University of Lynchburg

Purpose: Pursuing a decentralized approach to system organization is increasingly popular. For example, several large districts in the U.S. have implemented portfolio-managed approaches to system organization designed to enhance school leaders’ authority by enhancing system leaders’ oversight responsibilities. But there is an open question about how organizational conditions in decentralized systems shape the ways system leadership roles do or do not support a system's organizational effectiveness. The purpose of our study was to investigate the perspectives of Catholic school system leaders in order to examine how organizational conditions in these large decentralized systems of schools shape the system leadership roles diocesan superintendents have adopted. Research Methods: We conducted a qualitative analysis of data from 26 interviews with Catholic school superintendents leading a geographically diverse range of Catholic diocesan systems. Findings: We found superintendents believed the decentralized nature of their systems of schools required them to support the local reform efforts of individual schools within their portfolios rather than take on more active accountability and oversight responsibilities. Implications: These findings indicate the tendency for these system leaders to defer to local decision-making often came at the expense of these leaders’ maintaining consistent quality expectations across their systems. Ultimately, the analyses in this paper suggest the long term success of intentionally decentralized systems may rely on system leaders finding ways to counteract the tendencies identified by our participants.

O presente estudo tem como tema a gestão democrática como princípio essencial para a efetivação do direito à educação no Brasil. O objetivo central é discutir o papel da gestão escolar democrática na concretização do direito à educação, de modo a contribuir para o debate contemporâneo sobre as políticas públicas educacionais. A pesquisa utilizou o método de revisão bibliográfica, com abordagem qualitativa e descritiva, fundamentada em obras, dissertações, artigos e dispositivos legais, como a Constituição Federal de 1988 e a Lei de Diretrizes e Bases da Educação (Lei nº 9.394/1996). Os resultados apontaram que, embora a legislação brasileira assegure a gestão democrática como princípio do ensino público, sua efetivação ainda enfrenta entraves como a centralização administrativa, a fragilidade dos colegiados escolares e a limitação de recursos. Evidenciou-se que a democratização da gestão requer autonomia institucional, fortalecimento dos conselhos escolares, incentivo à participação da comunidade e valorização dos profissionais da educação. Conclui-se que a gestão democrática deve ser compreendida como prática social e política voltada à construção de uma escola participativa, essencial para garantir o direito à educação com equidade e qualidade.

Purpose Vitiligo often affects quality of life and psychosocial well-being. This analysis of the population-based global Vitiligo and Life Impact Among International Communities (VALIANT) study sought to understand the impact of vitiligo on depression and depressive symptoms from the patient perspective. Materials and methods The cross-sectional survey collected information on patient demographics, clinical characteristics, mental health diagnoses, and depressive symptoms (assessed using the Patient Health Questionnaire–Depression screener [PHQ-9]) among recruited patients who reported a vitiligo diagnosis. Results Of 3541 VALIANT respondents, 24.5% reported formal diagnosis of depression, and 55.0% reported moderate-to-severe symptoms of depression per the PHQ-9. Rates of formally diagnosed depression and moderate-to-severe depressive symptoms were significantly higher in younger patients, those with Fitzpatrick skin types IV–VI (i.e. darker skin), >5% affected body surface area, hand or face involvement, and those receiving mental healthcare versus their counterparts (all p < 0.0001). Interestingly, moderate-to-severe depressive symptoms were more common among patients with shorter disease duration (≤2 vs 3–9 and ≥10 years; p < 0.01), but there was no correlation between diagnosed depression and disease duration. Conclusions These VALIANT study findings highlight that depression may be common but often undiagnosed among patients with vitiligo, reinforcing the importance of an improved and multifaceted approach to vitiligo management.

