Explore the vast range of titles available.

The purpose of this quantitative study was to determine the effect, if any, that school size and per pupil expenditure have on student achievement in Catholic elementary schools within a particular diocese. As decisions are made regarding the future viability and sustainability of Catholic schools, it is prudent to examine the relationship between the size of student populations and the per pupil expenditure in Catholic schools and student achievement in these schools. The research question for this study was, \"What is the percentage of variance in student Terra Nova Assessment scores accounted for by the variance in school size and per pupil expenditure?\" This study examined the five year period from 2008-2012. Terra Nova Assessment score data from 36 elementary schools in the diocese under study was used as the measure of student achievement in this study. The student score data examined was from students in grades 2 through 7. This study utilized correlation analysis to test the strength of the linear relationship between the independent variables and the dependent variable, and when a significant correlation was discovered for a particular case, regression analysis was then employed to further examine the relationship. The findings of this study support the assertion that the percentage of variance in student Terra Nova Assessment scores that is accounted for by school size and per pupil expenditure in the diocese under study is not at a level that makes the effect practical for decision making regarding the future of Catholic education in the diocese under study. School size and per pupil expenditure may be major factors when making decisions about the viability of Catholic schools in the diocese under study for other reasons aside from the level of student achievement, and the findings of this study suggest that such decisions that use school size and per pupil expenditure as factors can be made without major concern for the effect on student achievement.

Data suggest that clinical applications of human induced pluripotent stem cells (hiPSCs) will be realized. Nonetheless, clinical applications will require hiPSCs that are free of exogenous DNA and that can be manufactured through Good Manufacturing Practice (GMP). Optimally, derivation of hiPSCs should be rapid and efficient in order to minimize manipulations, reduce potential for accumulation of mutations and minimize financial costs. Previous studies reported the use of modified synthetic mRNAs to reprogram fibroblasts to a pluripotent state. Here, we provide an optimized, fully chemically defined and feeder-free protocol for the derivation of hiPSCs using synthetic mRNAs. The protocol results in derivation of fully reprogrammed hiPSC lines from adult dermal fibroblasts in less than two weeks. The hiPSC lines were successfully tested for their identity, purity, stability and safety at a GMP facility and cryopreserved. To our knowledge, as a proof of principle, these are the first integration-free iPSCs lines that were reproducibly generated through synthetic mRNA reprogramming that could be putatively used for clinical purposes.

Vestibular schwannomas (VS) are the most common tumor of the skull base with available treatment options that carry a risk of iatrogenic injury to the facial nerve, which can significantly impact patients’ quality of life. As facial nerve outcomes remain challenging to prognosticate, we endeavored to utilize machine learning to decipher predictive factors relevant to facial nerve outcomes following microsurgical resection of VS. A database of patient-, tumor- and surgery-specific features was constructed via retrospective chart review of 242 consecutive patients who underwent microsurgical resection of VS over a 7-year study period. This database was then used to train non-linear supervised machine learning classifiers to predict facial nerve preservation, defined as House-Brackmann (HB) I vs. facial nerve injury, defined as HB II–VI, as determined at 6-month outpatient follow-up. A random forest algorithm demonstrated 90.5% accuracy, 90% sensitivity and 90% specificity in facial nerve injury prognostication. A random variable (rv) was generated by randomly sampling a Gaussian distribution and used as a benchmark to compare the predictiveness of other features. This analysis revealed age, body mass index (BMI), case length and the tumor dimension representing tumor growth towards the brainstem as prognosticators of facial nerve injury. When validated via prospective assessment of facial nerve injury risk, this model demonstrated 84% accuracy. Here, we describe the development of a machine learning algorithm to predict the likelihood of facial nerve injury following microsurgical resection of VS. In addition to serving as a clinically applicable tool, this highlights the potential of machine learning to reveal non-linear relationships between variables which may have clinical value in prognostication of outcomes for high-risk surgical procedures.

Bloodstream infections occurring in persons residing in the community, regardless of whether those persons have been receiving health care in an outpatient facility, have traditionally been categorized as community-acquired infections. To develop a new classification scheme for bloodstream infections that distinguishes among community-acquired, health care-associated, and nosocomial infections. Prospective observational study. One academic medical center and two community hospitals. All adult patients admitted to the hospital with bloodstream infection. Demographic characteristics, living arrangements before hospitalization, comorbid medical conditions, factors predisposing to bloodstream infection, date of hospitalization, dates and number of positive blood cultures, results of microbiological susceptibility testing, dates of hospital discharge or death, and mortality rates at 3 to 6 months of follow-up. 504 patients with bloodstream infections were enrolled; 143 (28%) had community-acquired bloodstream infections, 186 (37%) had health care-associated bloodstream infections, and 175 (35%) had nosocomial bloodstream infections. Of the 186 patients with health care-associated bloodstream infection, 29 resided in a nursing home, 64 were receiving home health care, 78 were receiving intravenous or intravascular therapy at home or in a clinic, and 117 had been hospitalized in the 90 days before their bloodstream infection. Cancer was more common in patients with health care-associated or nosocomial bloodstream infection than in patients with community-acquired bloodstream infection. Intravascular devices were the most common source of health care-associated and nosocomial infections, and Staphylococcus aureus was the most frequent pathogen in these types of infections. Methicillin-resistant S. aureus occurred with similar frequency in the groups with health care-associated infection (52%) and nosocomial infection (61%) but was uncommon in the group with community-acquired bloodstream infection (14%) (P = 0.001). Mortality rate at follow-up was greater in patients with health care-associated infection (29% versus 16%; P = 0.019) or nosocomial infection (37% versus 16%; P < 0.001) than in patients with community-acquired infection. Health care-associated bloodstream infections are similar to nosocomial infections in terms of frequency of various comorbid conditions, source of infection, pathogens and their susceptibility patterns, and mortality rate at follow-up. A separate category for health care-associated bloodstream infections is justified, and this new category will have obvious implications for choices about empirical therapy and infection-control surveillance.

