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Background: House dust mite (HDM) is the most common sensitising allergen in asthma. Ethnic minority groups (EMGs) in the UK are more likely to live in deprived conditionings with a greater exposure to HDM and other aero‐allergens. Aim: To compare the ethnicity‐based patterns of sensitisation to aero‐allergens and the impact of ethnicity on clinical outcomes in patients with difficult‐to‐treat asthma (DTA). Methods: Data of patients with DTA were extracted from the registry of the Birmingham Regional Severe Asthma Service (BRSAS), which have a catchment population of 7.3million from Central England. Patients from White and EMG backgrounds were compared in terms of the prevalence of atopy, total serum immunoglobulin E (IgE), specific serum IgE (ssIgE) and asthma related clinical outcomes. Logistic regression analysis was conducted to explore ethnicity‐based risk factors for HDM sensitisation. Results: A total of 1272 patients [White 1016 (79.9%), EMG 256 (20.1%) EMG] with a median age of 51 years (range 16–97) were included in the analysis. Patients from EMG were more likely (64%) to reside in the worst scale of index of multiple deprivation (IMD) than the White patients (25.5%), p < 0.0001. Positive HDM sensitisation was more prevalent in the EMG than in the White group [142/216 (66%) versus 375/842 (45%), p < 0.0001]. The median HDM ssIgE level was higher in the EMG than in the White group [3.0 KUA/L (IQR 0.06, 11.5) versus 0.1 (0.01, 3.0), p < 0.000001]. The odds ratio for positive sensitisation to HDM conveyed by the EMG status was 2.61 (95%CI, 1.8–3.8), p < 0.0001. Compared to the White group, the EMG had higher median total serum IgE [326 KU/L (115, 971) versus 114 (29.8, 434.8), p < 0.000001], higher blood eosinophil count (0.36 × 109(0.18, 0.62) versus 0.23 (0.1,0.47), p < 0.000001), were marginally more atopic (79.2% vs. 75.6%, p = 0.098) and were less likely to being on maintenance oral corticosteroids (22% vs. 39.7%, p < 0.0001). Conclusion: In this DTA cohort, positive HDM sensitisation was greater amongst the EMG than the White patients. The EMG status was a significant risk factor for HDM sensitisation. [ABSTRACT FROM AUTHOR]

Purpose: Nearly all schools in the United States closed in spring 2020, at the onset of the COVID-19 pandemic. We analyze traditional public and charter school reopenings for the 2020–21 school year in five urban districts. We provide a rich and theoretically grounded description of how and why educational leaders made reopening decisions in each of our case districts. Research Methods: We used data from a multiple-case study from March 2020 to July 2021. The research team conducted 56 interviews with school, district, and system-level leaders; triangulated with publicly available data; and also drew on interview data from a subsample of parents and guardians in each of our sites. We analyzed these data through qualitative coding and memo writing and conducted detailed single- and cross-case analyses. Findings: School system leaders in our case sites generally consulted public health authorities, accounted for state-level health and educational guidance, and engaged with and were responsive to the interests of different stakeholders. Districts' adherence to and strategic uses of public health guidance, as well as a combination of union-district relations and labor market dynamics, influenced reopening. Parents, city, and state lawmakers, and local institutional conditions also played a role, helping to explain differences across cases. Implications: In contrast to the "politics or science" framing that has dominated research and public discourse on school reopening, we show that local pandemic conditions and local political dynamics both mattered and in fact were interrelated. Our findings have some implications for how educational leaders might navigate future crises. [ABSTRACT FROM AUTHOR]

Governmental policies in the United States and beyond increasingly call for school leaders to involve local communities in decision-making, yet engagement practices have often centered the perspectives of White parents and marginalized the voices of racially minoritized families. In this comparative case study of seven school districts, we draw on critical race theory to explore how race and racism shaped district practices under a statewide community engagement policy. Our findings suggest that, without careful attention to racial power and privilege, the implementation of community engagement policies may promote racism in practice, highlighting the need for culturally responsive approaches to engagement. [ABSTRACT FROM AUTHOR]

Background: Across families from all backgrounds, and for all students, when parents and the broader community engage in sustained systematic program improvements, schools and districts are more likely to focus on and maintain improvements. As a result, federal and state lawmakers have implemented engagement mandates. The ways in which these mandates are interpreted and implemented influence the success of the engagement practices. Research Design: We conducted a comparative case study and analyzed state representative survey data. Research Questions: How has Local Control Funding Formula (LCFF) local engagement played out over time? What has been learned? What may be facilitating and inhibiting "meaningful" engagement? Conclusions: Through the lens of democratic engagement, we find broad community and district leadership support for the ideals of community engagement. However, we also find that community engagement over time has generally lacked both depth and breadth and was specifically constrained for traditionally marginalized communities. Our analysis also identifies outlier districts that have established ways to implement broader and deeper engagement activities that focus on utilizing their communities as assets. Our research suggests that district leaders and educators need greater support to fully realize these democratic processes. [ABSTRACT FROM AUTHOR]

The paradigm of test-based accountability has been a dominant force for decades, yet some argue that we have recently witnessed a dramatic change in the key beliefs influencing educational policy. To understand the extent of this transformation, we investigated the policy narrative supporting the adoption of a multiple measure accountability system in California's CORE Districts. Our data revealed a narrative integrating key beliefs about knowledge, accountability, and social-emotional learning. This narrative continues the major themes of the previous accountability paradigm, but with two notable differences regarding the use of measurement data and role of social-emotional learning. [ABSTRACT FROM AUTHOR]

Background/Context: Researchers have amassed considerable evidence on the use of student performance data (e.g., benchmark and standardized state tests) to inform educational improvement, but few have examined the use of nonacademic indicators (e.g., indicators of social and emotional well-being) available to educators, and whether the factors shaping academic data use remain true for these newer types of data. While the field continues to advocate for greater attention to the social-emotional development of students, there remains little guidance on conditions supporting the use of data on these important mindsets, dispositions, beliefs, and behaviors. Purpose/Focus of the Study: In this article, we use sensemaking theory, prior research on academic data use, and research from a study of "early adopter" California districts to develop a framework for understanding conditions likely to shape educators' use of social-emotional learning (SEL) indicators to inform practice. Research Design: We develop our findings and framework by drawing on prior research and theory, as well as data from a multiyear research-practice partnership with a consortium of California districts that began measuring SEL as part of the No Child Left Behind waiver they received from the U.S. Department of Education. We draw on more than 125 interviews with consortium leaders, central office administrators, leaders, teachers, and staff in 25 schools and six districts to understand how they made sense of SEL and SEL survey data, as well as the practices employed to support SEL. Findings: We find that five categories of conditions appear to shape how educators interpret and respond to SEL indicators: policy context, organizational conditions, interpersonal relationships and interactions, data user characteristics, and data properties. Much like academic data use, we find: (1) the accountability policy context can convey a sense of importance, but may also lead to distortive responses; (2) district and school leaders are critical for allocating time and staff, and cultivating a data culture; (3) collaboration facilitates sensemaking; (4) individual-level knowledge and beliefs can shape interpretation; and (5) timeliness and perceived relevance of data matter. Some of these conditions, however, are uniquely relevant to the use of SEL data, which brings greater ambiguity, uncertainty, and a decoupling from the traditional academic role of educators. We find that including SEL indicators in multiple measure systems can lead to uncertainty and interpretive complexity, and divide educators' attention. Deficit conceptions may also shape sensemaking and are especially germane in the SEL context given documented gaps by race/ethnicity on measures of SEL. Another condition especially relevant to SEL indicator usage is the lack of coherence or clarity around SEL. The frequent misunderstandings of and disagreement about SEL--sometimes shaped by disciplinary background--could lead to different interpretations and responses. All of these conditions suggest that sensemaking and response to SEL data indicators are complex processes that require multiple enabling factors. Conclusions and Implications: Given the significant investments in supporting and measuring student social-emotional development, it behooves policymakers, education leaders and practitioners to better understand the conditions facilitating and inhibiting productive use of SEL indicators. The framework provided herein presents a set of concepts and conditions that may be useful in supporting this process. The findings also raise a cautionary flag that while sometimes consistent with the process of using academic data, the use of SEL indicators may present added challenges worthy of attention. We conclude with implications for policy, practice, and research. Notably, education leaders and practitioners may want to invest in building common understanding of SEL and capacity to interpret and act on these indicators, and consider how equity orientations shape understanding and usage of SEL indicators. Policymakers may want to consider more formative uses of SEL data that are provided to educators earlier in the year, and attend to the human capital needs that accompany SEL data usage. Finally, researchers might build on this work by further examining the relationship between SEL and culture/climate and the ways in which educators respond to data on both, and also investigate the outcomes of SEL data usage, such as actions that lead to meaningful improvements in SEL. [ABSTRACT FROM AUTHOR]

