-FP-CIT) SPECT reflects dopamine dysfunction, while other imaging markers could be complementary when used together. We assessed how well 123I-FP-CIT SPECT differentiates dementia with Lewy bodies (DLBs) from Alzheimer's disease dementia (ADem) and whether multimodal imaging provides additional value. 123I-FP-CIT SPECT, magnetic resonance imaging, [18F]2-fluoro-deoxy-D-glucose-positron emission tomography (PET), and 11C-Pittsburgh compound B (PiB)-PET were assessed in 35 participants with DLBs and 14 participants with ADem (autopsy confirmation in 9 DLBs and 4 ADem). Nigrostriatal dopamine transporter uptake was evaluated with 123I-FP-CIT SPECT using DaTQUANT software. Hippocampal volume was calculated with magnetic resonance imaging, cingulate island sign ratio with FDG-PET, and global cortical PiB retention with PiB-PET. The DaTQUANT z-scores of the putamen showed the highest c-statistic of 0.916 in differentiating DLBs from ADem among the analyzed imaging biomarkers. Adding another imaging modality to 123I-FP-CIT SPECT had c-statistics ranging from 0.968 to 0.975, and 123I-FP-CIT SPECT in combination with 2 other imaging modalities presented c-statistics ranging from 0.987 to 0.996. These findings suggest that multimodal imaging with 123I-FP-CIT SPECT aids in differentiating DLBs and ADem and in detecting comorbid Lewy-related and Alzheimer's disease pathology in patients with DLBs and ADem.

The funeral service profession has used formaldehyde-containing embalming solutions for the preparation of decedents since the early 1900s. The available literature regarding funeral director exposure to formaldehyde largely consists of data collected prior to 2000, with most studies reporting task-length exposure concentrations rather than full-shift time-weighted average concentrations. As formaldehyde undergoes review in the U.S. Environmental Protection Agency Toxic Substances Control Act (TSCA) risk evaluation process, accurately characterizing long-term exposure potential in this profession is critical. This study presents passive badge sampling and air change rate measurement results conducted at 13 funeral home locations across the United States. Full-shift (approximately 8-hr) samples were collected on one embalmer per day in each funeral home and on one occupational non-user (ONU), e.g., a receptionist. Additionally, task-length samples were collected during each embalming that occurred during the shift, were one to occur. Full-shift concentrations ranged from 0.007 to 1.1 ppm and 0.007 to 0.042 ppm for embalmers and ONUs, respectively. Task-length formaldehyde concentrations ranged from 0.058 to 1.4 ppm, with the average embalming taking 72.8 min to complete. Air change rates in the preparation rooms ranged from 2.8 to 28.3 air changes per hour; however, no correlation between task-length formaldehyde concentrations and air change rate was observed. Following empirical data collection, a Monte Carlo analysis of estimated annual 8-hr time-weighted average (TWA) exposure was conducted to determine the potential exposure distribution for embalmers employed at private funeral homes. Inputs to the simulation were derived from responses to a National Funeral Directors Association survey and from empirical measurements collected during the study. With respect to the reconstructed 8-hr TWAs, the median 8-hr TWA was 0.037 ppm, with 93.6% of the predicted concentrations below 0.1 ppm. This study provides a robust characterization of contemporary formaldehyde exposures in the funeral service profession. Further, it provides a strategy for interpreting the results along with surveyed responses regarding embalming frequency to better inform risks associated with formaldehyde exposure in this profession.

Prescription of opioid medication after ambulatory anorectal surgery may be excessive and lead to opioid misuse. The purpose of this study was to evaluate the efficacy of a multi-modality opioid-sparing approach to control postoperative pain and reduce opioid prescriptions after outpatient anorectal surgery. A prospective non-inferiority pre- and post-intervention study was completed at three academic hospitals. Patients included were 18–75 years of age who had outpatient anorectal surgeries. The Standardization of Outpatient Procedure (STOP) Narcotics intervention was implemented, which is a multi-pronged analgesia bundle integrating patient education, health care provider education, and intra-/postoperative analgesia focused on multi-modal pain control strategies and opioid-reduced prescriptions. The primary outcome was patient-reported average pain in the first 7 postoperative days. Secondary outcomes included patient-reported quality of pain management, medication utilization, prescription refills and medication disposal. Ninety-three patients had outpatient anorectal surgery (42 pre-intervention and 51 post-intervention). No difference was seen in average postoperative pain in the pre- vs. post-intervention groups (2.8 vs. 2.6 on an 11-point scale, p = 0.33) or patient-reported quality of pain control (good/very good in 57% vs. 63%, p = 0.58). The median oral morphine equivalents (OME) prescribed was significantly less [112.5 (IQR 50–150) pre-intervention vs. 50 (IQR 50–50) post-intervention, p