1. Classical research on animal toxicity has focused on the role of toxins in protection against predators, but recent studies suggest these same compounds can offer a powerful defense against parasites and infectious diseases. 2. Newts in the genus Taricha are brightly colored and contain the potent neurotoxin, tetrodotoxin (TTX), which is hypothesized to have evolved as a defense against vertebrate predators such as garter snakes. However, newt populations often vary dramatically in toxicity, which is only partially explained by predation pressure. 3. The primary aim of this study was to evaluate the relationships between TTX concentration and infection by parasites. By systematically assessing micro- and macroparasite infection among 345 adult newts (sympatric populations of Taricha granulosa and T. torosa), we detected 18 unique taxa of helminths, fungi, viruses and protozoans. 4. For both newt species, per-host concentrations of TTX, which varied from undetectable to >60 µg/cm² skin, negatively predicted overall parasite richness as well as the likelihood of infection by the chytrid fungus, Batrachochytrium dendrobatidis, and ranavirus. No such effect was found on infection load among infected hosts. Despite commonly occuring at the same wetlands, T. torosa supported higher parasite richness and average infection load than T. granulosa. Host body size and sex (females > males) tended to positively predict infection levels in both species. For hosts in which we quantified leucocyte profiles, total white blood cell count correlated positively with both parasite richness and total infection load. 5. By coupling data on host toxicity and infection by a broad range of micro- and macroparasites, these results suggest that-alongside its effects on predators—tetrodotoxin may help protect newts against parasitic infections, highlighting the importance of integrative research on animal chemistry, immunological defenses and natural enemy ecology.

Modern urban development provides an excellent laboratory for examining the interplay among socioecological relationships. We analyzed how the rapidly urbanizing Phoenix, Arizona metropolis has affected plant species diversity and community composition at a regional scale. Species diversity and plant density probably result from abiotic sorting in undeveloped desert sites, but not in urban sites. We found that species richness at the plot scale was higher for desert as opposed to urban sites; however, the estimated total species pool in the urban ecosystem is higher than that in the desert, as a result of the increased importation of introduced species through the nursery trade. Ordination of plant communities suggests three unique groupings of species based on land‐use type of the site (desert, urban, and agriculture) and two unique groupings of urban sites based on landscaping aesthetics (mesic or xeric). We therefore recognize both bottom‐up and top‐down controls of plant biodiversity within the urban ecosystem.

Losses in biodiversity can alter disease risk through changes in host species composition. Host species vary in pathogen susceptibility and competence, yet how changes in diversity alter host–pathogen dynamics remains unclear in many systems, particularly with respect to generalist pathogens. Amphibians are experiencing worldwide population declines linked to generalist pathogens, such as ranavirus, and thus represent an ideal group to investigate how host species composition affects disease risk. We conducted experiments in which amphibian larvae of three native species (Pacific tree frogs, Pseudacris regilla; Cascades frogs, Rana cascadae; and Western toads, Anaxyrus boreas) were exposed to ranavirus individually (in the laboratory) or as assemblages (in outdoor mesocosms). In a laboratory experiment, we observed low survival and high viral loads in P. regilla compared to the other species, suggesting that this species was highly susceptible to the pathogen. In the mesocosm experiment, we observed 41% A. boreas mortality when alone and 98% mortality when maintained with P. regilla and R. cascadae. Our results suggest that the presence of highly susceptible species can alter disease dynamics across multiple species, potentially increasing infection risk and mortality in co-occurring species.