Background/Context: School leaders are central to state and district human-capital reforms (HCRs), yet they are rarely equipped with the skills to implement new evaluation, professional development, and personnel data systems. Although districts increasingly offer principals coaching and training, there has been limited empirical work on how these supports influence principals' HCR-related practices. Purpose: Drawing on a two-year, mixed-methods study in the Los Angeles Unified School District (LAUSD), this article examines the role of principal supervisors in HCRs. We ask: What role did principal supervisors (Instructional Directors [IDs]) play in the implementation of human-capital reforms? What did high-quality coaching on the part of IDs look like in this context? Research Design: Our two-part analysis draws upon survey and interview data. First, we conducted descriptive analyses and significance testing using principal and ID survey data to examine the correlations among principals' ratings of ID coaching quality, ID coaching practices, and principals' implementation of HCRs. Second, we conducted in-depth interviews, using a think-aloud protocol, with two sets of IDs--those consistently highly-rated and those with mixed ratings--who were identified using principals' reports of coaching quality. Following interview coding, we created various case-ordered metamatrix displays to analyze our qualitative data in order to identify patterns in coaching strategy and approach across IDs, content, and contexts. Findings: First, our survey data indicate that receiving high-quality coaching from IDs is correlated with stronger principal support for and implementation of HCRs. Our survey findings further illustrate that IDs support a wide range of principals' HCR activities. Second, our think-aloud interviews with case IDs demonstrate that coaching strategy and approach vary between consistently highly-rated and mixed-rated coaches: Consistently highlyrated IDs emphasize the importance of engaging in, or defining HCR problems as, joint work alongside principals, while mixed-rated IDs often emphasize the use of tools to guide principal improvement. We find that, on the whole, the consistently highly-rated IDs in our sample employ a nondirective approach to coaching more often than mixed-rated coaches. Conclusions: These findings contribute to a growing literature on the crucial role of principal supervisors as coaches to improve principals' instructional leadership and policy implementation. While exploratory, this study offers the first steps toward building greater evidence of the connections between high-quality coaching and policy implementation, and it may have implications for the design and implementation of professional development for principal supervisors and the selection and placement of supervisors with principals. [ABSTRACT FROM AUTHOR]

The structure of US public education is changing. Rather than exclusive district management of schools with standardized programs, new types of systems have emerged. In the case of "portfolio" systems, advocates argue that choice, performance-based accountability, and autonomy challenge traditional schooling and foster a diversity of options for parents. Yet there is limited empirical evidence on these claims. Our mixed-methods study examines the values and reported practices of schools in Los Angeles. We find limited evidence of variation across schools. Rather, institutional forces appear to be shaping common commitments to academics, whole child support, community, and professionalism, with some fine-grained differences connected to organizational characteristics. Ultimately, this lack of diversity and the complexity of multiple logics do not appear to challenge the idea of a shared "grammar of schooling" across schools. This research advances our understanding of institutional logics in schools and provides implications for policy and future research. [ABSTRACT FROM AUTHOR]

This study sought to understand how teachers learn through the process of implementing supplementary curricula, and to what extent the use of curricular materials leads to changes in instructional approaches. Through implementing a STEM supplementary curricular unit aligned to NGSS, the researchers conducted multiple case studies to examine teacher learning and identified potential factors that mediated instructional change. Based on experiences of seven teacher participants, results showed different learning trajectories, wherein teachers either moved towards student-directed instructional roles or maintained teacher-directed roles. Doubt and self-questioning appear to be important mediating aspects of teacher self-reflection, which then impacts instructional role change. • Teachers enacted different instructional roles based on sensemaking of supplementary curricular demands. • Learning trajectories emerged in which teachers either did or did not shift instructional roles. • Instructional roles shifted towards student-centered practices or remained teacher-directed. • Doubt induced from practice is an impetus for teacher self-reflection and potential role change. [ABSTRACT FROM AUTHOR]

We examine how district administrators' conceptions of equity relate to the implementation of finance reform. We use sensemaking theory and four views of equity—libertarian, liberal, democratic liberal, and transformative—to guide a case study of two districts, finding evidence of two conceptions of equity: (1) greater resources for students with greater needs and (2) equal distribution of resources for all students. One district demonstrated an organization-wide belief in the first conception, whereas the other conveyed individual-level understandings of both conceptions. These beliefs were mirrored in resource allocation decisions and informed by districts' student demographics, organizational identities, and perceptions of adequacy. [ABSTRACT FROM AUTHOR]

Background Motivated by the unexplained variation in the performance of some vaccines across different settings, we extend previous theoretical work to consider the potential impact of incomplete case ascertainment on measures of vaccine efficacy (VE), which is more likely in subclinical or clinically unimportant infections, such as rotavirus gastroenteritis. Methods By simulating the measurement of VE under outbreak conditions using a discrete time stochastic SIR model, we compare three commonly used measures, VE Risk , VE Rate , and VE Hazard , calculated respectively based on risk ratio, rate ratio and hazard ratio of disease. We investigate how these measures are influenced by factors such as biological activity, action mechanism of vaccine, proportion of cases ascertained, and underlying force of infection. Results Under plausibly low levels of ascertainment, the group with the most infections, and therefore the most missed cases, has the most falsely inflated denominator, producing similar rates in the control and intervention groups. As a result, VE Rate and VE Hazard will underestimate the true VE compared to high case ascertainment scenarios. Furthermore, the extent of underestimation is greater for leaky vaccine models with lower biological protective effects and under conditions which are conducive to high transmission. Conclusions This study demonstrates that a biologically active vaccine may produce a low measured VE under a range of epidemiological, vaccine-related and logistical conditions. Low case ascertainment may partly explain the observed heterogeneity in the performance of rotavirus vaccine across different settings, and should be considered in the design and interpretation of future field trials. [ABSTRACT FROM AUTHOR]