Synthesis writing is widely taught across domains and serves as an important means of assessing writing ability, text comprehension, and content learning. Synthesis writing differs from other types of writing in terms of both cognitive and task demands because it requires writers to integrate information across source materials. However, little is known about how integration of source material may influence overall writing quality for synthesis tasks. This study examined approximately 900 source-based essays written in response to four different synthesis prompts which instructed writers to use information from the sources to illustrate and support their arguments and clearly indicate from which sources they were drawing (i.e., citation use). The essays were then scored by expert raters for holistic quality, argumentation, and source use/inferencing. Hand-crafted natural language processing (NLP) features and pre-existing NLP tools were used to examine semantic and keyword overlap between the essays and the source texts, plagiarism from the source texts, and instances of source citation and quoting. These variables along with text length and prompt were then used to predict essays scores. Results reported strong models for predicting human ratings that explained between 47 and 52% of the variance in scores. The results indicate that text length was the strongest predictor of score but also that more successful writers include stronger, semantically-related information from the source, provide more citations and do so later in the text, and copy less from the text. This work introduces the use of NLP techniques to assess source integration, provides details on the types of source integration used by writers, and highlights the effects of source integration on writing quality.

Literacy is a critically important and contemporary issue for educators, scientists, and politicians. Efforts to overcome the challenges associated with illiteracy, and the subsequent development of literate societies, are closely related to those of poverty reduction and sustainable human development. In this paper, the authors examine literacy from the lens of text and discourse theorists who focus on the higher-order comprehension processes involved in literacy. Discourse processing models make the assumption that comprehension emerges from the construction of a mental model of the text, which relies on the reader generating inferences to connect ideas within the text and to what the reader already knows. The article provides a broad overview of the theoretical models that drive research on text comprehension and production, as well as how this research shapes literacy instruction and effective interventions. The authors focus on two interventions with proven success in improving deep comprehension and writing, iSTART and the Writing Pal. Increasing literacy across the world call for a greater focus on theory driven strategy interventions to be integrated within classrooms and community at large.

Automated Writing Evaluation systems have been developed to help students improve their writing skills through the automated delivery of both summative and formative feedback. These systems have demonstrated strong potential in a variety of educational contexts; however, they remain limited in their personalization and scope. The purpose of the current study was to begin to address this gap by examining whether individual differences could be modeled in a source-based writing context. Undergraduate students (n=106) wrote essays in response to multiple sources and then completed an assessment of their vocabulary knowledge. Natural language processing tools were used to characterize the linguistic properties of the source-based essays at four levels: descriptive, lexical, syntax, and cohesion. Finally, machine learning models were used to predict students’ vocabulary scores from these linguistic features. The models accounted for approximately 29% of the variance in vocabulary scores, suggesting that the linguistic features of source-based essays are reflective of individual differences in vocabulary knowledge. Overall, this work suggests that automated text analyses can help to understand the role of individual differences in the writing process, which may ultimately help to improve personalization in computer-based learning environments.

Text summarization is an effective reading comprehension strategy. However, summary evaluation is complex and must account for various factors including the summary and the reference text. This study examines a corpus of approximately 3,000 summaries based on 87 reference texts, with each summary being manually scored on a 4-point Likert scale. Machine learning models leveraging Natural Language Processing (NLP) techniques were trained to predict the extent to which summaries capture the main idea of the target text. The NLP models combined both domain and language independent textual complexity indices from the ReaderBench framework, as well as state-of-the-art language models and deep learning architectures to provide semantic contextualization. The models achieve low errors – normalized MAE ranging from 0.13–0.17 with corresponding R2 values of up to 0.46. Our approach consistently outperforms baselines that use TF-IDF vectors and linear models, as well as Transfomer-based regression using BERT. These results indicate that NLP algorithms that combine linguistic and semantic indices are accurate and robust, while ensuring generalizability to a wide array of topics.

