Subsequent Grade Research Articles

A Multi-Site Study of Student Experiences with Code- and Meaning-Focused Literacy in Preschool-Third Grade Classrooms

ABSTRACT Purpose We examine the content, context, and management of literacy learning opportunities in a large, diverse sample in the US and whether these opportunities were differentiated by children’s oral language and decoding skill levels. Method A total of 1,404 children in 153 preschool-through-third-grade classrooms were observed for several multi-hour observations of their literacy time. Children were administered assessments of code-focused and meaning-focused skills before each observation. Results Code-focused instruction was most common in kindergarten and was appropriately differentiated only in this grade. Significantly more meaning-focused instruction was observed in 1st–3rd grades than in earlier grades and there was limited evidence of differentiation of this type of instruction. Conclusion Kindergarten is a focus year for learning to read and children who do not make sufficient progress may face challenges due to limited, undifferentiated learning opportunities in subsequent grades. Meaning-focused instruction time is emphasized in later grades, which is a missed opportunity for younger learners.

Correlation of Grading and Number of Ear Subunits With Auditory Brainstem Response Findings in Children With Microtia.

The association between microtia severity and hearing function has been thoroughly investigated. This study examined the relationship between microtia grade, number of ear subunits (i.e., helix, antihelix, scapha, triangularis fossa, concha, lobule, tragus, and antitragus) with auditory brainstem response (ABR) findings in children with microtia. A retrospective chart review was employed in this study. We analyzed the ABR test results and photographs of 22 children with 30 microtia ears at Dr. Cipto Mangunkusumo National Hospital, Jakarta. The ABR test results were acquired using click (air conduction only) and 500-Hz tone burst stimuli (air- and bone-conduction). Ear photographs were overlaid with a template of a normal ear to determine the number of ear subunits present and the subsequent microtia grade. Number of ear subunits and ABR results were analyzed using the chi-square, Mann-Whitney U, and Spearman's correlation tests. ABR thresholds for click and 500-Hz tone bursts air-conduction were significantly poorer for ears with a subunit < 5 compared to ears with a subunit ≥ 5. No significant difference was observed in 500 Hz bone-conduction ABR thresholds between these groups. Correlation analysis showed a significant negative correlation between increased ear subunits and click ABR thresholds. No significant correlation was found between ear subunits and 500-Hz air- and bone-conduction ABR thresholds. A higher number of ear subunits are associated with a lower hearing threshold, as assessed using ABR with click stimuli. Therefore, the number of ear subunits and microtia grades can be used to examine the hearing level thresholds in infants and children with microtia. https://doi.org/10.23641/asha.25669440.

Incorporation Level of Health Concepts in Social Studies Textbooks in the Primary Education Stage in the State of Qatar

Objectives: This study aims to identify health concepts in social studies textbooks for grades four to six in primary school and assess the distribution and proportion of these concepts in relation to the overall textbook area. Methods: Employing a descriptive analytical approach, a list of health concepts was compiled and categorized into four main areas within social studies textbooks in Qatar's primary education stage. Tool validity was confirmed through expert review, and to ensure analysis stability, a study unit was analyzed by the researcher and another curriculum specialist using the Cooper equation, resulting in an 84.5% analysis stability. Results: Environmental health concepts had the highest frequency (213), while concepts related to "diseases and health problems" had the lowest (5). Examining frequencies by grade, the fourth grade had the highest repetitions (125), followed by the fifth grade, second semester (96), and the sixth grade, first semester, had the lowest repetitions (37). Regarding the area of health concepts by grade, the fourth grade occupied the highest area (9.61) pages, while the sixth grade had the smallest area (2.84). Conclusions: The study revealed that the fourth grade had the highest frequency and allocated space for health concepts, whereas the sixth grade ranked the lowest. This suggests a deliberate emphasis on depth and breadth in the early stages of the curriculum to solidify information, gradually decreasing in subsequent grades.