Purpose: The Every Student Succeeds Act (ESSA) represents a notable shift in K-12 accountability, requiring a more comprehensive approach to assessing school performance and a less prescriptive approach to intervening in low-performing schools. In this article, we seek to leverage the experiences of California’s CORE (California Office to Reform Education) waiver districts to better understand what it means to implement an ESSA-like system. Specifically, we examine educators’ attitudes about CORE’s accountability system, how it was implemented, and its intermediate outcomes. Research Methods: We use a multiple, embedded case study design, examining the implementation of CORE’s accountability system across all six CORE Districts. We draw on interviews with CORE staff (n = 4), district leaders (n = 6) and administrators (n = 29), and school principals (n = 15); observations of CORE meetings (42 hours); and documentation. Findings: We find strong buy-in for CORE’s accountability system and considerable adaptation of its key elements. District administrators also reported challenges with achieving reciprocity in collaborative activities, and limited capacity, validity concerns, and policy misalignment constrained implementation. Reported effects on practice and learning indicate CORE efforts were a work in progress. Implications for Research and Practice: This research suggests lessons about what it means to be “data-driven” in a multiple-measures accountability era and raises questions about how to facilitate school improvement. While efforts to motivate change via test-based measures, sanctions, and prescribed interventions in prior accountability eras may not have yielded all the expected positive results, our study indicates that a shift to multiple measures, greater flexibility, and locally determined capacity-building efforts brings its own set of challenges. [ABSTRACT FROM AUTHOR]

Despite the press for data-informed decision making, there is still much to learn about when and under what conditions data promote changes in instruction and when they may contribute to other outcomes. The study uses qualitative comparative analysis to examine 245 cases of teachers’ data use in five middle schools from a year-long study in the United States. Analysis points to the important influence that certain types of data, the involvement of a coach or peer group, and the school culture can have on teachers’ instructional responses to data. [ABSTRACT FROM AUTHOR]

Purpose: Supporting teachers’ use of data has become a large part of educational leaders’ instructional leadership. Drawing on sensemaking theory, we explore how features of data and teachers’ perceptions of them may matter when teachers consider student learning data. Design: The article draws on a 1-year, comparative case study of five low-income, high needs middle schools in three districts. Data sources include interviews with district leaders (n = 13); school administrators, coaches, and case study teachers (n = 73); focus groups (n = 6) with non–case study teachers (n = 24); observations (n = 20); web-based activity logs; and document review. Findings: Different forms of data lead to a wide range of instructional responses. State assessments, used largely at the beginning of the school year, aided teachers in grouping their students but did little to promote change in instructional delivery. District benchmark data, which teachers did not generally find useful, were associated with reteaching and retesting content, creating small groups, and having students reflect on their data, usually without a shift in pedagogy. Data from common grade assessments—valued for their closeness to instruction as well as their predictive information for future success on state assessments—were most often tied to regrouping or reteaching standards not yet mastered by students, but there was some promise of change in pedagogy. Classroom assessment results and student work, identified by teachers as very useful, were proportionately most often linked to changes in instructional delivery. Implications: We offer implications for leadership preparation and practice, education policy, and future research on data use. [ABSTRACT FROM AUTHOR]

Background: Scholars widely acknowledge that politics help explain why policies are adopted and how they play out in states, districts, and schools. To date, political analyses of education reform tend to isolate a particular policy and examine the politics of its adoption or implementation, but pay less attention to the effects of the politics of surrounding reforms and broader issues. Purpose: In this article, I use the instrumental case of the Los Angeles Public School Choice Initiative (PSCI) to demonstrate the ways in which the political dynamics of other policy issues in the same local environment greatly affect the form and fate of a reform. The article examines what led to the adoption of PSCI and what explains its implementation and adaptation over time. Research Design: The study employed an embedded case study design and gathered 3 years of data from leader interviews, observations, interviews, and focus groups in nine case study schools, media articles, and documents. I drew on an ecological-political framework to analyze these data and to understand the evolution of PSCI. Findings: I find that PSCI provided a vehicle to advance the goals of six education reform "subgames"-- decentralization, charter expansion, accountability, union reform, academic rigor, and community empowerment --as well as goals of two broader local "games" of electoral politics and bridging, and that each was consequential to at least one or more phase of PSCI. At times in its evolution, players seeking success in one area of reform aligned with, used, or were used by players seeking success in other areas of reform. It is the interactions of these players in relation to the environment and to others working to advance complementary and conflicting reform issues and goals that explains how a reform touted to improve accountability and learning for low-performing schools and to empower the community became a broader referendum on school governance and reform writ large. Conclusions: Consistent with recent scholarship, this research demonstrates that an increasingly broad set of actors are engaging in decisions around public schooling and changing the nature of educational governance. The study also illustrates the value of examining local policy with an ecological-political lens and poses several hypotheses that could be explored in future studies. Finally, it suggests that prior to adoption, policymakers consider the extent to which a new policy advances or competes with the goals of surrounding reforms and investigate ways to bolster bridging games. [ABSTRACT FROM AUTHOR]

Objective: To develop customized biometric charts to better define abnormal fetal growth.Methods: A total of 1056 singleton fetuses from the Raine Study underwent serial ultrasound biometry (abdominal circumference [AC], head circumference, and femur length) at 18, 24, 28, 34, and 38 weeks' gestation. Customized biometry trajectories were developed adjusting for epidemiological influences upon fetal biometry using covariates available at 18 weeks gestation. Prediction accuracy (areas under the receiver operating characteristic curve [AUC] and 95% confidence interval [95%CI]) was evaluated by repeated random sub-sampling cross-validation methodology.Results: The model for derived estimated fetal weight (EFW) performed well for EFW less than 10th predicted percentile (AUC = 0.695, 95%CI, 0.692-0.699) and EFW greater than 90th predicted percentile (AUC = 0.705, 95%CI, 0.702-0.708). Fetal AC was also well predicted for growth restriction (AUC = 0.789, 95%CI, 0.784-0.794) and macrosomia (AUC = 0.796, 95%CI, 0.793-0.799). Population-derived, sex-specific charts misclassified 7.9% of small fetuses and 10.7% of large fetuses as normal. Conversely, 9.2% of those classified as abnormally grown by population-derived charts were considered normal by customized charts, potentially leading to complications of unnecessary intervention.Conclusions: Customized fetal biometric charts may offer improved ability for clinicians to detect deviations from optimal fetal growth and influence pregnancy management. [ABSTRACT FROM AUTHOR]

Purpose: A common strategy used in school improvement efforts is a mandated process of formal planning, yet little is known about the quality of plans or the relationship between plan quality and implementation. This mixed-methods article investigates plan quality, factors associated with plan quality, and the relationship between plan quality and implementation, drawing on the first 3 years of a Los Angeles Unified School District school improvement initiative that relied on formal school planning. Research Design: Our research team rated all 206 school plans submitted to the district in the first 3 years of the initiative and drew on surveys of applicant teams and principals implementing the plans. We use these data in descriptive analyses to explore relationships between plan quality and various inputs and outcomes. We also utilized school- and system-level qualitative data to contextualize and explain our findings. Findings: We find that, although average plan quality was relatively low throughout the reform, quality increased during the first phase of the initiative but decreased in the second phase. The two critical elements of the reform intended to drive plan quality, competition and technical support, were negatively or not associated with higher quality plans. However, we find positive relationships between plan quality and reported implementation outcomes in the first phase of the reform, but not in the second. Conclusions: We explore possible explanations for these patterns using qualitative case study and interview data. In the conclusion of the article, we discuss the implications for future school improvement initiatives and research. [ABSTRACT FROM AUTHOR]

Despite a growing body of research on data use in education, there has been relatively little focus on the role of students. This article begins to fill this gap by exploring teacher and administrator reports on engaging students in data use at six middle schools. Even though teachers expressed a belief that involving students in data use would motivate students, they often enacted potentially demotivating, performance-oriented classroom structures: sharing data publically, comparing results with others, focusing on status, and providing limited feedback/support on how to close gaps in knowledge. School and district conditions and accountability policies shaped these classroom practices. In some cases, these contextual factors pressed teachers to focus on performance; in others, it buffered them, allowing for a greater emphasis on individual student learning. The authors contribute a theoretically driven, motivational perspective on data use and a cautionary tale of the “trickle-down” effects of accountability policy on students. [ABSTRACT FROM AUTHOR]

