Efforts to support children in schools require addressing not only academic issues, but also out-of-school factors that can affect students’ ability to succeed. This study examined academic achievement of students participating in City Connects, a student support intervention operating in high-poverty elementary schools. The sample included 7,948 kindergarten to fifth-grade students in a large urban district during 1999–2009. School- and student-level treatment effects on report card grades and standardized test scores in elementary through middle school were estimated. Propensity score methods accounted for pre-intervention group differences. City Connects students demonstrated higher report card scores than comparisons and scored higher on middle school English language arts and mathematics tests. This study provides evidence for the value of addressing out-of-school factors that impact student learning.

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Background: Data on patient characteristics and provider practices in the management of lipids per the new guidelines in specific secondary prevention patients in the Middle East is limited. Objective: To explore patient characteristics and lipid management practices according to the new cholesterol guidelines in secondary prevention patients, up to one year following discharge for coronary artery bypass graft surgery (CABG). Methods: A retrospective chart review of patients discharged post CABG between February 2017 and February 2018 at a quaternary care centre in the Middle East. Patients were characterized by baseline demographics, comorbidities, and use of lipid lowering medications. Results: 189 patients were included in the analysis. Most were diabetic (70.9%) and classified as very high risk per the ACC/AHA guidelines (84.1%) and as extremely high risk per the AACE guidelines (85.2%). Most patients (93.1%) were discharged on high intensity statin. About one third (28.6%) were never seen or only followed once within the first 2 weeks post discharge. Of those who continued to follow up beyond 3 months and within 1 year of discharge (44.4%), about half (51.2%) had follow-up lipid panels performed. Patients who followed up and were seen by a cardiologist were five times more likely to have lipid panels ordered than those seen solely by a CT surgeon. Of those with follow-up lipid panels beyond 3 months: 59.3% achieved LDL goal of <70 mg/dL and 29% achieved LDL <55 mg/dL based on their respective goals. Conclusions: Most patients undergoing CABG in a quaternary care centre in the Middle East are high risk ASCVD. Nonetheless, lipid goals are not commonly achieved nor routinely monitored. Providers will need to transition from the previous risk stratification and statin-only focused approach to adopt the most recent guidelines.

<b><i>Background and Aim:</i></b> We have previously shown in a retrospective analysis that the plasma thyroid-stimulating hormone (TSH) rises significantly post-Ramadan in levothyroxine-treated hypothyroid patients, possibly as a result of lifestyle alterations and time restrictions during the nonfasting period from dusk until dawn. The aim of this study is to determine the best time to instruct patients to take levothyroxine during Ramadan so as to minimize changes in thyroid function tests during this period. <b><i>Methods:</i></b> In a randomized prospective design, hypothyroid patients taking levothyroxine were randomized to receive instructions to take levothyroxine at one of the following 3 times during Ramadan: (group 1) at dusk 30-min before Iftar meal, (group 2) 3 or more hours after Iftar meal, or (group 3) at dawn 30-min before Suhur meal. Thyroid function tests were performed within 3 months before Ramadan and within 6 weeks post-Ramadan. Data from patients with at least 1 blood test before or after Ramadan were analyzed using mixed-effects regression models. <b><i>Results:</i></b> Plasma TSH levels were available at one or more time points for 148 patients, group 1 (<i>n</i> = 50), group 2 (<i>n</i> = 46), and group 3 (<i>n</i> = 52). A statistically significant within-patient increase in plasma TSH was seen in patients at the 25th percentile pre-Ramadan in groups 2 and 3 (<i>p</i> values &#x3c;0.001), but not in group 1. A statistically significant within-patient decrease in plasma TSH was found in patients at the 75th percentile in group 1 only. For patients at the 50th percentile pre-Ramadan, no statically significant within-patient changes were found, though descriptively, increases in plasma TSH were observed for groups 2 and 3, while a decrease was observed in group 1. <b><i>Conclusions:</i></b> Our data suggest that instructing patients to take levothyroxine at the time of breaking the fast 30 min before the Iftar meal minimizes unfavorable changes in plasma TSH post-Ramadan. In contrast, instructing patients to take levothyroxine 3 h post-Iftar or 30 min before Suhur led to a greater rise in post-Ramadan TSH.

Dropping out of high school has adverse consequences, including negative effects on employment, lifetime earnings, and physical health. Students often fail to complete high school for complex reasons that often manifest long before they reach high school. This study examines the link between participation in a comprehensive elementary school student support intervention and high school dropout. In this study, students who attended intervention elementary schools in a large, urban, high-poverty district during 2001–2014 ( N=894) were compared to students who did not attend intervention schools ( N=10,200). Likelihood of dropping out in grades 9–12 was estimated using propensity score-weighted Discrete Event History Analysis. Intervention students had approximately half the odds of dropout ( p<.001); the probability of dropout for intervention was 9.2%, compared to 16.6% for non-intervention students. Individually tailored student support interventions during elementary school can lead to lasting and meaningful effects.