청소년의 다문화 수용에서 주체적 자아(I)의 역할

Cross-cultural acceptability in youth tends to be higher than that in adults. This is a phenomenon that is difficult to explain within the general concept of socialization. It suggests that there is a unique recognition mechanism for cross-cultural acceptability in the experience of youths. This study searched for clues to the mechanism in the self concept proposed by Mead, namely, Me (the social self) and I (the subjective self). The study applied a growth curve model from the second year of middle school to the third year of high school to investigate trends in students’ cross-cultural acceptability and the influence of the subjective self as a developmental factor. Cross-cultural acceptability was analyzed by applying the Guttman scale to items measuring social distances, such as neighbors, friends, close friends, opposite gender friends, and marriage partners. The results show that cross-cultural acceptability increases in a non-linear form from the second year of middle school to the third year of high school. The subjective self significantly increases the level of cross-cultural acceptability in the second year of middle school, but as the grades increase, the influence of the subjective self on cross-cultural acceptability decreases. In cases where the subjective self is high, the function of the subjective self has already been mobilized to increase cross-cultural acceptability in the second year of middle school, and a high level of cross-cultural acceptability has been reached, resulting in its influence decreasing in subsequent grades. The results are evidence that the role of the subjective self, which awakens youths’ spontaneity, initiative, and willingness, is at work in an environment where youth are experiencing the low cross-cultural acceptability of adult society.

A modified model of peer support in asynchronous online introductory accounting: is it effective?

ABSTRACT Low passing rates are common in asynchronous introductory accounting courses due to the challenging material and the online setting. While peer support involving knowledgeable peer assistants has been shown to improve face-to-face students’ performance, it is unknown whether it will be effective when used online. Another issue of traditional peer support is the low participation rate. This study implemented a modified peer support model that involved a direct peer assistant (DPA) actively engaging online introductory accounting students. We found that students with a DPA participated in substantially more peer-supported activities (PSAs), especially when their current exam performance was low. Further, PSA participants had more positive subsequent grade changes and visited learning and homework systems more frequently than non-participants. Overall, the study suggests that in asynchronous introductory accounting, peer support carefully designed to provide extra student engagement will achieve desired participation rates and increase student grades and effort.

Perceived Stress and Perceived Lack of Control of Student Teachers in Field Practice Placements in Schools during the COVID-19 Pandemic: Validity of the PSS-10 Adapted to the Field Practice Context

Field practice placements contribute substantially to students’ gradual attainment and final mastery of the skills of the teaching profession. The aim of this study was to adapt the Danish consensus translation of the PSS-10 to assess perceived stress during field practice placements of varying durations and to investigate its validity for use with student teachers in field practice during the COVID-19 pandemic. Data were collected upon completion of 6 weeks of a field placement at one of three levels (N = 359), and grades from the field practice exam were obtained. To resolve any issues with differential item functioning and lack of item independence, graphical loglinear Rasch models were used. Criterion validity was investigated in relation to the level of field practice and subsequent grades. The results showed that items 10 and 4 had to be eliminated; both subscales had locally dependent items, and one item in the perceived lack of control subscale functioned differentially relative to the level of field practice placement. Criteria expectations were confirmed, though not all were significant. The psychometric properties of the adapted PSS-10 were in line with previous findings on the original PSS-10 subscales. Score levels can be used as benchmarks in post-COVID-19 studies of student teachers’ field-practice-related perceived stress.