To evaluate the intraocular pressure (IOP)-lowering effect and safety of up to 2 bimatoprost implant administrations versus selective laser trabeculoplasty (SLT). Phase 3 (Stage 2), randomized, 24-month, multicenter, patient- and efficacy evaluator-masked, paired-eye clinical trial (NCT02507687). Patients (n = 183) with open-angle glaucoma or ocular hypertension inadequately managed with topical IOP-lowering medication for reasons other than efficacy. Patients received a single 360° SLT procedure in 1 eye and 10-µg bimatoprost implant administration in the contralateral eye. Initially, implant-treated eyes received a second implant at week 16 if safety criteria were met. After a protocol amendment, implant-treated eyes were retreated with flexible scheduling if IOP was >17 mm Hg and safety criteria were met. The primary efficacy variable was IOP change from baseline, with primary timepoints at weeks 4, 12, and 24. Safety measures included treatment-emergent adverse events (TEAEs) and ocular safety measures. Mean (±SE) baseline IOP (mm Hg) was 25.2 ± 0.22 and 25.1 ± 0.22 in implant- and SLT-treated eyes, respectively. Least-squares mean (±SE) IOP reduction from baseline (mm Hg) for eyes treated with up to 2 implants versus SLT was 6.8 ± 0.28 versus 6.2 ± 0.28 at week 4, 6.9 ± 0.30 versus 6.4 ± 0.30 at week 12, and 6.9 ± 0.27 versus 6.5 ± 0.28 at week 24. The probability of not having required nonstudy (rescue) IOP-lowering treatment at days 360 and 720, respectively, was 67.5% and 50.2% for implant-treated eyes versus 68.7% and 60.6% for SLT-treated eyes. The most common ocular TEAE in both implant- and SLT-treated eyes was increased IOP attributed to wearing off of efficacy. Mean (±SE) percentage change in corneal endothelial cell density from baseline at month 24 was -6.2 ± 1.13% in implant-treated eyes (-7.9 ± 2.04% with fixed readministration; -5.2 ± 1.35% with flexible readministration) versus -3.1 ± 0.43% in SLT-treated eyes. The bimatoprost implant demonstrated statistical and clinical noninferiority to SLT in IOP reduction from baseline at weeks 4, 12, and 24. In subgroup analysis, patients with flexible implant readministration met the same criteria. Both the implant and SLT demonstrated sustained (2-year) IOP lowering in many eyes. A flexible administration schedule improved the safety profile of the implant over the fixed administration schedule.

Team-based learning (TBL) is a type of active learning. While TBL was first used in medical instruction at the start of the 2000s, its efficacy within the physician assistant (PA) education has yet to be demonstrated. The objective of this study was to determine existing information about TBL in PA education and to demonstrate the need for further study. A mixed scoping review was undertaken. Articles were identified across the search engines CINAHL Complete, Embase, ERIC, and PubMed. Findings were then evaluated using Rayyan and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Forty-nine articles were identified across all databases, with 2 independent reviewers screening records. Ultimately, 6 studies were included. Four studies were original articles, and the other 2 were conference abstracts. Based on the limited data available, TBL was generally beneficial in all available studies; however, results should be interpreted with caution given the paucity of available data. Studies included both hybrid curriculum and TBL alone. Studies demonstrated significant findings when evaluating TBL course outcomes, examination grades, and student confidence. All articles evaluated different outcomes, so comparison between results is challenging. The strength of research from conference abstracts was limited. Further study is necessary to determine if TBL is effective in other programs. If demonstrated to be effective in PA education, TBL may be used to improve outcomes such as examination performance, course grades, long-term retention of knowledge, or student confidence.

Let's step back from the details of C++ and think about something in the big picture: specifically, the need for thinking about the big picture. In the rest of life, doesn't planning help? You wouldn't build a house, or cook a meal, without a plan. (Heating soup in the microwave doesn't count.)

We've had too much fun. It's time to get serious.

Background Metabolic dysfunction-associated steatotic liver disease (MASLD) constitutes a significant cause of chronic liver disease globally. Type 2 diabetes mellitus (T2DM) is a crucial risk factor for MASLD. This investigation is aimed at assessing hepatic fibrosis in T2DM patients with MASLD. Methods This cross-sectional study focused on T2DM patients with MASLD attending a tertiary care center in eastern India. Exclusion criteria were chronic alcohol intake (more than 21 units/week for males and more than 14 units/week for females), other chronic liver diseases, and pregnancy. The study utilized abdominal ultrasonography and transient elastography, complemented by calculating the BARD score, nonalcoholic fatty liver disease (NAFLD) fibrosis score, aspartate aminotransferase to platelet ratio index (APRI) score, and fibrosis 4 (FIB-4) index. The prevalence of advanced fibrosis in patients with T2DM and MASLD was assessed using transient elastography. Results Among the 149 T2DM patients with MASLD studied, 59.7% were female, with an average age of 49.09 years and a T2DM duration of 7.3 years. Transaminitis was detected in 9.4% of the subjects. The risk assessment of hepatic fibrosis revealed that 14.1% of patients had a high risk of hepatic fibrosis on BARD scoring, the NAFLD fibrosis score was in the range of F3-F4 in 8.7% of patients, the FIB-4 index showed a high risk of fibrosis in 5.4% of patients, and the APRI scoring showed severe fibrosis in 3.4% of patients.The prevalence of advanced fibrosis in patients with T2DM and MASLD was 7.4% (95% confidence interval (CI) 3.7 to 12.8), while 75.8% (95% CI 68.2 to 82.5) of participants had at least some level of hepatic fibrosis as measured by transient elastography.Notably, there was a significant positive correlation between these scores and the duration of diabetes and serum bilirubin levels, as corroborated by concordant transient elastography findings. On multivariate logistic regression, systolic blood pressure, serum total bilirubin level, and serum aspartate aminotransferase level had significant predictive value for advanced hepatic fibrosis. Conclusion The significant predictive value of systolic blood pressure, serum total bilirubin level, and serum aspartate aminotransferase level for hepatic fibrosis emphasizes the importance of integrated monitoring for these patients.