Analyzing mathematics and reading achievement outcomes from a district-level random assignment study fielded in over 500 schools within 59 school districts and seven states, the authors estimate the 1-year impacts of a data-driven reform initiative implemented by the Johns Hopkins Center for Data-Driven Reform in Education (CDDRE). CDDRE consultants work with districts to implement quarterly student benchmark assessments and provide district and school leaders with extensive training on interpreting and using the data to guide reform. Relative to a control condition, in which districts operated as usual without CDDRE services, the data-driven reform initiative caused statistically significant districtwide improvements in student mathematics achievement. The CDDRE intervention also had a positive effect on reading achievement, but the estimates fell short of conventional levels of statistical significance.

Background-Warfarin is characterized by marked variations in individual dose requirements and a narrow therapeutic window. Pharmacogenetics (PG) could improve dosing efficiency and safety, but clinical trials evidence is meager. Methods and Results-A Randomized and Clinical Effectiveness Trial Comparing Two Pharmacogenetic Algorithms andStandard Care for Individualizing Warfarin Dosing (CoumaGen-II) comprised 2 comparisons: (1) a blinded, randomized comparison of a modified 1-step (PG-1) with a 3-step algorithm (PG-2) (Nϭ504), and (2) a clinical effectiveness comparison of PG guidance with use of either algorithm with standard dosing in a parallel control group (Nϭ1866). A rapid method provided same-day CYP2C9 and VKORC1 genotyping. Primary outcomes were percentage of out-of-range international normalized ratios at 1 and 3 months and percentage of time in therapeutic range. Primary analysis was modified intention to treat. In the randomized comparison, PG-2 was noninferior but not superior to PG-1 for percentage of out-of-range international normalized ratios at 1 month and 3 months and for percentage of time in therapeutic range at 3 months. However, the combined PG cohort was superior to the parallel controls (percentage of out-of-range international normalized ratios 31% versus 42% at 1 month; 30% versus 42% at 3 months; percentage of time in therapeutic range 69% versus 58%, 71% versus 59%, respectively, all PϽ0.001). Differences persisted after adjustment for age, sex, and clinical indication. There were fewer percentage international normalized ratios Ն4 and Յ1.5 and serious adverse events at 3 months (4.5% versus 9.4% of patients, PϽ0.001) with PG guidance. Conclusions-These findings suggest that PG dosing should be considered for broader clinical application, a proposal that is being tested further in 3 major randomized trials. The simpler 1-step PG algorithm provided equivalent results and may be preferable for clinical application. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00927862. Key Words: anticoagulants Ⅲ clinical trial Ⅲ genetics Ⅲ pharmacogenetics Ⅲ warfarin P harmacogenomics, the study of interactions of genetics with pharmacotherapy, is a promising area for applying genetics to personalized or precision medicine. [1][2][3] Warfarin is prescribed to over 2 million patients in the United States for prevention of thromboembolic events associated with atrial fibrillation, venous and arterial thrombosis, orthopedic surgery, and prosthetic heart valves. Unfortunately, clinical management is difficult because of a narrow therapeutic index and marked interpatient variability in drug pharmacokinetics and pharmacodynamics, which lead to unpredictable and variable (up to 10-fold or greater) dosing requirements. 4 Anticoagulation trials for nonrheumatic atrial fibrillation have determined the optimal prothrombin time international normalized ratio (INR) range to be 2 to 3 with ratios Ͻ2 increasing thrombotic events and those Ͼ4 increasing hemorrhagic events. 5...

Background Sciatica has a substantial impact on individuals and society. Stratified care has been shown to lead to better outcomes among patients with non-specific low back pain, but it has not been tested for sciatica. We aimed to investigate the clinical and cost-effectiveness of stratified care versus non-stratified usual care for patients presenting with sciatica in primary care. MethodsWe did a two-parallel arm, pragmatic, randomised controlled trial across three centres in the UK (North Staffordshire, North Shropshire/Wales, and Cheshire). Eligible patients were aged 18 years or older, had a clinical diagnosis of sciatica, access to a mobile phone or landline number, were not pregnant, were not currently receiving treatment for the same problem, and had no previous spinal surgery. Patients were recruited from general practices and randomly assigned (1:1) by a remote web-based service to stratified care or usual care, stratified by centre and stratification group allocation. In the stratified care arm, a combination of prognostic and clinical criteria associated with referral to spinal specialist services were used to allocate patients to one of three groups for matched care pathways. Group 1 was offered brief advice and support in up to two physiotherapy sessions; group 2 was offered up to six physiotherapy sessions; and group 3 was fast-tracked to MRI and spinal specialist assessment within 4 weeks of randomisation. The primary outcome was self-reported time to first resolution of sciatica symptoms, defined as "completely recovered" or "much better" on a 6-point ordinal scale, collected via text messages or telephone calls. Analyses were by intention to treat. Health-care costs and cost-effectiveness were also assessed. This trial is registered on the ISRCTN registry, ISRCTN75449581.

The rate of suicide among adolescents is rising in the US, yet many adolescents at risk are unidentified and receive no mental health services.OBJECTIVE To develop and independently validate a novel computerized adaptive screen for suicidal youth (CASSY) for use as a universal screen for suicide risk in medical emergency departments (EDs). DESIGN, SETTING, AND PARTICIPANTSStudy 1 of this prognostic study prospectively enrolled adolescent patients at 13 geographically diverse US EDs in the Pediatric Emergency Care Applied Research Network. They completed a baseline suicide risk survey and participated in 3-month telephone follow-ups. Using 3 fixed Ask Suicide-Screening Questions items as anchors and additional items that varied in number and content across individuals, we derived algorithms for the CASSY. In study 2, data were collected from patients at