bluuebunny/crossref_metadata_2025 huggingface dataset:
Utah's School Counseling Data Projects: A Statewide Initiative
Authors: Bitner Kathryn S. , Kay-Stevenson Dawn , Burnham Brent , Whitely Adele , Whitaker Annette B. , Sachse Tom
Published: September 2018

The statewide Utah Model for Comprehensive Counseling and Guidance: K-12 Programs (Utah State Office of Education, 2008) began implementation in 1988. Beginning with the 2004-2005 school year, data collection has been required for all schools collecting program funds. This article reviews research data from three Utah schools–-one elementary school, one junior high school, and one high school. Each review details the intended behavior, desired results, guidance activity, evaluation method, and study results. A brief history of Utah's comprehensive counseling and guidance program is provided and specific recommendations for districtwide or statewide data collection are provided.
Evaluating a Small-Group Counseling Program—A Model for Program Planning and Improvement in the Elementary Setting
Authors: Bostick Dee , Anderson Ron
Published: September 2018

School counselors are under increasing pressure to evaluate their programs in a manner consistent with teachers and other educators. A small-group counseling intervention was used by a school counselor as part of a three-level program planning initiative that illustrated best research practices to evaluate program outcomes. Forty-nine third-grade students with social skills deficits participated in a 10-week social skills intervention. Results indicated that children participating in the intervention experienced reduced loneliness and social anxiety as well as improved academic achievement. Implications for school counselors conducting evaluations in a practical and time-efficient manner are discussed.
Closing the Gap: A Group Counseling Approach to Improve Test Performance of African-American Students
Authors: Bruce Angelia M. , Getch Yvette Q. , Ziomek-Daigle Jolie
Published: September 2018

This article evaluated the impact of a group counseling intervention on African-American students’ achievement rates during the spring administration of high-stakes testing at a rural high school in Georgia. Eighty percent ofeligible students who participated in the intervention received passing scores on the four sections tested during the spring administration of the Georgia High School Graduation Tests (GHSGT), and all participating students received passing scores on the English Language Arts and Math sections of the GHSGT. Additionally, the achievement gap between African-American students and White students on the Enhanced Math narrowed during the 2007-2008 testing period, with 63.2% of African-American students achieving pass rates as compared to 70.5% of White students. The pass rate increased from the 38.7% pass rate among African-American students from the previous school year, indicating that the intervention was successful in improving pass rates on high-stakes testing. Implications for professional school counselors include utilizing the practice of group counseling and disaggregating data to promote achievement among underachieving student subsets.
Advocacy and Impact: A Comparison of Administrators’ Perceptions of the High School Counselor Role
Authors: Dodson Tammy
Published: September 2018

This article compares administrators’ perceptions of the high school counselor role in a Recognized ASCA Model Program (RAMP) versus the perceptions that administrators had of the high school counselor role in counseling departments that had not received the RAMP designation. An analysis of the data revealed that administrators from both RAMP and non-RAMP designated counseling programs had both positive and negative perceptions of the appropriate and inappropriate roles of the school counselor role. The most significant finding in the administrator perceptions was that RAMP administrators viewed their school counselors as having a significant role in collaborating with teachers to present guidance curriculum lessons.
At-Risk Ninth-Grade Students: A Psychoeducational Group Approach to Increase Study Skills and Grade Point Averages
Authors: Kayler Holly , Sherman Jamie
Published: September 2018

The purpose of this article is to describe a large-scale psychoeducational study skills group for ninth-grade students whose academic performance is in the bottom 50 percent of their class. The ASCA National Model® (American School Counselor Association, 2005) was used as a framework for development, delivery, and evaluation. The authors found that a small-group counseling intervention strengthened studying behaviors as measured by pretest-posttest design. Additional results include promoting school counselor visibility and increasing and improving school counselor relationships with students, parents, and other stakeholders.
Promoting Cultural Responsiveness and Closing the Achievement Gap with Standards Blending
Authors: Schellenberg Rita , Grothaus Timothy
Published: September 2018

In this article, standards blending–-the integration of core academic and school counseling standards–-is demonstrated as a culturally responsive strategy to assist in closing the achievement gap for a group of third-grade African American males. The small-group intervention described resulted in knowledge gains in both the school counseling and academic curriculum content areas. All participants also reported experiencing increased self-esteem.
The Impact of Positive Behavior Support to Decrease Discipline Referrals with Elementary Students
Authors: Sherrod Maria Dunn , Getch Yvette Q. , Ziomek-Daigle Jolie
Published: September 2018

The study in this article was designed to examine the outcomes of positive behavior support approaches at a Southeastern suburban elementary school that had been experiencing increased discipline referrals. School-wide initiatives were implemented as well as a support group for targeted students. Post-intervention data indicated that behavioral referrals decreased. Additionally, the positive behavior ratings reported by teachers increased for most of the children who participated in the support group. After participating in the intervention, 60% of those students participating in the support group reduced their discipline referrals to zero.
The Brotherhood: Empowering Adolescent African-American Males toward Excellence
Authors: Wyatt Shelby
Published: September 2018