740 Implementation and Retrospective Assessment of a Modified Graft Loss Grading System

Abstract Introduction Success of split-thickness skin grafting (STSG) is a cornerstone of modern burn care and sets the stage for success in acute, rehabilitative and reconstructive care. Shupp et al, proposed a graft loss grading system, which the authors then modified to reflect true clinical practice and changes in management. Purpose of the quality improvement (QI) project was to design, implement and assess this grading system. Methods A modified graft loss grading system was developed and implemented. Burn patients requiring STSG were tracked over a five month period, and initial (first takedown) and subsequent (either outpatient or 7 days after initial assessment) graft loss grades and contributing factors were noted. Assessments were performed an APP and burn surgeon with agreement of an assigned grade. Patient demographic data was recorded. Results 63 patients underwent 66 STSG procedures during the review period (44 males, 19 females). Average age was 33.3 years (range: 1-86). Average % TBSA burn was 10.2% (range 0.2-67%). Obesity was present in 33.3% of patients, cardiac disease (hypertension, coronary artery disease or congestive heart failure) in 21.2%, DM in 21.2% and 24.2% of patients were active smokers. Flame burns represented the etiology in the majority (51.5%) of patients. Overall, 10 patients (16%) on initial assessment and 18 patients (29%) on subsequent assessment had evidence of graft loss. Etiology of graft loss included wound bed viability - the default etiology (10 patients/55%), infection (3 patients/17%) and hematoma/seroma (4 patients/22%). Of the 18 patients, 5 (28%) required re-grafting. Of patients with graft loss, 89% had a comorbidity including DM (28%) and smoking history (28%). Malnutrition was felt to contribute in 3 (17%) of patients. Conclusions A graft loss grading system is a beneficial quality improvement project to characterize the surgical results of burn patients undergoing STSG. This modified grading system better characterizes graft loss outcomes and subsequent changes in management if applicable. Wound bed viability remains a major factor in graft loss, although the majority of these patients had a contributing comorbidity. Applicability of Research to Practice Implementation of a graft loss grading system can be a valuable quality improvement tool that can be employed by burn centers to assessment surgical results.

Student Athletes’ Causal Attributions for Sport and School Achievement in Relation to Sport Dropout and Grade Point Average

The present study longitudinally examined stability and change in the attributional profiles of Finnish student athletes (n = 391) in upper secondary sport schools. Moreover, it examined the extent to which these profiles, and changes in them, were associated with athletes' level of sport competition and school achievements and dropouts at the end of upper secondary sport school. Using latent profile analysis, five different and highly stable attributional profiles were identified for student athletes: (a)depressive (6.9%), (b)athletic self-serving (23.0%), (c)average (16.4%), (d)learned helplessness (30.9%), and (e)responsible (22.8%). The results further showed that over the 3-year study period, the responsible attributional style, wherein individuals take responsibility for successes and failures, predicted student athletes' subsequent high grade point average and low sport dropout rates even after controlling for the impacts of their earlier grade point average, gender, and type of sport.

School-Level Longitudinal Predictors of Alcohol, Cigarette, and Marijuana Use.

This study analyzed measures aggregated at the school level to identify key predictors of drinking alcohol, binge drinking, smoking cigarettes, and using marijuana. Using data collected from 6th through 12th grade students between 2011 and 2015, we identify school-level variables that predict school-level prevalence in the subsequent year. Data included prior year assessments of: (1) school-wide prevalence, (2) perceived ease of access to drugs, (3) perceived adult disapproval of drug use, (4) perceived peer disapproval of drug use, and (5) perceived prevalence of drug use. We regressed grade-level behaviors on predictor variables from the previous school year. In middle schools, prior grade prevalence and prior grade perceived norms were significant predictors of subsequent grade prevalence. For high schools, prior year prevalence, aggregated peer norms, and perceived ease of access predicted subsequent use. These analyses provide evidence that a school's culture is predictive of changes in prevalence over time.

The Effect on Patients' Visual Acuity and Grade, Secondary to Non-Attendance at Treatment Centers, Post Referral from Diabetic RetinaScreen Ireland.

Patient non-attendance following referral to hospital is a significant challenge, in particular, for persons with diabetes. We sought to determine the impact on both visual acuity and the subsequent follow-up retinopathy grade of patients when they fail to attend Diabetic Retinopathy Treatment (DRT) Centers following referral from Diabetic RetinaScreen (DRS). A retrospective analysis of patients discharged from DRT due to multiple consecutive missed appointments between January 2016 and June 2021. Patients discharged for non-attendance were compared with patients discharged from completed treatment. Of the 24,945 NEC patients referred to DRT, 5900 (24%) and 9345 (37%) were discharged back to DRS due to non-attendance and completed treatment, respectively. Those discharged for non-attendance were younger (60.7 v 63.4, p < 0.001) and had higher proportions of males (67% v 63%, p < 0.001) and people with type 1 diabetes (27% v 18%, p < 0.001). After attending rescreening after discharge, those discharged for non-attendance were significantly more likely to have a worsening of DR grade (26% v 8%, p < 0.001). Despite being notified that further investigation (with possible treatment) was required post DRS, many diabetic patients failed to attend for further management of their eye care in DRT. These patients had worse visual outcomes compared to those that attended. Improved patient education and communication are required to mitigate against the consequences of non-attendance.

