Middle Level Education Research Articles

Knowledge and Attitudes about Breast Cancer among Women: A Wake-Up Call in Nigeria.

BACKGROUND:Preventable deaths resulting from the scourge of breast cancer has become alarming and worrisome in many societies in developing countries, including Nigeria. Of much concern is the fact that breast cancer has continued to claim the precious lives of young, middle-aged, old, educated and non-educated women irrespective of their religion, socio-economic background and socio-demographic characteristics.AIM:This study attempts to ascertain the knowledge and attitudes of women to breast cancer in Ogun State, Nigeria.METHODS:The study adopts both primary and secondary data sources to examine the level of knowledge and attitude of women towards breast cancer with the view of suggesting probable solutions and recommendations for policy.RESULTS:The result indicates that the awareness about breast cancer is overwhelming but only few women know about mammography; women in older age are 0.193 times less likely to attend breast cancer screening (p=0.000). Older women with secondary education that are either self-employed outside the home or full-time housewives are unfavourably disposed to breast cancer screening.CONCLUSION:The authors recommend that concerned stakeholders in the health sector and policy decision makers should intensify action on cancer programmes and campaigns that could target older women especially housewives and women in middle level education.

MODERNIZATION OF SCHOOL EDUCATION IN UKRAINE: WAYS OF INTERNATIONALIZATION

Having analysed the internationalization of the educational process of the middle level education in Ukraine and compared the results with similar processes abroad, the ways of internationalization of school education in Ukraine were revealed through modernization and convergence. The internationallization of school education in Ukraine is closely linked to the processes of globalization, European integration, international cooperation, mobility, modernization, autonomy and development.

Prevalence and Risk Factors for Anemia in Non-pregnant Childbearing Women from the Chinese Fifth National Health and Nutrition Survey

Anemia is a public health issue for developing countries, especially for women of childbearing age. The aim of this study was to assess the anemia status and analyze the risk factors for anemia in Chinese childbearing women aged 18–49 years. Hemoglobin concentration was measured by the HiCN method in the Fifth Chinese National Nutrition and Health Survey (CNNHS) in 2010–2012. Age, region type, ethnicity, bodyweight, height, education, season and smoke habit were recorded in unified questionnaires. Latitude was divided by China’s Qinling Mountains and Huaihe River. Childbearing women (28,289) from the CNNHS 2010–2012 were included in this study. The median hemoglobin concentration was 136.2(126.6–145.0) g/L, and it was significantly higher than in CNNHS 2002 (132.5 (122.3–141.6) g/L). The prevalence of anemia was 15.0%, and it was significantly lower than 10 years ago. The logistic regression analysis showed anemia in Chinese childbearing women was specifically related to 30–39 age group (P = 0.004), in spring (P < 0.0001) or in winter (P = 0.006), small and medium-sized cities (P = 0.044) and middle school education level (P = 0.027). The results showed that anemia status among childbearing women was greatly improved over 10 years since 2002, but it was still more severe than the rest of the populations. The nutrition propaganda and education is recommended for childbearing women to help them to improve the nutritional status on their own.

A community and place-based approach to middle childhood science teacher education

This article discusses how a place-based approach to middle-level science teacher education prepares middle grades teacher candidates to leverage local culture and community to create interdisciplinary and relevant curriculum for all middle grades students. The article describes evidence-based strategies that capitalize on local place and university–community partnerships to promote empowering and equitable teaching and learning experiences. Specifically, examples of how to use the place-based approaches of photovoice, citizen science, and problem-based learning are provided.

Socioeconomic factors, body mass index and bariatric surgery: a Swedish nationwide cohort study