This chapter focuses on the notion of the deep comprehension of text and discourse, and what it means across a broad range of diverse readers. We discuss theoretical models of comprehension and levels of comprehension, focusing in particular on the distinction between surface and deep comprehension. This distinction is discussed with respect to four groups of readers: adolescent and adult readers, younger developing readers, second language (L2) learners, and adult literacy learners. Most theories of comprehension assume that comprehension occurs at all levels of comprehension, and deeper comprehension is associated with a more coherent mental representation. Such a model leads to the conclusion that readers should be encouraged to use metacognitive reading strategies even at early stages of learning to read. However, there are implementation and translation gaps between theories of comprehension and educational practice. As a consequence, educational practice often emphasizes a linear sequence of skill development, focusing on word decoding first, and then focusing on higher order strategies only after word and sentence decoding are fully developed. Potential solutions for bridging gaps between reading researchers and to practice are discussed.

The assessment of argumentative writing generally includes analyses of the specific linguistic and rhetorical features contained in the individual essays produced by students. However, researchers have recently proposed that an individual’s ability to flexibly adapt the linguistic properties of their writing may more accurately capture their proficiency. However, the features of the task, learner, and educational context that influence this flexibility remain largely unknown. The current study extends this research by examining relations between linguistic flexibility, reading comprehension ability, and feedback in the context of an automated writing evaluation system. Students (n = 131) wrote and revised six argumentative essays in an automated writing evaluation system and were provided both summative and formative feedback on their writing. Additionally, half of the students had access to a spelling and grammar checker that provided lower-level feedback during the writing period. The results provide evidence for the supposition that skilled writers demonstrate linguistic flexibility across the argumentative essays that they produce. However, analyses also indicate that lower-level feedback (i.e., spelling and grammar feedback) have little to no impact on the properties of students’ essays nor on their variability across prompts or drafts. Overall, the current study provides important insights into the role of flexibility in argumentative writing skill and develops a strong foundation on which to conduct future research and educational interventions.

Background Laparoscopic splenectomy is a second-line therapy for immune thrombocytopenia with a sustained success rate of 66%. In a climate of new available medical therapies for immune thrombocytopenia, the comparative safety and efficacy of laparoscopic splenectomy are worthy of attention. The purpose of this study is to identify factors predictive of laparoscopic splenectomy success that will enable preoperative prognostication. Methods A retrospective cohort study was conducted of patients undergoing laparoscopic splenectomy for immune thrombocytopenia. The data collected evaluated response to medical and surgical therapy, which was defined on a platelet level of 50 × 109/L with no bleeding events. Univariate and multivariate analyses were conducted to evaluate factors predictive of laparoscopic splenectomy success, with an additional subanalysis planned to assess for laparoscopic splenectomy safety in individuals ≥65 years. Results One hundred forty-one patients were reviewed. Operative outcomes showed a 3.6% conversion rate and 8.5% complication rate. Disease remission was achieved in 78.7% of patients. Response to initial corticosteroid therapy was associated with a laparoscopic splenectomy success rate of 90% and increased odds of surgical success by 5.58 over individuals with no response to corticosteroids. Age did not confer an increased risk of failure or complications. Conclusion Laparoscopic splenectomy is a safe and effective intervention for immune thrombocytopenia regardless of age. Initial response to corticosteroids is associated with laparoscopic splenectomy success rate of 90% and improved odds of surgical success. Laparoscopic splenectomy should be the standard second-line therapy for immune thrombocytopenia, especially in patients responding to corticosteroids.

Background knowledge is a strong predictor of reading comprehension, yet little is known about how different types of background knowledge affect comprehension. The study investigated the impacts o...

