Building on the research of National Board Certification and its effect on teacher quality, student achievement, and professional development, this dissertation seeks to explore the factors that ...influence teachers when it is time to renew their National Board Certification. Using a qualitative methodology, this study seeks to describe the process of National Board Certification, the process of renewal of National Board Certification, and the individual stories of nine Nationally Board Certified teachers and the factors that influenced them when it was time to renew their National Board Certification. A case study approach was utilized to address the research question. Data were collected through an online survey, individual interviews with nine participants, and two focus group interviews, one with five participants and one with three participants. Data analysis employed open coding and a priori coding of the individual interviews and the focus group interviews through the use of QDA Miner. QDA Miner is a qualitative data analysis software program that assists researchers in managing, coding and analyzing qualitative data. Interviews were transcribed within 48 hours and uploaded into the software and examined by the researcher to identify patterns and themes related to the factors that influence teachers when it is time to renew their National Board Certification. Excerpts from participant responses in individual interviews and focus group interviews are included. Identification of conceptual categories and sub-categories were identified. The main reasons for non-renewal of National Board Certification were: 1) lack of financial assistance to offset the cost of the renewal process, 2) no financial supplement offered, and 3) lack of prestige surrounding National Board Certification. Recommendations for further study include additional research regarding the National Board Certification process, the process of renewal in other states, and teacher prestige. It would be advantageous to replicate the study in other counties in Georgia and in other states in which incentives are offered for achievement of National Board Certification. The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.
Many preschool children develop recurrent, severe episodes of lower respiratory tract illness (LRTI). Although viral infections are often present, bacteria may also contribute to illness ...pathogenesis. Strategies that effectively attenuate such episodes are needed.
To evaluate if early administration of azithromycin, started prior to the onset of severe LRTI symptoms, in preschool children with recurrent severe LRTIs can prevent the progression of these episodes.
A randomized, double-blind, placebo-controlled, parallel-group trial conducted across 9 academic US medical centers in the National Heart, Lung, and Blood Institute's AsthmaNet network, with enrollment starting in April 2011 and follow-up complete by December 2014. Participants were 607 children aged 12 through 71 months with histories of recurrent, severe LRTIs and minimal day-to-day impairment.
Participants were randomly assigned to receive azithromycin (12 mg/kg/d for 5 days; n = 307) or matching placebo (n = 300), started early during each predefined RTI (child's signs or symptoms prior to development of LRTI), based on individualized action plans, over a 12- through 18-month period.
The primary outcome measure was the number of RTIs not progressing to a severe LRTI, measured at the level of the RTI, that would in clinical practice trigger the prescription of oral corticosteroids. Presence of azithromycin-resistant organisms in oropharyngeal samples, along with adverse events, were among the secondary outcome measures.
A total of 937 treated RTIs (azithromycin group, 473; placebo group, 464) were experienced by 443 children (azithromycin group, 223; placebo group, 220), including 92 severe LRTIs (azithromycin group, 35; placebo group, 57). Azithromycin significantly reduced the risk of progressing to severe LRTI relative to placebo (hazard ratio, 0.64 95% CI, 0.41-0.98, P = .04; absolute risk for first RTI: 0.05 for azithromycin, 0.08 for placebo; risk difference, 0.03 95% CI, 0.00-0.06). Induction of azithromycin-resistant organisms and adverse events were infrequently observed.
Among young children with histories of recurrent severe LRTIs, the use of azithromycin early during an apparent RTI compared with placebo reduced the likelihood of severe LRTI. More information is needed on the development of antibiotic-resistant pathogens with this strategy.
clinicaltrials.gov Identifier: NCT01272635.
Idiopathic pulmonary fibrosis (IPF) is a chronic progressive lung disease with high morbidity and limited treatment options. Type 2 diabetes mellitus (T2DM) is a common comorbid illness among ...patients with IPF and is often treated with metformin, the first-line agent in the management of T2DM. There is growing evidence demonstrating metformin's anti-fibrotic properties; however, there is little real-world clinical data regarding its potential effectiveness in IPF. This study aims to evaluate the clinical benefit of metformin in patients with IPF and T2DM.