BackgroundBariatric surgery is considered to be the most effective method of weight loss today. The aim of the present Swedish study, which was performed in a country that has universal health care, was to investigate if there is an association between socioeconomic factors and bariatric surgery by taking body mass index (BMI) into account.MethodsIn this prospective cohort study, BMI data were collected for the period 1985–2010 from the Military Service Conscription Register (for men) and from the Medical Birth Register in the first trimester (for women). The follow-up period started in 2005 and continued until 2012. Age-standardized cumulative incidence rates (CR) of bariatric surgery were compared between different BMI groups by considering individual variables. We analyzed the association between the individual variables and bariatric surgery using Cox proportional hazard models.ResultsIn the study population of 814,703 women and 787,027 men, a total of 7433 women and 1961 men underwent bariatric surgery. In women, the hazard ratios (HRs) for bariatric surgery were higher for low and middle income and educational levels, compared to high income and educational levels. In men, the highest HR for bariatric surgery was found among those with a high income. The HRs when comparing the different socioeconomic groups in those with BMI > 40 kg/m2 showed no significant results, except for middle education in women.ConclusionDifferences in bariatric surgery between socioeconomic groups were found, favoring those with a low socioeconomic status. However, very few socioeconomic differences were found amongst those who had a BMI > 40 kg/m2. This indicates that the Swedish healthcare system seems to have achieved equal access to health care for bariatric surgery.

Psychometric properties of the Patient Assessment of Chronic Illness Care measure (PACIC-5A) among patients with obesity

BackgroundThe Patient Assessment of Chronic Illness Care (PACIC-5A) was developed to assess the satisfaction with patient-provider interaction based on the Chronic Care Model. The additional 5A approach (assess, advise, agree, assist, arrange) allows to score behavioral counseling. The aim of the study was to assess the psychometric properties of the German adaptation of the PACIC-5A questionnaire in a sample of general practitioners (GP) patients with obesity.MethodsAnalyses were based on data from the study “Five A’s counseling in weight management of obese patients in primary care: a cluster randomized controlled trial (INTERACT)”. Data were collected via standardized questionnaires containing the 26-item version of the PACIC-5A questionnaire. A total of 117 patients with obesity were included in the analyses. Statistical procedures comprised descriptive analyses, the calculation of Cronbach’s alpha, test-retest analyses and factor analyses in order to assess the psychometric properties including reliability and validity of the PACIC-5A.ResultsThe patient’s mean age was 43.4 years and the sample was mostly female (59%). Middle educational level was found for the majority (78%) and the mean Body Mass Index was 38.9 kg/m2. Descriptive analyses revealed a mean PACIC score of 2.33 and 5A sum score of 2.29. Notable floor effects were found. PACIC-5A showed high level of internal consistency (Cronbach’s alphas > 0.9) and exploratory factor analyses resulted in a unidimensional structure.ConclusionThe results of this study provide evidence regarding the psychometric properties of the German version of the PACIC-5A used in a sample of GP patients with obesity and make an important contribution to the reliable and valid assessment of the patient-GP interaction with regard to obesity counseling in primary care.

Standard Teacher Training Model Development through the Elementary and Middle School Safety Education Level Analysis

이 연구는 초&#8228;중등학교 안전교육 교원연수를 위한 안전교육 영역을 도출하고 영역별 난이도, 중요도, 빈도를 조사 분석하여 영역별 수준(상, 중, 하)을 분석하였다. 이를 위해 선행연구 고찰과 초등학교와 중&#903;고등학교 교원 대상으로 설문조사를 실시하였고, 연구 결과 및 결론은 다음과 같다. 첫째, 선행연구를 통한 초&#8228;중등 교원의 안전교육 영역은 생활안전, 교통안전, 약물 및 사이버 중독 예방(직업안전), 재난안전, 시설안전 5대 영역이다. 둘째, 초&#8228;중등 교원 안전교육 영역의 난이도, 중요도, 빈도 분석 결과, 교원들은 학교에서 안전사고가 자주 발생하고 있으며 이를 대처하는 학교안전 관련 업무가 대체로 어렵지만 중요하다고 인식한 것으로 나타났다. 셋째, 초&#903;중등 교원 안전교육 영역의 수준 분석 결과에 따른 연수과정(안)은 ①교통/시설안전 강화형 연수(1-3년차), ②재난안전 강화형 연수(4~6년차), ③생활안전(응급처치) 강화형 연수(7~9년차), ④생활안전(폭력예방) 강화형 연수(10~12년차) 4개 과정이며, 과정명의 교직 경력이 높을수록 높은 난이도의 연수과정을 의미한다. 마지막으로 이 연구에서 영역별&#903;수준별로 체계화한 연수과정은 초중등 교원표준연수모델을 개발하는 기초 자료를 제공하게 된다. 이는 초중등 교원이 재직하는 동안에 각 연수과정을 주기적으로 이수하여 학교안전 전문성을 함양하는 데에 기여하게 될 것이다.This research deduced a safety education domain for the elementary and middle school safety education teacher training, and made an investigation and analysis of domain difficulty level, importance level and frequency, and analyzed the domain level(superior, medium and inferior). To do this, we considered the advanced research and executed the questionnaire for the elementary, middle and high school teachers, having the following research result and conclusion. First, the elementary and middle school teacher’s safety education domains through the advanced research are 5 domains of life safety, traffic safety, drug and cyber addiction prevention(occupational safety), disaster safety and facility safety. Second, as the result of analyzing the difficulty level and importance level and frequency of elementary and middle school teacher’s safety education domain, the teachers recognized that the safety accident is frequently happening at school, and that the school safety related work to cope with it is generally difficult but important. Third, according to the elementary and middle school teacher’s safety education domain level analysis result, the training process(plan) is of 4 processes of ① traffic/facility safety reinforcement type training(1-3 years), ②disaster safety reinforcement type training(4~6 years), ③life safety(first aids)reinforcement type training(7~9 years) and ④life safety (violence prevention) reinforcement type training(10~12 years), and it means that the higher process teacher career the higher difficulty level training process. Finally, the systematized training process by domain and level of this research provided the basic data that develops the elementary and middle school teacher’s standard training model. And this will contribute for the elementary and middle school teacher to complete systematically each process during his tenure of office and to promote his specialities of school safety.