Teachers’ views on the role of economic and management sciences in preparing learners for accounting in the Further Education and Training Phase

With this study we explored teachers’ views on the role of economic and management sciences (EMS) in preparing learners for accounting in the Further Education and Training (FET) Phase. A qualitative research approach was employed along with the interpretivist paradigm to underpin the study. We used a qualitative case study approach to allow for an in-depth understanding of the views of the teachers by talking to them directly. Semi-structured individual and focus-group interviews were used as data collection methods. Participants in the study included 5 Grade 9 EMS teachers and 5 Grade 10 accounting teachers who were conveniently and purposively sampled from 5 secondary schools. A thematic analysis approach was adopted to analyse the interview responses. The findings of the study reveal that teachers understood that EMS was an integrated subject. However, Grade 9 teachers struggled to teach EMS in an integrated manner and this hampered the teaching of financial literacy. The challenges in teaching EMS are aggravated by the lack of relevant pedagogical strategies, the lack of adequate knowledge of the subject and missing pertinent foundational content in the EMS curriculum and textbooks. As a result, learners enter the FET phase without being adequately prepared to study accounting in subsequent grades.

Revisiting age- and schooling-related growth in school readiness skills: A multimethod validation study.

In the present study, we investigated the relative impact of age- versus schooling-related growth in school readiness skills using four modeling approaches that leverage natural variation in longitudinal data collected within the preschool year. Our goal was to demonstrate the applicability of different analytic techniques that do not rely on assumptions inherent in commonly applied methods (e.g., the school entrance cutoff method, regression discontinuity design) that selection into subsequent grades is based on birthdate alone and that the quality of experiences between grades are not responsible for differences in outcomes. Notably, these alternative methods also do not require data collected across multiple grades. Participants included 316 children (Mage = 54.77 months; 47.15% male) who mostly identified as White (64%) or Latinx (20%). A little over half of the sample attended Head Start preschools (54.75%). Four modeling techniques that leverage data collected at two timepoints in preschool were used to examine schooling effects on children's preliteracy, emergent math, and executive function (EF) skills. Results replicate evidence from previous research using traditional methods. Specifically, findings across all models demonstrate a schooling effect on preliteracy skills during the preschool year, above and beyond maturation, but not on emergent math or EF. We discuss the advantages and disadvantages of each analytical tool for researchers who are interested in answering questions about the effects of schooling with diverse data collection strategies, as well as broader implications for the integrity of educational and developmental science. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Safety analysis of high-dose methotrexate in pediatric non-Hodgkin lymphomas.

High-dose methotrexate (HD-MTX) with rigorous supportive care is essential to the treatment of pediatric non-Hodgkin lymphomas (NHL). We describe the safety and tolerability of HD-MTX in patients with NHL treated at our center. In our cohort of 46 patients, the majority had at least one course of delayed clearance and/or creatinine elevation. Additionally, more than one-third of patients experienced an episode of grade ≥3 mucositis. Creatinine elevations and delayed clearance were independently associated with subsequent grade ≥3 mucositis. We advocate for greater availability of methotrexate monitoring to allow dose escalation of this essential modality around the world.

Childhood stunting and subsequent educational outcomes: a marginal structural model analysis from a South African longitudinal study.

To examine the association between childhood stunting and grade completion (as educational outcome) in South Africa. Longitudinal study. Data were obtained using the National Income Dynamics Study over five waves (2008 to 2017). Children were tracked at wave 1 in 2008 until wave 5 in 2017 to determine their total years of schooling. We controlled for time-variant and time-varying confounding with a marginal structural model to estimate the associations between childhood stunting and subsequent grade completion. Nationally representative study of South African households. A total of 2629 children aged 2 and 3 years in 2008. We observed a substantial decrease in the prevalence of stunting between wave 1 (28·2 %) and wave 4 (8·6 %). Our marginal structural model results suggest that childhood stunting was significantly associated with decreased odds (22 % less likely) of grade completion (OR = 0·78; 95 % CI: 0·40, 0·86; P = 0·015), while those who were only stunted during early childhood had a 29 % reduction in the odds of grade completion (OR = 0·71; 95 % CI: 0·51, 0·82; P = 0·020). These findings underscore the fact that stunting is a significant predictor of academic achievement, whose effects might be long-lasting.

