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The purpose of this study was to examine patterns and factors influencing exclusion rates and achievement on large-scale assessments in Canada. Data analysis employed a case study to examine policies and practices of exclusion, absenteeism, and social promotion related to large-scale assessments at the international, national, and provincial levels. In addition, information was solicited from assessment experts regarding exclusion rate practices. Findings revealed significant increases in student performance, which paralleled significant increases in exclusion rates. At the provincial level, the analysis led to the discovery of the relationship between social promotion policies and a document guiding assessment practices in Canada (i.e., Principles of Fair Assessment Practices). This relationship was the rationale given for excluding poor performing students, not learning or physically disabled students, from participating in large-scale assessments. Recommendations include an alignment of exclusion policies between the three levels of administration, documenting students who are unable to participate on large-scale assessment because they are operating too far below grade level as a result of being social promoted, and to over sample provinces and schools with high absenteeism on assessment days.

Objectives: To pilot whether a sensory-based food education program, "Rainbow Food Heroes," increases children's intended and actual fruit and vegetable consumption. Methods: The behavioral intervention, Rainbow Food Heroes, a sensory-based food education program, consisted of two 90-minute workshops delivered in one week, followed by a "Rainbow Plate" themed school assembly one week later. Baseline and post-intervention data were collected 11 days before the beginning of the intervention period and two days after the completion of the school assembly at the end of the intervention, respectively. The participants were 72 kindergarten children in a Canadian urban elementary school. The outcomes measured were intention to eat fruit and vegetables, number of colors of fruit and vegetables children selected, and actual consumption of these foods. Comprehension of the Rainbow Plate message was assessed by measuring the number of colors of pictures of fruit and vegetables added to a paper "theoretical Rainbow Plate" during the second workshop. Results: Post-intervention, children selected an average of 261.13 grams of fruit and vegetables compared to 185.96 grams at baseline assessment (75.17 grams more). They also selected more varied colors (0.3) on their plates compared to baseline. Children consumed an average of 159.35 grams post-intervention compared to 106.74 grams at baseline, which was an increase of 52.6 grams. Children added, on average, four different colored fruits and vegetables to their theoretical rainbow plates, which suggested good comprehension of the Rainbow Plate concept during the workshop. Applications to Child Nutrition Professionals: The Rainbow Food Heroes sensory-based food education program may influence children to increase fruit and vegetable consumption. The Rainbow Food Heroes program may be adopted as a fun sensory-based element of a nutrition curriculum.

Introduction: Frailty is a complex geriatric syndrome with a multifaceted etiology. We aimed to identify the best combinations of risk factors that predict the development of frailty using recursive partitioning models. Methods: We analyzed reports from 1,724 community-dwelling men and women aged 65–74 years participating in the International Mobility in Aging Study (IMIAS). Frailty was measured using frailty phenotype scale that included five physical components: unintentional weight loss, weakness, slow gait, exhaustion, and low physical activity. Frailty was defined as presenting three of the above five conditions, having one or two conditions indicated prefrailty and showing none as robust. Socio-demographic, physical, lifestyle, psycho-social, and life-course factors were included in the analysis as potential predictors. Results: 21% of pre-frail and robust participants showed a worse stage of frailty in 2014 compared to 2012. In addition to functioning variables, fear of falling (FOF), income, and research site (Canada vs. Latin America vs. Albania) were significant predictors of the development of frailty. Additional significant predictors after exclusion of functioning factors included education, self-rated health, and BMI. Conclusions: In addition to obvious risk factors for frailty (such as functioning), socio-economic factors and FOFs are also important predictors. Clinical assessment of frailty should include measurement of these factors to identify high-risk individuals. [ABSTRACT FROM AUTHOR]

This study examined gender differences in the experiences of 923 officer cadets attending Canadian Military Colleges and 135 officer cadets attending civilian universities who completed a survey. Overall, the findings revealed that the experience of officer cadets in civilian universities was more positive, gender neutral, and their institutions' values and culture were a better fit for them compared to their peers in Canadian Military Colleges. For officer cadets in Canadian Military Colleges, the results revealed that women were less likely to perceive gender equality in the way they were treated, the fairness of complaint mechanisms, and being treated with respect compared to men. Men in Canadian Military Colleges were less likely to perceive gender equality in performance standards than women. There were no gender differences in experiences for officer cadets in civilian universities. [ABSTRACT FROM AUTHOR]

Background: With advancements in basic science and clinical medicine, lung transplantation (LT) has evolved rapidly over the last three decades. However, it is unclear if significant regional variations exist in long-term outcomes after LT., Methods: To investigate potential differences, we performed a retrospective, comparative cohort analysis of adult patients undergoing deceased donor single or double LT in North America (NA) or Europe between January 2006 and December 2016. Data up to April 2019 were abstracted from the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Organ Registry. We compared overall survival (OS) between North American and European LT centers in a propensity score matched analysis., Results: In 3,115 well-matched pairs, though 30-day survival was similar between groups (NA 96.2% vs Europe 95.4%, p = 0.116), 5-year survival was significantly higher in European patients (NA 60.1% vs Europe 70.3%, p < 0.001)., Conclusions: This survival difference persisted in a sensitivity analysis excluding Canadian patients. Prior observations suggest that these disparities are at least partly related to better access to care via universal healthcare models prevalent in Europe. Future studies are warranted to confirm our findings and explore other causal mechanisms. It is likely that potential solutions will require concerted efforts from healthcare providers and policymakers., (Copyright © 2022 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