Middle Level Education in Rural Communities

Middle level teachers and administrators working in small or rural schools often face unique obstacles in implementing recommended middle level practices. From sharing staff and schedules with other school sites, to inappropriate instructional techniques, to a general lack of understanding of the middle level philosophy, these obstacles can be a source of frustration for school leaders and hinder school improvement initiatives. A better understanding of these issues and the discussion of potential solutions will benefit teachers, administrators, and policy makers in improving middle level education in rural communities. By building on the positive characteristics found in rural and smaller schools, as well as identifying and addressing the obstacles encountered at smaller schools, middle level leaders can create and maintain distinctive and effective programs for their students.

Empirical evaluation of professional traineeships for young people up to 30 years of age

Abstract In this article, we evaluate ‘Professional traineeships for young people up to 30 years’, an active labour market policy measure implemented in the Czech Republic. Professional traineeships were one of the possibilities for suitable offer to young people within Youth Guarantee in the Czech Republic in 2014 and 2015. First, we conducted a process evaluation (document analysis and interviews) to uncover the design and implementation aspects of the program. Next, we followed the counterfactual impact evaluation approach towards the estimate of returns to unemployment (competing risk analysis) based on individual administration data from public employment services. We have found that professional traineeships were successful in attracting the interest of both young people and employers. Mainly young people with middle and high level education have entered the program. Most of them have been provided with on-the-job subsidies in the private sector. When considering the impact of the program on the unemployment of participants and a control group, it was shown that after two years, the measure was effective only for young people with long pre-program Employment Office registration. When we consider the reasons for leaving Employment Office registration, the measure seems to be more effective, since many young people in the control group left the Employment Office register in favour of options that were outside of the labour market.

Present Status of Organic Sheep Production in Ramgoti Upazila of Lakshmipur District

The experiment was conducted to investigate the present status and potentialities of organic sheep production in Lakshmipur district of Bangladesh. Data were collected through an interview schedule personally from 30 respondents in 3 villages of Ramgoti Upazila who were involved in sheep production. Parameter studied were origin, feeds and fodder, breeding, health care, living condition of livestock and factors related to organic sheep production. All sheep was indigenous. 60 per cent farmers used roadside grass and 40% cultivated and roadside grass. Most of the farmers used mixed feed which was bought from local market and 17% farmers used vitamin mineral supplementation. All farmers used natural breeding. About 80, 80 and 83% farmers practiced vaccination, de-worming and grooming, respectively. About 13% farmers used hormone, antibiotic and growth promoter and only 33% farmers remove sick or injured animal from healthy stock. All farmers allowed access to outdoor and pasturing during winter season and none reared male and female sheep separately. Farmers did not keep and kept their livestock record were 90 and 10%, respectively. Most of the farmers were middle aged categories (53%) and education level of farmers of primary, secondary and higher secondary were 63, 30 and 7%, respectively.J. Environ. Sci. &amp; Natural Resources, 10(2): 95-103 2017