A review of the literature reveals that African-American males do not achieve at the same academic levels as their White counterparts. This article reports the effectiveness of a school-based male mentoring program established by a professional school counselor in an urban high school that formed a relationship of support for male students enhancing academic achievement. The program incorporates the principles of the ASCA National Model®, empowerment theory, and Nguzo Saba. Results indicate that participation in a mentoring program can improve student academic achievement and foster personal and social growth and aspirations of success.
Protective Factors Contributing to the Academic Resilience of Students Living in Poverty in Turkey
Authors: Gizir Cem Ali , Aydin Gul
Published: September 2018

This article examines the potential individual characteristics and environmental protective factors that promote academic resilience among impoverished eighth-grade students in Turkey. Study results revealed that home high expectations, school caring relationships and high expectations, and peer caring relationships were the prominent external protective factors that predicted academic resilience. Considering the internal protective factors, the following were positively linked with the academic resilience of adolescents in poverty: havingpositive self-perceptions ahoutone's academic abilities, high educational aspirations, empathic understanding, an internal locus of control, and hope for the future.
Supporting Latino and African-American Students in Advanced Placement Courses: A School Counseling Program's Approach
Authors: Ohrt Jonathan H. , Lambie Glenn W. , Ieva Kara P.
Published: September 2018

Traditionally, Latino and African-American students have been underrepresented in Advanced Placement courses. However, professional school counselors work to remove barriers to all students’ success. This article (a) identifies challenges that Latino and African-American students encounter in accessing Advanced Placement courses, (b) reviews the role of professional school counselors in serving traditionally disenfranchised student populations, and (c) intro-duces a school counseling program's approach to supporting these students and their families.
Using Leader-Member Exchange Theory to Examine Principal–School Counselor Relationships, School Counselors’ Roles, Job Satisfaction, and Turnover Intentions
Authors: Clemens Elysia V. , Milsom Amy , Cashwell Craig S.
Published: September 2018

Principals have considerable influence on shaping the role of school counselors with whom they work (Amatea & Clark, 2005; Dollarhide, Smith, & Lemberger, 2007; Ponec & Brock, 2000). Researchers used leader-member exchange theory (Graen & Uhl-Bien, 1995) to examine the relevance of principal–school counselor relationships to school counselors’ role definition, job satisfaction, and turnover intentions. A path analysis model explained 15% of the variance in how school counselors’ roles are defined at the building level, 49% of the variance in school counselors’ job satisfaction, and 20% of the variance in school counselors’ turnover intentions. Implications for school counseling practice and leadership are provided.
The Girls’ Leadership Experience Camp: A Parallel Process of Leadership Skill Development for School Counselors-in-Training
Authors: Briggs Michele Kielty , Staton A. Renée , Gilligan Tammy D.
Published: September 2018

School counseling programs must provide counselors-in-training with effective and multifaceted leadership skill-building opportunities (Brott, 2006; DeVoss & Andrews, 2006; Dollarhide, Gibson, & Saginak, 2008; Kaffenberger & Murphy, 2007). The Girls’ Leadership Experience Camp (GLEC) was created by the authors to enhance the leadership abilities of local girls while providing a training ground for future school counselors to develop their own leadership abilities. The camp participants included 16 rising sixth-grade girls who were potential first-generation college students and were identified by school personnel as possible leaders. The training experiences were framed using the core qualities and components of the ASCA National Model® (American School Counselor Association, 2005). This article describes the processes and outcomes related to leadership training of future school counselors via the GLEC.
School Counselors’ Strategies for Social Justice Change: A Grounded Theory of What Works in the Real World
Authors: Singh Anneliese A. , Urbano Alessandra , Haston Meg , McMahan Eleanor
Published: September 2018

A qualitative study used a grounded theory methodology to explore the strategies that 16 school counselors who self-identified as social justice agents used to advocate for systemic change within their school communities. Findings included seven overarching themes: (a) using political savvy to navigate power structures, (b) consciousness raising, (c) initiating difficult dialogues, (d) building intentional relationships, (e) teaching students self-advocacy skills, (f) using data for marketing, and (g) educating others about the school counselor role of advocate.
School Counselor Program Choice and Self-Efficacy: Relationship to Achievement Gap and Equity
Authors: Bodenhorn Nancy , Wolfe Edward W. , Airen Osaro E.
Published: September 2018

This article reports the results of a national study of American School Counselor Association members (N = 860). Information includes level of school counselor self-efficacy, type of program, status of achievement gap, and equity in their schools. School counselors with higher self-efficacy were more aware of achievement gap data, and school counselors who indicated a program approach and high self-efficacy were more likely to report narrowing achievement gaps. One fifth reported no awareness of achievement gap data. Implications for school counselors are included.
Predictive Factors in Intensive Math Course-Taking in High School
Authors: Sciarra Daniel T.
Published: September 2018