The Influence of Body Mass Index on the Histopathology and Outcomes of Patients Diagnosed with Atypical Breast Lesions.

Multiple studies have demonstrated a link between obesity and breast cancer; however, the potential association between obesity and atypical high-risk breast lesions has not been well characterized. We sought to evaluate the characteristics and clinical outcomes of patients with breast atypia based on a woman's body mass index (BMI). We retrospectively identified adult women diagnosed with atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and/or lobular carcinoma in situ (LCIS) at a single institution from 2008 to 2017. BMI groups were defined as a BMI 18.5 to <30 or BMI ≥30 (obese). Adjusted logistic regression was used to estimate the association of BMI group with the odds of (1) upstage to cancer after atypia on needle biopsy, and (2) subsequent diagnosis of breast cancer. Breast atypia was identified in 503 patients (most advanced atypia: 74.8% ADH, 4.6% ALH, 20.7% LCIS), and 41% of these patients were classified as obese. After adjustment, BMI group was not associated with upstage to breast cancer at surgical excision following needle biopsy (p=0.16) or development of a subsequent breast cancer (p=0.08). For those upstaged to breast cancer at the time of surgical excision, or those who developed a subsequent malignancy, tumor subtype, grade and stage were not associated with BMI group (p>0.05). In a large cohort of patients diagnosed with atypical breast histology, the risk of upstaging and/or subsequent progression to a breast malignancy was not associated with BMI. Factors other than obesity may influence breast cancer risk.

A phase III, randomized, sham-controlled trial of acupuncture for treatment of radiation-induced xerostomia (RIX) in patients with head and neck cancer: Wake Forest NCI Community Oncology Research Program Research Base (WF NCORP RB) trial WF-97115.

12004 Background: The majority of head/neck (HN) patients who undergo radiotherapy develop RIX. Unfortunately, existing treatments are of limited benefit and have side effects. Initial small studies suggest acupuncture may treat chronic RIX. A multicenter, phase III, randomized, sham-controlled trial (NCT02589938) was conducted to compare true acupuncture (TA) with sham acupuncture (SA) and wait list control (WLC) group in treating chronic RIX. Methods: HN patients with chronic RIX at least 12 months post-RT were recruited through the WF NCORP RB network (2UG1CA189824). Patients must have received bilateral radiation therapy with subsequent grade 2 or 3 xerostomia per modified RTOG scale, with no history of xerostomia or other illness known to affect salivation prior to HN XRT. All patients received standard oral hygiene and were randomized to TA, SA, or WLC. Patients in TA and SA were treated 2 times per week for 4 weeks. Those experiencing a marginal response (10-19 point decrease on the Xerostomia questionnaire (XQ)) received another 4 weeks of the respective treatment. Patients who had no response (increase in XQ score or decrease of &lt; 10 points from baseline), partial response (20 or more point decrease in XQ score from baseline), or complete response (XQ score = 0) did not receive further treatment. Patient outcomes including XQ and FACT-HN were collected at baseline, 4, 8, and 12 weeks; the primary endpoint was XQ at 4 weeks. A sample size of 80 per group (240 total), had 80% power to detect a difference of 10 points between groups, assuming two-sided alpha = 0.013 and 20% attrition. Analysis of covariance adjusted for baseline XQ and Bonferroni corrections for pairwise comparisons. Results: 258 from 33 different practices participated. Average age was 65 years, 78% male, and 67% had AJCC stage IV a,b disease. At week 4, there was a group main effect on the XQ (P = 0.02) revealing significant between group differences between TA and WLC (51.1 vs 56.8, P = 0.008), with marginal between group difference between TA and SA (51.1 vs 54.5, P = 0.066) and no difference between SA and WLC (P = 0.36). A similar pattern was seen at week 8 (TA = 48.3, SA = 50.8, WLC = 54.8; only TA vs WLC significant, P = 0.012) and 12 (TA = 48.6, SA = 49.3.8, WLC = 54.6; TA vs WLC, P = 0.02; SA vs WLC, P = 0.04; TA vs SA, P = 0.79). Incidence of clinically significant RIX (XQ scores &gt; 30) followed a similar pattern. The FACT-HN at week 12 revealed statistically and clinically significant group differences for the total score and several subscales between TA vs SA and WLC with no differences between SA and WLC. Completer and mediation analyses will be presented. Conclusions: True acupuncture was more effective in treating chronic RIX and improving QOL one or more years after the end of XRT than sham acupuncture or standard oral hygiene. Clinical trial information: NCT02589938.