Funds of Identity and Humanizing Research as a Means of Combating Deficit Perspectives of Homelessness in the Middle Grades

Youth experiencing homelessness have seldom had the opportunity to contribute to conversations about policies and practices that impact their day-to-day lives. Brinegar highlighted middle level education research’s contribution to the lack of representation of the voices of youth from marginalized perspectives. Where opportunities lack, dominant narratives persist. The word homeless often conjures deficit-laden images of ineptitude and unintelligence. This qualitative humanizing research study worked with one participant, AJ, who created maps and other identity artifacts as a means of illuminating his funds of identity that were then analyzed using Creswell and Poth’s data analysis spiral. Though results showed AJ to be a young adolescent with multiple funds of identity, the purpose of this article is to present how AJ draws great strength and purpose from his identity as a creator, despite transience between schools, who leverages technology for his personal and academic benefit. These results describe a young adolescent whose resilience and funds of identity transcend dominant narratives surrounding homelessness and point to opportunities for educator support in curriculum development and school-level policy.

Analysis of the Achievements of Daegu Happiness Competency Education with a Focus on Curriculum

본 연구는 21세기 핵심역량이 대두되면서 시작된 대구행복역량교육의 교육과정 편성·운영 측면에서 성과를 분석하기 위해 실시되었다. 교육과정 편성·운영의 측면에서 볼 때 학생, 학부모, 교원·교육전문직은 대구행복역량교육에 대하여 모두 중간 이상 수준의 인식을 하고 있음이 확인되었다. 평균치를 비교하면 학생과 학부모는 큰 차이가 없었고 교원의 인식 수준이 상대적으로 높았는데 이는 교원이 교육과정 편성·운영의 주체라는 점에서 이해 가능한 결과이다. 또한 학부모는 학교급에 따라 통계적으로 유의한 차이가 나타나지 않은데 반해, 학생과 교원은 모두 유의한 차이가 있었다. 특히 예측과는 달리 학생과 교원 모두 학교급이 올라가면서 인식 수준이 낮아졌으며, 특목고·자율고와 특성화고에서 가장 낮은 결과를 보였다. 이는 대구행복역량교육이 2014년에 본격 시행되어 아직 초기라는 점과 함께 대학 입시나 취업으로 인한 부담으로 새로운 교육과정을 인식하고 받아들일 여지가 적었기 때문일 것으로 볼 수 있다. 앞으로 교육과정이 안착되면서 자연히 개선되겠으나 여기에서 대구행복역량교육의 안착을 위한 시사점도 찾아볼 수 있을 것이다. 교육과정 편성·운영에 대한 평가를 CIPP 모형에 근거한 설문 조사를 실시함으로써 상황, 투입, 과정, 산출로 나누어 평가한 결과, 학생과 학부모는 산출에 대해 매우 높은 평가를 내리고 있음을 알 수 있었다. 반면, 교원의 경우 투입에 대한 평가가 가장 높았다. 비록 학생과 학부모는 상황과 투입에 대한 설문 조사를 실시하지 않았으나 학생과 학부모의 산출평가 문항 평균값이 교원의 투입평가 문항 평균값과 유사하였다. 성과에 해당하는 산출평가만을 기준으로 한다면 교육의 대상인 학생들로부터 교육과정 편성·운영에 대해 긍정적인 평가를 받고 있다는 점은 매우 의미 있는 결과라고 할 수 있다.The purpose of this study was to analyze the performance of the Daegu Happiness Competency Education Program. It was confirmed that students, parents, teachers, and education professions are aware of the middle and higher level of education for happiness in Daegu in terms of the formation and operation of the curriculum. There is no significant difference between students and parents in terms of average value, and teachers’ perception level is relatively high, which is understandable in that teachers are the subjects of the curriculum organization and operation. In addition, there was no statistically significant difference between the parents and the school level, but there were significant differences between students and teachers. In particular, students’ and teachers’ perceptions were lowered as the number of schools increased, unlike the predictions. They showed the lowest results in the special schools, autonomous schools and special schools. The reason for this is that Daegu Happiness Competency Education was implemented in 2014, and it was because there was little room to recognize and accept the new curriculum due to the burden of college entrance examination or employment. In the future, it will naturally improve as the education process is settled, but here we can find suggestions for the establishment of Daegu Happiness Competency Education.