This nationwide cohort study used de-identified administrative claims data from OptumLabs® Data Warehouse to identify 3599 adults with IPF and concomitant T2DM between January 1, 2014 and June 30, 2019. Two cohorts were created: a cohort treated with metformin (n = 1377) and a cohort not treated with metformin (n = 2222). A final 1:1 propensity score-matched cohort compared 1100 patients with IPF and T2DM receiving metformin to those with both diagnoses but not receiving metformin; matching accounted for age, sex, race/ethnicity, residence region, year, medications, oxygen use, smoking status, healthcare use, and comorbidities. Outcomes were all-cause mortality (primary) and hospitalizations (secondary).
Among 2200 patients with IPF and T2DM included in this matched analysis, metformin therapy was associated with a reduction in all-cause mortality (hazard ratio HR, 0.46; 95% confidence interval CI, 0.36-0.58; p < 0.001) and hospitalizations (HR, 0.82; 95% CI, 0.72-0.93; p = 0.003) compared to patients not receiving metformin.
Among patients with IPF and T2DM, metformin therapy may be associated with improved clinical outcomes. However, further investigation with randomized clinical trials is necessary prior to metformin's broad implementation in the clinical management of IPF.
Obesity is a well-established risk factor for human cancer, yet the underlying mechanisms remain elusive. Immune dysfunction is commonly associated with obesity but whether compromised immune ...surveillance contributes to cancer susceptibility in individuals with obesity is unclear. Here we use a mouse model of diet-induced obesity to investigate tumor-infiltrating CD8
T cell responses in lean, obese, and previously obese hosts that lost weight through either dietary restriction or treatment with semaglutide. While both strategies reduce body mass, only dietary intervention restores T cell function and improves responses to immunotherapy. In mice exposed to a chemical carcinogen, obesity-related immune dysfunction leads to higher incidence of sarcoma development. However, impaired immunoediting in the obese environment enhances tumor immunogenicity, making the malignancies highly sensitive to immunotherapy. These findings offer insight into the complex interplay between obesity, immunity and cancer, and provide explanation for the obesity paradox observed in clinical immunotherapy settings.
Prenatal phthalate exposure impairs testicular function and shortens anogenital distance (AGD) in male rodents. We present data from the first study to examine AGD and other genital measurements in ...relation to prenatal phthalate exposure in humans. A standardized measure of AGD was obtained in 134 boys 2-36 months of age. AGD was significantly correlated with penile volume (R = 0.27, p = 0.001) and the proportion of boys with incomplete testicular descent (R = 0.20, p = 0.02). We defined the anogenital index (AGI) as AGD divided by weight at examination AGI = AGD/weight (mm/kg) and calculated the age-adjusted AGI by regression analysis. We examined nine phthalate monoester metabolites, measured in prenatal urine samples, as predictors of age-adjusted AGI in regression and categorical analyses that included all participants with prenatal urine samples (n = 85). Urinary concentrations of four phthalate metabolites monoethyl phthalate (MEP), mono-n-butyl phthalate (MBP), monobenzyl phthalate (MBzP), and monoisobutyl phthalate (MiBP) were inversely related to AGI. After adjusting for age at examination, p-values for regression coefficients ranged from 0.007 to 0.097. Comparing boys with prenatal MBP concentration in the highest quartile with those in the lowest quartile, the odds ratio for a shorter than expected AGI was 10.2 (95% confidence interval, 2.5 to 42.2). The corresponding odds ratios for MEP, MBzP, and MiBP were 4.7, 3.8, and 9.1, respectively (all p-values < 0.05). We defined a summary phthalate score to quantify joint exposure to these four phthalate metabolites. The age-adjusted AGI decreased significantly with increasing phthalate score (p-value for slope = 0.009). The associations between male genital development and phthalate exposure seen here are consistent with the phthalate-related syndrome of incomplete virilization that has been reported in prenatally exposed rodents. The median concentrations of phthalate metabolites that are associated with short AGI and incomplete testicular descent are below those found in one-quarter of the female population of the United States, based on a nationwide sample. These data support the hypothesis that prenatal phthalate exposure at environmental levels can adversely affect male reproductive development in humans.