Background: In recent years, school districts have experienced a complex policy environment with myriad reforms aimed at addressing longstanding and historically entrenched disparities in opportunities and outcomes between racially minoritized students and White students. One such reform is standards-based accountability, with its emphasis on documenting and addressing racial disparities in testing outcomes. Recently, educators and lawmakers have sought to address persistent racial disproportionality in disciplinary actions. New behavioral policies may be seen as a response to national attention and outrage regarding the "school-to-prison pipeline," which indicates that school discipline practices contribute to the over-representation of Black men in the criminal justice system. In recent years, local leaders have been tasked with implementing new disciplinary reforms alongside their ongoing efforts at instructional improvement. Purpose: As districts face an increasingly complex policy environment and constrained resources, researchers must understand how district leaders make sense of and manage the varied policies they are tasked with implementing. This study contributes to the knowledge base on K–12 policy implementation by examining how school district leaders manage multiple policies—particularly when some new practices engage beliefs around racial discrimination or structural racism. We contribute to the gap in the literature by asking: What differences emerged in the early implementation processes of an instructional policy and a discipline policy in the Elmwood school district, and what might explain those differences? Research Design: To answer this question, we employ a comparative, embedded case study design and examine extensive qualitative data from a single school district. Oakes's (1992) framework of technical, normative, and political dimensions of policy change guided the analysis and was applied to rich interview data. Conclusions: Overall, our findings highlight significant differences in how Elmwood leadership implemented the two policies. Our study indicates that though both instructional and disciplinary reforms purport to address racial outcome gaps, district leaders may view discipline in a racialized way that they do not view instructional policy. The perceived racialized nature of discipline policy may significantly influence implementation practices. Ultimately, the data suggests that racialized normative beliefs and values, along with political and technical investments, greatly influence the implementation process and raise larger questions about the role of racism in education reform. [ABSTRACT FROM AUTHOR]

Objective & Design. We undertook a retrospective review of children diagnosed with acute lymphoblastic leukemia (ALL) and treated with modern COG protocols (n=80) to determine longitudinal changes in body mass index (BMI) and the prevalence of obesity compared with a healthy reference population. Results. At diagnosis, the majority of patients (77.5%) were in the healthy weight category. During treatment, increases in BMI z-scores were greater for females than males; the prevalence of obesity increased from 10.3% to 44.8% (P<0.004) for females but remained relatively unchanged for males (9.8% to 13.7%, P=0.7). Longitudinal analysis using linear mixed-effects identified associations between BMI z-scores and time-dependent interactions with sex (P=0.0005), disease risk (P<0.0001), age (P=0.0001), and BMI z-score (P<0.0001) at diagnosis and total dose of steroid during maintenance (P=0.01). Predicted mean BMI z-scores at the end of therapy were greater for females with standard risk ALL irrespective of age at diagnosis and for males younger than 4 years of age at diagnosis with standard risk ALL. Conclusion. Females treated on standard risk protocols and younger males may be at greatest risk of becoming obese during treatment for ALL. These subgroups may benefit from intervention strategies to manage BMI during treatment for ALL. [ABSTRACT FROM AUTHOR]

Background: Despite increased access to student teaming data, scholars have demonstrated that teachers do not always know how to use these data in ways that lead to deep changes in instruction and often lack skills and knowledge to interpret results and develop solutions. In response, administrators have invested in instructional coaches, data coaches, and professional learning communities (PLCs) to support teachers in this process. Despite their popularity, there is limited research on the ways in which coaches and PLCs mediate teachers' use of data and the various types of expertise brought to bear on this process. Purpose: This exploratory study examined how working with a coach or PLC shaped teachers' responses to data in six middle schools and the factors that influenced the activities and effects of coaches and PLCs. Our intent was to deeply examine processes and identify key constructs and relationships to guide future research and practice. Research Design: Our research involved a year-long comparative case study of six low-performing middle schools in four districts that supported teacher data use via literacy coaches, data coaches, or PLCs. We draw on cultural historical activity theory and data from 92 interviews, 6 focus groups, 20 observations of meetings, and monthly surveys of case study teachers (15), coaches (4), and PLC lead teachers (2). Findings: We found that coaches and PLCs played important roles in mediating teachers' responses to data and were often associated with instances in which teachers used data to alter their instructional delivery (as opposed to surface-level changes in materials and topics). Further, the dynamic relationship between vertical expertise (an individual's knowledge and skills) and horizontal expertise (knowledge that is co-created through interactions and movement across contexts) may help explain the ways in which PLCs and coaches facilitated deeper level changes in pedagogy. Finally, dialogue was a central mediating practice, and school leadership and the district-level context shaped the possibility for change. Conclusions: Our research adds conceptual clarity to what types of expertise may be needed to ensure that teachers respond productively to data. The study suggests that administrators should consider multiple facets of expertise when designing interventions, recruiting coaches, assembling PLCs, and developing professional development for coaches and teacher leaders. The centrality of dialogue also suggests the need for policies and structures allowing for uninterrupted time for educators to collectively reflect on data. [ABSTRACT FROM AUTHOR]

As accountability systems have increased demands for evidence of student learning, the use of data in education has become more prevalent in many countries. Although school and administrative leaders are recognizing the need to provide support to teachers on how to interpret and respond to data, there is little theoretically sound research on data-driven decision making (DDDM) to guide their efforts. Drawing on sociocultural learning theory, extant empirical literature, and findings from a recent study, this paper develops a framework for understanding how to build teacher capacity to use data, specifically informing what practices administrators might employ, when in the DDDM process to employ these practices, and how these mechanisms may build teacher knowledge and skills. Given the global economic climate, administrators face difficult choices in how to invest scarce resources to support data use and once invested, how to ensure that teachers gain, and sustain, the needed capabilities once the supports are removed. The framework provided herein presents a set of concepts that may be useful in guiding these decisions. Implications for leadership practice, as well as suggestions to guide future research and theory development, are discussed. [ABSTRACT FROM PUBLISHER]

This article examines parent engagement in a Los Angeles portfolio district reform. Based on data from a 3-year study, we use the lens of democratic theory to examine the design and implementation of mechanisms seeking parent input in the selection of plans to operate low-performing and new schools. We find that despite significant efforts to move toward a more deliberative model over time, the process remained primarily interest-based in most cases, due in large part to structural constraints, limited access to information, and mistrust. The article concludes with implications for policy, practice, and research. [ABSTRACT FROM AUTHOR]

