Paradise Valley Community College

Educating the Phoenix focuses on the rebuild of an entire school system in the wake of absolute physical devastation and population diaspora from wildfire. When school started on November 8, 2018, the Paradise Unified School District (PUSD) boasted a thriving network of eleven campuses housing 3,401 students and 390 full-time employees. Four hours later, the Camp Fire had reduced three schools to ash, and all PUSD power, communications and maintenance infrastructures were wiped out. The food service warehouse and offices were gone. The transportation office was gone. Seventeen buses were damaged or converted to melted, sooty shells. The remaining eight campuses were in various states of ruin, from smoke damage only (one school and the District Office) to partially or mostly destroyed (seven schools). Nearly all of the students and seventy percent of PUSD employees also lost their homes. Meanwhile, some teachers, bus drivers, administrators, and other school personnel shepherded thousands of children to safety in a small, spontaneous Dunkirk of the Sierra Nevada foothills. Many of their colleagues stayed at the campuses, checking every cranny in every school to make sure no one was left behind. It may be the most dramatic story of in loco parentis ever recorded. California law required that the PUSD shut down, perhaps permanently, but this is not what the students or their parents said they wanted. When PUSD leadership visited with families, the message was clear: These children had already lost nearly everything else that was stable in their lives, and dispersing them to unfamiliar schools would be another blow. They wanted to be together with their friends and their teachers. Hearing this feedback, Superintendent Michelle John O’Neal led the charge to keep the PUSD intact. She prevailed, and many kids came back, even if that meant their first “classroom” was an aisle in an empty hardware store in a nearby city. By the fifth anniversary of the Fire, PUSD had rebuilt a dynamic, fully functioning district with six beautiful campuses and an e-learning academy. This book uses interviews with key personnel to tell the remarkable story of how the people of the PUSD made this happen.

Systemic lupus erythematosus (SLE) is an autoimmune disease linked to higher cardiovascular risks, such as acute coronary syndrome (ACS). Limited real-world data exist on ACS outcomes in patients with SLE. This study examines trends in ACS hospitalizations among patients with SLE (2006-2019) and compares outcomes and healthcare utilization between ACS patients with and without SLE. Using data from the US National Inpatient Sample from 2006 to 2019, ACS hospitalizations were classified by the presence or absence of SLE using International Classification of Diseases (ICD), 9th (ICD-9) and 10th revisions (ICD-10) codes. Hospitalization rates, mortality, length of stay, and charges were compared between the 2 groups. Chi-square and t tests assessed associations with SLE for categorical and continuous variables, respectively, with P < 0.05 as the significance threshold. Of 17,318,554 ACS hospitalizations, 70,882 involved patients with SLE, who were more often < 50 years of age, female, Black, and had higher rates of antiphospholipid syndrome, chronic and endstage kidney disease, and prior thromboembolism. From 2006 to 2019, ACS hospitalization rates fell by 40% in patients with SLE-mainly from 2015 to 2019-and by 50% in patients without SLE. In-hospital mortality was similar (7% vs 6.9%, P = 0.52), though patients with SLE experienced longer hospital stays (6.22 vs 5.51 days, P < 0.001) and higher charges (US $79,909 vs $74,294, P < 0.001). SLE patients with ACS require higher healthcare utilization, with longer hospital stays and higher charges. Although ACS hospitalization rates declined for both groups, the decrease was greater in patients without SLE. These findings underscore the need for continuous targeted cardiovascular risk management strategies in patients with SLE to reduce morbidity and healthcare burden.

Abstract This paper introduces QRL-AFOFA, a Q-learning-enhanced adaptive fractional-order firefly algorithm developed to address the challenges of large-scale and dynamic multiobjective optimization problems. While fractional-order metaheuristics provide memory-driven search dynamics and reinforcement learning (RL) offers adaptive policy control, existing hybrid methods often face critical limitations such as parameter sensitivity, premature convergence, and poor diversity preservation. To overcome these challenges, QRL-AFOFA integrates five synergistic innovations: real-time adaptive tuning of fractional-order parameters, entropy-regularized Q-value updates, stagnation-aware restart strategies, reflection-based boundary handling, and dual-phase learning rate scheduling. Extensive experiments on the 2021 IEEE Congress on Evolutionary Computation (CEC2021) benchmark functions demonstrate that QRL-AFOFA consistently outperforms other state-of-the-art algorithms across diverse problem categories. Accordingly, the proposed QRL-AFOFA demonstrated superior performance in 97.5% of test cases and outperformed the state-of-the-art algorithms in 34-40 out of 40 benchmark problems, with particularly impressive gains in dynamic and large-scale scenarios. Statistical validation using the Wilcoxon signed-rank and Friedman tests confirms the significance of the improvements. Notably, QRL-AFOFA achieves exceptional performance in high-dimensional (up to 10,000 variables) and dynamic optimization settings. Its self-adaptive design eliminates manual parameter tuning, making it a robust, scalable, and intelligent optimization framework for complex real-world applications.