Impact of Asymptomatic Rejection Steroid Treatment Choice on Subsequent Biopsy Result

<h3>Purpose</h3> Guidelines recommend routine surveillance biopsies for the first year after transplant, however the need for treatment of asymptomatic 2R rejection remains controversial. Surveillance strategies across programs are currently highly dynamic with a variety of approaches incorporating non-invasive monitoring techniques. This review was conducted to determine the relationship between 2R rejection steroid treatment intensity and subsequent biopsy findings. <h3>Methods</h3> We conducted a single center, retrospective analysis of heart transplant recipients receiving protocolized biopsies for their first year. Patients with 2R rejection were reviewed for pharmacologic response to 2R rejection and hemodynamic measurements were collected. Statistical analyses using Fishers Exact Test with descriptive statistics were performed. <h3>Results</h3> We reviewed 59 patients transplanted from September 2019 - December 2020 who were an average 50 ± 11 years, were 82% white and 79% male. A total of 78 rejection episodes were analyzed, with subsequent biopsy (Figure 1). When comparing IV steroids use > 250 mg, oral steroid pulse or no pulse, no difference was found for likelihood of subsequent biopsy graded ≥ 2R (24%, 20% and 25% respectively p=0.35). Follow up biopsies were performed an average 15 days post rejection episode. All initial biopsies were protocolized and no rejection were associated with an ejection fraction < 50%. <h3>Conclusion</h3> In our population, steroid choice of treatment for asymptomatic rejection did not impact subsequent biopsy grade. Further opportunities exist to minimize steroid exposure with non-invasive biomarkers and reduction of surveillance biopsies for hemodynamically insignificant rejection.

The roles of suspensions for minor infractions and school climate in predicting academic performance among adolescents.

African American adolescents are grossly overrepresented in rates of school suspensions for minor disciplinary infractions; however, the consequences associated with this disciplinary practice are unknown. African American adolescents who were suspended for minor infractions may perceive school rules and adults as unfair and illegitimate, and these poor perceptions toward school may compromise their social and interpersonal resources necessary for academic success. The present study investigates: (a) whether suspensions for minor infractions predict lower school grades longitudinally, and (b) whether poor school climate perceptions mediate the longitudinal link between suspensions for minor infractions and school grades. Based on 3 years of school records and social survey data from 2,381 adolescents (35% African American, 65% White), results illustrated that more African American adolescents were suspended for minor infractions than their White peers who committed similar infractions. In addition, African American adolescents suspended for minor infractions also had lower grades 1 and 2 years later. The longitudinal relation between suspensions for minor infractions and subsequent grades was partially mediated by African American adolescents' school climate perceptions. Implications are discussed in relation to racial biases and developmentally appropriate, equitable disciplinary practices. Public Significance Statement: The present study shows that more African American youth are suspended for minor infractions than White youth. In addition, these suspensions predicted poor school grades and school climate perceptions for African American youth. These findings raise concerns about school adults' discretion in using punitive school discipline policies and practices, as they may be contributing to academic disparities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The integrity of cfDNA in follicular fluid and spent medium from embryo culture is associated with embryo grade in patients undergoing in vitro fertilization.