This article presents a study that investigated factors that distinguish high school students who completed at least one course beyond Algebra 2 from those who completed a course in Algebra 2 or less. The sample included a cohort of 11,909 high school seniors who participated in the Educational Longitudinal Study 2002–2004. Data were analyzed using a multinomial logistic regression and results indicated that student expectations, parent aspirations, race, and socioeconomic status were among the most significant predictors. Implications for school counselors are discussed.
School-Family-Community Partnerships: Applying Epstein's Theory of the Six Types of Involvement to School Counselor Practice
Authors: Griffin Dana , Steen Sam
Published: September 2018

This article investigates school counselor involvement in partnerships using Epstein's six types of school-family-community involvement interactions (i.e., parenting, communicating, volunteering, learning at home, decision-making, and collaborating with the community). Findings show more involvement in parenting and collaborating with the community interactions and reveal a new partnership interaction practiced by school counselors. Recommendations for school counselors and areas for future research are discussed.
The Developmental Assets and ASCA's National Standards: A Crosswalk Review
Authors: Stevens Holly , Wilkerson Kevin
Published: September 2018

This article offers a comprehensive literature review of Developmental Assets™, defined as the positive building blocks that all children and adolescents need to succeed. The article examines the usefulness of the Developmental Assets for a comprehensive, developmental, and strengths-based school counseling program. A crosswalk comparing the Developmental Assets to the American School Counselor Association's National Standards illustrates that the Developmental Assets complement the academic and personal/social domains but lack a substantial career component.
School Counselors and Collaboration: Finding Resources through Community Asset Mapping
Authors: Griffin Dana , Farris Amy
Published: September 2018

Budget cuts in education demand that school counselors learn how to do more with what is presently available, and to collaborate with families and communities to find resources that meet student needs. In an effort to address how school counselors can be proactive in finding needed resources, this article draws on information from various disciplines to explore the utility of community asset mapping. An approach for developing and creating a community asset map is presented.
Use of Group Counseling to Address Ethnic Identity Development: Application with Adolescents of Mexican Descent
Authors: Malott Krista M. , Paone Tina R. , Humphreys Kourtney , Martinez Triana
Published: September 2018

This article provides qualitative outcomes from a group counseling intervention whose goal was to facilitate the ethnic identity development of Mexican-origin youth. Outcomes revealed that participants perceived group participation as meaningful. Themes that emerged from the data included the importance of the relationship to engender change, growth in several aspects of ethnic identity (knowledge of culture, traits, and ethnic pride), and increased relational skills.
The School Counseling Program Implementation Survey: Initial Instrument Development and Exploratory Factor Analysis
Authors: Clemens Elysia V. , Carey John C. , Harrington Karen M.
Published: September 2018

This article details the initial development of the School Counseling Program Implementation Survey and psychometric results including reliability and factor structure. An exploratory factor analysis revealed a three-factor model that accounted for 54% of the variance of the intercorrelation matrix and a two-factor model that accounted for 47% of the variance. Cronbach's alpha reliability estimates for subscales ranged from .79 to .87. Subscales of the instrument may be used to assess ASCA National Model program implementation, programmatic orientation, school counseling services, and school counselors’ use of computer software.
Academically Successful African American Male Urban High School Students’ Experiences of Mattering to Others at School
Authors: Tucker Catherine , Dixon Andrea , Griddine Ke'Shana
Published: September 2018

Mattering to others has been shown to be a key construct of mental health and wellness. Emerging research links interpersonal mattering and school climate. In this study, the authors use transcendental phenomenology to explore how interpersonal mattering impacts the academic achievement of urban African American males who are academically successful in high school. Implications for the integration of this new information in school counseling are discussed.
American Indian Adolescents and Disordered Eating
Authors: Buser Juleen K.
Published: September 2018

School counselors play an important role in identifying and intervening with students struggling with disordered eating (e.g., Bardick et al., 2004). Research has shown that American Indian adolescents report higher rates of certain disordered eating behaviors than other racial groups. The literature on the prevalence and etiology of disordered eating among American Indian adolescents can assist school counselors in gaining understanding of this mental health struggle and can contribute to school counseling prevention and intervention.
Youth Participatory Action Research Groups as School Counseling Interventions
Authors: Smith Laura , Davis Kathryn , Bhowmik Malika
Published: September 2018

Youth participatory action research (YPAR) projects offer young people the opportunity to increase their sociocultural awareness, critical thinking abilities, and sense of agency within a collaborative group experience. Thus far, however, such projects have been primarily the province of educators and social psychologists, and not substantively explored as a basis for school counseling interventions. This article suggests the initiation of such exploration within the framework of existing ecological and social justice models for school counseling practice, and presents an overview of a year-long, school-based YPAR project to exemplify this idea.
Answering the Call: Facilitating Responsive Services for Students Experiencing Homelessness
Authors: Grothaus Tim , Lorelle Sonya , Anderson Kie , Knight Jasmine
Published: September 2018

