Improved detection of cystic fibrosis by the California Newborn Screening Program for all races and ethnicities.

BACKGROUND: Newborn screening (NBS) for cystic fibrosis (CF) is universal in the United States. Protocols vary but include an immunoreactive trypsinogen (IRT) level and CFTR variant panel. California CF NBS has a 3-step screening: IRT level, variant panel, and CFTR sequencing if only one variant identified on panel. METHODS: This was a cohort study of infants with CF born in California (2007-2021) to examine racial and ethnic differences in having a false-negative NBS result for CF and at which step the false-negative occurred. We examined how different CFTR variant panels would improve detection of variants by race and ethnicity: original 39-variant panel, current 75-variant panel, and all 402 disease-causing CFTR variants in the CFTR2 database. RESULTS: Of the 912 infants born in California with CF, 84 had a false-negative result: 38 due to low IRT level and 46 with a high IRT value (but incomplete variant detection). Asian (OR 6.3) and Black infants (OR 2.5) were more likely to have a false-negative screening result than non-Hispanic white infants. The majority of false-negative screening (but CF diagnosis) cases among American Indian/Native Alaskan and non-Hispanic White infants were due to low IRT levels. The majority of Asian and Hispanic infants with false-negative screening had no variants detected. Detection of two CFTR variants was improved with the 75-variant panel in Black, Hispanic, and non-Hispanic White infants and with the 402-variant panel in Black, Hispanic, non-Hispanic White, and other race infants. CONCLUSIONS: Larger CFTR panels in NBS improved the detection of CF in all races and ethnicities.

Do Special and General Education Teachers' Mindset Theories About the Malleability of Writing and Intelligence Predict Their Writing Practices?

Seventy-five general and 65 special education teachers working in the same 65 elementary schools in 12 different U.S. school districts were surveyed about their mindsets concerning the malleability of writing and intelligence as well as their practices for teaching writing. All teachers taught writing to one or more fourth-grade students receiving special education services, including students with learning disabilities. Both general and special education teachers typically held a growth mindset toward the malleability of writing and intelligence. Collectively, these teachers' mindsets predicted writing frequency (i.e., frequency of students' writing) and how often they taught writing skills and processes once variance due to teachers' preparation, efficacy to teach writing, teaching experience, and type of teacher was first controlled. The observed relationships between teachers' mindsets and reported practices for teaching writing were not mediated by type of teacher (i.e., general or special education). General and special education teachers did not differ in writing frequency for three types of writing collectively (narrative, informative, and persuasive) or how frequently they made 18 adaptations for teaching writing collectively, but general education teachers reported teaching writing skills and processes more often than their special education counterparts. Recommendations for future research and implications for practice are presented.

Artificial intelligence in medical referrals triage based on Clinical Prioritization Criteria.

The clinical prioritisation criteria (CPC) are a clinical decision support tool that ensures patients referred for public specialist outpatient services to Queensland Health are assessed according to their clinical urgency. Medical referrals are manually triaged and prioritised into three categories by the associated health service before appointments are booked. We have developed a method using artificial intelligence to automate the process of categorizing medical referrals based on clinical prioritization criteria (CPC) guidelines. Using machine learning techniques, we have created a tool that can assist clinicians in sorting through the substantial number of referrals they receive each year, leading to more efficient use of clinical specialists' time and improved access to healthcare for patients. Our research included analyzing 17,378 ENT referrals from two hospitals in Queensland between 2019 and 2022. Our results show a level of agreement between referral categories and generated predictions of 53.8%.

Efficacy for writing self-regulation, attitude toward writing, and quality of second grade students' writing.

