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We estimate the impact of district-level schooling mode (in-person versus hybrid or virtual learning) in the 2020–2021 school year on students’ pass rates on standardized tests in grades 3–8 across 11 states. Pass rates declined from 2019 to 2021: an average of 12.8 percentage points in math and 6.8 in English language arts (ELA). Focusing on within-state, within–commuting zone variation in schooling mode, we estimate that districts with full in-person learning had significantly smaller declines (13.4 pp in math, 8.3 in ELA). The value to in-person learning was larger for districts with larger populations of Black students.

Background Fear of cancer recurrence (FCR) is a significant unmet need amongst cancer survivors and is consistently associated with psychological distress and impaired quality of life. Psychological interventions for FCR, such as ConquerFear, have demonstrated efficacy in reducing FCR and improving emotional wellbeing. Unfortunately, there are barriers to the uptake of evidence-based FCR treatments in clinical practice. A stepped-care FCR treatment model may overcome these barriers and has demonstrated potential in people with advanced melanoma. This study aims to evaluate the acceptability, feasibility, and impact of a stepped-care FCR treatment model ( Fear-Less ) in people with other cancer types, who have completed treatment with curative intent. Methods Sixty people with early-stage cancer (defined as individuals who have received treatment with curative intent and with no metastatic disease) will be screened for FCR using the Fear of Cancer Recurrence Inventory—Short Form (FCRI-SF). Individuals reporting moderate FCR (FCRI-SF between 13 and 21) will be offered a clinician-guided self-management resource; those reporting high FCR (FCRI-SF ≥ 22) will be offered individual therapy according to the ConquerFear protocol. Participants will complete purpose-built evaluation surveys assessing their FCR screening and intervention experiences. Clinicians will also complete a survey regarding their experiences of the treatment model. Fear-Less will be evaluated in terms of (1) acceptability (i.e., patient and clinician experience), (2) feasibility (i.e., referral uptake, treatment adherence, and time taken to screen and deliver interventions), and (3) impact (i.e., pre- to post-intervention FCR changes). Discussion The Fear-Less stepped-care model is a novel framework for screening FCR and stratifying survivors to the appropriate level of treatment. Our study will provide an indication of whether Fear-Less is a feasible and acceptable FCR model of care amongst survivors with early-stage disease and inform further investigations of this model. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR); ACTRN12622000818730 .

What is already known about this topic? Reduced access to in-person learning is associated with poorer learning outcomes and adverse mental health and behavioral effects in children. What is added by the report? Although access to in-person, hybrid, and virtual learning modes varied throughout the school year, during January–April 2021, access to full-time in-person learning for non-Hispanic White students increased by 36.6 percentage points, 31.1 percentage points for non-Hispanic Black students, 22.0 percentage points for Hispanic students, and 26.6 percentage points for students of other race/ethnicities. What are the implications for public health practice? To increase equitable access to full-time in-person learning for the 2021–22 school year, school leaders should focus on providing safety-optimized in-person learning options across grade levels in all geographic areas. Vaccination and other efforts to reduce levels of community transmission should be intensified.

Purpose: In recent years, there has been growing awareness among educators and researchers about long-term English learners (LTELs). Unfortunately, there is limited information on how leaders are supporting their LTELs, particularly at the high school level, or on these students’ key characteristics in Minnesota. The purpose of this study was to explore how district and school leaders identify and support LTELs in Minnesota high schools, as well as to explore key characteristics of the state’s LTELs.Research Methods: This qualitative study examined data from 17 interviews with school and district leaders across eight school districts in Minnesota, as well as de-identified student demographic information and academic performance data from the Minnesota Department of Education.Findings: This study identified four key findings: (a) No leaders identified a formal districtwide definition for LTELs, with some leaders citing little to no familiarity with the term “LTEL”; (b) LTELs represent nearly 40 percent of Minnesota’s high school EL population. The majority of LTELs in study districts reached Levels 3 and 4 on the ACCESS assessment, with listening as their strongest area and speaking as their weakest domain; (c) Leaders indicated that a primary barrier for LTELs is that they are not receiving the instruction they need in general education classrooms; (d) Leaders primarily reported meeting their LTELs’ needs through co-taught instruction, school-district collaborations, and strong high school EL staff.Conclusions and Implications: This study concludes that a first step in addressing LTELs’ needs would be for district leaders to establish and communicate a definition for LTELs so that decisions about serving those students can be made with consistency. In addition, district and school leaders need to seek ways to collaborate to address diverse EL needs at the secondary level, including reviewing student schedules and school programming, hiring EL staff, and reviewing EL instructional models. Leadership preparation programs can also assist in improving LTELs’ education by including content about the diversity of the EL student population, the process of EL language acquisition, language assessments, and how to support a schoolwide focus on academic language.