Engaging Marginalized, “At-Risk” Middle-Level Students: A Focus on the Importance of a Sense of Belonging at School

The philosophy of middle level education is to intentionally create a learning environment that supports every young adolescent. The literature around engagement points to the need for students to experience (among other requirements) a sense of belonging at school (SOBAS). When the need for belonging is not achieved there may be significant consequences, including an impact on intellectual performance, and hence, learning potential may not be achieved. For students with marginalized identities, an intensification of factors that create challenges places them at-risk of disengaging and their sense of belonging at school is more likely to be compromised. Nurturing SOBAS is positively associated with the retention of students who are at-risk of dropping out of, thereby being an aspirational goal of education. Methods: The findings of a systematic literature review related to young adolescents and the importance of SOBAS forms a focused literature base. We highlight findings from a study that explored the effectiveness of engagement strategies for marginalized students in one educational jurisdiction in Australia. Data in the form of a series of interviews and focus groups conducted with 25 students, 25 of their teachers, and 39 school leaders provides a rich data set for thematic content analysis. Inductive analysis and in vivo coding led to a framework that summarized each of the sub-group data sets to convey emergent themes. Results: Five themes related to SOBAS emerged from the data: (a) Relationships in School; (b) School Climate; (c) Pedagogical Practices; (d) Specific Programs and Activities; and (e) Other Issues, mainly variables such as family, mental health, trauma and poverty that impacted on a student’s SOBAS. Conclusion: The systematic literature review and the findings of the empirical study presented in this paper highlight aspects of SOBAS that can be formalized into a series of strategies to increase retention of marginalized students.

The social stratification of the 2018 vote in Italy: between continuity and change

ABSTRACTThe massive vote shift in the 2018 elections, underlies a changed configuration of the social stratification of the vote. The end-result is one of an increased heterogeneity of the social bases of partisan support and of the contradictory social landscape parties are confronted with. Driven by the paramount salience of economic concerns among voters, labour market position and type of employment appear to be the main axes of stratification: self-employed voters massively supported the centre-right coalition and especially the Lega, attracted by the promise of huge tax cuts; but the Lega disproportionally attracted also manual workers with poor education. On the other hand, non-manual employees and skilled manual labour, with middle-level education, showed a clear propensity to vote for the M5s; which also revealed a huge appeal among unemployed, especially young, and inactive women. This social configuration of the vote is reflected in the clear-cut territorial divide of the vote: supremacy of the M5s in the Southern regions and predominance of the Lega in the North (and in some Central regions as well). The PD – the big loser of the elections in political terms --seems to have appealed especially to more socially established and secure social groups (Northerner, aged, educated employees and, above all, pensioners). This social stratification of the PD’s vote is not a surprise and is in line with a long-running trend. It signals the relative unattractiveness of the PD for those social groups which think they are bearing the brunt of globalization’s downside and feel inadequately protected and insecure in their daily lives.

Students taking action together: Social action in urban middle schools

Teaching character virtues and social–emotional skills in isolation of social–political context is incomplete at best. Further, racial and ethnic inequity in social action and political influence spans from youth to adults and must be addressed (Kahne & Middaugh, 2008b). Middle school is a crucial developmental time to cultivate students’ social–emotional and character competencies alongside their social actions promoting positive change (Jones & Kahn, 2017). This article describes how our social–emotional and character development curriculum, called Mastering Our Skills and Inspiring Character (MOSAIC), inspired students to improve their school, community, and world. The lessons required students to engage in the kind of active learning that the Association for Middle Level Education champions through its statement, This We Believe: Keys to Educating Young Adolescents, by applying the skills they learn in the classroom to relevant social issues (National Middle School Association [NMSA], 2010). Our article brings this approach to life by illustrating its use in an under-resourced, highly stressed, urban school system.