Motivational beliefs, such as writing self-efficacy and attitude toward writing, are believed to foster or hinder writing by influencing if one chooses to write, how much effort is committed to writing, and what cognitive resources writers apply. In the current study, we examined self-efficacy for writing self-regulation and attitude toward writing of 2,124 Grade 2 Norwegian students (1,069 girls; 1,055 boys). We investigated if there were differences in each of these beliefs between girls and boys and students who differed in their language status (Norwegian first language, Norwegian and another language both first language, or language other than Norwegian first language). We further tested if each of these writing motivational beliefs made statistically unique contributions to predicting the quality of students' writing. In each of these analyses, we controlled for variance related to individual- and school factors. Girls were more positive about writing than boys, and they were confident about their abilities to self-regulate writing. Students with Norwegian and another language both as first language ("bilingual" students) had a more positive attitude toward writing than the other two language groups. Efficacy for writing self-regulation and attitude toward writing both made statistically significant unique contributions to predicting the quality of students writing, although these two writing beliefs collectively accounted for just 2% of the variance in writing quality scores once individual- and school-factors were controlled. Recommendations for future research and implications of the finding are discussed.

Shadow of a Pandemic: Persistence of Prenatal SARS-CoV-2 Antibodies in Newborn Blood Spots.

To investigate COVID-19 surveillance among pregnant women, the California Genetic Disease Screening Program conducted a screening performance and seroprevalence evaluation of maternal SARS-CoV-2 antibodies detected in banked newborn dried blood spots (DBS). We obtained seropositive results for 2890 newborn DBS from cohorts in 2020 and 2021 using Enable Bioscience's Antibody Detection by Agglutination-PCR (ADAP) assay for SARS-CoV-2 antibodies. To infer maternal infection, we linked 312 women with a known laboratory-confirmed COVID-19 episode with their newborn's DBS SARS-CoV02 antibody result. Among 2890 newborns, we detected 453 (15.7%) with SARS-CoV-2 antibodies in their DBS. Monthly snapshot statewide seroprevalence among neonates was 12.2% (95% CI 10.3-14.1%, n =1156) in December 2020 and 33.3% (95% CI 29.1-37.4%, n = 26) in March 2021. The longest time recorded from COVID-19 infection to a seropositive neonatal result was 11.7 months among the 312 mothers who had an available SARS-CoV-2 PCR test result. Approximately 94% (153/163) of DBS were seropositive when a known maternal infection occurred earlier than 19 days before birth. The estimated relative sensitivity of DBS to identify prevalent maternal infection was 85.1%, specificity 98.5% and PPV 99.2% (n = 312); the sensitivity was lowest during the December 2021 surge when many infections occurred within 19 days of birth. Fifty pre-pandemic specimens (100% seronegative) and 23 twin-pair results (100% concordant) support an intrinsic specificity and PPV of ADAP approaching 100%. Maternal infection surveillance is limited by a time lag prior to delivery, especially during pandemic surges.

A latent scale model to minimize subjectivity in the analysis of visual rating data for the National Turfgrass Evaluation Program.

Introduction: Traditional evaluation procedure in National Turfgrass Evaluation Program (NTEP) relies on visually assessing replicated turf plots at multiple testing locations. This process yields ordinal data; however, statistical models that falsely assume these to be interval or ratio data have almost exclusively been applied in the subsequent analysis. This practice raises concerns about procedural subjectivity, preventing objective comparisons of cultivars across different test locations. It may also lead to serious errors, such as increased false alarms, failures to detect effects, and even inversions of differences among groups. Methods: We reviewed this problem, identified sources of subjectivity, and presented a model-based approach to minimize subjectivity, allowing objective comparisons of cultivars across different locations and better monitoring of the evaluation procedure. We demonstrate how to fit the described model in a Bayesian framework with Stan, using datasets on overall turf quality ratings from the 2017 NTEP Kentucky bluegrass trials at seven testing locations. Results: Compared with the existing method, ours allows the estimation of additional parameters, i.e., category thresholds, rating severity, and within-field spatial variations, and provides better separation of cultivar means and more realistic standard deviations. Discussion: To implement the proposed model, additional information on rater identification, trial layout, rating date is needed. Given the model assumptions, we recommend small trials to reduce rater fatigue. For large trials, ratings can be conducted for each replication on multiple occasions instead of all at once. To minimize subjectivity, multiple raters are required. We also proposed new ideas on temporal analysis, incorporating existing knowledge of turfgrass.

