Over the last decade, multiple therapies have become available providing effective, actionable treatment options for Non–Small Cell Lung Cancer (NSCLC) patients targeting biomarkers such as ALK, EGFR, and PD-L1. This has brought the promise of Precision Medicine to NSCLC patients where treatment of NSCLC continues to be more biomarker-driven with increasing targeted therapies available to patients testing positive for various biomarkers. We assessed the US testing landscape and testing behaviors for EGFR, ALK, and PD-L1 (NCCN category 1 NSCLC biomarkers) at diagnosis to uncover trends in biomarker testing.

Abstract Introduction Pediatric positive airway pressure (PAP) therapy can be challenging for children and their parent/guardian (PG). These challenges are complicated by the need to facilitate behavioral competency in the management of both device equipment and therapy. Methods As part of a larger quality management project aimed to improve PG and patient satisfaction we developed a targeted education visit provided by registered nurses prior to PAP trial initiation. Principle aims were to measure satisfaction with education and increase PG confidence in ability to manage therapy. The nurse session included: education on Obstructive Sleep Apnea (OSA) and PAP therapy, development of plan for first month of therapy, concepts of desensitization, regular practice, discussion and identification of concerns (assessment of barriers to implementation). A survey was administered pre-intervention to assess PG confidence in ability to manage therapy. Post-intervention, PG rated the interventions impact on baseline confidence, as well as an assessment of satisfaction with the education and content. Descriptive statistics were utilized to summarize the Likert survey questions. Results A total of 21of 25 (84%) participants completed surveys. 100% of PG that responded was either extremely satisfied or very satisfied with the educational intervention. Prior to the intervention, 19% (N4) indicated little to no confidence, 19% (N4) indicated some confidence and 62% (N13) indicated being very confident. 62% (N13) of PG’s indicated the information covered was new to them, while 24% (N5) indicated some information was new and 14% (N3) indicated none of the information was new. Regardless of baseline confidence, 100% (N21) responded that the intervention further improved confidence to a great degree. Conclusion The nurse visit resulted in high satisfaction with care and education and impacted PG confidence in ability to implement treatment. Future studies are needed to determine the impact on patient compliance. Support

In this study we measured the impact of a professional development model that included directive coaching on the instructional practices of Western Australian primary school teachers taking up explicit instruction. We developed and validated protocols that enabled us to measure teachers' fidelity to the salient elements of explicit instruction and interviewed participants about the impact of the coaching program on student learning, their feelings of self-efficacy and attitudes to being coached. Numerical scores to indicate teachers' demonstration of explicit instruction lesson design and delivery components changed positively over the five observed lessons and directive coaching had a positive impact on teachers' competence and confidence. The elements of the coaching process that the teachers found valuable were the coach's positive tone, the detailed written feedback, and the specificity, directness and limited number of the suggestions. Implications for schools with reform-based agendas wanting to change teachers' instructional practices through instructional coaching are discussed.

Follow-up care of obstructive sleep apnea and positive airway pressure (PAP) therapy has become increasingly complicated due to regulatory requirements and the paucity of primary providers who are capable of managing long-term PAP therapy. We present a multidisciplinary approach to chronic care for stable PAP users. We utilized the Plan-Do-Study-Act (PDSA) process to develop a multidisciplinary follow-up clinic to meet regulatory requirements and quality measures for the care of long term stable PAP users. A validated screening process identified eligible patients to be scheduled in the clinic. Up to 5 patients were scheduled for each 15 minute block, with a maximum of 20 patients scheduled for the 90 minute clinic. The clinic was staffed by a physician or NP/PA who conducted face-to-face visits when required, and provided supervision for the 3 registered nurses who assessed PAP patients, renewed prescriptions, and adjusted PAP therapy via established protocols. The nurse visit assessed PAP downloads, weight, blood pressure, Epworth, Promis10, and offered weight management counseling, if indicated. A sleep technologist provided interface optimization when needed. Patients completed satisfaction surveys after the visit. Surveys were distributed to 130 consecutive patients seen in our Collaborative Care Clinic. Of the 68 (52%) respondents, 57 (84%) rated satisfaction at 9 or 10, with 10 being extremely satisfied, and 58 (85%) indicated they would prefer this visit type in the future. Clinical encounter time for follow-up of stable PAP patients was reduced 66%. Qualitative survey results reflected themes of satisfaction with short wait times, ability to obtain an expeditious appointment, appreciation of the team approach, and educational reinforcement. The collaborative care visit model has customized our ongoing care options to better meet the needs of established PAP therapy users while maximizing time efficiency and patient satisfaction. Support (If Any):