Background/Context: In recent years, states, districts, schools, and external partners have recognized the need to proactively foster the use of data to guide educational decision-making and practice. Understanding that data alone will not guarantee use, individuals at all levels have invested in interventions to support better access to, interpretation of and responses to data of all kinds. Despite the emergence of these efforts, there has been little systematic examination of research on such efforts. Purpose/Objective/Research Question/Focus of Study: This article synthesizes what we currently know about interventions to support educators' use of data--ranging from comprehensive, system-level initiatives, such as reforms sponsored by districts or intermediary organizations, to more narrowly focused interventions, such as a workshop. The article summarizes what is what is known across studies about the design and implementation of these interventions, their effects at the individual and organizational levels, and the conditions shown to affect implementation and outcomes. Research Design: Literature review. Data Collection and Analysis: This review entailed systematic searches of electronic databases and careful sorting to yield a total of 41 books, peer-reviewed journal articles, and reports. Summaries of each publication were coded to identify the study methods (design, framework, sample, time frame, data collection), intervention design (level of schooling, focal data and data user, leverage points, components), and findings on implementation, effects, and conditions. Findings/Results: The review uncovers a host of common themes regarding implementation, including promising practices (e.g., making data "usable" and "safe," targeting multiple leverage points) and persistent challenges (e.g., developing support that is generic but also customized, sustaining sufficient support). The review also finds mixed findings and levels of research evidence on effects of interventions, with relatively more evidence on effects on educators' knowledge, skills, and practice than on effects on organizations and student achievement. The article also identifies a set of common conditions found to influence intervention implementation and effects, including intervention characteristics (capacity, data properties), broader context (leadership, organizational structure), and individual relationships and characteristics (trust, beliefs and knowledge). Conclusions/Recommendations: The review finds that the current research base is limited in quantity and quality. It suggests the need for more methodologically rigorous research and greater attention to the organizational and student-level outcomes of interventions, comparative analyses, interventions that help educators move from knowledge to action, and specific ways in which the quality of data and leadership practices shape the effectiveness of interventions. [ABSTRACT FROM AUTHOR]

Background and Aim: Environmental factors including excessive caloric intake lead to disordered lipid metabolism and fatty liver disease (FLD). However, FLD demonstrates heritability suggesting genetic factors are also important. We aimed to use a candidate gene approach to examine the association between FLD and single nucleotide polymorphisms (SNPs) in lipid metabolism genes in the adolescent population-based Western Australian Pregnancy (Raine) Cohort. Methods: A total 951 seventeen year-olds underwent hepatic ultrasound, anthropometric and biochemical characterization, DNA extraction and genotyping for 57 SNPs in seven lipid metabolism genes (ApoB100, ATGL, ABHD5, MTTP, CETP, SREBP-1c, PPARα). Associations were adjusted for metabolic factors and Bonferroni corrected. Results: The prevalence of FLD was 16.2% (11.4% male vs 21.2% female, P = 0.001). Multivariate analysis of metabolic factors found suprailiac skinfold thickness (SST) to be the major predictor of FLD in females and males (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.08-1.15, P = 1.7 × 10−10 and OR 1.17, 95%CI 1.13-1.22, P = 2.4 × 10−11, respectively). In females, two SNPs in linkage disequilibrium from the CETP gene were associated with FLD: rs12447924 (OR 2.16, 95%CI 1.42-3.32, P = 0.0003) and rs12597002 (OR = 2.22, 95%CI 1.46-3.41 P = 0.0002). In lean homozygotes, the probability of FLD was over 30%, compared with 10-15% in lean heterozygotes and 3-5% in lean wild-types. However, these associations were modified by SST, such that for obese individuals, the probability of FLD was over 30% in all genotype groups. Conclusions: Cholesteryl ester transfer protein gene polymorphisms are associated with an increased risk of FLD in adolescent females. The effect is independent of adiposity in homozygotes, thereby placing lean individuals at a significant risk of FLD. [ABSTRACT FROM AUTHOR]

This article examines the convergence of two popular school improvement policies: instructional coaching and data-driven decision making (DDDM). Drawing on a mixed methods study of a statewide reading coach program in Florida middle schools, the article examines how coaches support DDDM and how this support relates to student and teacher outcomes. Authors find that although the majority of coaches spent time helping teachers analyze student data to guide instruction, data support was one among many coach activities. Estimates from models indicate that data analysis support, nevertheless, has a significant association with both perceived improvements in teaching and higher student achievement. [ABSTRACT FROM AUTHOR]

Edison Schools, Inc., is the largest and most visible among a growing number of Education Management Organizations that have entered into contracts to manage public schools, including both conventional and charter schools. Edison's approach to managing schools is comprehensive, and it distinguishes itself from most other school improvement strategies by simultaneously addressing both the resources and assistance provided to schools and the accountability systems under which school staff operate. In this article we explore the ways in which the assistance and resources provided by Edison (including diverse professional development opportunities, materials, technology, and other tools), as well as accountability mechanisms (such as monitoring and rewards), have translated into principal and teacher actions, and the factors that facilitated or constrained educators' efforts to implement the Edison design and improve teaching and learning. Drawing on data gathered from extensive interviews, observations, and document reviews collected during a four-year comprehensive study of Edison schools, we demonstrate how Edison intends to promote not only educators' capacity but also their motivation and opportunity to deliver high-quality instruction. We examine variation that occurs across schools as teachers and principals respond to these system-level efforts. In addition, we identify several important predictors of variation in implementation, including the strength of instructional leadership provided by the principal and the presence or absence of district-imposed constraints such as union contract rules. [ABSTRACT FROM AUTHOR]

The current high-stakes accountability environment has created strong incentives for educators to systematically collect and use data to inform instructional decisions. This article examines the strategies employed by three urban school districts to promote data use for instructional improvement and their effect on administrator, principal, and teacher practice. Several factors are found to affect data use, including accessibility and timeliness of data, perceptions of data validity, training, and support for teachers with regard to data analysis and interpretation, and the alignment of data strategies with other instructional initiatives. [ABSTRACT FROM AUTHOR]

