Workshop report from the National Institutes of Health Taskforce on the Research Needs of Eosinophil-Associated Diseases (TREAD)

Eosinophils are blood cells that are often found in high numbers in the tissues of allergic conditions and helminthic parasite infections. The pathophysiologic roles that eosinophils may serve in other human "eosinophil-associated" diseases remain obscure.

National institutes of health stroke scale score and vessel occlusion in 2152 patients with acute ischemic stroke

Background and Purpose—There is some controversy on the association of the National Institutes of Health Stroke Scale (NIHSS) score to predict arterial occlusion on MR arteriography and CT arteriography in acute stroke. Methods—We analyzed NIHSS scores and arteriographic findings in 2152 patients (35.4% women, mean age 66±14 years) with acute anterior or posterior circulation strokes. Results—The study included 1603 patients examined with MR arteriography and 549 with CT arteriography. Of those, 1043 patients (48.5%; median NIHSS score 5, median time to clinical assessment 179 minutes) showed an occlusion, 887 in the anterior (median NIHSS score 7/0–31), and 156 in the posterior circulation (median NIHSS score 3/0–32). Eight hundred sixty visualized occlusions (82.5%) were located centrally (ie, in the basilar, intracranial vertebral, internal carotid artery, or M1/M2 segment of the middle cerebral artery). NIHSS scores turned out to be predictive for any vessel occlusions in the anterior circulation. Best cut-off values within 3 hours after symptom onset were NIHSS scores ≥9 (positive predictive value 86.4%) and NIHSS scores ≥7 within >3 to 6 hours (positive predictive value 84.4%). Patients with central occlusions presenting within 3 hours had NIHSS scores <4 in only 5%. In the posterior circulation and in patients presenting after 6 hours, the predictive value of the NIHSS score for vessel occlusion was poor. Conclusions—There is a significant association of NIHSS scores and vessel occlusions in patients with anterior circulation strokes. This association is best within the first hours after symptom onset. Thereafter and in the posterior circulation the association is poor.

Laparoscopic appendectomy outcomes on the weekend and during the week are no different: a national study of 151,774 patients

The "weekend effect" is defined as increased morbidity and mortality for patients admitted on weekends compared with weekdays. It has been observed for several diseases, including myocardial infarction and renal insufficiency; however, it has not yet been investigated for laparoscopic appendectomy in acute appendicitis-one of the most prevalent surgical diagnoses.

Outcome at two years of age in a Swiss national cohort of extremely preterm infants born between 2000 and 2008

Background While survival rates of extremely preterm infants have improved over the last decades, the incidence of neurodevelopmental disability (ND) in survivors remains high. Representative current data on the severity of disability and of risk factors associated with poor outcome in this growing population are necessary for clinical guidance and parent counselling. Methods Prospective longitudinal multicentre cohort study of preterm infants born in Switzerland between 240/7 and 276/7 weeks gestational age during 2000–2008. Mortality, adverse outcome (death or severe ND) at two years, and predictors for poor outcome were analysed using multilevel multivariate logistic regression. Neurodevelopment was assessed using Bayley Scales of Infant Development II. Cerebral palsy was graded after the Gross Motor Function Classification System. Results Of 1266 live born infants, 422 (33%) died. Follow-up information was available for 684 (81%) survivors: 440 (64%) showed favourable outcome, 166 (24%) moderate ND, and 78 (11%) severe ND. At birth, lower gestational age, intrauterine growth restriction and absence of antenatal corticosteroids were associated with mortality and adverse outcome (p < 0.001). At 360/7 weeks postmenstrual age, bronchopulmonary dysplasia, major brain injury and retinopathy of prematurity were the main predictors for adverse outcome (p < 0.05). Survival without moderate or severe ND increased from 27% to 39% during the observation period (p = 0.02). Conclusions In this recent Swiss national cohort study of extremely preterm infants, neonatal mortality was determined by gestational age, birth weight, and antenatal corticosteroids while neurodevelopmental outcome was determined by the major neonatal morbidities. We observed an increase of survival without moderate or severe disability.