Patients experience disturbed and poor quality sleep during hospitalization that correlates with negative outcomes and poor patient satisfaction. We report outcomes from focused sleep enhancement interventions on a medical inpatient unit. Based upon sleep improvement opportunities identified via patient survey, we implemented a project with two principle aims (1) Develop a standard “sleep rounding” process to anticipate and meet patient’s individual sleep preferences, and (2) improve the competency of the care team to address sleep complaints via specific sleep education and enhancement protocols. Five interventions were designed and then underwent Plan, Do, Study, Act (PDSA) cycles. These included: a sleep enhancement video viewed upon admission, a sleep enhancement menu/whiteboard, poster highlighting sleep enhancement items in hallway, workflow adjustments to minimize disruption of sleep, and a staff sleep education program. The program effectiveness was evaluated via pre-discharge patient-completed surveys. In addition, a survey was completed by staff implementing the project. 80 patients completed surveys after final version implementation. 99% of patients endorsed receiving the sleep enhancement interventions. Of these, 96% felt the sleep menu was helpful. The most requested interventions included warm blankets, guided imagery, aromatherapy, backrubs, and fans. 30% of patients utilized television or tablet in addition to sleep menu offerings. Nurse survey (N=16) results reflected 69% felt the sleep enhancement offerings were beneficial and 38% perceived a reduction in call lights or patient complaints about sleep. The sleep education video and enhancement menu was well received by patients. Patients were resistant to trying unfamiliar sleep enhancement techniques during acute hospitalization, often reverting to coping utilized for sleep at home. Patient satisfaction was positive with the program even if sleep quality was perceived as poor. This implies focused interventions to promote sleep can be drivers to patient satisfaction during hospitalization, possibly even if sleep quality remains suboptimal. The authors express gratitude to the Mayo Center for Innovation (CFI) which funded the project via a CoDE Innovation Award.

David Bertelsen recently published an essay (Bertelse n 2014) discussing some methodological aspects of plant ecology. The methods he addresse d hav long been debated in the ecological literature and there is no need to comment on them here. However, his essay also critiqued our recent paper on plant distributions and climate change in the Santa Catalina Mountains (Brusca et al. 2014) and, incidentally, also the work of Robert Whittake r and William Niering (Whittaker & Niering 1964; Whittaker 1967). We feel that Mr. Bertelsen’s s ummary of our paper was inaccurate and misleading, and we take this opportunity to correct his misunderstanding of our work.

Vocabulary knowledge is an important predictor of literacy and broader academic outcomes, and children's literature is a rich source of sophisticated vocabulary. This study investigated the effect of providing instruction in word meanings as an adjunct to story-book read-aloud sessions in Grade One classrooms. The main intervention programme ran for 18 weeks over three terms in low socio-economic status (SES) schools. Two intervention models incorporating explicit instruction components were compared with existing classroom practice. Teaching a greater number of word meanings more briefly was contrasted with teaching fewer words in greater depth. Pre- and post-instruction vocabulary knowledge was assessed using curriculum-based assessments. Both explicit approaches were more effective in improving word learning than a traditional constructivist approach. Increased intensity of instruction resulted in better learning for individual words. There was no discernible carryover to scores on standardised vocabulary tests.

