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Maintaining mitochondrial function is critical to an improved healthspan and lifespan. Introducing mild stress by inhibiting mitochondrial translation invokes the mitochondrial unfolded protein response (UPR mt ) and increases lifespan in several animal models. Notably, lower mitochondrial ribosomal protein (MRP) expression also correlates with increased lifespan in a reference population of mice. In this study, we tested whether partially reducing the gene expression of a critical MRP, Mrpl54 , reduced mitochondrial DNA-encoded protein content, induced the UPR mt , and affected lifespan or metabolic health using germline heterozygous Mrpl54 mice. Despite reduced Mrpl54 expression in multiple organs and a reduction in mitochondrial-encoded protein expression in myoblasts, we identified few significant differences between male or female Mrpl54 +/− and wild type mice in initial body composition, respiratory parameters, energy intake and expenditure, or ambulatory motion. We also observed no differences in glucose or insulin tolerance, treadmill endurance, cold tolerance, heart rate, or blood pressure. There were no differences in median life expectancy or maximum lifespan. Overall, we demonstrate that genetic manipulation of Mrpl54 expression reduces mitochondrial-encoded protein content but is not sufficient to improve healthspan in otherwise healthy and unstressed mice.

Accurate measurement of arsenic (As) in air is critical to providing a more robust understanding of arsenic exposures and associated human health risks. Although there is extensive information available on total arsenic in air, less is known on the relative contribution of each arsenic species. To address this data gap, the authors conducted an in-depth review of available information on speciated arsenic in air. The evaluation included the type of species measured and the relative abundance, as well as an analysis of the limitations of current analytical methods. Despite inherent differences in the procedures, most techniques effectively separated arsenic species in the air samples. Common analytical techniques such as inductively coupled plasma mass spectrometry (ICP-MS) and/or hydride generation (HG)- or quartz furnace (GF)-atomic absorption spectrometry (AAS) were used for arsenic measurement in the extracts, and provided some of the most sensitive detection limits. The current analysis demonstrated that, despite limited comparability among studies due to differences in seasonal factors, study duration, sample collection methods, and analytical methods, research conducted to date is adequate to show that arsenic in air is mainly in the inorganic form. Reported average concentrations of As(III) and As(V) ranged up to 7.4 and 10.4 ng/m⊃, respectively, with As(V) being more prevalent than As(III) in most studies. Concentrations of the organic methylated arsenic compounds are negligible (in the pg/m 3 range). However, because of the variability in study methods and measurement methodology, the authors were unable to determine the variation in arsenic composition as a function of source or particulate matter (PM) fraction. In this work, the authors include the implications of arsenic speciation in air on potential exposure and risks. The authors conclude that it is important to synchronize sample collection, preparation, and analytical techniques in order to generate data more useful for arsenic inhalation risk assessment, and a more robust documentation of quality assurance/quality control (QA/QC) protocols is necessary to ensure accuracy, precision, representativeness, and comparability.

This article serves as an invitation to rethink and to broaden the scope of learning disabilities (LD) research and practice. We begin with 3 assumptions: Education in a representative democracy is inevitably a political enterprise; social justice is everyone's responsibility, but educators have a special role to play; and segregated schooling is neither equal nor equitable. After an analysis of the primary extant discourses, we argue for a more comprehensive and more openly political vision of the LD field, which we think is supported by Disability Studies in Education. Finally, we draw 3 conclusions relevant to our collective work as researchers and educators. First, learning disabilities are not objective fact; they are historically and culturally determined. Second, disability is both a personal and a societal attribute. Finally, learning disabilities are not and have never been immutable. We contend that we are ethically bound to transform educational practices to both welcome and accommodate everybody's children.

From a disability studies (DS) perspective, the authors analyze how the historical conflation of disability with other identity factors and the ideology of normalcy contribute to the disproportionality problem in K-12 special education. They argue that this conflation and ideology make labeling and segregated education seem natural and legitimate for students carrying the high-incidence, legally defined labels Learning Disabled (LD), Mentally Retarded (MR), and Emotionally Disturbed (ED). The authors then apply their insights to the scant literature on college access for students labeled LD. Although it appears that disabled students are succeeding at increasing rates, the overall picture obscures the continued effects of the historical legacy embedded in the intersections of race, class, gender, and disability for K-16 students.

Differentiating instruction, a comprehensive approach to teaching, enables the successful inclusion of all students, including the disabled, in general-education classrooms. As inclusive educators, we argue that disability is an enacted, interactional process and not an empirical, stable fact or condition. We recommend planning responsive lessons that differentiate instruction for all students from the outset, instead of modifying one for disabled students. General-education teachers, who with appropriate supports learn to attend to every student's individual needs, can replace the specially designed, and often uninteresting one-to-one skills and drills, typically suggested for disabled students, with responsive class activities contingent on individual performance. This shift in instructional focus supports the provision of access to the general education curriculum required by the No Child Left Behind Act of 2001 and the Individuals with Disabilities Education Act. We also address practical, disability-related issues for effectively differentiating instructional in inclusive classrooms.