After a review of the literature elucidating the status quo for students experiencing homelessness, this article shares the results of a mixed methods study. With a phenomenological qualitative emphasis, the mixed methods study explored the perceptions of parents and children experiencing homelessness regarding their academic needs and the services they considered to be helpful. The researchers also examined archival data associated with an after school tutoring program offered at an agency that works with families experiencing homelessness. A paired samples t test indicated a significant difference the number of failed courses for participants in the tutoring program over a one-year period. Difference in grade point average was not significant over the same period of time. The article shares implications and recommendations for practice.
Students Living with Chronic Illness: The School Counselor's Role
Authors: Hamlet Helen S. , Gergar Patricia G. , Schaefer Barbara A.
Published: September 2018

To investigate the current practices of schools and school counselors working with students with chronic illness and the protocols for providing these services, the authors conducted a mixed design, grounded theory study, with an eye toward pinpointing any trends or patterns in service provision. They identified a collaborative, developmental, multisystemic model for working with these students. This article also discusses counselors’ recommendations on how to improve the responsive service delivery process.
Response to Intervention: An Opportunity for School Counselor Leadership
Authors: Ryan Theresa , Kaffenberger Carol J. , Carroll Amy Gleason
Published: September 2018

This article describes a novel implementation of a response to intervention (RTI) model at the elementary school level, with particular focus on the role of the school counselor. The RTI process was used with all K-2 students as a way of delivering research-based best practice to all students, and as a way of documenting the educational progress of students identified as at risk for school problems. A member of the development and implementation team, the school counselor collected data to estimate the impact of the model on student progress after the first year of data collection. The article also shares implications for the role of the elementary school counselor.
How Important is Personal/Social Development to Academic Achievement? The Elementary School Counselor's Perspective
Authors: Barna Jennifer S. , Brott Pamelia E.
Published: September 2018

This study explored elementary school counselors’ perceptions of importance and implementation for state standards in support of academic achievement. Results indicate that Academic and Personal/Social standards are important to achievement with no statistical difference between the standards. Further, counselors implement Personal/Social standards at slightly higher levels in their programs compared to Academic standards. Counselors consistently rated principles of character and qualities of effort, hard work, and persistence as most important and of highest implementation. This article also discusses implications for elementary school counseling practice.
A Phenomenology of Alienation in High School: The Experiences of Five Male Non-completers
Authors: Schulz Lisa L. , Rubel Deborah J.
Published: September 2018

This phenomenological study examined the experiences of males aged 16–19 who self-identified as being alienated from their school system. Five participants engaged in three semi-structured interviews and one perception check. Descriptions revealed common themes throughout the structure of the experience. These themes were: (1) need to build relationships despite negative consequences, (2) loss of trust in school adults, and (3) fear of failure and of disappointing self and family. The invariant structure (essence) that emerged was the interrelationship among these themes as related to belonging, trust, and self-worth.
Relational-Cultural Theory for Middle School Counselors
Authors: Tucker Catherine , Smith-Adcock Sondra , Trepal Heather C.
Published: September 2018

Young adolescents (ages 11–14), typically in the middle school grades, face life tasks involving connections and belonging with their peer group along with the development of their individual identity (Henderson & Thompson, 2010). Learning to negotiate through these developmental tasks, they face myriad relational challenges. This article explores the application of Relational-Cultural Theory (RCT) with early adolescents. It provides implications and recommendations for school counselors.
Third Culture Kids: Implications for Professional School Counseling
Authors: Limberg Dodie , Lambie Glenn W.
Published: September 2018

The increase of international business, military placements, and immigration has led to an increase in students attending schools in a country other than where they were born: third culture kids (TCKs). TCKs have unique educational needs, necessitating the support of their school counselors. This article (a) defines and introduces the needs and characteristics of TCKs, (b) reviews interventions for school counselors working with TCKs during transitional stages, and (c) presents a case illustration of a middle school counselor employing the suggested strategies.
Comprehensive School Counseling Programs, Job Satisfaction, and the ASCA National Model
Authors: Pyne Jaymes R.
Published: September 2018

This study examined the level of school counselor job satisfaction and implementation of comprehensive school counseling programs in secondary schools in one state. Participants included 103 secondary school counselors selected using a cluster sampling of Michigan public school districts. The Job in General (JIG) scale was used to measure their job satisfaction. The Comprehensive School Counseling Implementation Measure (CSCIM), based on the ASCA National Model, was used to measure the level of implementation of a comprehensive school counseling program in their schools. The individual items “administrative support” and “facilitating communication between staff” on the CSCIM showed high correlations with job satisfaction, while moderate to high correlations were found in the items “serving all students,” “clearly written and defined program philosophy,” and “creating time for planning and evaluating the program.” This article discusses limitations of this study and suggested directions for further research.
An Examination of Culturally Relevant Stressors, Coping, Ethnic Identity, and Subjective Well-Being in Urban, Ethnic Minority Adolescents
Authors: Vera Elizabeth M. , Vacek Kimberly , Coyle Laura D. , Stinson Jennifer , Mull Megan , Doud Katherine , Buchheit Christine , Gorman Catherine , Hewitt Amber , Keene Chesleigh , Blackmon Sha'kema , Langrehr Kimberly J.
Published: September 2018