Writing knowledge, practices, efficacy, interests, attitudes, and beliefs of deaf education teachers: a randomized controlled trial.

Writing teachers play an extraordinarily important role in their students' writing development. Teachers' motivational beliefs, such as attitudes toward writing, perceptions of their efficacy to teach writing, or preparation to use evidence-based instructional practices, impact their writing instruction, which directly affects the advancement of students' writing skills. Deaf writers are a subpopulation of writers who may face discriminatory beliefs toward their writing development stemming from ableism, audism, or linguicism. Deaf education teachers may doubt their abilities to teach bilingual/multilingual students or teach deaf students experiencing language deprivation. The current study investigates whether deaf education teachers' beliefs can be fostered through an intensive one-year professional development (PD) program designed specifically for deaf education teachers. In this randomized controlled trial, we examine the extent to which the participation of deaf education teachers in specialized PD and subsequent writing instruction implementation (n = 26) impacts their pedagogical content knowledge, use of evidence-based practices for teaching writing, interest, attitudes, efficacy in teaching writing, and epistemological beliefs about writing compared to teachers in a business as usual condition (n = 24). Pre-post regression analyses indicate statistically significant group differences (with the treatment group scoring higher) on all variables except attitude and some epistemological beliefs. We speculate that specialized, sustained PD paired with supported implementation of writing instruction and ongoing teacher reflection are contributing factors to changes in teachers' motivational beliefs.

Understanding the interplay between text quality, writing self-efficacy and writing anxiety in learners with and without migration background.

Writing presents considerable challenges to students' motivation. Yet there is a dearth of studies assessing the role of affect and motivation in writing performance for students with migration backgrounds (MB), who often underachieve in writing. Our study addressed this research gap by investigating the interplay between writing self-efficacy, writing anxiety, and text quality in 208 secondary students with and without MB using Response Surface Analyses. The data showed comparable levels of self-efficacy and, notably, lower writing anxiety levels among students with MB despite lower writing achievements. In the full sample, we observed positive correlations between self-efficacy and text quality and negative correlations between writing anxiety and text quality. When modeling efficacy and anxiety measures and their interplay to predict text quality, self-efficacy measures continued to account for statistically detectable unique variance in text quality, whereas writing anxiety did not. However, students with MB demonstrated differing interplay patterns, with less efficacious students with MB showing positive relations between writing anxiety and text quality.

A longitudinal intervention study of the effects of increasing amount of meaningful writing across grades 1 and 2.

The current study examined the effectiveness of a writing is caught approach with young developing writers in Norway. This method is based on the premise that writing competence is acquired naturally through real use in meaningful contexts. Our longitudinal randomized control trial study tested this proposition by examining if increasing first grade students' opportunities to write in various genres for different purposes and for a range of audiences over a two-year time period improved the quality of their writing, handwriting fluency, and attitude towards writing. The study included data from 942 students (50.1% girls) in 26 schools randomly assigned to the experimental treatment, and 743 students (50.6% girls) in 25 schools randomly assigned to the business-as-usual (BAU) control condition. Across Grades 1 and 2, experimental teachers were asked to supplement their typical writing instruction by implementing 40 writing activities designed to increase students' purposeful writing. Increasing experimental students' writing over the two-year period did not result in statistically detectable differences in the writing quality, handwriting fluency, and attitude towards writing of students in the experimental and BAU control conditions. These findings did not provide support for the effectiveness of the writing is caught approach. Implications for theory, research, and practiced are discussed.

The Long-Term Effects of the COVID-19 Pandemic on Children's Writing: a Follow-up Replication Study.