We estimate the impact of district-level schooling mode (in-person versus hybrid or distance learning) on test scores. We combine Spring 2021 state standardized test score data with comprehensive data on schooling in the 2020-21 school year across 12 states. We find that pass rates declined compared to prior years and that these declines were larger in districts with less in-person instruction. Passing rates in math declined by 14.2 percentage points on average; we estimate this decline was 10.1 percentage points smaller for districts fully in-person. Changes in English language arts scores were smaller, but were significantly larger in districts with larger populations of students who are Black, Hispanic or eligible for free and reduced price lunch.

Background:After a serious knee injury, up to half of athletes do not return to competitive sport, despite recovering sufficient physical function. Athletes often desire psychological support for the return to sport, but rehabilitation clinicians feel ill-equipped to deliver adequate support.Objective:We aimed to design and develop an internet-delivered psychological support program for athletes recovering from knee ligament surgery.Methods:Our work for developing and designing the Back in the Game intervention was guided by a blend of theory-, evidence-, and target population–based strategies for developing complex interventions. We systematically searched for qualitative evidence related to athletes’ experiences with, perspectives on, and needs for recovery and return to sport after anterior cruciate ligament (ACL) injury. Two reviewers coded and synthesized the results via thematic meta-synthesis. We systematically searched for randomized controlled trials reporting on psychological support interventions for improving ACL rehabilitation outcomes in athletes. One reviewer extracted the data, including effect estimates; a second reviewer checked the data for accuracy. The results were synthesized descriptively. We conducted feasibility testing in two phases—(1) technical assessment and (2) feasibility and usability testing. For phase 1, we recruited clinicians and people with lived experience of ACL injury. For phase 2, we recruited patients aged between 15 and 30 years who were within 8 weeks of ACL reconstruction surgery. Participants completed a 10-week version of the intervention and semistructured interviews for evaluating acceptability, demand, practicality, and integration. This project was approved by the Swedish Ethical Review Authority (approval number: 2018/45-31).Results:The following three analytic themes emerged from the meta-synthesis (studies: n=16; participants: n=164): (1) tools or strategies for supporting rehabilitation progress, (2) barriers and facilitators for the physical readiness to return to sport, and (3) barriers and facilitators for the psychological readiness to return to sport. Coping strategies, relaxation, and goal setting may have a positive effect on rehabilitation outcomes after ACL reconstruction (randomized controlled trials: n=7; participants: n=430). There were no trials of psychological support interventions for improving the return to sport. Eleven people completed phase 1 of feasibility testing (technical assessment) and identified 4 types of software errors, which we fixed. Six participants completed the feasibility and usability testing phase. Their feedback suggested that the intervention was easy to access and addressed the needs of athletes who want to return to sport after ACL reconstruction. We refined the intervention to include more multimedia content and support access to and the use of the intervention features.Conclusions:The Back in the Game intervention is a 24-week, internet-delivered, self-guided program that comprises 7 modules that complement usual rehabilitation, changes focus as rehabilitation progresses, is easy to access and use, and includes different psychological support strategies.

Introduction Postoperative morbidity and mortality in patients undergoing major emergency gastrointestinal surgery are a major burden on healthcare systems. Optimal management of perioperative intravenous fluids may reduce mortality rates and improve outcomes from surgery. Previous small trials of cardiac-output guided haemodynamic therapy algorithms in patients undergoing gastrointestinal surgery have suggested this intervention results in reduced complications and a modest reduction in mortality. However, this existing evidence is based mainly on elective (planned) surgery, with little evaluation in the emergency setting. There are fundamental clinical and pathophysiological differences between the planned and emergency surgical setting which may influence the effects of this intervention. A large definitive trial in emergency surgery is needed to confirm or refute the potential benefits observed in elective surgery and to inform widespread clinical practice. Methods The FLO-ELA trial is a multi-centre, parallel-group, open, randomised controlled trial. 3138 patients aged 50 and over undergoing major emergency gastrointestinal surgery will be randomly allocated in a 1:1 ratio using minimisation to minimally invasive cardiac output monitoring to guide protocolised administration of intra-venous fluid, or usual care without cardiac output monitoring. The trial intervention will be carried out during surgery and for up to 6 h postoperatively. The trial is funded through an efficient design call by the National Institute for Health and Care Research Health Technology Assessment (NIHR HTA) programme and uses existing routinely collected datasets for the majority of data collection. The primary outcome is the number of days alive and out of hospital within 90 days of randomisation. Participants and those delivering the intervention will not be blinded to treatment allocation. Participant recruitment started in September 2017 with a 1-year internal pilot phase and is ongoing at the time of publication. Discussion This will be the largest contemporary randomised trial examining the effectiveness of perioperative cardiac output-guided haemodynamic therapy in patients undergoing major emergency gastrointestinal surgery. The multi-centre design and broad inclusion criteria support the external validity of the trial. Although the clinical teams delivering the trial interventions will not be blinded, significant trial outcome measures are objective and not subject to detection bias. Trial registration ISRCTN 14729158. Registered on 02 May 2017.