RATIONALE: Identifying barriers to dietary adherence in food-allergic children is necessary for improving dietary counseling. The aim of this study was to identify barriers to and factors contributing to dietary adherence in a specific population of children with Eosinophilic Gastrointestinal Diseases. METHODS: An IRB approved self-administered questionnaire focusing on barriers to dietary adherence was administered to consenting participants at the American Partnership for Eosinophilic Disorders patient symposium in July 2010. RESULTS: Participants completing the questionnaire were primarily parents (93%) of food-allergic children (7% were adolescents). Results described the experiences of 45 children (69% males, ages 1-18 years) with multiple food allergies (96% with >1 food allergy). Self-reported levels of dietary adherence varied with 37% reporting not always following the diet. Adherence was not associated with the number of food allergies (NS). Most dietary instruction was provided by physicians (69%) and 44% did not receive any education from a dietitian. Patients who did not follow the diet tended to be older (NS) and not supported in school (p<0.027). Participants reported seeking diet support online (85%), through community (46%) and were least likely to seek support through their faith community (6%) or school (3%). Membership in support groups tended to correlate with dietary adherence (NS). CONCLUSIONS: A potential barrier to dietary adherence is absence of education from dietitians. Education from dietitians may be a potential avenue for improvement to care of food-allergic children.

RATIONALE: EoE has a great impact on affected children's qol and that of their families. However, the specific determinants of decreased qol for youth or their families are unknown. METHODS: Baseline data from a longitudinal follow-up study were examined for 54 youth and their parents evaluated at a tertiary care referral center. We used a symptom questionnaire and the parent proxy, child self-report and family impact modules of the PedsQL (100-point scales, high scores indicate better qol). Chi square and t-tests were used to test relationships. RESULTS: Subjects were 2-18 years old (x=9.0, SD=4.8), 64% male and 88% Caucasian. Forty-one (76%) had an EoE diagnosis and 13 (24%) had indeterminate esophagitis. There was no difference in symptom pattern or in qol levels for patients regardless of EoE diagnosis. Self-report total PedsQL scores (n=40) were significantly lower for children with nausea (69.1, SD=11.5 vs. 78.3, SD=12.5; p<0.03) and with vomiting (64.3, SD=11.0 vs. 79.2, SD=11.0; p<0.0005) when compared with patients without those symptoms. Parent proxy PedsQL total scores were significantly lower for children with vomiting (60.6, SD=18.6 vs. 73.9, SD=16.2; p<0.04) and also anorexia/early satiety (59.6, SD=19.1 vs. 74.8, SD=15.2; p<0.02). Family Impact total scores were significantly lower for children with anorexia/early satiety (61.4, SD=19.6 vs. 71.9 SD=16.4; p<0.04). CONCLUSIONS: Self-reports by pediatric patients indicate that symptoms of nausea and vomiting strongly impact their qol. Parents also report the negative impact of vomiting on their children's qol. However, they believe that anorexia/early satiety also impacts their children's qol and strongly impacts the family's qol.

Children with weak oral language skills are at risk of experiencing difficulty with early literacy acquisition. Intensive small group intervention during the preprimary year has the potential to improve children's success in developing emergent literacy skills. Education assistants are a potentially powerful resource for supporting students at educational risk. In this study, education assistants at four schools were trained to provide a daily half-hour emergent literacy program to pre-primary students with low oral language skills. The program focused on developing phonological awareness, letter-sound knowledge and vocabulary using both explicit and in-context (embedded) learning activities. The students undertaking the program made significant gains on early language and literacy measures. Case studies are presented that illustrate the strengths and limitations of the intervention for children and schools.

Shelley Mehigan, Wendy Moore and Linda Hayes argue for nationally recognized standards in training for sexual and reproductive health care

©FSRH J Fam Plann Reprod Health Care 2010: 36(1) Background Since the demise of the National Boards in 2002, the quality of post-registration nurse education has become unacceptably variable. At its worst, it lacks structure, does not meet required standards and in some places is nonexistent. The days of employing nurses who have a nationally recognised post-registration qualification in sexual and reproductive health (SRH) are long gone. What we have now is a mishmash of different courses, at variable levels, spread intermittently across the UK. How can we rectify the current situation? The arrival of e-learning and the revision of the Diploma of the Faculty of Sexual and Reproductive Healthcare (DFSRH)1 provide us with an opportunity to revolutionise post-registration nurse training in this field. Many of us remember the ‘901’. Of course, there were many incarnations of this nationally recognised family planning course, ranging from the Family Planning Association Certificate, JBCNS 900, 901 to the later 8103. The standards set by these courses enabled a practice or clinic in each of the four UK countries to know what they were getting when they employed a family planning trained nurse. Initially the standards survived the move that nurse education took into universities and higher education institutions (HEIs), where the new diploma and degree courses were built around the existing, recognised clinical curricula. Career progression became dependent on having a degree when it was still unusual for pre-registration nursing courses to be at degree level. Post-registration courses at degree level were developed to enable nurses to progress in their careers. They have become less important now more pre-registration nurse education is at degree level (and will become the norm in the future). The current situation in nurse education was precipitated by the changes in nurse administration that took place in 2002. As in the medical profession, there have been different organisations, which have been responsible for different elements in nursing such as professional registration, indemnity insurance, union representation, and education. In 1983, the United Kingdom Central Council (UKCC) replaced the GNC (General Nursing Council) as having responsibility for nurse registration issues. At this time all education issues became the Nurse training in sexual and reproductive health