The relative complexity of the mechanisms underlying savanna ecosystem dynamics, in comparison to other biomes such as temperate and tropical forests, challenges the representation of such dynamics in ecosystem and Earth system models. A realistic representation of processes governing carbon allocation and phenology for the two defining elements of savanna vegetation (namely trees and grasses) may be a key to understanding variations in tree–grass partitioning in time and space across the savanna biome worldwide. Here we present a new approach for modelling coupled phenology and carbon allocation, applied to competing tree and grass plant functional types. The approach accounts for a temporal shift between assimilation and growth, mediated by a labile carbohydrate store. This is combined with a method to maximize long-term net primary production (NPP) by optimally partitioning plant growth between fine roots and (leaves + stem). The computational efficiency of the analytic method used here allows it to be uniquely and readily applied at regional scale, as required, for example, within the framework of a global biogeochemical model.We demonstrate the approach by encoding it in a new simple carbon–water cycle model that we call HAVANA (Hydrology and Vegetation-dynamics Algorithm for Northern Australia), coupled to the existing POP (Population Orders Physiology) model for tree demography and disturbance-mediated heterogeneity. HAVANA-POP is calibrated using monthly remotely sensed fraction of absorbed photosynthetically active radiation (fPAR) and eddy-covariance-based estimates of carbon and water fluxes at five tower sites along the North Australian Tropical Transect (NATT), which is characterized by large gradients in rainfall and wildfire disturbance. The calibrated model replicates observed gradients of fPAR, tree leaf area index, basal area, and foliage projective cover along the NATT. The model behaviour emerges from complex feedbacks between the plant physiology and vegetation dynamics, mediated by shifting above- versus below-ground resources, and not from imposed hypotheses about the controls on tree–grass co-existence. Results support the hypothesis that resource limitation is a stronger determinant of tree cover than disturbance in Australian savannas.

BackgroundWhile the majority of patients with atopic dermatitis (AD) achieve disease control with dupilumab treatment, there is variability in which patients achieve clear disease. The predictors of these responses are currently unclear. Integrated models were developed to evaluate the exposure–response (E-R) relationship of dupilumab in children, adolescents, and adults with AD.MethodsData from six Phase II and III clinical studies were pooled (2,366 adults [> 18 years], 243 adolescents [≥ 12 to < 18 years] and 359 children [≥ 6 to < 12 years]) for model development. Efficacy was assessed using the Eczema Area and Severity Index (EASI) and Investigator’s Global Assessment (IGA). Indirect response models were applied to link measures of efficacy and functional serum dupilumab concentrations. The covariates on individual placebo-corrected response were assessed. Clinical trial scenarios were simulated to compare E-R relationships across age groups. Safety was not explored.ResultsAfter correcting for differences in placebo response and dupilumab exposure: 1) older age, higher body weight, lower baseline thymus and activation-regulated chemokine, and Asian race were associated with slightly lower EASI response, and no clear covariates were identified on IGA response; 2) clinical trial simulations generally showed slightly higher response at a given dupilumab concentration in children compared to adults and adolescents with severe and moderate AD.ConclusionsThe collectively tested covariates explain some of the variability in dupilumab response in patients with AD. Patients in all age groups showed adequate response to dupilumab; however, children showed slightly higher drug effects compared to adults and adolescents at equivalent concentrations.

AbstractObjectiveTo evaluate whether a progressive course of outpatient physiotherapy offers superior outcomes to a single physiotherapy review and home exercise based intervention when targeted at patients with a predicted poor outcome after total knee arthroplasty.DesignParallel group randomised controlled trial.Setting13 secondary and tertiary care centres in the UK providing postoperative physiotherapy.Participants334 participants with knee osteoarthritis who were defined as at risk of a poor outcome after total knee arthroplasty, based on the Oxford knee score, at six weeks postoperatively. 163 were allocated to therapist led outpatient rehabilitation and 171 to a home exercise based protocol.InterventionsAll participants were reviewed by a physiotherapist and commenced 18 sessions of rehabilitation over six weeks, either as therapist led outpatient rehabilitation (progressive goal oriented functional rehabilitation protocol, modified weekly in one-one contact sessions) or as physiotherapy review followed by a home exercise based regimen (without progressive input from a physiotherapist).Main outcome measuresPrimary outcome was Oxford knee score at 52 weeks, with a 4 point difference between groups considered to be clinically meaningful. Secondary outcomes included additional patient reported outcome measures of pain and function at 14, 26, and 52 weeks post-surgery.Results334 patients were randomised. Eight were lost to follow-up. Intervention compliance was more than 85%. The between group difference in Oxford knee score at 52 weeks was 1.91 (95% confidence interval −0.18 to 3.99) points, favouring the outpatient rehabilitation arm (P=0.07). When all time point data were analysed, the between group difference in Oxford knee score was a non-clinically meaningful 2.25 points (0.61 to 3.90, P=0.01). No between group differences were found for secondary outcomes of average pain (0.25 points, −0.78 to 0.28, P=0.36) or worst pain (0.22 points, −0.71 to 0.41, P=0.50) at 52 weeks or earlier time points, or of satisfaction with outcome (odds ratio 1.07, 95% confidence interval 0.71 to 1.62, P=0.75) or post-intervention function (4.64 seconds, 95% confidence interval −14.25 to 4.96, P=0.34).ConclusionsOutpatient therapist led rehabilitation was not superior to a single physiotherapist review and home exercise based regimen in patients at risk of poor outcomes after total knee arthroplasty. No clinically relevant differences were observed across primary or secondary outcome measures.Trials registrationCurrent Controlled Trials ISRCTN23357609 and ClinicalTrials.gov NCT01849445.