Analysis of 124 Suicide Cases in Wuhua District in Kunming

To analyze the relationship between the suicide method and the sex, age, education background and cause of suicide to provide reference for the forensic identification of suicide. After scene investigation, external body examination, autopsy and case investigation, 124 identified suicide cases which happened in recent three years in Wuhua district in Kunming were collected. Analytical methods as chi-square test and descriptive statistics were performed by SPSS 22.0. In all the suicide cases, male to female ratio was 1.53∶1. The suicide methods were mainly fatal fall, hanging and drowning. The ratio of local to non-native residents was 1∶1. The suicide rate in the people with primary school or junior middle school education level was highest. The group of >10-50 years tended to choose fatal fall suicide and people over 60 years were more likely to choose hanging. People with different academic background tended to choose fatal fall suicide. The suicide methods as fatal fall and hanging were chosen because of mental and physical diseases and economic problems, while the suicides with emotional problems were more likely to choose fatal fall and poisoning. Suicide belongs to a kind of complex cases. For the cases of suspected suicide, complete exploration and overall consideration should be done to determine the nature of cases based on comprehensive analysis of all the influence factors.

Public's Willingness to Pay Towards a Medical Device for Detecting Foot Ulceration in People with Diabetes.

Diabetic foot ulceration (DFU) is a common and serious complication among diabetic patients. A medical device has been developed to prevent the occurrence of DFU. The aim of this study was to investigate the willingness to pay (WTP) for this device among the general public in the UK. A contingent valuation survey was administered to 1051 participants through an online survey including questions on socio-demographic characteristics, self-reported health, knowledge of diabetes and medical devices, and WTP. A two-part model was used to analyse determinants of WTP, including a logistic model in the first part and a generalised linear model with a log-transformed WTP in the second part. More than half (55.9%) of the participants expressed a positive WTP. The annual mean (standard deviation) and median (interquartile range) WTP values were £76.9 (69.1) and £50 (80), respectively. Older age, middle-level education, good/excellent self-reported health, visiting doctors once/2-5 times, diabetes experience, medical device experience and more than average self-perceived likelihood of using similar devices were associated with a higher likelihood of willingness to pay. Younger age, male gender and higher household income were associated with higher WTP values. This study demonstrated that people are willing to pay for this device and they tend to contribute when they have experience of diabetes or similar devices and perceive self-benefit.

Technology gap, constraint analysis and improved production technologies for yield enhancement of barley (Hordeum vulgare) and chickpea (Cicer arietinum) under arid conditions of Rajasthan

Agriculture is the mainstay of livelihood in arid region of Rajasthan and improvement in the agricultural productivity is one of the most important strategies to reduce poverty, ensuring food and livelihood security in the region. Moreover, the region is highly prone to recurrent drought owing to its harsh and frequent climatic aberrations which limit the scope of sustainable crop production and encourage the degradation of natural resources. Therefore, majority of farming community is engaged in subsistence farming due lack of adequate resources and because of poor and instable crop production, socio-economic status of the farmers is very poor. This has necessitated improvement in agricultural production by imposing improved production technologies. Barley (Hordeum vulgare L.) and chickpea (Cicer arietinum L.) are the most important food grain crops grown during rainy season under conserved moisture or limited irrigation condition of the region, but average productivity of both the crops is very low. In addition to unfavourable climatic conditions, use of traditional practices is also important factor responsible for low yield. The present study was therefore conducted in five villages of three districts of arid region of Rajasthan during 2013-14 and 2014-15 to understand socio-economic profile of the farmers and also to study the effect of improved production technologies on the yield and economics of barley and chickpea. The results revealed that majority of the respondents (37.93%) had middle level of education and 55.17% of total respondents belong to medium farm size category. None of the respondents has used improved production technologies as per the recommendations for the cultivation of barley and chickpea crops, indicating 100% adoption gap. Further, all the respondents (100%) viewed low price of crop produce as major constraint followed by lack of marketing facility (96.55%), non-availability of improved seed (89.65%), high cost of cultivation (81.03%) and lack of effective extension agencies (81.03%). The grain yield of barley and chickpea showed remarkable improvement due to adoption of improved production technologies. Increase in the grain yield of barley and chickpea recorded as 19.37 to 24.83% and 28.63 to 38.07% respectively, over farmer’s practice. Increase in net return was obtained up to 43.78% due to improved production technologies of barley and 50.11% in chickpea. However, socio-economic status and livelihood of the farmers can be improved due to the adoption of improved production technologies of crops in arid region of Rajasthan.