Love and Marriage in 18th-Century Britain Wendy Moore (bio) William Hogarth graphically depicted the pitfalls of arranged marriage in his cautionary cartoon series Marriage à-la-mode, published in 1745. Samuel Johnson famously described second marriages as the "triumph of hope over experience." The Georgians' fixation with wedlock was no accident. The secret of a successful marriage was one of the most hotly debated topics in the salons and coffee-houses of 18th-century England, and the outcome of this febrile discourse set the tone for our modern-day Western approach to marriage based on the ideal of a harmonious, companionable partnership founded in mutual love.1 The shift in ideas about marriage was profound. At the beginning of the 18th century most marriages among landed or moneyed families were essentially financial arrangements designed to cement powerful alliances and exchange or acquire land and property. Although people in working-class and agricultural communities were more or less free to choose their own partners for life—albeit generally within the same narrow economic group and geographical area—the vast majority of marriages among aristocratic, wealthy, and middle-class families were arranged by parents with the prospective bride and bridegroom having little or no say. Children were often betrothed in infancy and married in their teens, frequently to partners they barely knew and sometimes with disastrous consequences. Lord Halifax in his Advice to a Daughter, published in 1688, made the prospects plain when he explained: "It is one of the Disadvantages belonging to your Sex, that young Women are seldom permitted to make their own Choice."2 But if Lord Halifax—and presumably his daughter—was prepared to accept such an arrangement, others were not. In a scathing indictment of marriage published in 1700, the writer Mary Astell demanded to know: "If Marriage be such a blessed State, how comes it, may you say, that there are so few happy marriages?"3 She remained a spinster. When the 23-year-old Lady Mary Pierrepont was betrothed by her father in 1712 to an Irish aristocrat she had never met, she described her wedding arrangements as "daily preparations for my journey to Hell."4 Rather than descend into eternal torment, she eloped and married her lover, Edward Wortley Montagu, just days before the planned ceremony. Click for larger view View full resolution From William Hogarth's Marriage à-la-mode, "The Toilette Scene," 1745. Library of Congress, Prints and Photographs Division [reproduction number, LC-USZ62-112875]. As a growing number of thwarted young lovers voted with their feet, so criticism of arranged marriages increased during the first half of the 18th century. Hogarth's popular series of six scenes, which depict the tragic outcome of a marriage contracted by money-grasping parents and silver-tongued lawyers between a debauched young earl and the daughter of a rich merchant, reflected the mood. The writer Hester Chapone characterized such matches as "Smithfield bargains," in reference to the famed London meat market, and exclaimed, "so much ready money for so much land, and my daughter flung in into the bargain!"5 At the same time, the emphasis on self-expression, free will, and personal feelings in early 18th-century novels such as Daniel Defoe's Roxana (1724) and Samuel Richardson's Pamela (1740) was blamed for undermining the concept of arranged marriages and fueling expectations of romantic love.6 Whether the rising popularity of novels really influenced views on marriage or simply reflected changing opinion can probably never be determined. But certainly the former was the perception among disapproving older generations. François Fénelon, Archbishop of Cambray, in his Instructions for the Education of a Daughter, translated into English in 1713, warned of the dangers of girls reading "romances" and then being "astonished, not to find in the World real Persons, who may answer to these Romantick Heroes."7 Pressure from disgruntled parents, cheated out of advantageous matches by runaway couples, eventually led to the 1753 Marriage Act. Regulating marriage by the state for the first time in England with a series of rules standardizing weddings, the act stipulated that parental consent was required for couples wishing to marry under the age of 21. Undeterred, many...