The Impact of Restorative Practices on the Use of Out-of-School Suspensions: Results from a Cluster Randomized Controlled Trial.

The overuse of exclusionary discipline practices, such as out-of-school suspensions (OSS), has consistently been documented over several decades. The resulting racial discipline disparities and the negative outcomes related to OSS have led policy makers and educators to consider other approaches to school discipline. One such approach, which has gained increasing use in the USA, is restorative practices (RP). However, despite its popularity, the experimental evidence base of the effects of RP and suspensions is extremely limited. To add to this knowledge base, we present findings from a cluster randomized controlled trial with 18 K-12 schools in an urban district in the US Northeast with 5878 students. Multilevel regression results, after 1 year of the intervention, showed no differences in the likelihood of suspension between students in the intervention and control schools and that the effects of the intervention did not vary by race/ethnicity, gender, or student disability status. However, for students in the intervention group, we show reductions in the likelihood of receiving an OSS for students who had previously been suspended.

Evaluation of the whole school restorative practices project: One-year impact on discipline incidents.

The current study addressed the need for experimental research on Restorative Practices (RP) in its evaluation of the Morningside Center for Teaching Social Responsibility's Whole School RP Project. The study was conducted in a large Northeastern city using a cluster randomized controlled design in 18 elementary, middle, and high schools. In a single year, before the COVID-19 pandemic, and with data from 5878 students, the study found that overall, students in the RP Project schools were less likely to receive a discipline incident record (11.1%) as compared to students in the comparison schools (18.2%). However, differential treatment effects based on sex, race/ethnicity, and disability status were not found. The findings suggest prevention efforts are a cornerstone of practice/policy reforms to reduce the use of exclusionary discipline. Findings also suggest multi-year initiatives are needed to address discipline disparities.

Postoperative Hypotension and Adverse Clinical Outcomes in Patients Without Intraoperative Hypotension, After Noncardiac Surgery.

BACKGROUND: Postoperative hypotension (POH) is associated with major adverse events. However, little is known about the association of blood pressure thresholds and outcomes in postoperative patients without intraoperative hypotension (IOH) on the general-care ward. We evaluated the association of POH with major adverse cardiac or cerebrovascular events (MACCE) in patients without IOH. METHODS: This retrospective analysis included 67,968 noncardiac patient-procedures (2008-2017) for patients discharged to the ward with postoperative mean arterial pressure (MAP) readings, managed for ≥48 hours postsurgery, with no evidence of IOH. The primary outcome was 30-day MACCE evaluated by postoperative MAP thresholds: ≤75, ≤65, and ≤55 mm Hg (POH defined as a single measurement below threshold). Secondary outcomes included all-cause mortality (30-/90-day), 30-day acute myocardial infarction, 30-day acute ischemic stroke, 30-day readmission, 7-day acute kidney injury, and 30-day readmission. Associations between POH and adverse events were also evaluated in a cohort (#2) of 16,034 patient-procedures with IOH (intraoperative MAP ≤65 mm Hg). RESULTS: In patients without IOH, exposure to POH was not associated with MACCE at any investigated MAP threshold (P < .016 was considered significant: ≤75 mm Hg, hazard ratio [HR] 1.18 [98.4% confidence interval {CI} 0.99-1.39], P = .023; ≤65 mm Hg, HR 1.18 [0.99-1.41], P = .028; ≤55 mm Hg, HR 1.23 [0.90-1.71], P = .121); however, associations were observed at all MAP thresholds for secondary outcomes of acute kidney injury and 30-day readmission, for 30-/90-day mortality for MAP ≤65 mm Hg, and 90-day mortality for MAP ≤55 mm Hg, compared to those without POH. No associations were detected between POH and secondary outcomes of acute ischemic stroke or acute myocardial infarction at any MAP threshold. No interaction between POH and IOH was found when we evaluated the association of POH on outcomes in the data set including all patients, regardless of IOH status (P values for interaction terms nonsignificant). When the interaction term was utilized, the association between POH without IOH and MACCE was significant for MAP ≤75 mm Hg (HR 1.20 [1.01-1.41]) and MAP ≤65 mm Hg (HR 1.21 [1.02-1.45]), but not MAP ≤55 mm Hg. Cohort #2 (POH with IOH) showed largely similar results for MACCE: not significant for MAP ≤75 and ≤65 mm Hg, but significant for MAP ≤55 mm Hg (HR 1.53 [1.05-2.22], P = .006). CONCLUSIONS: POH in patients without IOH was not associated with MACCE at any MAP investigated. No interaction was identified between POH and IOH. Large prospective randomized trials are necessary to develop better evidence and inform clinicians the value of postoperative blood pressure management.