The Complexities of Middle Level Teacher Credentialing: Status Report and Future Directions

Specialized preparation and credentialing for teachers of young adolescents continue to be the focus of advocacy efforts within the field of middle level education. To better understand the status of middle level teacher credentialing throughout the United States, this descriptive, pragmatic, qualitative study explored how specialized middle level teacher credentials are addressed in the United States and what options are available. Researchers reviewed publicly available documents from each state and the District of Columbia. The findings revealed wide variations in the (a) credentialing authority, (b) credential name, (c) credential grade bands, (d) extent of overlapping credentials, (e) testing requirements, and (f) field experience requirements. Findings draw attention to the complexity of educator credentialing in the United States and document the extreme variations of middle level teacher credentialing across the country. Implications for policymakers and institutions of higher education are discussed.

Do Patients Live Longer After THA and Is the Relative Survival Diagnosis-specific?

Hip replacements are successful in restoring mobility, reducing pain, and improving quality of life. However, the association between THA and the potential for increased life expectancy (as expressed by mortality rate) is less clear, and any such association could well be influenced by diagnosis and patient-related, socioeconomic, and surgical factors, which have not been well studied. (1) After controlling for birth year and sex, are Swedish patients who underwent THA likely to survive longer than individuals in the general population? (2) After controlling for relevant patient-related, socioeconomic/demographic factors and surgical factors, does relative survival differ across the various diagnoses for which THAs were performed in Sweden? Data from the Swedish Hip Arthroplasty Register, linked to administrative health databases, were used for this study. We identified 131,808 patients who underwent THA between January 1, 1999, and December 31, 2012. Of these, 21,755 had died by the end of followup. Patient- and surgery-specific data in combination with socioeconomic data were available for analysis. We compared patient survival (relative survival) with age- and sex-matched survival data in the entire Swedish population according to Statistics Sweden. We used multivariable modeling proceeded with a Cox proportional hazards model in transformed time. Patients undergoing elective THA had a slightly improved survival rate compared with the general population for approximately 10 years after surgery. At 1 year after surgery, the survival in patients undergoing THA was 1% better than the expected survival (r = 1.01; 95% confidence interval [CI], 1.01-1.02; p < 0.001); at 5 years, this increased to 3% (r = 1.03; 95% CI, 1.03-1.03; p < 0.001); at 10 years, the difference was 2% (r = 1.02; 95% CI, 1.02-1.03; p < 0.001); and by 12 years, there was no difference between patients undergoing THA and the general population (r = 1.01; 95% CI, 0.99-1.02; p = 0.13). Using the diagnosis of primary osteoarthritis as a reference, hip arthroplasties performed for sequelae of childhood hip diseases had a similar survival rate (hazard ratio [HR], 1.02; 95% CI, 0.88-1.18; p = 0.77). Patients undergoing surgery for osteonecrosis of the femoral head (HR, 1.69; 95% CI, 1.60-1.79; p < 0.001), inflammatory arthritis (HR, 1.49; 95% CI, 1.38-1.61; p < 0.001), and secondary osteoarthritis (HR, 2.46; 95% CI, 2.03-2.99; p < 0.001) all had poorer relative survival. Comorbidities and the Elixhauser comorbidity index had a negative association with relative survival. Level of achieved education (middle level of education: HR, 0.90, 95% CI, 0.87-0.93, p < 0.001; high level: 0.76, 95% CI, 0.73-0.80, p < 0.001) and marital status (single status: HR, 1.33; 95% CI, 1.28-1.38; p < 0.001) were also negatively associated with survival. Whereas it has been known that in most patients, THA improves quality of life, this study demonstrates that it also is associated with a slightly increased life expectancy that lasts for approximately 10 years after surgery, especially among patients whose diagnosis was primary osteoarthritis. This adds further proof of a health-economic value for this surgical intervention. The reasons for the increase in relative survival are unknown but are probably multifactorial. Level III, therapeutic study.