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This department focuses on literacy leaders, including school and instructional leaders, teachers, and external partners, who are working to improve outcomes for adolescent and adult learners in a wide range of education settings. Columns investigate the challenges and complexities inherent in such work and share lessons learned, impactful strategies and approaches, and promising pathways forward.

In this Research Connections column, Editor David Moore interviews Cynthia Greenleaf, Gayle Cribb, and Heather Howlett. Greenleaf codirects the Strategic Literacy Initiative and leads professional development projects in its Reading Apprenticeship instructional framework. Her approach to disciplinary literacy instruction is based on her findings that readers do well to clarify and develop their reading processes through metacognitive conversations. Cribb and Hoslett are secondary teachers who have participated in the Reading Apprenticeship training. Cribb realized the value of linking literacy with her history teaching when her initial attempts at engaging students in conversations about historical texts were productive and students more and more began reading and thinking historically. Howlett was persuaded to link literacy with science especially when her students who struggled in science benefited from discussing their thoughts and understandings of various science texts.

Ontario Finance Minister Dwight Duncan has asked his federal counterpart for a face-to-face meeting in an effort to resolve what he describes as discrepancies between Jim Flaherty's public statements and his own budget documents.

Our family has received overwhelming support during this difficult time and we thank our neighbours on Riverside Drive, our families, friends and everyone else who made donations of money, clothing and food.

Argentine President Eduardo Du-halde has told Prime Minister Jean Chretien that Canadian bankers will no longer be banned from leaving his country.

Background Train-the-trainer (TTT) is a promising method for implementing evidence-based psychological treatments (EBPTs) in community mental health centers (CMHCs). In TTT, expert trainers train locally embedded individuals (i.e., Generation 1 providers) to deliver an EBPT, who then train others (i.e., Generation 2 providers). The present study will evaluate implementation and effectiveness outcomes of an EBPT for sleep and circadian dysfunction—the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C)—delivered to CMHC patients with serious mental illness by Generation 2 providers (i.e., trained and supervised within CMHCs via TTT). Specifically, we will investigate whether adapting TranS-C to fit CMHC contexts improves Generation 2 (a) patient outcomes and (b) providers’ perceptions of fit. Methods TTT will be implemented in nine CMHCs in California, USA ( N  = 60 providers; N  = 130 patients) via facilitation. CMHCs are cluster-randomized by county to Adapted TranS-C or Standard TranS-C. Within each CMHC, patients are randomized to immediate TranS-C or usual care followed by delayed treatment with TranS-C (UC-DT). Aim 1 will assess the effectiveness of TranS-C (combined Adapted and Standard), compared to UC-DT, on improvements in sleep and circadian problems, functional impairment, and psychiatric symptoms for Generation 2 patients. Aim 2 will evaluate whether Adapted TranS-C is superior to Standard TranS-C with respect to Generation 2 providers’ perceptions of fit. Aim 3 will evaluate whether Generation 2 providers’ perceived fit mediates the relation between TranS-C treatment condition and patient outcomes. Exploratory analyses will (1) evaluate whether the effectiveness of TranS-C for patient outcomes is moderated by generation, (2) compare Adapted and Standard TranS-C on patient perceptions of credibility/improvement and PhenX Toolkit outcomes (e.g., substance use, suicidality), and (3) evaluate other possible moderators. Discussion This trial has potential to (a) inform the process of embedding local trainers and supervisors to expand delivery of a promising transdiagnostic treatment for sleep and circadian dysfunction, (b) add to the growing body of TTT literature by evaluating TTT outcomes with a novel treatment and population, and (c) advance our understanding of providers’ perceptions of EBPT “fit” across TTT generations. Trial registration ClinicalTrials.gov identifier NCT05805657 . Registered on April 10, 2023.

Tebentafusp is a first-in-class immunotherapy agent that comprises an engineered T-cell receptor targeting a gp100 epitope presented by human leukocyte antigen-A*02:01 cells, fused to an anti-CD3 single-chain variable fragment. Tebentafusp is both the first bispecific T-cell engager to show efficacy in the treatment of advanced solid cancer and the first anti-cancer treatment to demonstrate an overall survival benefit in patients with uveal melanoma (UM). This review article will focus on the clinical development of tebentafusp, the mechanism of action and resultant evolution of the management of advanced UM.