Intraoperative Hypotension Is Associated With Adverse Clinical Outcomes After Noncardiac Surgery.

BACKGROUND: Intraoperative hypotension (IOH) occurs frequently during surgery and may be associated with organ ischemia; however, few multicenter studies report data regarding its associations with adverse postoperative outcomes across varying hemodynamic thresholds. Additionally, no study has evaluated the association between IOH exposure and adverse outcomes among patients by various age groups. METHODS: A multicenter retrospective cohort study was conducted between 2008 and 2017 using intraoperative blood pressure data from the US electronic health records database to examine postoperative outcomes. IOH was assessed in 368,222 noncardiac surgical procedures using 5 methods: (a) absolute maximum decrease in mean arterial pressure (MAP) during surgery, (b) time under each absolute threshold, (c) total area under each threshold, (d) time-weighted average MAP under each threshold, and (e) cumulative time under the prespecified relative MAP thresholds. MAP thresholds were defined by absolute limits (≤75, ≤65, ≤55 mm Hg) and by relative limits (20% and 40% lower than baseline). The primary outcome was major adverse cardiac or cerebrovascular events; secondary outcomes were all-cause 30- and 90-day mortality, 30-day acute myocardial injury, and 30-day acute ischemic stroke. Residual confounding was minimized by controlling for observable patient and surgical factors. In addition, we stratified patients into age subgroups (18-40, 41-50, 51-60, 61-70, 71-80, >80) to investigate how the association between hypotension and the likelihood of major adverse cardiac or cerebrovascular events and acute kidney injury differs in these age subgroups. RESULTS: IOH was common with at least 1 reading of MAP ≤75 mm Hg occurring in 39.5% (145,743) of cases; ≤65 mm Hg in 19.3% (70,938) of cases, and ≤55 mm Hg in 7.5% (27,473) of cases. IOH was significantly associated with the primary outcome for all age groups. For an absolute maximum decrease, the estimated odds of a major adverse cardiac or cerebrovascular events in the 30-day postsurgery was increased by 12% (95% confidence interval [CI], 11-14) for ≤75 mm Hg; 17.0% (95% CI, 15-19) for ≤65 mm Hg; and by 26.0% (95% CI, 22-29) for ≤55 mm Hg. CONCLUSIONS: IOH during noncardiac surgery is common and associated with increased 30-day major adverse cardiac or cerebrovascular events. This observation is magnified with increasing hypotension severity. The potentially avoidable nature of the hazard, and the extent of the exposed population, makes hypotension in the operating room a serious public health issue that should not be ignored for any age group.

Student Self-Reported Positive Purpose Over Two Years in Urban Middle Schools.

We used Developmental Systems Theory as a framework for understanding the role of contextual factors in the development of purpose in urban adolescents. The sample included primarily low-socioeconomic students of color attending urban middle schools (n = 2,629; 10-16 years of age). Longitudinal data were collected at four time points across two years. We used hierarchical linear modeling to model change in purpose. On average, purpose declined over time. We also identified several predictors of intercept and slope. For example, Black youth had a higher average purpose intercept, as well as a steeper average decline than other racial/ethnic groups. Females demonstrated a higher average purpose intercept than males, but this effect disappeared when academic achievement was added to the model.

What determines do-not-resuscitate status in critically ill HIV-infected patients admitted to ICU?

