With secondary English learners (ELs) often falling behind their peers in reaching grade-level expectations, a push to find research-based strategies to aid instruction to significantly decrease this gap is in place. This chapter addresses where to begin assessment and instruction with limited-level English learners to aid these students in accessing grade-level academic content in a timely manner. It provides key principles and research-based strategies for developing assessments and assignments to help break through initial barriers and provide an affective atmosphere (promoting confidence) for students to begin experimenting with language through meaningful and culturally relevant topics that will also address grade-level content standards. The texts and assignments should be rigorous, challenging the student to higher-order thinking and guiding the student to reach their full potential. Instruction should include multiple opportunities for extended discourse to allow the student to experiment and practice language across all language domains: reading, writing, listening, speaking.

Background: Patients with type II diabetes are at major risk for cardiovascular disease. Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) have demonstrated benefit for these patients. The purpose of this study is to determine whether SGLT-2 inhibitors significantly reduce heart failure readmission rates and improve outcomes in patients with congestive heart failure (CHF). Methods: Patient data was pulled on CHF patients with an active prescription for an SGLT-2 inhibitor, and it was analyzed using Fischer's Exact tests and two-tailed t-tests. The primary outcome was a 6-month hospital readmission rate due to CHF while taking SGLT-2 inhibitors. Secondary outcomes included 6-month all-cause hospital readmissions, renal function as measured by an estimated glomerular filtration rate change between admissions, mortality rates, and ejection fraction. Results: Of the 138 patients that met inclusion criteria for the first admission, the 6-month all-cause readmission rate for CHF patients still taking SGLT-2 inhibitors at readmission was 21 percent vs 16 percent (p=0.6) for the control group not taking SGLT-2 inhibitors. The 6-month CHF readmission rate in patients taking SGLT-2 inhibitors was 7.2 percent, and a CHF specific readmission rate was not collected for the control group. In patients with an eGFR less than 90, the average eGFR for the SGLT-2 group declined slightly but was not significant between patients at first admission and those with readmission (p=0.21). Conclusion: The use of SGLT-2 inhibitors in patients with CHF did not change the overall hospital readmission rate; however, larger randomized controlled trials are needed for further evaluation of the potential benefit.