The COVID-19 pandemic and the move by governments worldwide to cancel in-class instruction and move to emergency remote instruction in March and April of 2020 created an unprecedented disruption in children's education. As the COVID-19 pandemic took form and continued to impact education in the following 2020/2021 academic year, multiple concerns were raised about possible negative effects on students' learning. The current longitudinal replication study examined this proposition for second-grade students in Norway. In a previous investigation (Skar et al. Journal of Educational Psychology 114:1553-1566, 2022), we found that scores for quality of writing, handwriting fluency, and attitude toward writing of first-grade children tested immediately after emergency remote instruction ended in the Spring of 2020 (During COVID-19 cohort) were lower than the scores of first-grade students from the same schools tested a year earlier before the start of the pandemic (Before COVID-19 cohort). In the present study, we compared the scores for the During COVID-19 cohort (333 girls, 308 boys) on these same writing measures 1 year later at the end of second grade to a During COVID-19 cohort of second-graders (888 girls, 780 boys) from the same schools tested 2 years earlier before the start of the pandemic. The initial negative impact of the COVID-19 pandemic on first-grade students' writing observed by Skar et al. (Journal of Educational Psychology 114:1553-1566, 2022) was no longer evident 1 year later at the end of second grade in the current study.

Special and General Education Teachers' Beliefs About Writing and Writing Instruction.

Seventy-six general education and 67 special education teachers working in the same 66 elementary schools were surveyed about their beliefs about writing. Each teacher taught writing to one or more fourth-grade students receiving special education services, including students with learning disabilities. Survey findings indicated that general education teachers believed that they were better prepared to teach writing than special education teachers, and they were more positive about their own efforts to learn to teach writing. General education teachers also held more positive attitudes about teaching writing and their own capabilities as a writer than their special education counterparts. Furthermore, general educators were more likely than special educators to indicate that writing developed through effort and process, and less likely to think that writing knowledge came from experts. Beliefs about adequacy of preparation to teach writing predicted teachers' beliefs about their level of knowledge to teach writing, efficacy to overcome students' writing difficulties, and attitudes toward teaching writing. Recommendations for future research and implications for practice are presented.

CFTR gene variants, air pollution, and childhood asthma in a California Medicaid population.

Carriers of the cystic fibrosis transmembrane conductance regulator (CFTR) gene ("carriers") have been found to have an increased risk of persistent asthma. However, it is unclear at what level of CFTR function this risk exists and whether it is modified by asthmogens, such as air pollution. We conducted a retrospective cohort study of children born in California between July 2007 and December 2013, linking CFTR genotype data from the California newborn screening program to Medicaid claims records through March 17, 2020 to identify asthma cases, and to air pollution data from CalEnviroScreen 3.0 to identify levels of particulate matter with diameter 2.5 microns or smaller (PM2.5 ). Log-binomial regression models for asthma risk were fitted, adjusting for race/ethnicity and sex. Compared to population controls, carriers had higher risk of asthma (adjusted risk ratio (aRR) = 1.29, 95% confidence interval (CI): 0.98, 1.69; p < 0.1). Other non-CF-causing variants on the second allele did not appear to further increase risk. Genotypes with the greatest asthma risk were F508del with an intron 10 T7 or (TG)11T5 in trans (aRR=1.52, 95% CI: 1.10, 2.12). This association was higher among children living in areas at or above (aRR = 1.80) versus below (aRR = 1.37) the current national air quality standard for PM2.5 , though this difference was not statistically significant (pinteraction > 0.2). These results suggest carriers with CFTR functional levels between 25% and 45% of wildtype are at increased risk of asthma. Knowledge of CFTR genotype in asthmatics may be important to open new CFTR-related treatment options for these patients.

Expanding the Direct and Indirect Effects Model of Writing (DIEW): Reading-Writing Relations, and Dynamic Relations As a Function of Measurement/Dimensions of Written Composition.