Background: In many countries, infant vaccination with acellular pertussis (aP) vaccines has replaced use of more reactogenic whole-cell pertussis (wP) vaccines. Based on immunological and epidemiological evidence, we hypothesised that substituting the first aP dose in the routine vaccination schedule with wP vaccine might protect against IgE-mediated food allergy. We aimed to compare reactogenicity, immunogenicity, and IgE-mediated responses of a mixed wP/aP primary schedule versus the standard aP-only schedule. Methods and findings: OPTIMUM is a Bayesian, 2-stage, double-blind, randomised trial. In stage one, infants were assigned (1:1) to either a first dose of a pentavalent wP combination vaccine (DTwP-Hib-HepB, Pentabio PT Bio Farma, Indonesia) or a hexavalent aP vaccine (DTaP-Hib-HepB-IPV, Infanrix hexa, GlaxoSmithKline, Australia) at approximately 6 weeks old. Subsequently, all infants received the hexavalent aP vaccine at 4 and 6 months old as well as an aP vaccine at 18 months old (DTaP-IPV, Infanrix-IPV, GlaxoSmithKline, Australia). Stage two is ongoing and follows the above randomisation strategy and vaccination schedule. Ahead of ascertainment of the primary clinical outcome of allergist-confirmed IgE-mediated food allergy by 12 months old, here we present the results of secondary immunogenicity, reactogenicity, tetanus toxoid IgE-mediated immune responses, and parental acceptability endpoints. Serum IgG responses to diphtheria, tetanus, and pertussis antigens were measured using a multiplex fluorescent bead-based immunoassay; total and specific IgE were measured in plasma by means of the ImmunoCAP assay (Thermo Fisher Scientific). The immunogenicity of the mixed schedule was defined as being noninferior to that of the aP-only schedule using a noninferiority margin of 2/3 on the ratio of the geometric mean concentrations (GMR) of pertussis toxin (PT)-IgG 1 month after the 6-month aP. Solicited adverse reactions were summarised by study arm and included all children who received the first dose of either wP or aP. Parental acceptance was assessed using a 5-point Likert scale. The primary analyses were based on intention-to-treat (ITT); secondary per-protocol (PP) analyses were also performed. The trial is registered with ANZCTR (ACTRN12617000065392p). Between March 7, 2018 and January 13, 2020, 150 infants were randomised (75 per arm). PT-IgG responses of the mixed schedule were noninferior to the aP-only schedule at approximately 1 month after the 6-month aP dose [GMR = 0·98, 95% credible interval (0·77 to 1·26); probability (GMR > 2/3) > 0·99; ITT analysis]. At 7 months old, the posterior median probability of quantitation for tetanus toxoid IgE was 0·22 (95% credible interval 0·12 to 0·34) in both the mixed schedule group and in the aP-only group. Despite exclusions, the results were consistent in the PP analysis. At 6 weeks old, irritability was the most common systemic solicited reaction reported in wP (65 [88%] of 74) versus aP (59 [82%] of 72) vaccinees. At the same age, severe systemic reactions were reported among 14 (19%) of 74 infants after wP and 8 (11%) of 72 infants after aP. There were 7 SAEs among 5 participants within the first 6 months of follow-up; on blinded assessment, none were deemed to be related to the study vaccines. Parental acceptance of mixed and aP-only schedules was high (71 [97%] of 73 versus 69 [96%] of 72 would agree to have the same schedule again). Conclusions Compared to the aP-only schedule, the mixed schedule evoked noninferior PT-IgG responses, was associated with more severe reactions, but was well accepted by parents. Tetanus toxoid IgE responses did not differ across the study groups. Trial registration: Trial registered at the Australian and New Zealand Clinical 207 Trial Registry (ACTRN12617000065392p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371998&isReview=true. Just one registry (as above). Gladymar Pérez Chacón and colleagues report the safety and immunogenicity of a mixed whole-cell and acellular pertussis vaccine in Australian infants in stage 1 of the two-stage OPTIMUM trial. Author summary: Why was this study done?: Evidence-based strategies to lower the risk of food allergies developing in young children are limited. A previous observational study suggested that food allergies appear to be less common among Australian-born children vaccinated with a first dose of whole-cell whooping cough (wP) vaccine before 4 months old versus those receiving a first dose of acellular whooping cough (aP) vaccine at the same age. Why did the researchers do and find?: In the first stage of a 2-stage, double-blind, noninferiority trial, Australian-born infants were randomised to receive a first dose of wP versus aP at approximately 6 weeks old; in both study groups, aP vaccine is given at 4 and 6 months old. Stage (phase) one examined the immunogenicity, reactogenicity, and IgE-mediated immune responses of the mixed vaccine schedule (wP/aP/aP) versus the standard aP-only vaccination strategy (aP/aP/aP) in a cohort of 150 infants; stage two is ongoing and was designed to ascertain the development of food allergy by 12 months old (primary outcome) in a cohort of up to 3,000 infants. At 7 months old, the mixed schedule was noninferior to the standard aP-only strategy with respect to pertussis toxin IgG responses; at the same age, we observed no difference across the study groups in IgE responses to hen's egg and tetanus toxoid antigens. The mixed schedule was more reactogenic but well accepted by parents. What do these findings mean?: These findings support the acceptable immunogenicity and reactogenicity of the mixed schedule and are relevant for countries in which wP and aP vaccines are licensed and readily available. While the reported IgE responses are not conclusive, further studies of CD4+ T cell polarisation in response to pertussis antigens, along with primary outcome data will provide a comprehensive picture of the atopic immunophenotypic responses across the study groups. Additional evidence is required to understand the population-level acceptability of the mixed vaccination strategy. [ABSTRACT FROM AUTHOR]

Clinical trials and real world studies demonstrated benefit of mepolizumab treatment in severe asthma but data on its effectiveness beyond 2 years remain limited. Herein, we provide mepolizumab treatment evaluation up to 4 years. we studied all patients initiated on mepolizumab in our center from June 2017 to August 2018. Clinical outcomes data were retrieved from the local dendrite systems registry. Comparison analyses and logistic regression were conducted to explore longevity and predictors of response to mepolizumab treatment. a total of 66 patients initiated on mepolizumab with a median follow-up of 45.8 (42.4,48.1) months were included in the study [mean age 50.3 years (range 18-79), females 50 (73%) ]. At 20.7 months of treatment, 42 patients (63.6%) had positive response, 13 (19.7%) negative response, and 11 (16.7%) discontinued due to other factors. At 45.8 months, 35 (53%) patients were still on mepolizumab, 21 (31.8%) switched to a different biologic, and 10 (15.2%) discontinued biologics. Two deaths were recorded during the study period. The median blood eosinophil was reduced from 0.43x109/L (0.27, 0.75) to 0.04 (0.0, 0.1) (p < 0.00001)]. The median annual exacerbations were reduced from 6.0 (4,8) to 1.0 (0.0,3.0) (p < 0.00001), and mOCS use was reduced from59% to 29%, p = 0.001. The mean asthma control questionnaire-6 (ACQ6) improved from 3.1 ± 1.7 to 2.1 ± 1.3 (p < 0.00001). mepolizumab clinical benefit was sustained over 4 years. However, approximately half of the cohort discontinued the treatment prompting the need for further research into the treatment response longevity. [ABSTRACT FROM AUTHOR]

Purpose: We examine policy influencers' perceptions of the targets of school-choice policy across five states, exploring how constructions varied for White and racially minoritized families, whether policy actors conceived of the "target" of policy as the child or the parent, and how these racialized constructions varied across different types of school-choice policies. Research Methods/Approach: We conducted 56 semistructured interviews in 2019 with state-level stakeholders across five states. Findings: We found that policy actors generally viewed White families as strong and racially minoritized families as weak. However, for both groups, we found variation in whether these constructions were positive or negative and differences between students and parents. We find that social constructions are fluid, with varying, sometimes conflicting and contradictory views of racially minoritized and White parents in the same period, within the same state context. Despite the salience of race throughout social constructions of the target population, policy actors primarily used color-evasive references. In general, we found little variation in policy components at the state level. Implications: Our work demonstrates how racialized social constructions matter for equity in school-choice policy, with implications for local, state, and federal policy and for future research. [ABSTRACT FROM AUTHOR]

Background: Safe, highly curative, short course, direct acting antiviral (DAA) therapies are now available to treat chronic hepatitis C. DAA therapy is freely available to all adults chronically infected with the hepatitis C virus (HCV) in Australia. If left untreated, hepatitis C may lead to progressive hepatic fibrosis, cirrhosis and hepatocellular carcinoma. Australia is committed to eliminating hepatitis as a public health threat by 2030 set by the World Health Organization. However, since the introduction of funded DAA treatment, uptake has been suboptimal. Australia needs improved strategies for testing, treatment uptake and treatment completion to address the persisting hepatitis C public health problem. PLATINUM C is a HCV treatment registry and research platform for assessing the comparative effectiveness of alternative interventions for achieving virological cure.Methods: PLATINUM C will prospectively enrol people with active HCV infection confirmed by recent detection of HCV ribonucleic acid (RNA) in blood. Those enrolled will agree to allow standardised collection of demographic, lifestyle, treatment, virological outcome and other relevant clinical data to better inform the future management of HCV infection. The primary outcome is virological cure evidenced by sustained virological response (SVR), which is defined as a negative HCV PCR result 6 to 18 months after initial prescription of DAA therapy and no less than 12 weeks after the completion of treatment. Study participants will be invited to opt-in to medication adherence monitoring and quality of life assessments using validated self-reported instruments (EQ-5D-5L).Discussion: PLATINUM C is a treatment registry and platform for nesting pragmatic trials. Data collected will inform the design, development and implementation of pragmatic trials. The digital infrastructure, study procedures and governing systems established by the registry will allow PLATINUM C to support a wider research platform in the management of hepatitis C in primary care.Trial Registration: The trial is registered with the Australia and New Zealand Clinical Trials Register ( ACTRN12619000023156 ). Date of registration: 10/01/2019. [ABSTRACT FROM AUTHOR]