This study explored relations between culturally relevant stressors (i.e., urban hassles, perceived discrimination) and subjective well-being (SWB; i.e., positive/negative affect, life satisfaction) to examine whether ethnic identity and/or coping strategies would serve as moderators of the relations between stress and SWB for 157 urban, ethnic minority adolescents. Ethnic identity moderated the relation between perceived discrimination and life satisfaction. Self-distraction coping moderated the relation between urban hassles and negative affect. This article discusses implications for school counseling prevention and interventions.
School Counselor Induction and the Importance of Mattering
Authors: Curry Jennifer R. , Bickmore Dana
Published: September 2018

This study explored the personal and professional needs of novice school counselors and the ways in which they feel mattered through qualitative methodology. Findings revealed that mattering manifested through interactions with administrators, positive student connections and student success, and collaborations with others. Factors that reduced feelings of mattering included lack of formal interaction with administrators, ineffective transition processes, and lack of an assigned, formal mentor.
Evaluation Capacity within State-Level School Counseling Programs: A Cross-Case Analysis
Authors: Martin Ian , Carey John C.
Published: September 2018

Many state departments of education have revised their state school counseling models to reflect the ASCA National Model for school counseling programs. Only a few states have developed statewide evaluation systems to gather information about program effectiveness and/or to promote effective local program evaluation. This qualitative study describes the statewide evaluation systems of two states (Missouri and Utah), which differ greatly in their state educational policy-making contexts. The authors also present recommendations for establishing a statewide evaluation system.
When is it Ethical to Inform Administrators about Student Risk-Taking Behaviors? Perceptions of School Counselors
Authors: Moyer Michael S. , Sullivan Jeremy R. , Growcock David
Published: September 2018

School counselors from across the United States responded to a survey asking when they should break confidentiality and report student risk-taking behaviors to school administrators. Generally, counselors believed it to be more ethical to break confidentiality when the behaviors were directly observed (as opposed to reported by students) and when the behaviors occurred on school grounds during school hours. Results also suggest counselors were more willing to break confidentiality when their school had a written policy guiding their actions. All behaviors showed some variance among respondents, suggesting a lack of agreement regarding when it is appropriate to break confidentiality and report risk-taking behaviors to administrators. This article discusses implications and suggestions for school counselors.
Improving College Access: A Review of Research on the Role of High School Counselors
Authors: McKillip Mary E. M. , Rawls Anita , Barry Carol
Published: September 2018

High school counselors potentially hold a key position to help increase the number of U.S. students receiving post-secondary degrees, particularly to address inequalities that prevent certain students from successfully transitioning to college. Using the model of student success (Perna & Thomas, 2008), this study reviewed the literature to understand how various contexts (social, school, family, student) shape high school counselor interactions with students as they work to improve post-secondary outcomes of college access and enrollment.
A Call for School Counseling Practitioner Research
Authors: Kaffenberger Carol J.
Published: September 2018

Despite the repeated call to increase the number of practitioner research manuscripts being published in counseling publications, practitioner research accounts for less than five percent of all manuscripts published. This article describes the challenges faced by practitioners seeking to publish their research, defines practitioner research, and renews the call for research conducted and reported by school counseling practitioners. It also offers resources to support practitioner research.
Mental Health Services in Public Schools: A Preliminary Study of School Counselor Perceptions
Authors: Carlson Laurie A. , Kees Nathalie L.
Published: September 2018

This descriptive survey research study (N = 120) examined the self-reported comfort level of school counselors in addressing the mental health needs of their students and school counselor perceptions regarding working relationships with school-based therapists. Survey results indicated that school counselors are generally confident in their counseling skills and comfortable addressing common issues brought to them by their students. However, these same school counselors indicated that they experience some discomfort in working with students living with DSM diagnoses and that specific courses within counselor training programs may have a mitigating effect on this discomfort. Results also revealed that school counselors are willing to lead and work with cross-disciplinary teams and school-based therapists to better meet the mental health needs of their students.
Students with Anxiety: Implications for Professional School Counselors
Authors: Thompson E. Heather , Robertson Phyllis , Curtis Russ , Frick Melodie H.
Published: September 2018