Within the context of the Direct and Indirect Effects model of Writing, we examined a dynamic relations hypothesis, which contends that the relations of component skills, including reading comprehension, to written composition vary as a function of dimensions of written composition. Specifically, we investigated (a) whether higher order cognitive skills (i.e., inference, perspective taking, and monitoring) are differentially related to three dimensions of written composition-writing quality, writing productivity, and correctness in writing; (b) whether reading comprehension is differentially related to the three dimensions of written composition after accounting for oral language, cognition, and transcription skills; and whether reading comprehension mediates the relations of discourse oral language and lexical literacy to the three dimensions of written composition; and (c) whether total effects of oral language, cognition, transcription, and reading comprehension vary for the three dimensions of written composition. Structural equation model results from 350 English-speaking second graders showed that higher order cognitive skills were differentially related to the three dimensions of written composition. Reading comprehension was related only to writing quality, but not to writing productivity or correctness in writing; and reading comprehension differentially mediated the relations of discourse oral language and lexical literacy to writing quality. Total effects of language, cognition, transcription, and reading comprehension varied largely for the three dimensions of written composition. These results support the dynamic relation hypothesis, role of reading in writing, and the importance of accounting for dimensions of written composition in a theoretical model of writing.

Teaching Chinese characters to students in grades 1 to 3 through emergency remote instruction during the COVID-19 pandemic.

The current study examined how Chinese characters were taught by primary grade teachers in Macao during online instruction resulting from the COVID-19 pandemic (i.e., emergency remote instruction). A random sample of 313 first to third grade teachers in public and private schools were surveyed about their instructional practices. Most teachers surveyed (72%) reported they taught a lesson about Chinese characters once every 3-4 weeks during emergency remote instruction, and 83% and 81% of teachers indicated they assigned homework for writing and reading characters, respectively, at the same rate. On average, they reportedly spent 97 min per week teaching students to write, read, and understand the meaning of new characters, devoting equal time to each of these skills. They also indicated students practiced writing and reading characters in class for 40 min per week. They further noted students were expected to spend 35 min a day practicing writing and reading characters for homework. While teachers reportedly used a variety of instructional practices for teaching characters (M = 30.38), the typical teacher applied less than one-half (N = 64) of practices assessed. Teachers reported use of asynchronous (online learning activities which can be completed at other times) and synchronous (real-time videos and audio/text) teaching methods and perceptions of adequacy of technical support predicted reported teaching practices. The findings from this study raise questions about the teaching of Chinese characters in Macao during emergency remote instruction.

Intermediate-Grade Teachers' Adaptations for Weaker Writers: A National Survey in Urban Schools in Chile.

Two hundred fifty-four intermediate-grade teachers (88% female) in urban public schools in Chile indicated how frequently they made writing instructional adaptations for their weakest writers, which included students with learning and other disabilities. A majority of teachers reported making the following adaptations for their weakest writers at least once a week: individual tutoring, assistance from a peer when writing, and extra instruction in grammar/spelling, planning/revising, handwriting, sentence construction, and text structure. On a monthly basis or more often, a majority of teachers reported they provided weaker writers with choice about writing assignments, the opportunity to complete an alternative writing assignment, and extra writing instruction via computer technology. How often an adaptation was applied did not differ by grade. The perceived adequacy of teacher undergraduate preparation to teach writing, their efficacy to teach writing, and the proportion of students with disability in their classes each made a unique and statistically significant contribution to predicting how frequently teachers applied adaptations for their weakest writers. The Chilean teachers in this study reportedly made adaptations for weaker writers in their class more often than teachers in studies conducted in other countries, including the United States.

Teaching Chinese characters to first and second graders during the first covid-19 school closure in China: an observational study.