Charter school policy represents two simultaneous forms of accountability, in which schools are accountable to both parents and authorizers. This study of a K-8 charter renewal decision interrogates these accountability relationships and the role of race and power in privileging the interests of particular stakeholders over others. Using counternarrative methodology and qualitative interviews and observations, we draw on critical race theory and new managerialism to make sense of the competing accounts surrounding a non-renewal process. We find four areas of tension, in which district officials subscribe to new managerialist authorizing styles that leave little room for participation from the Black and low-income school community. We conclude with recommendations for how districts can partner with communities to work toward frameworks of accountability that value the goals of multiple stakeholder groups. [ABSTRACT FROM AUTHOR]

The Staphylococcus aureus Network Adaptive Platform (SNAP) trial is a multifactorial Bayesian adaptive platform trial that aims to improve the way that S. aureus bloodstream infection, a globally common and severe infectious disease, is treated. In a world first, the SNAP trial will simultaneously investigate the effects of multiple intervention modalities within multiple groups of participants with different forms of S. aureus bloodstream infection. Here, we formalise the trial structure, modelling approach, and decision rules that will be used for the SNAP trial. By summarising the statistical principles governing the design, our hope is that the SNAP trial will serve as an adaptable template that can be used to improve comparative effectiveness research efficiency in other disease areas. Trial registrationNCT05137119. Registered on 30 November 2021. [ABSTRACT FROM AUTHOR]

Introduction: Video otoscopy plays an important role in improving access to ear health services. This study investigated the clinician-rated quality of video otoscopy recordings and still images, and compared their suitability for asynchronous diagnosis of middle-ear disease. Methods: Two hundred and eighty video otoscopy image–recording pairs were collected from 150 children (aged six months to 15 years) by an ear, nose, and throat (ENT) specialist, audiologists, and trained research assistants, and independently rated by an audiologist and ENT surgeon. On a five-point scale, clinicians rated the cerumen amount, field of view, quality, focus, light, and gave an overall rating, and asked whether they could make an accurate diagnosis for both still images and recordings. Results: More video otoscopy recordings were rated as 'good' or 'excellent' compared to still images across all domains. The mean difference between the two otoscopic procedures ratings was significant across almost all domains (p < 0.05), except 'cerumen amount'. The suitability to make a diagnosis significantly improved when using recordings (p<0.05). Younger participant age was found to have a significant, negative impact on the ratings across all domains (p < 0.03). The role of the tester conducting video otoscopy did not have a significant impact on the ratings. Discussion: Video otoscopy recordings were found to provide clearer views of the tympanic membrane and increase the ability to make diagnoses, compared to still images, for both audiologists and ENT surgeons. Research assistants with limited practice were able to obtain video otoscopy images and recordings that were comparable to the ones obtained by clinicians. [ABSTRACT FROM AUTHOR]

Infectious diseases contribute a substantial burden of ill-health in Australia’s Aboriginal children. Skin infections have been shown to be common in remote Aboriginal communities, particularly in the Northern Territory, Australia. However, primary care data on skin and other infectious diseases among Aboriginal children living in remote areas of Western Australia are limited. We conducted a retrospective review of clinic presentations of all children aged 0 to 5 years presenting to four clinics located in the Western Desert region of Western Australia between 2007 and 2012 to determine this burden at a local level. Infectious diseases accounted for almost 50% of all clinic presentations. Skin infections (sores, scabies and fungal infections) were the largest proportion (16%), with ear infections (15%) and upper respiratory infections (13%) also high. Skin infections remained high in all age groups; 72% of children presented at least once with skin infections. Scabies accounted for only 2% of all presentations, although one-quarter of children presented during the study for management of scabies. Skin sores accounted for 75% of the overall burden of skin infections. Improved public health measures targeting bacterial skin infections are needed to reduce this high burden of skin infections in Western Australia. [ABSTRACT FROM AUTHOR]

A 66‐year‐old woman had a new left breast mass with a prior history of a stage IIIC left breast cancer. She had excision of the mass. The pathology noted intravascular papillary endothelial hyperplasia (IPEH) also known as Masson's tumor. Although a benign lesion, this remains in the differential of breast lesions with vascular morphology. IPEH has been described at multiple sites throughout the body. It must be distinguished from angiosarcoma. Although Masson's tumor has been previously documented in the breast, prior treatment for breast cancer presents a diagnostic dilemma. Treatment for the breast cancer may be a contributing event for Masson's tumor. [ABSTRACT FROM AUTHOR]

This paper examines the effects of strategic new school openings (SNSOs) on student achievement at brand new (“relief”) campuses built to alleviate overcrowding at neighboring “feeder” campuses in the Los Angeles Unified School District (LAUSD). We focus on a subset of schools involved in LAUSD's Public School Choice Initiative (PSCI), which aimed to increase high quality school options by awarding management of newly-constructed relief schools to diverse operators based on innovative and evidence-based school plans and autonomies from district policies. We employ a Comparative Interrupted Time Series approach using administrative student-level data that tracks students for 10 years, following students in the first (1.0) and second (2.0) cohorts of PSCI schools for three and two years of implementation, respectively. We find that relief school openings had negative start-up effects on student achievement, but led to improved achievement in subsequent years of PSCI. We find suggestive evidence that improvements made to the reform after the first round of relief school openings helped Cohort 2.0 schools perform significantly better than Cohort 1.0 schools. [ABSTRACT FROM AUTHOR]

Background: Pneumonia remains a leading cause of hospitalization and death among young children worldwide, and the diagnostic challenge of differentiating bacterial from non-bacterial pneumonia is the main driver of antibiotic use for treating pneumonia in children. Causal Bayesian networks (BNs) serve as powerful tools for this problem as they provide clear maps of probabilistic relationships between variables and produce results in an explainable way by incorporating both domain expert knowledge and numerical data. Methods: We used domain expert knowledge and data in combination and iteratively, to construct, parameterise and validate a causal BN to predict causative pathogens for childhood pneumonia. Expert knowledge elicitation occurred through a series of group workshops, surveys and one-on-one meetings involving 6-8 experts from diverse domain areas. The model performance was evaluated based on both quantitative metrics and qualitative expert validation. Sensitivity analyses were conducted to investigate how the target output is influenced by varying key assumptions of particular high degree of uncertainty around data or domain expert knowledge. Results: Designed to apply to a cohort of children with X-ray confirmed pneumonia who presented to a tertiary paediatric hospital in Australia, the resulting BN offers explainable and quantitative predictions on a range of variables of interest, including the diagnosis of bacterial pneumonia, detection of respiratory pathogens in the nasopharynx, and the clinical phenotype of a pneumonia episode. Satisfactory numeric performance has been achieved including an area under the receiver-operating characteristics curve of 0.8 in predicting clinically-confirmed bacterial pneumonia with sensitivity 88% and specificity 66% given certain input scenarios (i.e., information that is available and entered into the model) and trade-off preferences (i.e., relative weightings of the consequences of false positive versus false negative predictions). We specifically highlight that a desirable model output threshold for practical use is very dependent upon different input scenarios and trade-off preferences. Three commonly encountered scenarios were presented to demonstrate the potential usefulness of the BN outputs in various clinical pictures. Conclusions: To our knowledge, this is the first causal model developed to help determine the causative pathogen for paediatric pneumonia. We have shown how the method works and how it would help decision making on the use of antibiotics, providing insight into how computational model predictions may be translated to actionable decisions in practice. We discussed key next steps including external validation, adaptation and implementation. Our model framework and the methodological approach can be adapted beyond our context to broad respiratory infections and geographical and healthcare settings. Author summary: Pneumonia is a leading cause of hospital visits among young children. Doctors need to weigh a range of observations to make timely diagnostic and management decisions, including to differentiate bacterial from viral infections. This is a difficult task to achieve without support due to the complex interactions among relevant factors, and is a major driver of unnecessary antibiotic use. We used domain expert knowledge and data to create a causal Bayesian network (BN) model which depicts an integrated picture of how biological, epidemiological and clinical processes interact to form the challenge of diagnosing and managing children who present to hospital for pneumonia. The model can produce reliable and explainable quantitative inference to help distinguish viral from bacterial infections. We used a few examples to demonstrate how the BN can be used in clinical context, and discussed how computational model predictions may be translated to actionable decisions in practice. We discussed key next steps including the evaluation of the model using external data sets, and adaptation and implementation of the model in other settings. We also discussed how our model framework and the methodological approach can be adapted beyond our context to broad respiratory infections and geographical and healthcare settings. [ABSTRACT FROM AUTHOR]