The aim of this study was to document the longitudinal experiences of chaplains who served during both the early AIDS (1981-1995) and early COVID-19 (2020-2021) pandemics. A total of 11 hospital ...chaplains were interviewed across the USA and the United Kingdom. Interviews were analyzed using a Grounded theory approach. Chaplains reported multiple stressors during both pandemics, including barriers to integration into care teams, tensions with home religions institutions, burnout, and challenges arising from the politicization of disease. Despite these challenges, chaplains play a vital role during pandemics. Insights from their experiences can inform future strategies for compassionate crisis response.The aim of this study was to document the longitudinal experiences of chaplains who served during both the early AIDS (1981-1995) and early COVID-19 (2020-2021) pandemics. A total of 11 hospital chaplains were interviewed across the USA and the United Kingdom. Interviews were analyzed using a Grounded theory approach. Chaplains reported multiple stressors during both pandemics, including barriers to integration into care teams, tensions with home religions institutions, burnout, and challenges arising from the politicization of disease. Despite these challenges, chaplains play a vital role during pandemics. Insights from their experiences can inform future strategies for compassionate crisis response.
Poor people in rural areas depend directly on functioning agroecosystems. Environmental rehabilitation, culminating in the reestablishment of tree cover, is seen as improving ecological functioning ...and in so doing, reducing the vulnerability of the poor who rely on these agroecosystems. This is what we refer to as the win-win vision for afforestation, reforestation, and revegetation (ARR) programs – increases in ecological resiliency will lead to increases in social resiliency. This highly appealing vision cannot be realized unless one takes seriously the two basic premises. First, to reduce the vulnerability of a rural population, even in rural areas of the Sahel, one must develop strategies to improve the conditions of the most vulnerable. Second, technical success in terms of ecological rehabilitation will not automatically reduce the vulnerability of the most vulnerable and may in fact directly or indirectly exacerbate their vulnerability. Thus, for ARR programs to approach their win-win goals, one must be attentive not only to their technical success, but also to their social consequences for the rural poor. The Great Green Wall program is the most ambitious ARR program in sub-Saharan Africa. It seeks to rehabilitate degraded lands and reduce the vulnerability of the rural poor in dryland West Africa. We reviewed project documents from twelve country programs of the World Bank’s Sahel and West Africa Program (SAWAP) initiative that falls under the visionary umbrella of the Great Green Wall. Our approach was to treat these project documents as “research sites,” allowing us to not only consider how these projects conceptualize the relationships between vulnerability environmental rehabilitation but also to identify the activities and outcomes that projects attend to and measure their success by. In general, attention was narrowly focused on achieving the technical goals of ARR with outcomes primarily measured by numbers of trees planted, hectares restored, and people trained. We looked for evidence in these documents of efforts and strategies used to identify and target benefits to the most vulnerable. We found little evidence in project design and evaluation of attention to the differential vulnerabilities of particular livelihood and demographic groups nor to the potential for these projects to serve as mechanisms of enclosure to benefit powerful local interests. Rapid rural appraisal at nine ARR sites in Niger revealed little attention to the needs of the most vulnerable with some of the most vulnerable either excluded (women with absent husbands) or ignored (pastoralists). Moreover, ARR activities often led to the direct and indirect enclosure of reclaimed sites benefiting powerful individuals. Options to improve these programs are discussed.
•Great Green Wall promises both vulnerability reduction and ecological recovery.•Study traces assumptions of win-win vision in project documents to material outcomes.•Program targets areas of higher resource potential and is inattentive to truly vulnerable.•Physical protection starts process of social enclosure/privatization benefiting elites.•Sociotechnical imaginary of revegetation reducing dryland vulnerability misleading.
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