The COVID-19 pandemic disrupted education around the world, resulting in the implementation of different forms of remote instruction. The present study provided a description of one interesting and unique approach to providing such instruction by analyzing 144 language arts lessons designed and implemented by 61 distinguished and experienced teachers in Xiangzhou, China. The lessons were used to teach first and second grade students the pronunciation, meaning, recognition, and writing of simplified Chinese characters. These lessons provide a possible model for teaching Chinese characters in the future. The 144 lessons were delivered synchronously through live video interactions with two to four students, while other students were able to access them simultaneously at home via an internet device or on TV (the lessons were accessed 2.1 million times). Lessons were taught four to seven times a week, and teachers devoted 58% of lesson time to teaching characters: 69% and 46% of lesson time was spent teaching characters in grades one and two, respectively. A large number of recommended behaviors for teaching characters (77 out of 80 behaviors assessed) were applied across the 144 lessons, but a relatively small number of teaching behaviors (14) were used in each lesson. This typically included two behaviors for teaching character recognition and four behaviors each for teaching pronunciation, meaning, and writing of characters. Congruently, 6.32, 5.83, 5.49, and 3.78 min per lessons were used to teach character pronunciation, writing, meaning, and recognition, respectively. Character instruction in these lessons was coherently and logically designed, but all live interactions between teachers and students were teacher directed. Directions for future research are presented and implications for practice discussed.

Infliximab for Paradoxical Reactions in Pediatric Central Nervous System Tuberculosis.

Paradoxical reactions in central nervous system tuberculosis (CNS-TB) are associated with significant morbidity and mortality. We describe 4 HIV-uninfected children treated for CNS-TB with severe paradoxical reactions unresponsive to corticosteroids. All made recovery after treatment with infliximab, highlighting the safety and effectiveness of infliximab for this complication, and need for prospective trials.

Does Teacher Self-Efficacy Predict Writing Practices of Teachers of Deaf and Hard of Hearing Students?

Forty-four elementary grade teachers of deaf and hard of hearing students were surveyed about how they taught writing and their beliefs about writing. Beliefs about writing included their self-efficacy to teach writing, attitude toward writing, and epistemological beliefs about writing. These teachers from fifteen different states in the United States slightly agreed that they were efficacious writing teachers and they were slightly positive about their writing. They slightly agreed that learning to write involves effort and process, moderately disagreed that writing development is innate or fixed, slightly disagreed that knowledge about writing is certain, and were equally split about whether writing knowledge comes from authorities and experts. On average, teachers applied the twenty-two instructional writing practices surveyed at least once a month. They reported their students wrote weekly, and their writing was supported through goal setting, feedback, and prewriting activities. Writing instruction mostly focuses on teaching grammar and how to plan compositions. Teacher self-efficacy uniquely and statistically predicted reported teaching practices after attitude toward writing, and epistemological beliefs were first controlled. Recommendations for future research and implications for practice are presented.

Do Children Classified With Specific Language Impairment Have a Learning Disability in Writing? A Meta-Analysis.

In this meta-analysis, we examined whether children classified with specific language impairment (SLI) experience difficulties with writing. We included studies comparing children with SLI to (a) typically developing peers matched on age (k = 39 studies) and (b) typically developing younger peers with similar language capabilities (k = six studies). Children classified with SLI scored lower on writing measures than their typically developing peers matched on age (g = -0.97) when all writing scores in a study were included in the analysis. This same pattern occurred for specific measures of writing: quality (g = -0.92), output (g = -1.00), grammar (g = -0.68), vocabulary (g = -0.68), and spelling (g = -1.17). A moderator analysis revealed that differences in the writing scores of children classified with SLI and typically developing peers matched on age were not as large, but were still statistically significant, when assessment involved a contrived response format (vs. measured based on students' writing), researcher-created measures (vs. norm-referenced tests), or SLI included just children with a speech disorder (vs. children with a language disorder). Children classified with SLI further scored lower on writing than typically developing peers with similar language capabilities (g = -0.47). We concluded that children with SLI experience difficulties with writing.