Anxiety is one of the most pervasive mental health concerns affecting students, yet a significant number of students with anxiety disorders remain underserved. If left untreated, anxiety can hinder students' personal/social, academic, and career development. The purpose of this article is to provide professional school counselors with helpful information about the etiology of anxiety disorders and brief, evidence-based prevention and intervention options. The authors discuss specific recommendations for the identification, assessment, and treatment of anxiety that fit within the unique school environment.
Outcomes of Limited Open Achilles Repair Using Modified Ring Forceps
Authors: Telleria Jessica J.M. , Smith Jeremy T. , Ready Lauren V. , Bluman Eric M.
Published: September 2018

Background:

The optimal treatment of acute Achilles tendon ruptures remains controversial. When surgical repair is undertaken, the reported rate of infections and wound-healing complications ranges from 2% to 5%. Meta-analyses have demonstrated that minimally invasive approaches have equivalent rerupture rates, a significantly lower risk of superficial infections, and higher patient satisfaction rates compared with traditional open Achilles repair techniques.

Purpose:

To review the clinical outcomes of acute, limited open Achilles tendon repair using modified ring forceps and to analyze functional results using foot and ankle–specific outcome measures.

Study Design:

Case series; Level of evidence, 4.

Methods:

The clinical records of 32 consecutive patients (mean age, 44 years) with 33 acute Achilles tendon ruptures were retrospectively reviewed. All patients underwent limited open repair with modified ring forceps through a 2- to 3-cm midline incision. Suture placement into the tendon stumps was guided using a pair of ring forceps bent 30°. Three No. 2 nonabsorbable sutures were placed in the proximal and distal segments, the tendon ends were reapproximated, and the sutures were tied to secure the tendon. Outcomes from a 10-cm visual analog scale (VAS), the Foot and Ankle Ability Measure (FAAM), and the Victorian Institute of Sport Assessment–Achilles (VISA-A) were assessed.

Results:

At final follow-up (mean, 42.1 months [range, 6-90 months]), 31 of 32 patients (33 Achilles tendons) reported no pain in their Achilles, with a mean Achilles VAS score of 0.7 ± 4.2 of 100. The mean postoperative VISA-A score was 82.3 ± 19.5 of 100. The mean FAAM activities of daily living and sports subscores were 96.5% ± 5.2% and 85.1% ± 21.2%, respectively. Regarding current functional level, 19 of 33 tendons (57.6%) were rated as “normal,” 10 (30.3%) as “nearly normal,” and 4 (12.1%) as “abnormal”; none were rated as “severely abnormal.” There was 1 case (3.0%) of a superficial infection; there were no cases of deep infections, sural neuritis, or reruptures. The cost of the modified ring forceps technique is 5.3 to 12.1 times less than commercially available devices.

Conclusion:

Limited open Achilles repair with modified ring forceps provides an economical repair with excellent pain relief, favorable functional outcomes, and a very low complication rate at midterm follow-up.
School Nurses’ Perceived Challenges With Concussion Management Procedures in the Secondary School Setting
Authors: Welch Bacon Cailee E. , Kay Melissa C. , Weber Michelle L. , Tierney Dayna K. , Valovich McLeod Tamara C.
Published: September 2018

School nurses have an integral role in managing student health concerns throughout the school day, yet little is known about their specific role in concussion management. Therefore, the purpose of this study was to explore the challenges encountered by school nurses regarding concussion management in the secondary school setting. Twenty-two school nurses employed in the secondary school setting were interviewed via phone. We analyzed the data via the consensual qualitative research paradigm. Overall, we found school nurses face consistent challenges with their role on the concussion management team, specifically related to education of school personnel, parents, and community health-care providers. Challenging topics included the inconsistency of community health-care provider recommendations and others’ perceptions of school nurses’ preparation and training to be important members of the concussion management team. Efforts to increase concussion education and improve communication across all stakeholders of the concussion management team should be implemented.
Open innovation in neuroscience research and drug discovery
Authors: Hunter Ann J. , Lee Wen H. , Bountra Chas
Published: September 2018

The pressures on the pharmaceutical industry have incentivised a number of new collaborative models of research and development which can be categorised as open innovation. Examples of the different types of models employed are discussed and some, but not all, of these have been used to promote research and drug discovery for central nervous system disorders. Some are completely open access, while others have some intellectual property restrictions. Going forward, more ways of promoting open innovation and the sharing of best practice, especially in the neurosciences, will stimulate research and hopefully accelerate new medicines development.
Using patient factors to predict obstetric complaints and litigation: A mixed methods approach to quality improvement
Authors: Nowotny Benjamin M , Loh Erwin , Davies-Tuck Miranda , Hodges Ryan , Wallace Euan M
Published: September 2018

Background

Traditionally, managing patient complaints and medicolegal claims has been largely a reactive process. However, attention has recently turned to systematically learning from complaints and litigation to prevent recurrence. Within a high-volume maternity service, we explored whether developing predictive tools for patient complaints and litigation to support proactive management was feasible.

Objectives

To develop and assess two screening tools to predict the likelihood of (i) patient complaints and/or (ii) medicolegal claims arising from maternity care and to assess practitioner awareness of patient risk factors.