PURPOSE: To identify factors associated with do-not-resuscitate (DNR) status in critically ill patients infected with human immunodeficiency virus (HIV) admitted to the Intensive Care Unit (ICU) in the era of combination antiretroviral therapy (cART). MATERIALS AND METHODS: Retrospective cohort study of first-time admissions of HIV-infected patients to ICUs in Edmonton, Alberta, from 2002 to 2014. Multivariable logistic regression analysis was performed to identify factors associated with DNR status. RESULTS: There were 282 HIV-infected patients with first-time ICU admissions, with an incidence rate of 6.6 per 1000 ICU admissions. Sixty-seven (24%) patients had a DNR designation and support was withdrawn in 37 (13%). In multivariable analysis, APACHE II score (OR 1.13; 95% CI, 1.08-1.19, p < 0.001), coronary artery disease (OR 5.70; 95% CI, 1.18-27.76, p = 0.031), prior opportunistic infection (OR 2.59; 95% CI, 1.20-5.57, p = 0.015) and duration of HIV infection (OR 1.07 per year; 95% CI, 1.01-1.14, p = 0.025) were independently associated with DNR status. Ethnicity, HIV risk factors, CD4 count and viral load were not associated with DNR status. CONCLUSIONS: One in four patients had a DNR designation. Illness acuity, selected comorbidity, previous opportunistic infection and HIV duration were associated with DNR designation.

Focused Classroom Coaching and Widespread Racial Equity in School Discipline.

We examined the effects of a teacher coaching program on discipline referrals using records from 7,794 secondary U.S. classrooms. Some classroom teachers took part in a trial: They were randomized to receive intensive coaching in a focal classroom or to form a business-as-usual control group. The remaining teachers taught in the same schools. Previous research suggested that the coaching program was associated with increasing equity in discipline referrals in focal coached classrooms (Gregory et al., 2016). The current study addressed the generalizability of effects from teachers' focal coached classrooms to diverse classrooms in their course load. Results suggested that the coaching program had no generalized effects on reducing referrals with African American students or racial referral gaps in classrooms with coached teachers, relative to the control teachers and the other teachers in the schools. We offer implications for coaching programs and directions for equity-oriented efforts to reduce racial discipline gaps.

Perceptions of Relatedness with Classroom Peers Promote Adolescents' Behavioral Engagement and Achievement in Secondary School.

Secondary school is a vulnerable time where stagnation or declines in classroom behavioral engagement occur for many students, and peer relationships take on a heightened significance. We examined the implications of adolescents' perceptions of relatedness with classroom peers for their academic learning. Participants were 1084 adolescents (53% female) in 65 middle and high school classrooms. Multilevel cross-lagged path analyses found that adolescents' perceived relatedness with classroom peers subsequently predicted their increased self-reported behavioral engagement in that classroom from fall to winter and again from winter to spring. Higher engagement in spring predicted higher end of year objective achievement test scores after statistical control of prior year test scores. Implications are discussed for increasing classroom peer relatedness to enhance adolescents' achievement.

The Relationship between Body Mass Index and the Severity of Coronary Artery Disease in Patients Referred for Coronary Angiography.

Background and Aim. Obesity is associated with an increased risk of cardiovascular disease and may be associated with more severe coronary artery disease (CAD); however, the relationship between body mass index [BMI (kg/m2)] and CAD severity is uncertain and debatable. The aim of this study was to examine the relationship between BMI and angiographic severity of CAD. Methods. Duke Jeopardy Score (DJS), a prognostic tool predictive of 1-year mortality in CAD, was assigned to angiographic data of patients ≥18 years of age (N = 8,079). Patients were grouped into 3 BMI categories: normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30 kg/m2); and multivariable adjusted hazard ratios for 1-year all-cause and cardiac-specific mortality were calculated. Results. Cardiac risk factor prevalence (e.g., diabetes, hypertension, and hyperlipidemia) significantly increased with increasing BMI. Unadjusted all-cause and cardiac-specific 1-year mortality tended to rise with incremental increases in DJS, with the exception of DJS 6 (p < 0.001). After adjusting for potential confounders, no significant association of BMI and all-cause (HR 0.70, 95% CI .48-1.02) or cardiac-specific (HR 1.11, 95% CI .64-1.92) mortality was found. Conclusions. This study failed to detect an association of BMI with 1-year all-cause or cardiac-specific mortality after adjustment for potential confounding variables.

Depressive symptomatology after spinal cord injury: A multi-center investigation of multiple racial-ethnic groups.