Dietary restriction of sodium has been suggested to prevent fluid overload and adverse outcomes for patients with heart failure. We designed the Study of Dietary Intervention under 100 mmol in Heart Failure (SODIUM-HF) to test whether or not a reduction in dietary sodium reduces the incidence of future clinical events. SODIUM-HF is an international, open-label, randomised, controlled trial that enrolled patients at 26 sites in six countries (Australia, Canada, Chile, Colombia, Mexico, and New Zealand). Eligible patients were aged 18 years or older, with chronic heart failure (New York Heart Association [NYHA] functional class 2–3), and receiving optimally tolerated guideline-directed medical treatment. Patients were randomly assigned (1:1), using a standard number generator and varying block sizes of two, four, or six, stratified by site, to either usual care according to local guidelines or a low sodium diet of less than 1500 mg/day. The primary outcome was the composite of cardiovascular-related admission to hospital, cardiovascular-related emergency department visit, or all-cause death within 12 months in the intention-to-treat (ITT) population (ie, all randomly assigned patients). Safety was assessed in the ITT population. This study is registered with ClinicalTrials.gov, NCT02012179, and is closed to accrual. Between March 24, 2014, and Dec 9, 2020, 806 patients were randomly assigned to a low sodium diet (n=397) or usual care (n=409). Median age was 67 years (IQR 58–74) and 268 (33%) were women and 538 (66%) were men. Between baseline and 12 months, the median sodium intake decreased from 2286 mg/day (IQR 1653–3005) to 1658 mg/day (1301–2189) in the low sodium group and from 2119 mg/day (1673–2804) to 2073 mg/day (1541–2900) in the usual care group. By 12 months, events comprising the primary outcome had occurred in 60 (15%) of 397 patients in the low sodium diet group and 70 (17%) of 409 in the usual care group (hazard ratio [HR] 0·89 [95% CI 0·63–1·26]; p=0·53). All-cause death occurred in 22 (6%) patients in the low sodium diet group and 17 (4%) in the usual care group (HR 1·38 [0·73–2·60]; p=0·32), cardiovascular-related hospitalisation occurred in 40 (10%) patients in the low sodium diet group and 51 (12%) patients in the usual care group (HR 0·82 [0·54–1·24]; p=0·36), and cardiovascular-related emergency department visits occurred in 17 (4%) patients in the low sodium diet group and 15 (4%) patients in the usual care group (HR 1·21 [0·60–2·41]; p=0·60). No safety events related to the study treatment were reported in either group. In ambulatory patients with heart failure, a dietary intervention to reduce sodium intake did not reduce clinical events. Canadian Institutes of Health Research and the University Hospital Foundation, Edmonton, Alberta, Canada, and Health Research Council of New Zealand.

Aging, polypharmacy (concurrent use of ≥ 5 medications), and functional impairment are global healthcare challenges. However, knowledge of the age/sex-specific effects of polypharmacy is limited, particularly on daily physical activities. Using continuous monitoring, we demonstrated how polypharmacy with high Drug Burden Index (DBI—cumulative anticholinergic/sedative exposure) affected behaviors over 23 h in male/female, young/old mice. For comparison, we also evaluated how different drug regimens (polypharmacy/monotherapy) influenced activities in young mice. We found that after 4 weeks of treatment, high DBI (HDBI) polypharmacy decreased exploration (reduced mean gait speed and climbing) during the habituation period, but increased it during other periods, particularly in old mice during the transition to inactivity. After HDBI polypharmacy, mean gait speed consistently decreased throughout the experiment. Some behavioral declines after HDBI were more marked in females than males, indicating treatment × sex interactions. Metoprolol and simvastatin monotherapies increased activities in young mice, compared to control/polypharmacy. These findings highlight that in mice, some polypharmacy-associated behavioral changes are greater in old age and females. The observed diurnal behavioral changes are analogous to drug-induced delirium and sundowning seen in older adults. Future mechanistic investigations are needed to further inform considerations of age, sex, and polypharmacy to optimize quality use of medicines.

Many crop plants rely on insect pollination, particularly insect-pollinated crops which are functionally dioecious. These crops require insects to move pollen between separate plants which are functionally male or female. While honey bees are typically considered the most important crop pollinator species, many other insects are known to visit crops but the pollination contribution of the full diversity of these flower visitors is poorly understood. In this study, we examine the role of diverse insect pollinators for two kiwifruit cultivars as model systems for dioecious crops: Actinidia chinensis var. deliciosa ‘Hayward’ (a green-fleshed variety) and A. chinensis var. chinensis ‘Zesy002’ (a gold-fleshed variety). In our round-the-clock insect surveys, we identified that psychodid flies and mosquitoes were the second and third most frequent floral visitors after honey bees ( Apis mellifera L), but further work is required to investigate their pollination efficiency. Measures of single-visit pollen deposition identified that several insects, including the bees Leioproctus spp. and Bombus spp. and the flies Helophilus hochstetteri and Eristalis tenax , deposited a similar amount of pollen on flowers as honey bees ( Apis mellifera ). Due to their long foraging period and high pollen deposition, we recommend the development of strategies to boost populations of Bombus spp., Eristalis tenax and other hover flies, and unmanaged bees for use as synergistic pollinators alongside honey bees.