A critical challenge for computer-based writing instruction is providing appropriate and adaptive practice. The current study examined three modes of computer-based writing practice with the goal of identifying those with the greatest learning and motivational value. High school students learned about writing strategies by studying lessons within the Writing Pal tutoring system and then practiced relevant strategies via essay-based practice, strategy practice, or game-based strategy practice. Students acquired strategy knowledge regarding their assigned topics, but there were no main effects of practice format. Similar findings were observed for students’ beliefs about the value of writing practice. However, the effects of practice format depended on prior literacy ability in subtle ways. Essay-based practice appeared to be more effective for skilled readers, whereas less skilled readers benefitted more from game-based practice. Overall, multiple forms of practice opportunities may optimize benefits, although non-game forms of strategy practice are less preferable to students than game-based formats.

The relationship between clinicopathologic diagnosis and 123I-FP-CIT SPECT in 18 patients with dementia (12 with Lewy body disease) from one center in the United States was assessed. The sensitivity and specificity of abnormal 123I-FP-CIT SPECT with reduced striatal uptake on visual inspection for predicting Lewy body disease were 91.7% and 83.3%, respectively. The mean calculated putamen to occipital ratio (mPOR) based on regions of interest was significantly reduced in Lewy body disease compared to non-Lewy body disease cases (P = 0.002). In this study, abnormal 123I-FP-CIT SPECT was strongly associated with underlying Lewy body disease pathology, supporting the utility of 123I-FP-CIT SPECT in the clinical diagnosis of dementia with Lewy bodies.

The broad use of computer-supported collaborative-learning (CSCL) environments (e.g., instant messenger-chats, forums, blogs in online communities, and massive open online courses) calls for automated tools to support tutors in the time-consuming process of analyzing collaborative conversations. In this article, the authors propose and validate the cohesion network analysis (CNA) model, housed within the ReaderBench platform. CNA, grounded in theories of cohesion, dialogism, and polyphony, is similar to social network analysis (SNA), but it also considers text content and discourse structure and, uniquely, uses automated cohesion indices to generate the underlying discourse representation. Thus, CNA enhances the power of SNA by explicitly considering semantic cohesion while modeling interactions between participants. The primary purpose of this article is to describe CNA analysis and to provide a proof of concept, by using ten chat conversations in which multiple participants debated the advantages of CSCL technologies. Each participant's contributions were human-scored on the basis of their relevance in terms of covering the central concepts of the conversation. SNA metrics, applied to the CNA sociogram, were then used to assess the quality of each member's degree of participation. The results revealed that the CNA indices were strongly correlated to the human evaluations of the conversations. Furthermore, a stepwise regression analysis indicated that the CNA indices collectively predicted 54% of the variance in the human ratings of participation. The results provide promising support for the use of automated computational assessments of collaborative participation and of individuals' degrees of active involvement in CSCL environments.

Open-ended constructed responses promote deeper processing of course materials. Further, evaluation of these explanations can yield important information about students’ cognition. This study examined how students’ constructed responses, generated at different points during learning, relate to their later comprehension outcomes. College students (N = 75) produced self-explanations during reading and explanatory retrievals after reading. The Constructed Response Assessment Tool (CRAT) was used to analyze these responses across multiple dimensions of language and relate these textual features to comprehension performance. Results indicate that the linguistic features of post-reading explanatory retrievals were more predictive of comprehension outcomes than self-explanations. Further, these models relied on different indices to predict performance.

Writing is a crucial means of communicating with others and thus is vital to success and survival in modern society. Writing processes rely on virtually all aspects of cognition (e.g., working memory, motivation, affect, self-regulation, prior knowledge, problem solving) and are naturally embedded in social contexts. Social factors include writers’ objectives, audience, genre, and mode of writing. For example, the increased use of the Internet has rendered writing for informal purposes more frequent, and writing mechanics (e.g., deleting, spell checking) and search for information more efficient. Research on educational interventions to improve writing points to the importance of providing students with instruction and practice using writing strategies, writing practice with feedback (e.g., instructor, automated), and collaborative writing (including peer feedback). Given the inherent complexity of writing, it is important to help students learn how to write across various situations with varying purposes and demands. This necessitates reading many types of text genres (e.g., narrative vs. informational writing), writing frequently, and revising based on feedback. Since the turn of the century, there has been a substantial increase in research on writing processes, including methods to improve writing. However, there remains a substantial need for additional experimental work to understand writing processes as well as more evidence on which types of interventions are most beneficial in helping students to improve their writing. Feedback from both cognitive and sociocultural researchers should inform future revisions of the standardized guidelines and assessments with the long-term goal of developing a clearly defined set of standards for academic excellence in writing.