OBJECTIVE: To identify (1) racial-ethnic differences in depressive symptomatology after spinal cord injury (SCI) and (2) the relationship of multiple additional factors to depressive symptoms, including health behaviors, employment, fatigue, and pain interference. DESIGN: Cross-sectional Setting: Data were collected at 3 specialty hospitals in different regions of the USA (Southeastern, Mountain, Western). PARTICIPANTS: Participants (N = 1,063) were identified from outpatient records of the 3 hospitals with oversampling of racial-ethnic minority groups. INTERVENTIONS: N/A Main Outcome Measure(s): The outcome, depressive symptomatology, was measured by the Older Adult Health and Mood Questionnaire (OAHMQ). Participant demographic and injury characteristics were measured as statistical controls, as well as other variables including health behavior factors, depression/stress relief medication usage, fatigue, and pain interference. The multivariate analyses were developed using OLS regression models and logistic regression models. RESULTS: Employment was protective for depressive symptomatology, whereas fatigue, pain interference, and binge drinking were risk factors for higher OAHMQ scores. Although there were no bivariate racial-ethnic differences in depressive symptoms, fatigue and pain interference had suppression effects on the relationship between race-ethnicity and depressive symptomatology. After controlling for fatigue and pain interference, Hispanic participants had significantly lower OAHMQ scores and lower odds of probable major depression (PMD) than non-Hispanic Whites and Blacks. CONCLUSIONS: Fatigue and pain interference are associated with both race-ethnicity and depressive symptomatology. Assuming the same level of fatigue and pain interference, Hispanics will have a lower risk of depressive symptoms than non-Hispanic Whites and Blacks.

Impact of Body Mass Index on Short-Term Outcomes in Patients Undergoing Percutaneous Coronary Intervention in Newfoundland and Labrador, Canada.

Background and Aim. Obesity (BMI ≥ 30 kg/m(2)) is associated with advanced cardiovascular disease requiring procedures such as percutaneous coronary intervention (PCI). Studies report better outcomes in obese patients having these procedures but results are conflicting or inconsistent. Newfoundland and Labrador (NL) has the highest rate of obesity in Canada. The aim of the study was to examine the relationship between BMI and vascular and nonvascular complications in patients undergoing PCI in NL. Methods. We studied 6473 patients identified in the APPROACH-NL database who underwent PCI from May 2006 to December 2013. BMI categories included normal, 18.5 ≤ BMI < 25.0 (n = 1073); overweight, 25.0 ≤ BMI < 30 (n = 2608); and obese, BMI ≥ 30.0 (n = 2792). Results. Patients with obesity were younger and had a higher incidence of diabetes, hypertension, and family history of cardiac disease. Obese patients experienced less vascular complications (normal, overweight, and obese: 8.2%, 7.2%, and 5.3%, p = 0.001). No significant differences were observed for in-lab (4.0%, 3.3%, and 3.1%, p = 0.386) or postprocedural (1.0%, 0.8%, and 0.9%, p = 0.725) nonvascular complications. After adjusting for covariates, BMI was not a significant factor associated with adverse outcomes. Conclusion. Overweight and obesity were not independent correlates of short-term vascular and nonvascular complications among patients undergoing PCI.

Closing the Racial Discipline Gap in Classrooms by Changing Teacher Practice.

Black students are issued school discipline sanctions at rates higher than members of other racial and ethnic groups, underscoring the need for professional development that addresses this gap. In 86 secondary classrooms, a randomized controlled trial examined the effects of a 2-year teacher coaching program, My Teaching Partner Secondary (MTP-S). Results from the second year of coaching and the year after coaching was discontinued replicated previous findings from the first year of coaching-intervention teachers had no significant disparities in discipline referral between Black students and their classmates, compared to teachers in the control condition, for whom racial discipline gaps remained. Thus, MTP-S effects were replicated in the second year of coaching and maintained when coaching was withdrawn. Mediational analyses identified mechanisms for these effects; Black students had a low probability of receiving disciplinary referrals with teachers who increased skills to engage students in high-level analysis and inquiry.

How teacher emotional support motivates students: The mediating roles of perceived peer relatedness, autonomy support, and competence.