Methods

Births between 1 April 2011 and 30 April 2016 at a university hospital maternity service in Melbourne, Australia were considered. Univariate binary logistic regression was performed to identify the variables contributing to complaints and claims. Backwards-stepwise logistic regression was applied to develop each screening tool. Clinicians completed a survey to assess awareness of identified risk factors.

Results

In the study period, there were 41,443 births, 173 complaints and 19 claims. The complaints tool had only fair predictive capacity (receiver operating characteristic 0.72, p < 0.001) and the claims tool failed. Neither approach afforded sufficient discrimination to be useful in routine predictive modelling. One hundred and one practitioners completed the survey (response rate 15.7%). Practitioners were better at recognising risk factors for legal claims than for patient complaints.

Conclusion

Whilst new risk factors for patient complaints and medicolegal claims were identified, we were unable to develop a screening tool that was sufficiently discriminatory to be useful in routine predictive triaging. However, increasing practitioner awareness of key risk factors may afford opportunities to improve care quality.
Improving CLL Vγ9Vδ2-T–cell fitness for cellular therapy by ex vivo activation and ibrutinib
Authors: de Weerdt Iris , Hofland Tom , Lameris Roeland , Endstra Sanne , Jongejan Aldo , Moerland Perry D. , de Bruin Renee C. G. , Remmerswaal Ester B. M. , ten Berge Ineke J. M. , Liu Nora , van der Stelt Mario , Faber Laura M. , Levin Mark-David , Eldering Eric , Tonino Sanne H. , de Gruijl Tanja D. , van der Vliet Hans J. , Kater Arnon P.
Published: September 2018

The efficacy of autologous (αβ) T-cell–based treatment strategies in chronic lymphocytic leukemia (CLL) has been modest. The Vγ9Vδ2-T cell subset consists of cytotoxic T lymphocytes with potent antilymphoma activity via a major histocompatibility complex–independent mechanism. We studied whether Vγ9Vδ2-T cells can be exploited as autologous effector lymphocytes in CLL. Healthy control Vγ9Vδ2-T cells were activated by and had potent cytolytic activity against CLL cells. However, CLL-derived Vγ9Vδ2-T cells proved dysfunctional with respect to effector cytokine production and degranulation, despite an increased frequency of the effector-type subset. Consequently, cytotoxicity against malignant B cells was hampered. A comparable dysfunctional phenotype was observed in healthy Vγ9Vδ2-T cells after coculture with CLL cells, indicating a leukemia-induced mechanism. Gene-expression profiling implicated alterations in synapse formation as a conceivable contributor to compromised Vγ9Vδ2-T–cell function in CLL patients. Dysfunction of Vγ9Vδ2-T cells was fully reversible upon activation with autologous monocyte-derived dendritic cells (moDCs). moDC activation resulted in efficient expansion and predominantly yielded Vγ9Vδ2-T cells with a memory phenotype. Furthermore, ibrutinib treatment promoted an antitumor T helper 1 (TH1) phenotype in Vγ9Vδ2-T cells, and we demonstrated binding of ibrutinib to IL-2-inducible kinase (ITK) in Vγ9Vδ2-T cells. Taken together, CLL-mediated dysfunction of autologous Vγ9Vδ2-T cells is fully reversible, resulting in potent cytotoxicity toward CLL cells. Our data support the potential use of Vγ9Vδ2-T cells as effector T cells in CLL immunotherapy and favor further exploration of combining Vγ9Vδ2-T-cell–based therapy with ibrutinib.
miR-150 downregulation contributes to the high-grade transformation of follicular lymphoma by upregulating FOXP1 levels
Authors: Musilova Katerina , Devan Jan , Cerna Katerina , Seda Vaclav , Pavlasova Gabriela , Sharma Sonali , Oppelt Jan , Pytlik Robert , Prochazka Vit , Prouzova Zuzana , Trbusek Martin , Zlamalikova Lenka , Liskova Kvetoslava , Kruzova Lenka , Jarosova Marie , Mareckova Andrea , Kornauth Christoph , Simonitsch-Klupp Ingrid , Schiefer Ana-Iris , Merkel Olaf , Mocikova Heidi , Burda Pavel , Machova Polakova Katerina , Kren Leos , Mayer Jiri , Zent Clive S. , Trneny Marek , Evans Andrew G. , Janikova Andrea , Mraz Marek
Published: September 2018