This study was conducted to verify if the cfDNA integrity (cfDI) in follicular fluid and subsequent spent embryo medium (SEM) could serve as potential non-invasive biomarker for high-grade embryo selection during IVF/ICSI. Thirty-two follicular fluids, 32 subsequent corresponding cleavage embryo SEM, and 23 subsequent blastocyst SEM were collected from 11 patients undergoing IVF/ICSI. CfDI was measured by ALU gene amplicons with different sizes by qPCR, as the ratio of long to short fragments. CfDI in follicular fluid corresponding to subsequent high-grade cleavage embryos and blastocysts was significantly lower than that related to low-grade embryos (p = 0.018). Conversely, cfDI in SEM was significantly and positively correlated with high-grade embryos at both stages (p = 0.009). ROC curves of the analysis of cfDI in follicular fluid showed great potential in predicting subsequent embryogenesis and embryo grade (AUC > 0.927). Regardless of the cleavage embryo grade by morphology, cfDI in day 3 SEM could predict if the cleavage embryo could develop to a high-grade blastocyst (AUC = 0.820). A concordant shift pattern of cfDI from follicular fluid to subsequent day 3 SEM and day 5 SEM was found in 81.82% participants featured by various clinical characteristics. CfDI in follicular fluid and SEM was significantly correlated with embryogenesis and embryo grade and could serve as a potential non-invasive biomarker in high-grade embryo selection. Direct qPCR was proved as a labor-saving and sensitive method for the analysis of cfDI in low volume of SEM.

Prospective Study Testing a Simplified Paclitaxel Premedication Regimen in Patients with Early Breast Cancer.

BackgroundIn early trials, hypersensitivity reactions (HSRs) to paclitaxel were common, thus prompting the administration of antihistamines and corticosteroids before every paclitaxel dose. We tested the safety of omitting corticosteroids after cycle 2 during the paclitaxel portion of the dose‐dense (DD) doxorubicin‐cyclophosphamide (AC)–paclitaxel regimen.Patients, Materials, and MethodsIn this prospective, single‐arm study, patients who completed four cycles of DD‐AC for stage I–III breast cancer received paclitaxel 175 mg/m2 every 2 weeks for four cycles. Patients received a standard premedication protocol containing dexamethasone, diphenhydramine, and a histamine H2 blocker prior to the first two paclitaxel cycles. Dexamethasone was omitted in cycles three and four if there were no HSRs in previous cycles. We estimated the rate of grade 3–4 HSRs.ResultsAmong 127 patients enrolled, 125 received more than one dose of protocol therapy and are included in the analysis. Fourteen (11.2%; 90% confidence interval, 6.9%–20.0%) patients had any‐grade HSRs, for a total of 22 (4.5%; 3.1%–6.4%) HSRs over 486 paclitaxel cycles. Any‐grade HSRs occurred in 1.6% (0.3%–5.0%), 6.5% (3.3%–11.3%), 7.4% (3.9%–12.5%), and 2.6% (0.7%–6.6%) of patients after paclitaxel cycles 1, 2, 3, and 4, respectively. Dexamethasone use was decreased by 92.8% in cycles 3 and 4. Only one patient experienced grade 3 HSR in cycles 3 or 4, for a rate of grade 3/4 HSR 0.4% (0.02%–2.0%) (1/237 paclitaxel infusions). That patient had grade 2 HSR during cycle 2, and the subsequent grade 3 event occurred despite usual dexamethasone premedication. A sensitivity analysis restricted to patients not known to have received dexamethasone in cycles 3 and 4 found that any‐grade HSRs occurred in 2.7% (3/111; 0.7%–6.8%) and 0.9% (1/109; 0.05%–4.3%) of patients in cycle 3 and 4, respectively.ConclusionCorticosteroid premedication can be safely omitted in cycles 3 and 4 of dose‐dense paclitaxel if HSRs are not observed during cycles 1 and 2.Implications for PracticeBecause of the potential for hypersensitivity reactions (HSRs) to paclitaxel, corticosteroids are routinely prescribed prior to each dose, on an indefinite basis. This prospective study, including 125 patients treated with 486 paclitaxel cycles, demonstrates that corticosteroids can be safely omitted in future cycles if HSRs did not occur during cycles 1 and 2 of paclitaxel and that this strategy reduces the use of corticosteroids in cycles 3 and 4 by 92.8% relative to current standard of care.