Multilevel mediation analyses test whether students' mid-year reports of classroom experiences of autonomy, relatedness with peers, and competence mediate associations between early in the school year emotionally-supportive teacher-student interactions (independently observed) and student-reported academic year changes in mastery motivation and behavioral engagement. When teachers were observed to be more emotionally-supportive in the beginning of the school year, adolescents reported academic year increases in their behavioral engagement and mastery motivation. Mid-year student reports indicated that in emotionally-supportive classrooms, adolescents experienced more developmentally-appropriate opportunities to exercise autonomy in their day-to-day activities and had more positive relationships with their peers. Analyses of the indirect effects of teacher emotional support on students' engagement and motivation indicated significant mediating effects of autonomy and peer relatedness experiences, but not competence beliefs, in this sample of 960 students (ages 11-17) in the classrooms of 68 middle and high school teachers in 12 U.S. schools.

Deletion of the MC4R gene in a 9-year-old obese boy.

BACKGROUND: The most common monogenic form of obesity is caused by mutations in the melanocortin 4 receptor (MC4R) gene. More than 150 mutations have been reported in the MC4R gene, the majority being point mutations. Most individuals with MC4R gene mutations have early-onset obesity, hyperphagia, and increased longitudinal growth. METHODS: A 9-year-old Caucasian boy was referred to genetics for obesity, food-seeking behavior, and developmental delay. History and physical exam were not consistent with Prader Willi syndrome, but revealed several minor anomalies. Owing to significant obesity and hyperphagia, a Prader Willi syndrome methylation test and a microarray were requested. RESULTS: Methlylation testing for Prader Willi syndrome was normal. Microarray analysis revealed two changes: (1) A 2.6-Mb deletion at chromosome 18q21.31 was identified and contained several OMIM genes, including the MC4R gene, and (2) an 0.87-Mb duplication at chromosome region 16p13.3 was found and contained one gene. Parental samples revealed that the boy's father had the same deletion and duplication. This case appears to be the first with a deletion of 18q21.31 encompassing the MC4R gene presenting with features of hyperphagia and obesity. CONCLUSIONS: Haploinsufficiency of the MC4R gene either through whole gene deletion or nonsense or missense mutations is associated with a significant risk of obesity. The case emphasizes both the role of the MC4R gene in obesity as well as the importance of looking for chromosomal microdeletions/duplications as a cause of obesity in children with minor anomalies or developmental delay.

Focusing on teacher-student interactions eliminates the negative impact of students' disruptive behavior on teacher perceptions.

This study tests the impact of a randomly assigned professional development coaching intervention (MyTeachingPartner-Secondary; MTP-S) on teacher projections of their students' educational attainment. Results indicate that students who report more behavior problems in the Fall of the academic year are projected by teachers to have lower future educational attainment in the Spring of the academic year. However, analyses further indicate that participation in the MTP-S intervention moderates the association between Fall student behavior problems and teachers' Spring projections for student attainment, such that this link is not significant for students in classrooms where the teacher is participating in MTP-S. In fact, results indicate that teachers who participate in the intervention project better educational attainment for their students than teachers who are in a business-as-usual control condition, regardless of their students' behavior. Findings are discussed in terms of the role that interventions targeting classroom interactions may play in altering teachers' internal view of students, thus ultimately promoting adolescent development.

Enhancing Secondary School Instruction and Student Achievement: Replication and Extension of the My Teaching Partner-Secondary Intervention.

My Teaching Partner-Secondary (MTP-S) is a web-mediated coaching intervention, which an initial randomized trial, primarily in middle schools, found to improve teacher-student interactions and student achievement. Given the dearth of validated teacher development interventions showing consistent effects, we sought to both replicate and extend these findings with a modified version of the program in a predominantly high school population, and in a more urban, sociodemographically diverse school district. MTP-S produced substantial gains in student achievement across 86 secondary school classrooms involving 1,194 students. Gains were robust across subject areas and equivalent to moving the average student from the 50th to the 59th percentile in achievement scores. Results suggest that MTP-S can enhance student outcomes across diverse settings and implementation modalities.

EFFECTS OF A PROFESSIONAL DEVELOPMENT PROGRAM ON BEHAVIORAL ENGAGEMENT OF STUDENTS IN MIDDLE AND HIGH SCHOOL.