IntroductionFor medical students, food is rarely discussed from the clinical perspective. Yet, in hospitals reduced food intake poses the risk of malnutrition, along with increased morbidity and mortality. The issue of food waste, a cause of inadequate dietary intake and a common issue within the National Health Service, is rarely addressed. The implementation of protected mealtimes has done little to solve this. This quality improvement project aimed to reduce the average amount of inpatient food waste by 20% by May 2022.MethodsA standardised meal size intervention was tested. Meals were weighed before and after meal services to collect baseline and postintervention data. The percentage consumed and the percentage wasted were then calculated. Finally, the overall average of the percentage wasted across both meal services was determined.ResultsQuantitative data showed a change in the average amount of food waste from 70.16% to 65.75%, a decrease of 4.41%. Survey results also found an increase of 3% in patient satisfaction with meal sizes.ConclusionStandardising meal sizes is shown to improve inpatient food waste and may serve as a starting point for healthcare providers to devise further strategies to reduce wastage in hospitals.

ObjectiveTo determine the cost-effectiveness of nurse practitioners delivering primary and specialised ambulatory care.DesignA systematic review of randomised controlled trials reported since 1980.Data sources10 electronic bibliographic databases, handsearches, contact with authors, bibliographies and websites.Included studiesRandomised controlled trials that evaluated nurse practitioners in alternative and complementary ambulatory care roles and reported health system outcomes.Results11 trials were included. In four trials of alternative provider ambulatory primary care roles, nurse practitioners were equivalent to physicians in all but seven patient outcomes favouring nurse practitioner care and in all but four health system outcomes, one favouring nurse practitioner care and three favouring physician care. In a meta-analysis of two studies (2689 patients) with minimal heterogeneity and high-quality evidence, nurse practitioner care resulted in lower mean health services costs per consultation (mean difference: −€6.41; 95% CI −€9.28 to −€3.55; p<0.0001) (2006 euros). In two trials of alternative provider specialised ambulatory care roles, nurse practitioners were equivalent to physicians in all but three patient outcomes and one health system outcome favouring nurse practitioner care. In five trials of complementary provider specialised ambulatory care roles, 16 patient/provider outcomes favouring nurse practitioner plus usual care, and 16 were equivalent. Two health system outcomes favoured nurse practitioner plus usual care, four favoured usual care and 14 were equivalent. Four studies of complementary specialised ambulatory care compared costs, but only one assessed costs and outcomes jointly.ConclusionsNurse practitioners in alternative provider ambulatory primary care roles have equivalent or better patient outcomes than comparators and are potentially cost-saving. Evidence for their cost-effectiveness in alternative provider specialised ambulatory care roles is promising, but limited by the few studies. While some evidence indicates nurse practitioners in complementary specialised ambulatory care roles improve patient outcomes, their cost-effectiveness requires further study.

Background. Improved quality of care and control of healthcare costs are important factors influencing decisions to implement nurse practitioner (NP) and clinical nurse specialist (CNS) roles. Objective. To assess the quality of randomized controlled trials (RCTs) evaluating NP and CNS cost-effectiveness (defined broadly to also include studies measuring health resource utilization). Design. Systematic review of RCTs of NP and CNS cost-effectiveness reported between 1980 and July 2012. Results. 4,397 unique records were reviewed. We included 43 RCTs in six groupings, NP-outpatient ( n = 11 ), NP-transition ( n = 5 ), NP-inpatient ( n = 2 ), CNS-outpatient ( n = 11 ), CNS-transition ( n = 13 ), and CNS-inpatient ( n = 1 ). Internal validity was assessed using the Cochrane risk of bias tool; 18 (42%) studies were at low, 17 (39%) were at moderate, and eight (19%) at high risk of bias. Few studies included detailed descriptions of the education, experience, or role of the NPs or CNSs, affecting external validity. Conclusions. We identified 43 RCTs evaluating the cost-effectiveness of NPs and CNSs using criteria that meet current definitions of the roles. Almost half the RCTs were at low risk of bias. Incomplete reporting of study methods and lack of details about NP or CNS education, experience, and role create challenges in consolidating the evidence of the cost-effectiveness of these roles.

Fruits of the most recent research on the worlds of the eleventh and twelfth centuries are presented in this collection. It features several articles on textual criticism with important revisions to controversial texts and their readings, as well as pieces on cultural history, an investigation into monetary history, and analyses of the legal and political mechanisms of conquest. Contributors: MARTIN AURELL, NICHOLAS PAUL, ROBERT F. BERKHOFER III, STEFAN JURASINSKI, JULIE KERR, KIMM STARR-REID, TARA GALE, JOHN LANGDON, NATALIE LEISHMAN, ALAN M. STAHL, KENNETH PENNINGTON