During the past 15 years, opioid-related overdose death rates for women have increased 471%. Many surgeons provide opioid prescriptions well in excess of what patients actually use. This study assessed a health systems intervention to control pain adequately while reducing opioid prescriptions in ambulatory breast surgery. This prospective non-inferiority study included women 18–75 years of age undergoing elective ambulatory general surgical breast procedures. Pre- and postintervention groups were compared, separated by implementation of a multi-pronged, opioid-sparing strategy consisting of patient education, health care provider education and perioperative multimodal analgesic strategies. The primary outcome was average pain during the first 7 postoperative days on a numeric rating scale of 0–10. The secondary outcomes included medication use and prescription renewals. The average pain during the first 7 postoperative days was non-inferior in the postintervention group despite a significant decrease in median oral morphine equivalents (OMEs) prescribed (2.0/10 [100 OMEs] pre-intervention vs 2.1/10 [50 OMEs] post-intervention; p = 0.40 [p

This study examines the extent to which instructions to self-explain vs. other-explain a text lead readers to produce different forms of explanations. Natural language processing was used to examine the content and characteristics of the explanations produced as a function of instruction condition. Undergraduate students (n = 146) typed either self-explanations or other-explanations while reading a science text. The linguistic properties of these explanations were calculated using three automated text analysis tools. Machine learning classifiers in combination with the features were used to predict instruction condition (i.e., self- or other-explanation). The best machine learning model performed at rates above chance (kappa = .247; accuracy = 63%). Follow-up analyses indicated that students in the self-explanation condition generated explanations that were more cohesive and that contained words that were more related to social order (e.g., ethics). Overall, the results suggest that natural language processing techniques can be used to detect subtle differences in students' processing of complex texts.

Source-based essays are evaluated both on the quality of the writing and the content appropriate interpretation and use of source material. Hence, composing a high-quality source-based essay (an essay written based on source material) relies on skills related to both reading (the sources) and writing (the essay) skills. As such, source-based writing must involve language comprehension and production processes. The purpose of the current study is to examine the impact of reading, writing, and blended (i.e., reading and writing) strategy training on students’ performance on a content-specific source-based essay writing task. In contrast to general source-based writing tasks, content-specific source-based writing tasks are tasks wherein writers are provided the source material on which to base their essays. Undergraduate students (n = 175) were provided with strategy instruction and practice in the context of two intelligent tutoring systems, Writing Pal and Interactive Strategy Training for Active Reading and Thinking (iSTART). Results indicated that participants in the blended strategy training condition produced higher quality source-based essays than participants in the reading comprehension-only, writing-only, or control condition, with no differences observed between the latter three conditions. Further, the benefits of this blended strategy instruction remained significant regardless of prior reading and writing skills, or time on task.

This study aimed to investigate the functional outcomes of infants who underwent neurotization for shoulder abduction and elbow flexion in Narakas grade 1 birth-related brachial plexus palsy (BRBPP) and compare this cohort to children who progressed past the point of needing intervention. A cohort study was conducted at a single center between 1999 and 2010. Two-hundred and eight infants were identified with BRBPP that presented for neurosurgical care as infants. Of those, 38 (18 %) received neurosurgical intervention with approximate 2-year follow-up. Only infants undergoing cranial nerve XI to suprascapular nerve neurotization for shoulder abduction (SA) weakness and medial pectoral nerve to musculocutaneous nerve neurotization for elbow flexion (EF) weakness were included. In addition, 30 infants who improved past the need for surgical intervention and had been followed for close to 24 months were identified for comparison. Descriptive statistics and exploratory analysis were performed using SAS 9.2 and JMP 9.0.2. Shoulder abduction For SA, there were no differences in age at presentation between the operative (6–9 months) and non-operative (5–9 months) groups (p = 0.99). Infants in the operative cohort had significantly worse initial function (p = 0.008). At 2-year follow-up, the two groups had become similar (p = 1.0). Elbow flexion For EF, there were no differences in age at presentation between the operative (6–8 months) and non-operative (5–8.5 months) groups (p = 0.98). Infants in the operative cohort had significantly worse initial function (p = 0.002). At 2-year follow-up, those two groups had become similar (p = 0.26). Infants undergoing neurotization for Narakas grade 1 brachial plexus injury had similar long-term function to those who had improved and never required surgery. The preoperative exam findings were significantly different between the intervened and non-intervened groups, while the postoperative exam findings were not.

