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In this article the authors describe a project during which they unpacked fraction standards, created rigorous tasks and lesson plans, and developed formative and summative assessments to analyze students' thinking about fraction multiplication. The purpose of this article is to (1) illustrate a process that can be replicated by educators interested in using rigorous mathematical tasks and assessments to support and advance their students' mathematical thinking; and (2) share the artifacts and instructional products that educators can use to improve mathematics assessment practices.

Directed at a diverse audience of students, legal and public health practitioners, and anyone interested in understanding what human rights-based approaches (HRBAs) to health and development mean and why they matter, Power, Suffering, and the Struggle for Dignity provides a solid foundation for comprehending what a human rights framework implies and the potential for social transformation it entails. Applying a human rights framework to health demands that we think about our own suffering and that of others, as well as the fundamental causes of that suffering. What is our agency as human subjects with rights and dignity, and what prevents us from acting in certain circumstances? What roles are played by others in decisions that affect our health? How do we determine whether what we may see as \"natural\" is actually the result of mutable, human policies and practices?Alicia Ely Yamin couples theory with personal examples of HRBAs at work and shows the impact they have had on people's lives and health outcomes. Analyzing the successes of and challenges to using human rights frameworks for health, Yamin charts what can be learned from these experiences, from conceptualization to implementation, setting out explicit assumptions about how we can create social transformation. The ultimate concern of Power, Suffering, and the Struggle for Dignity is to promote movement from analysis to action, so that we can begin to use human rights frameworks to effect meaningful social change in global health, and beyond.

A 30-month-old boy was admitted to the hospital for the third time in 4 weeks because of fever. Evaluation was notable for lymphadenopathy, splenic lesions, pulmonary opacities, and leukocytosis. A diagnosis was made.

Background Qualitative methods are a critical tool for enhancing implementation planning and tailoring, yet rapid turn-around of qualitative insights can be challenging in large implementation trials. The Department of Veterans Affairs-funded EMPOWER 2.0 Quality Enhancement Research Initiative (QUERI) is conducting a hybrid type 3 effectiveness-implementation trial comparing the impact of Replicating Effective Programs (REP) and Evidence-Based Quality Improvement (EBQI) as strategies for implementing three evidence-based practices (EBPs) for women Veterans. We describe the development of the Rapid Implementation Feedback (RIF) report, a pragmatic, team-based approach for the rapid synthesis of qualitative data to aid implementation planning and tailoring, as well as findings from a process evaluation of adopting the RIF report within the EMPOWER 2.0 QUERI. Methods Trained qualitative staff conducted 125 semi-structured pre-implementation interviews with frontline staff, providers, and leadership across 16 VA sites between October 2021 and October 2022. High-priority topic domains informed by the updated Consolidated Framework for Implementation Research were selected in dialogue between EMPOWER 2.0 implementation and evaluation teams, and relevant key points were summarized for each interview to produce a structured RIF report, with emergent findings about each site highlighted in weekly written and verbal communications. Process evaluation was conducted to assess EMPOWER 2.0 team experiences with the RIF report across pre-implementation data collection and synthesis and implementation planning and tailoring. Results Weekly RIF updates supported continuous EMPOWER 2.0 team communication around key findings, particularly questions and concerns raised by participating sites related to the three EBPs. Introducing the RIF report into team processes enhanced: team communication; quality and rigor of qualitative data; sensemaking around emergent challenges; understanding of site readiness; and tailoring of REP and EBQI implementation strategies. RIF report findings have facilitated rapid tailoring of implementation planning and rollout, supporting increased responsiveness to sites’ needs and concerns. Conclusions The RIF report provides a structured strategy for distillation of time-sensitive findings, continuous team communication amid a complex multi-site implementation effort, and effective tailoring of implementation rollout in real-time. Use of the RIF report may also support trust-building by enhancing responsiveness to sites during pre- and early implementation. Trial registration Enhancing Mental and Physical Health of Women Veterans (NCT05050266); https://clinicaltrials.gov/study/NCT05050266?term=EMPOWER%202.0&rank=1 Date of registration: 09/09/2021.