Student behavioral engagement is a key condition supporting academic achievement, yet student disengagement in middle and high schools is all too common. The current study used a randomized controlled design to test the efficacy of the My Teaching Partner-Secondary program to increase behavioral engagement. The program offers teachers personalized coaching and systematic feedback on teachers' interactions with students, based on systematic observation of videorecordings of teacher-student interactions in the classroom. The study found that intervention teachers had significantly higher increases, albeit to a modest degree, in student behavioral engagement in their classrooms after 1 year of involvement with the program compared to the teachers in the control group (explaining 4% of variance). In exploratory analyses, two dimensions of teachers' interactions with students-their focus on analysis and problem solving during instruction and their use of diverse instructional learning formats-acted as mediators of increased student engagement. The findings offer implications for new directions in teacher professional development and for understanding the classroom as a setting for adolescent development.

Melanin-concentrating hormone receptor 1 polymorphisms are associated with components of energy balance in the Complex Diseases in the Newfoundland Population: Environment and Genetics (CODING) study.

BACKGROUND: The melanin-concentrating hormone receptor 1 (MCHR1) is a G protein-coupled receptor that regulates energy balance and body composition in animal models. Inconsistent effects of MCHR1 polymorphisms on energy homeostasis in humans may partly be attributable to environmental factors. OBJECTIVES: We examined the effect of 4 single nucleotide polymorphisms (rs133073, rs133074, rs9611386, and rs882111) in the MCHR1 gene on body composition as well as energy-related lifestyle factors (diet and physical activity). We also examined the effect of gene-lifestyle interactions on body composition. DESIGN: A total of 1153 participants (248 men and 905 women) from the cross-sectional Complex Diseases in the Newfoundland Population: Environment and Genetics (CODING) study were genotyped by using probe-based chemistry validated assays. Diet and physical activity were estimated by using validated frequency questionnaires, and body composition was assessed by using dual-energy X-ray absorptiometry. RESULTS: Three polymorphisms (rs9611386, rs882111, and rs133073) were associated with differences in body-composition measurements (all P < 0.05). There was an interaction between rs9611386 and carbohydrate intake on total mass and waist circumference (both P ≤ 0.01). There was also an interaction between rs9611386 and body mass index categories (normal weight, overweight, and obese) on energy intakes (P = 0.02). A similar interaction was shown with rs882111 (P = 0.02). Interactions were also observed between each of these polymorphisms (rs9611386, rs882111, and rs133073) and physical activity score on body-composition measurements (all P < 0.05). CONCLUSION: These findings suggest that polymorphisms in the MCHR1 gene are associated with differences in body composition and interact with physiologic and energy-related lifestyle factors.

It takes a village: the effects of 10th grade college-going expectations of students, parents, and teachers four years later.

Adolescents are surrounded by people who have expectations about their college-going potential. Yet, few studies have examined the link between these multiple sources of college-going expectations and the actual status of students in postsecondary education years later. The study draws on data collected in the 2002-2006 Educational Longitudinal Study and employs an underutilized statistical technique (cross-classified multilevel modeling) to account for teacher reports on overlapping groups of students (typical of high school research). Results showed that positive expectations of students, parents, English, and mathematics teachers in the 10th grade each uniquely predicted postsecondary status 4 years later. As a group, the four sources of expectations explained greater variance in postsecondary education than student characteristics such as socioeconomic status and academic performance. This suggests positive expectations are additive and promotive for students regardless of their risk status. Teacher expectations were also found to be protective for low income students. Implications for future expectancy research and equity-focused interventions are discussed.

Bullying climate and school engagement in ninth-grade students.

BACKGROUND: Many authorities agree that bullying has a widespread impact on school climate, affecting bystanders as well as victims. This study tested the contention that a climate of bullying can have a schoolwide impact on student engagement in school. METHODS: Hierarchical linear modeling assessed the relations between student perception of bullying climate and student engagement at the individual and school level in a statewide sample of 7058 ninth graders randomly selected from 289 schools participating in the Virginia High School Safety Study. Student engagement was assessed by self-report scales measuring commitment to school and involvement in school activities. RESULTS: Individual differences in perception of school climate characterized by bullying were associated with lower commitment to school, but not less involvement in school activities. School-level differences in student perceptions of bullying climate were associated with both lower commitment to school and less involvement in school activities, after controlling for the effects of gender, race, school size, proportion of ethnic minority students in the school, and individual-level perception of bullying climate. CONCLUSION: Efforts to improve student engagement should consider the schoolwide impact of bullying on all students.