Background and ObjectiveSTS101 is an investigational drug–device combination comprising 5.2 mg dihydroergotamine (DHE) powder (6.0 mg DHE mesylate) in a single-use nasal delivery device for the acute treatment of migraine. The primary objective of the ASCEND trial was to assess long-term safety and tolerability of STS101 in the acute treatment of migraine attacks across 12–18 months, with secondary objectives describing efficacy.MethodsASCEND was an open-label study of STS101 in adults aged 18–65 years with a ≥ 1 year history of migraine with or without aura, with onset before the age of 50 years and 4–12 migraine attacks/month and < 15 headache days/month in each of the 3 months prior to screening. Exclusion criteria included diagnosis of non-migraine headache, history of cerebrovascular disease, and ≥ 2 cardiovascular risk factors. After establishing eligibility, participants could self-administer STS101 5.2 mg as needed for up to 2 doses within 24 h to treat a single migraine attack and up to 12 doses/month. Safety and tolerability evaluations included physical and nasal examinations, vital signs, laboratory tests, and treatment-emergent adverse event (TEAE) assessments. Participants used an electronic diary to record exploratory efficacy parameters, including intensity of headache pain and associated migraine symptoms (photophobia, phonophobia, and nausea). Participant impression questions were asked at months 3, 6, and 12.ResultsOf the 6610 migraine attacks treated with a total of 8234 STS101 doses in 344 participants, 945/6610 (14.3%) were associated with a TEAE. Events were predominantly mild or moderate in nature and rarely led to premature study discontinuation (15/344 [4.4%] participants). Treatment was associated with rapid onset of freedom from pain (36.6%, 67.1%, and 85.5% of treated attacks 2, 4, and 24 h post-dose, respectively), freedom from most bothersome symptoms (54.3%, 79.6%, and 91.3%), and headache relief (66.5%, 89.1%, and 94.3%). Most participants rated treatment results as good or very good and ease of use as easy or very easy at all time points (months 3, 6, and 12) and indicated they were likely or very likely to use STS101 again.ConclusionsThe repeated long-term, as-needed use of STS101 was well tolerated, demonstrating a favorable safety profile in the acute treatment of migraine attacks in appropriately indicated adults. Exploratory efficacy evaluations indicated beneficial effects, which warrant further evaluation.Trial RegistrationClinicalTrials.gov identification NCT04406649.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40263-024-01118-8.

Background:After approval of Sientra silicone gel breast implants in March of 2012, the U.S. Food and Drug Administration required completion of a 10-year U.S. postapproval study. The authors present results from the first 6 years of this study.Methods:An ongoing, open-label, prospective, multicenter study is being conducted to evaluate the long-term clinical performance of Sientra implants in patients undergoing breast augmentation, reconstruction, and revision in the postmarket environment. Enrollment of 5197 patients (10,327 implants) was completed on March 6, 2015 (4046 primary augmentation, 895 revision-augmentation, 149 primary reconstruction, and 107 revision-reconstruction). Analyses were conducted at year 6 (database lock: January 24, 2022).Results:Across all cohorts who received an implant, the Kaplan-Meier risk of investigator-reported Baker grade III/IV capsular contracture was 4.1% (3.9% with submuscular placement and 6.75%with subglandular placement), the risk of reoperation was 11.6%, and the risk of implant removal was 7.8% (5.9% with implant replacement and 2.0% without replacement). The primary reason (>50%) for reoperation was aesthetic (eg, style/size change). The Kaplan-Meier risk of rupture, calculated for patients who underwent explantation or MRI for rupture evaluation, was 5.8%. Overall, 82.6% of patients were highly satisfied/happy with their implant. No cases of breast implant–associated anaplastic large cell lymphoma were reported.Conclusion:Six-year results of the postapproval study were consistent with the 10-year core study and provide additional evidence in a large data set supporting the comprehensive safety and effectiveness profile of the Sientra implants.

Purpose: The purpose of this study was to examine the relationship between speech skills and language development in children with nonsyndromic cleft palate with or without cleft lip (NSCP/L). Specifically, the correlation between speech and expressive vocabulary development was examined as well as the correlation between speech and morphological development. Method: A meta-analysis was used to summarize the average correlation between speech and expressive vocabulary skills as well as speech and morphology skills. Articles for inclusion in the meta-analysis were identified using PubMed and PsycINFO. A total of eight articles met the inclusion criteria for this meta-analysis. Procedures followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA). Result: The average correlation between consonant inventory and expressive vocabulary skills was .62, which was a significant positive correlation. For speech and mean length of utterance (MLU), the average correlation was .41, although this correlation was not significant. Conclusion: This meta-analysis revealed a significant, strong, positive correlation between consonant inventory and expressive vocabulary and a nonsignificant moderate correlation between speech and mean length of utterance (MLU). The relationship between early speech and expressive vocabulary in children with NSCP/L is relevant when assessing and planning intervention.