Summarization is an effective strategy to promote and enhance learning and deep comprehension of texts. However, summarization is seldom implemented by teachers in classrooms because the manual evaluation of students’ summaries requires time and effort. This problem has led to the development of automated models of summarization quality. However, these models often rely on features derived from expert ratings of student summarizations of specific source texts and are therefore not generalizable to summarizations of new texts. Further, many of the models rely of proprietary tools that are not freely or publicly available, rendering replications difficult. In this study, we introduce an automated summarization evaluation (ASE) model that depends strictly on features of the source text or the summary, allowing for a purely text-based model of quality. This model effectively classifies summaries as either low or high quality with an accuracy above 80%. Importantly, the model was developed on a large number of source texts allowing for generalizability across texts. Further, the features used in this study are freely and publicly available affording replication.

This chapter outlines various methodologies that have been used to address research questions related to text memory, comprehension, and learning. It discusses innovative methods that are currently being developed to address these questions in new ways. The chapter describes various methods that have been used to assess text comprehension processes across multiple levels of representation. It provides a brief overview of research in this domain and described the most common methods for assessing text comprehension. The chapter also describes assessments that focus on the "off-line" or final understanding of a text that a reader develops, as well as assessments that tap into the processes that contribute to this understanding. The majority of contemporary models of text comprehension share a common goal of understanding the cognitive processes and knowledge that shape readers' mental representations of texts. Text comprehension is most commonly assessed using post-reading measures, which occur off-line and assess the mental representation after reading.

Most studies evaluating acute care surgery (ACS) models of care for patients with emergency general surgery (EGS) conditions have focused on patients who undergo surgery while admitted under the care of the ACS service. The purpose of this study was to prospectively examine the case mix of admissions and consultations to an ACS service at a tertiary centre to identify the frequency and distribution of both operatively and nonoperatively managed EGS conditions.In this prospective cohort study, we evaluated consecutive patients assessed by the ACS team between July 1 and Aug. 31, 2015, at a large Canadian tertiary care centre. This included all consultations and outside hospital transfers. Diagnoses, demographic characteristics, comorbidities, intervention(s), complications, readmission and in-hospital death were captured.The ACS team was involved in the care of 359 patients, 176 (49.0%) of whom were admitted under the direct care of the ACS team. Nonoperative care was indicated in 82 patients (46.6%) admitted to the ACS service and 151 (82.5%) of those admitted to a non-ACS service (Acute care surgery teams care for a wide breadth of disease, a considerable amount of which is managed nonoperatively.La plupart des études qui ont évalué les modèles de soins chirurgicaux aigus (SCA) chez des patients souffrant de problèmes de santé nécessitant un traitement de chirurgie générale (TCG) d'urgence ont porté sur des patients ayant subi une intervention lors de leur admission dans un service de SCA. Le but de cette étude était d'analyser de manière prospective la clientèle admise ou vue en consultation dans le service de SCA d'un centre de soins tertiaires pour connaître la fréquence et la distribution des problèmes de santé nécessitant un TCG d'urgence effectivement traités chirurgicalement ou autrement.Dans cette étude de cohorte prospective, nous avons évalué des patients consécutifs vus par l'équipe de SCA entre le 1er juillet et le 31 août 2015 dans un grand centre canadien de soins tertiaires. Cela incluait toutes les consultations et les transferts en provenance d'autres hôpitaux. Nous avons noté les diagnostics, les caractéristiques démographiques, les comorbidités, les interventions, les complications, réadmissions et les décès en cours d'hospitalisation.L'équipe de SCA a assuré les soins de 359 patients, dont 176 (49,0 %) avaient été admis directement au service de SCA. Des soins non chirurgicaux étaient indiqués chez 82 patients (46,6 %) admis au service de SCA et chez 151 (82,5 %) patients admis dans d'autres services (Les équipes de soins chirurgicaux aigus prennent en charge un vaste éventail de pathologies, dont une part importante est gérée de manière non chirurgicale.