Objective: The objective of this study is to evaluate the influence of urinary incontinence (UI) on physical performance. Method: In prospective analyses from the International Mobility in Aging Study (IMIAS), 915 women (65-74 years) from Canada, Colombia, Albania, and Brazil were evaluated in relation to self-reported UI (past week) and physical performance (Short Physical Performance Battery [SPPB]), with reevaluation after 2 years. Linear mixed models examined the influence of UI on SPPB, adjusted by covariates (age, study site, education, income sufficiency, body mass index [BMI] and parity). Results: Women reporting some UI presented lower SPPB mean (β = -0.41, p = .009) and a greater reduction (β = -0.53, p = .001) over 2 years than those reporting no UI. Discussion: Compared with no reported UI, some UI was associated with worse and more pronounced declines in physical performance over 2 years. This study highlights the importance of practices to reduce UI to contribute to healthier aging.

OBJECTIVEThere remains uncertainty regarding the appropriate level of care and need for repeating neuroimaging among children with mild traumatic brain injury (mTBI) complicated by intracranial injury (ICI). This study's objective was to investigate physician practice patterns and decision-making processes for these patients in order to identify knowledge gaps and highlight avenues for future investigation.METHODSThe authors surveyed residents, fellows, and attending physicians from the following pediatric specialties: emergency medicine; general surgery; neurosurgery; and critical care. Participants came from 10 institutions in the United States and an email list maintained by the Canadian Neurosurgical Society. The survey asked respondents to indicate management preferences for and experiences with children with mTBI complicated by ICI, focusing on an exemplar clinical vignette of a 7-year-old girl with a Glasgow Coma Scale score of 15 and a 5-mm subdural hematoma without midline shift after a fall down stairs.RESULTSThe response rate was 52% (n = 536). Overall, 326 (61%) respondents indicated they would recommend ICU admission for the child in the vignette. However, only 62 (12%) agreed/strongly agreed that this child was at high risk of neurological decline. Half of respondents (45%; n = 243) indicated they would order a planned follow-up CT (29%; n = 155) or MRI scan (19%; n = 102), though only 64 (12%) agreed/strongly agreed that repeat neuroimaging would influence their management. Common factors that increased the likelihood of ICU admission included presence of a focal neurological deficit (95%; n = 508 endorsed), midline shift (90%; n = 480) or an epidural hematoma (88%; n = 471). However, 42% (n = 225) indicated they would admit all children with mTBI and ICI to the ICU. Notably, 27% (n = 143) of respondents indicated they had seen one or more children with mTBI and intracranial hemorrhage demonstrate a rapid neurological decline when admitted to a general ward in the last year, and 13% (n = 71) had witnessed this outcome at least twice in the past year.CONCLUSIONSMany physicians endorse ICU admission and repeat neuroimaging for pediatric mTBI with ICI, despite uncertainty regarding the clinical utility of those decisions. These results, combined with evidence that existing practice may provide insufficient monitoring to some high-risk children, emphasize the need for validated decision tools to aid the management of these patients.

Background: A poor ability of recommended risk scores for predicting in-hospital bleeding has been reported in elderly patients with acute coronary syndromes (ACS). No study assessed the prediction of post-discharge bleeding in the elderly. The new BleeMACS score (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome), was designed to predict post-discharge bleeding in ACS patients. We aimed to assess the predictive ability of the BleeMACS score in elderly patients., Methods: We assessed the incidence and characteristics of severe bleeding after discharge in ACS patients aged ≥ 75 years. Bleeding was defined as any intracranial bleeding or bleeding leading to hospitalization and/or red blood transfusion, occurring within the first year after discharge. We assessed the predictive ability of the BleeMACS score according to age by Fine-Gray proportional hazards regression analysis, calculating receiver-operating characteristic (ROC) curves and the area under the ROC curves (AUC)., Results: The BleeMACS registry included 15,401 patients of whom 3,376/15,401 (21.9%) were aged ≥ 75 years. Elderly patients were more commonly treated with clopidogrel and less often treated with ticagrelor or prasugrel. Of 3,376 elderly patients, 190 (5.6%) experienced post-discharge bleeding. The incidence of bleeding was moderately higher in elderly patients (hazard ratio [HR], 2.31, 95% confidence interval [CI], 1.92-2.77). The predictive ability of the BleeMACS score was moderately lower in elderly patients (AUC, 0.652 vs. 0.691, p  = 0.001)., Conclusion: Elderly patients with ACS had a significantly higher incidence of post-discharge bleeding. Despite a lower predictive ability in older patients, the BleeMACS score exhibited an acceptable performance in these patients., Competing Interests: None., (Schattauer GmbH Stuttgart.)