Background: While most Australian children are vaccinated, delays in vaccination can put them at risk from preventable infections. Widespread mobile phone ownership in Australia could allow automated short message service (SMS) reminders to be used as a low-cost strategy to effectively 'nudge' parents towards vaccinating their children on time. Methods: AuTOMATIC is an adaptive randomised trial which aims to both evaluate and optimise the use of SMS reminders for improving the timely vaccination of children at primary care clinics across Australia. The trial will utilise high levels of digital automation to effect, including eligibility assessment, randomisation, delivery of intervention, data extraction and analysis, thereby allowing healthcare-embedded trial delivery. Up to 10,000 parents attending participating primary care clinics will be randomised to one of 12 different active SMS vaccine reminder content and timing arms or usual practice only (no SMS reminder). The primary outcome is vaccine receipt within 28 days of the scheduled date for the index vaccine (the first scheduled vaccine after randomisation). Secondary analyses will assess receipt and timeliness for all vaccine occasions in all children. Regular scheduled analyses will be performed using Bayesian inference and pre-specified trial decision rules, enabling response adaptive randomisation, suspension of any poorly performing arms and early stopping if a single best message is identified. Discussion: This study will aim to optimise SMS reminders for childhood vaccination in primary care clinics, directly comparing alternative message framing and message timing. We anticipate that the trial will be an exemplar in using Bayesian adaptive methodology to assess a readily implementable strategy in a wide population, capable of delivery due to the levels of digital automation. Methods and findings from this study will help to inform strategies for implementing reminders and embedding analytics in primary health care settings. Trial registration: ANZCTR: ACTRN12618000789268. [ABSTRACT FROM AUTHOR]

Many urban school districts are adopting restorative practices (RP) as a means to reduce suspensions and resolve racial discipline gaps. In this study, we use a sensemaking framework to examine educators' beliefs about discipline and their perceptions of RP and its implementation. We draw on survey responses (N = 363) administered after educators attended RP trainings in a large, diverse county in California. Our results show the majority of respondents possess beliefs or an understanding of RP that are compatible with the goals of the approach. Survey respondents cite challenges to implementing RP that are at times consistent (e.g., lack of time) and at times at odds (e.g., relatively low emphasis on lack of leadership as a hindrance) with the current literature. As suggested by sensemaking theory, we find attitudes and beliefs are predictors of educators' experiences implementing RP, including challenges to implementation and effects of the practices. [ABSTRACT FROM AUTHOR]

Background: Prioritisation of clinical trials ensures that the research conducted meets the needs of stakeholders, makes the best use of resources and avoids duplication. The aim of this review was to identify and critically appraise approaches to research prioritisation applicable to clinical trials, to inform best practice guidelines for clinical trial networks and funders. Methods: A scoping review of English-language published literature and research organisation websites (January 2000 to January 2020) was undertaken to identify primary studies, approaches and criteria for research prioritisation. Data were extracted and tabulated, and a narrative synthesis was employed. Results: Seventy-eight primary studies and 18 websites were included. The majority of research prioritisation occurred in oncology and neurology disciplines. The main reasons for prioritisation were to address a knowledge gap (51 of 78 studies [65%]) and to define patient-important topics (28 studies, [35%]). In addition, research organisations prioritised in order to support their institution’s mission, invest strategically, and identify best return on investment. Fifty-seven of 78 (73%) studies used interpretative prioritisation approaches (including Delphi surveys, James Lind Alliance and consensus workshops); six studies used quantitative approaches (8%) such as prospective payback or value of information (VOI) analyses; and 14 studies used blended approaches (18%) such as nominal group technique and Child Health Nutritional Research Initiative. Main criteria for prioritisation included relevance, appropriateness, significance, feasibility and cost-effectiveness. Conclusion: Current research prioritisation approaches for groups conducting and funding clinical trials are largely interpretative. There is an opportunity to improve the transparency of prioritisation through the inclusion of quantitative approaches. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus bloodstream (SAB) infection is a common and severe infectious disease, with a 90-day mortality of 15%–30%. Despite this, <3000 people have been randomized into clinical trials of treatments for SAB infection. The limited evidence base partly results from clinical trials for SAB infections being difficult to complete at scale using traditional clinical trial methods. Here we provide the rationale and framework for an adaptive platform trial applied to SAB infections. We detail the design features of the Staphylococcus aureus Network Adaptive Platform (SNAP) trial that will enable multiple questions to be answered as efficiently as possible. The SNAP trial commenced enrolling patients across multiple countries in 2022 with an estimated target sample size of 7000 participants. This approach may serve as an exemplar to increase efficiency of clinical trials for other infectious disease syndromes. [ABSTRACT FROM AUTHOR]

Background: Rotarix (GlaxoSmithKline) oral rotavirus vaccine is licensed as 2 doses in the first 6 months of life. In settings with high child mortality rates, clinical protection conferred by 2 doses of Rotarix is reduced. We assessed vaccine immune response when an additional dose of Rotarix was given to Australian Aboriginal children 6 to <12 months old.Methods: ORVAC is a 2-stage, double-blind, randomized, placebo-controlled trial. Australian Aboriginal children 6 to <12 months old who had received 1 or 2 prior doses of Rotarix rotavirus vaccine were randomized 1:1 to receive an additional dose of Rotarix or matched placebo. The primary immunological end point was seroresponse defined as an anti-rotavirus immunoglobulin A level ≥20 AU/mL, 28-56 days after the additional dose of Rotarix or placebo.Results: Between March 2018 and August 2020, a total of 253 infants were enrolled. Of these, 178 infants (70%) had analyzable serological results after follow-up; 89 were randomized to receive Rotarix, and 89 to receive placebo. The proportion with seroresponse was 85% after Rotarix compared with 72% after placebo. There were no occurrences of intussusception or any serious adverse events.Conclusions: An additional dose of Rotarix administered to Australian Aboriginal infants 6 to <12 months old increased the proportion with a vaccine seroresponse.Clinical Trials Registration: NCT02941107. [ABSTRACT FROM AUTHOR]

Districts are relying on school autonomy to help schools differentiate educational programming for students and improve low-performing schools, yet we know little about how schools use autonomy in practice. Drawing on school case study and principal survey data from the Los Angeles Unified School District, we find variation in perceived school leader autonomy stemming from each school model's governance design, district-provided capacity building, and other organizational conditions. Principal perceptions of autonomy are positively associated with perceived implementation ease of school plans which, in turn, is positively related to reports of teacher collegiality and responsive school practices. [ABSTRACT FROM AUTHOR]