"From Dartboards to Dashboards: The Imperative of using Data to Improve Student Achievement"

Aimee Guidera, Director of the National Data Quality Campaign, delivered the second annual Lee Gurel '48 Lecture in Education, "From Dartboards to Dashboards: The Imperative of Using Data to Improve Student Outcomes." Aimee Rogstad Guidera is the Founding Executive Director of the Data Quality Campaign. She manages a growing partnership among national organizations collaborating to improve the quality, accessibility and use of education data to improve student achievement. Working with 10 Founding Partners, Aimee launched the DQC in 2005 with the goal of every state having a robust longitudinal data system in place by 2009. The Campaign is now in the midst of its second phase focusing on State Actions to ensure effective data use. Aimee joined the National Center for Educational Accountability as Director of the Washington, DC office in 2003. During her eight previous years in various roles at the National Alliance of Business, Aimee supported the corporate community's efforts to increase achievement at all levels of learning. As NAB Vice President of Programs, she managed the Business Coalition Network, comprised of over 1,000 business led coalitions focused on improving education in communities across the country. Prior to joining the Alliance, Aimee focused on school readiness, academic standards, education goals and accountability systems while in the Center for Best Practices at the National Governors Association. She taught for the Japanese Ministry of Education in five Hiroshima high schools where she interviewed educators and studied the Japanese education system immediately after receiving her AB from Princeton University’s Woodrow Wilson School of Public & International Affairs. Aimee also holds a Masters Degree in Public Policy from Harvard’s John F. Kennedy School of Government.

Incidence and outcome of chronic graft-versus-host disease using National Institutes of Health consensus criteria

Chronic graft-versus-host disease (cGVHD), a common complication after stem cell transplant (SCT), has an impact on morbidity and survival. Previous classification of cGVHD has not been reproducible or prognostic for nonrelapse mortality (NRM). Recently the National Institutes of Health (NIH) consensus criteria were proposed, but the ability of this classification to predict outcome of various subtypes of cGVHD is unknown. Patients (N = 110) undergoing an SCT for a hematologic malignancy and surviving until day 100 posttransplant from 2001 to 2003 were studied. The overall survival (OS) using a landmark analysis at day 100 was 44% versus 66% (no GVHD vs. GVHD, P = .026). The OS of patients with various types of GVHD as proposed by the NIH criteria were significantly different (P < .0001). In a univariate analyses, this was more apparent when patients with any acute features of GVHD were compared to classic cGVHD (3-year OS 46% vs. 68%, P = .033). The 3-year NRM for the entire cohort was 21%, and was not affected by presence or absence of GVHD or subtypes of GVHD. In a multivariable analysis, extensive cGVHD (hazard ratio [HR] 0.35, P = .015) and having any acute feature of GVHD after day 100 (HR 3.36, P = .0144) were significant independent predictors of survival. The OS with different NIH subtypes of GVHD after day 100 from SCT varies, and is superior for patients with classic cGVHD.

Governmentality in higher education : a critical analysis of the National Survey of Student Engagement (NSSE)

In this dissertation, the National Survey of Student Engagement (NSSE) serves as a nodal point through which to examine the power relations shaping the direction and practices of higher education in the twenty-first century. Theoretically, my analysis is informed by Foucault’s concept of governmentality, briefly defined as a technology of power that influences or shapes behavior from a distance. This form of governance operates through apparatuses of security, which include higher education. Foucault identified three essential characteristics of an apparatus—the market, the milieu, and the processes of normalization—through which administrative mechanisms and practices operate and govern populations. In this project, my primary focus is on the governance of faculty and administrators, as a population, at residential colleges and universities. I argue that the existing milieu of accountability is one dominated by the neoliberal assumption that all activity—including higher education—works best when governed by market forces alone, reducing higher education to a market-mediated private good. Under these conditions, what many in the academy believe is an essential purpose of higher education—to educate students broadly, to contribute knowledge for the public good, and to serve as society’s critic and social conscience (Washburn 227)—is being eroded. Although NSSE emerged as a form of resistance to commercial college rankings, it did not challenge the forces that empowered the rankings in the first place. Indeed, NSSE data are now being used to make institutions even more responsive to market forces. Furthermore, NSSE’s use has a normalizing effect that tends to homogenize classroom practices and erode the autonomy of faculty in the educational process. It also positions students as part of the system of surveillance. In the end, if aspects of higher education that are essential to maintaining a civil society are left to be defined solely in market terms, the result may be a less vibrant and, ultimately, a less just society.