Background Young people are challenged with sexual and reproductive health (SRH) problems due to limited access to services and information. It contributes a high burden of sexually transmitted disease, unsafe abortion, and premature mortality, especially in low-income countries like Ethiopia. Hence, this study aimed at assessing the SRH service utilization and associated factors among college students at West Arsi Zone in Oromia region, Ethiopia. Methods Institutional-based cross-sectional study was conducted among 519 randomly selected college students from January 01, 2019, up to April 30, 2019. Data were collected through self-administered pretested questionnaires. Data entry and analysis for descriptive and logistic regression models were performed by using SPSS (version 23). The result was declared as statistically significant at p < 0.05. Results The utilization of at least one SRH service in the last twelve months was seen in 304 (58.6%) students. Mainly information and counseling (81.3%), voluntary testing and counseling for HIV (80.6%), condom service (37.2%), pregnancy test (35.5%), family planning services (33.2%), and abortion care services (26.0%) were most frequently utilized. The students' aged between 20 and 24 years [AOR = 2.05, 95% CI: 1.38–3.06], female students [AOR = 1.92, 95% CI: 1.30–2.82], those not living with family [AOR = 1.54, 95% CI: 1.05–2.26], those who discussed about SRH with family/friends [AOR = 1.92, 95% CI: 1.31–2.82], and those who participated in school clubs [AOR = 1.75, 95% CI: 1.19, 2.58] more frequently used SRH service compared with their counterparts. Conclusions The utilization of SRH services was low when compared with other studies and needs improvements to tackle RH-related problems. It requires pertinent health education and the SRH club at higher educational institutions is crucial.

Stromal cell derived factor-1a (SDF-1a) and its receptor CXCR4 modulate stem cell recruitment to neural injury sites. SDF-1a gradients originating from injury sites contribute to chemotactic cellular recruitment. To capitalize on this injury-induced cell recruitment, further investigation of SDF-1a/CXCR4 signaling dynamics are warranted. Here, we studied how exogenous SDF-1a delivery strategies impact spatiotemporal SDF-1a levels and the role autocrine/paracrine signaling plays. We first assessed total SDF-1a and CXCR4 levels over the course of 7days following intracortical injection of either bolus SDF-1a or SDF-1a loaded nanoparticles in CXCR4-EGFP mice. We then investigated cellular contributors to SDF-1a autocrine/paracrine signaling via time course in vitro measurements of SDF-1a and CXCR4 gene expression following exogenous SDF-1a application. Lastly, we created mathematical models that could recapitulate our in vivo observations. In vivo, we found sustained total SDF-1a levels beyond 3days post injection, indicating endogenous SDF-1a production. We confirmed in vitro that microglia, astrocytes, and brain endothelial cells significantly change SDF-1a and CXCR4 expression after exposure. We found that diffusion-only based mathematical models were unable to capture in vivo SDF-1a spatial distribution. Adding autocrine/paracrine mechanisms to the model allowed for SDF-1a temporal trends to be modeled accurately, indicating it plays an essential role in SDF-1a sustainment. We conclude that autocrine/paracrine dynamics play a role in endogenous SDF-1a levels in the brain following exogenous delivery. Implementation of these dynamics are necessary to improving SDF-1a delivery strategies. Further, mathematical models introduced here may be utilized in predicting future outcomes based upon new biomaterial designs.

Historically, jazz musicians learned to play by ear as they developed their individual voices to express their musical ideas. When jazz entered the schools, however, learning to play jazz became relegated to reading printed music, and directors rehearsed jazz ensembles similar to concert bands. Jazz, then, moved almost entirely into the realm of formal music learning in school music programs and the aural aspects of learning became diminished. Not all of these voices in jazz disappeared, and exemplary examples of learning jazz music via aural, oral, and physical ways still occur. As jazz musicians and narrative researchers, we explore how narrative inquiry can aid with portraying the varied dimensions of learning in jazz. Using Lefebvre’s (Rhythmanalysis: Space, time and everyday life. A&C Black Publishing, London, 2004) theoretical framework of sociological and historical orientation of human spatial experience, we define how we use the term narrative inquiry followed by an exploration into how the processes of narrative inquiry and learning in jazz share many parallels. We then use examples from our research to demonstrate how narrative inquiry can aid with portraying all voices embedded in the spaces where learning jazz music occurs.