Follicular lymphoma (FL) is a common indolent B-cell malignancy with a variable clinical course. An unfavorable event in its course is histological transformation to a high-grade lymphoma, typically diffuse large B-cell lymphoma. Recent studies show that genetic aberrations of MYC or its overexpression are associated with FL transformation (tFL). However, the precise molecular mechanisms underlying tFL are unclear. Here we performed the first profiling of expression of microRNAs (miRNAs) in paired samples of FL and tFL and identified 5 miRNAs as being differentially expressed. We focused on one of these miRNAs, namely miR-150, which was uniformly downmodulated in all examined tFLs (∼3.5-fold), and observed that high levels of MYC are responsible for repressing miR-150 in tFL by binding in its upstream region. This MYC-mediated repression of miR-150 in B cells is not dependent on LIN28A/B proteins, which influence the maturation of miR-150 precursor (pri-miR-150) in myeloid cells. We also demonstrated that low miR-150 levels in tFL lead to upregulation of its target, namely FOXP1 protein, which is a known positive regulator of cell survival, as well as B-cell receptor and NF-κB signaling in malignant B cells. We revealed that low levels of miR-150 and high levels of its target, FOXP1, are associated with shorter overall survival in FL and suggest that miR-150 could serve as a good biomarker measurable in formalin-fixed paraffin-embedded tissue. Overall, our study demonstrates the role of the MYC/miR-150/FOXP1 axis in malignant B cells as a determinant of FL aggressiveness and its high-grade transformation.
B cells with aberrant activation of Notch1 signaling promote Treg and Th2 cell–dominant T-cell responses via IL-33
Authors: Arima Hiroshi , Nishikori Momoko , Otsuka Yasuyuki , Kishimoto Wataru , Izumi Kiyotaka , Yasuda Koubun , Yoshimoto Tomohiro , Takaori-Kondo Akifumi
Published: September 2018

The Notch-signaling pathway in a variety of mature B-cell neoplasms is often activated by gene alterations, but its role remains unclear. Here, we show that B cells harboring dysregulated activation of Notch1 signaling have an immunomodulatory effect on T cells by amplifying regulatory T (Treg) and T helper 2 (Th2) cell responses in an interleukin-33 (IL-33)-dependent manner. A conditional mouse model, in which constitutive expression of an active form of Notch1 is induced in B cells by Aicda gene promoter-driven Cre recombinase, revealed no obvious phenotypic changes in B cells; however, mice demonstrated an expansion of Treg and Th2 cell subsets and a decrease in cytokine production by Th1 and CD8+ T cells. The mice were susceptible to soft tissue sarcoma and defective production of CD8+ T cells specific for inoculated tumor cells, suggesting impaired antitumor T-cell activity. Gene-expression microarray revealed that altered T-cell responses were due to increased IL-33 production by Notch1-activated B cells. Knockout of IL33 or blockade of IL-33 by a receptor-blocking antibody abrogated the Treg and Th2 cell–dominant T-cell response triggered by B cells. Gene-expression data derived from human diffuse large B-cell lymphoma (DLBCL) samples showed that an activated Notch-signaling signature correlates positively with IL33 expression and Treg cell–rich gene-expression signatures. These findings indicate that B cells harboring dysregulated Notch signaling alter T-cell responses via IL-33, and suggest that aberrant activation of Notch signaling plays a role in fostering immune privilege in mature B-cell neoplasms.
Sympathetic tales: subdivisons of the autonomic nervous system and the impact of developmental studies
Authors: Ernsberger Uwe , Rohrer Hermann
Published: September 2018

Remarkable progress in a range of biomedical disciplines has promoted the understanding of the cellular components of the autonomic nervous system and their differentiation during development to a critical level. Characterization of the gene expression fingerprints of individual neurons and identification of the key regulators of autonomic neuron differentiation enables us to comprehend the development of different sets of autonomic neurons. Their individual functional properties emerge as a consequence of differential gene expression initiated by the action of specific developmental regulators. In this review, we delineate the anatomical and physiological observations that led to the subdivision into sympathetic and parasympathetic domains and analyze how the recent molecular insights melt into and challenge the classical description of the autonomic nervous system.
Addressing Financial Barriers to Patient Participation in Clinical Trials: ASCO Policy Statement
Authors: Winkfield Karen M. , Phillips Jonathan K. , Joffe Steven , Halpern Michael T. , Wollins Dana S. , Moy Beverly
Published: September 2018

Research conducted through clinical trials is essential for evaluating new treatment modalities, establishing new standards of cancer care, and ultimately improving and prolonging the lives of patients with cancer. However, participation in trials has been low, and this is attributable to various factors including patient financial barriers. Such financial barriers include the rising cost of cancer care; a lack of transparency in coverage policy; and the perception of ethical, compliance, or institutional impediments to patient financial support. ASCO convened a roundtable discussion with a variety of stakeholders to define the scope of the problem, as well as to identify clinical practice and policy solutions applicable at the institutional and system-wide levels. This statement summarizes key discussions from the ASCO Roundtable, as well as findings from the literature, and provides ASCO’s recommendations for overcoming financial barriers that may otherwise prevent participation in clinical trials. These recommendations broadly address the following key areas: (1) improving the policy environment for coverage of clinical trials; (2) facilitating transparency among providers, patients, and payers for trial-related out-of-pocket costs; (3) refuting the specter of inducement to enable targeted financial support for patients; and (4) improving the available data on costs of cancer clinical trials.