Community managed rural water supply systems in the Dominican Republic : assessment of sustainability of systems built by the National Institute of Potable Water and Peace Corps, Dominican Republic

In the Dominican Republic economic growth in the past twenty years has not yielded sufficient improvement in access to drinking water services, especially in rural areas where 1.5 million people do not have access to an improved water source (WHO, 2006). Worldwide, strategic development planning in the rural water sector has focused on participatory processes and the use of demand filters to ensure that service levels match community commitment to post-project operation and maintenance. However studies have concluded that an alarmingly high percentage of drinking water systems (20-50%) do not provide service at the design levels and/or fail altogether (up to 90%): BNWP (2009), Annis (2006), and Reents (2003). World Bank, USAID, NGOs, and private consultants have invested significant resources in an effort to determine what components make up an “enabling environment” for sustainable community management of rural water systems (RWS). Research has identified an array of critical factors, internal and external to the community, which affect long term sustainability of water services. Different frameworks have been proposed in order to better understand the linkages between individual factors and sustainability of service. This research proposes a Sustainability Analysis Tool to evaluate the sustainability of RWS, adapted from previous relevant work in the field to reflect the realities in the Dominican Republic. It can be used as a diagnostic tool for government entities and development organizations to characterize the needs of specific communities and identify weaknesses in existing training regimes or support mechanisms. The framework utilizes eight indicators in three categories (Organization/Management, Financial Administration, and Technical Service). Nineteen independent variables are measured resulting in a score of sustainability likely (SL), possible (SP), or unlikely (SU) for each of the eight indicators. Thresholds are based upon benchmarks from the DR and around the world, primary data collected during the research, and the author’s 32 months of field experience. A final sustainability score is calculated using weighting factors for each indicator, derived from Lockwood (2003). The framework was tested using a statistically representative geographically stratified random sample of 61 water systems built in the DR by initiatives of the National Institute of Potable Water (INAPA) and Peace Corps. The results concluded that 23% of sample systems are likely to be sustainable in the long term, 59% are possibly sustainable, and for 18% it is unlikely that the community will be able to overcome any significant challenge. Communities that were scored as unlikely sustainable perform poorly in participation, financial durability, and governance while the highest scores were for system function and repair service. The Sustainability Analysis Tool results are verified by INAPA and PC reports, evaluations, and database information, as well as, field observations and primary data collected during the surveys. Future research will analyze the nature and magnitude of relationships between key factors and the sustainability score defined by the tool. Factors include: gender participation, legal status of water committees, plumber/operator remuneration, demand responsiveness, post construction support methodologies, and project design criteria.

Want Amid Plenty: Developing and Testing a Cross-National Measure of Anomie

One of the biggest challenges facing researchers trying to empirically test structural or institutional anomie theories is the operationalization of the key concept of anomie. This challenge is heightened by the data constraints involved in cross-national research. As a result, researchers have been forced to rely on surrogate or proxy measures of anomie and indirect tests of the theories. The purpose of this study is to examine an innovative and more theoretically sound measure of anomie and to test its ability to make cross-national predictions of serious crime. Our results are supportive of the efficacy of this construct to explain cross-national variations in crime rates. Nations with the highest rates of structural anomie also have the highest predicted rates of homicide.

Genetic Characterization of a New U.S. Bovine Rotavirus Isolate

We have identified a new group A rotavirus associated with diarrheic calves in the field. The VP7 gene of this virus (designated VMRI-29), appears to differ genetically from that of the reference strain NCDV-Lincoln. Studies are underway to determine the importance of this genetic variant in the etiology of rotavirus-induced calf diarrhea.