Objective In vitro, in vivo, and open‐label studies suggest that interferon gamma (IFN‐γ 1b) may improve clinical features in Friedreich Ataxia through an increase in frataxin levels. The present study evaluates the efficacy and safety of IFN‐γ 1b in the treatment of Friedreich Ataxia through a double‐blind, multicenter, placebo‐controlled trial. Methods Ninety‐two subjects with FRDA between 10 and 25 years of age were enrolled. Subjects received either IFN‐γ 1b or placebo for 6 months. The primary outcome measure was the modified Friedreich Ataxia Rating Scale (mFARS). Results No difference was noted between the groups after 6 months of treatment in the mFARS or secondary outcome measures. No change was noted in buccal cell or whole blood frataxin levels. However, during an open‐label extension period, subjects had a more stable course than expected based on natural history data. Conclusions This study provides no direct evidence for a beneficial effect of IFN‐γ1b in FRDA. The modest stabilization compared to natural history data leaves open the possibility that longer studies may demonstrate benefit.

Objective Friedreich ataxia (FRDA) is an autosomal recessive ataxia resulting from mutations in the frataxin gene (FXN). Such mutations, usually expanded guanine–adenine–adenine (GAA) repeats, give rise to decreased levels of frataxin protein in both affected and unaffected tissues. The goal was to understand the relationship of frataxin levels in peripheral tissues to disease status. Methods Frataxin levels were measured in buccal cells and blood, and analyzed in relation to disease features. Site‐directed mutant frataxin was also transfected into human embryonic kidney cells to model results from specific point mutations. Results There was no evidence for change in frataxin levels over time with repeated measures analysis, although linear regression analysis of cross‐sectional data predicted a small increase over decades. GAA repeat length predicted frataxin levels in both tissues, and frataxin levels themselves predicted neurological ratings (accounting for age). Compound heterozygous patients for a GAA expansion and a point mutation in FXN generally had lower levels of frataxin than those homozygous for the presence of two GAA repeat expansions, though levels varied dramatically between tissues in some compound heterozygotes for point mutations. The G130V mutation led to decreased levels of frataxin in vitro as well as in vivo, while the R165C mutation produced normal immunoreactive levels of frataxin both in vitro and in vivo. Start codon mutations led to low levels of frataxin in buccal cells but preserved immunoreactive frataxin levels in blood. Interpretation The present data show that peripheral frataxin levels reflect disease features in FRDA, but emphasize the need for interpretation of such levels in the context of specific mutations.

Objective Friedreich ataxia (FRDA) is a progressive neurodegenerative disorder of adults and children. This study analyzed neurological outcomes and changes to identify predictors of progression and generate power calculations for clinical trials. Methods Eight hundred and twelve subjects in a natural history study were evaluated annually across 12 sites using the Friedreich Ataxia Rating Scale (FARS), 9‐Hole Peg Test, Timed 25‐Foot Walk, visual acuity tests, self‐reported surveys and disability scales. Cross‐sectional outcomes were assessed from recent visits, and longitudinal changes were gaged over 5 years from baseline. Results Cross‐sectional outcomes correlated with measures of disease severity. Age, genetic severity (guanine‐adenine‐adenine [GAA] repeat length), and testing site predicted performance. Serial progression was relatively linear using FARS and composite measures of performance, while individual performance outcomes were nonlinear over time. Age strongly predicted change from baseline until removing the effects of baseline FARS scores, when GAA becomes a more important factor. Progression is fastest in younger subjects and subjects with longer GAA repeats. Improved coefficients of variation show that progression results are more reproducible over longer assessment durations. Interpretation While age predicted progression speed in simple analyses and may provide an effective way to stratify cohorts, separating the effects of age and genetic severity is difficult. Controlling for baseline severity, GAA is the major determinant of progression rate in FRDA. Clinical trials will benefit from enrollment of younger subjects, and sample size requirements will shrink with longer assessment periods. These findings should prove useful in devising gene therapy trials in the near future.

It is only through the development of true partnerships between researchers and clinicians that mental health treatment can achieve an optimal level of success.This highly accessible desk reference will assist clinicians in easily incorporating findings from current evidence-based research into their day-to-day practice.

Yamin reviews Pathologies of Power: Health, Human Rights and the New War on the Poor by Paul Farmer.