Cardiovascular complications associated with elevated levels of glucose in the blood (Hyperglycemia, HG) is a growing health concern. HG is known to be associated with a variety of cardiovascular morbidities including higher incidence of electrical disturbances. Although effects of chronic HG have been widely investigated, electrophysiological effects of acute hyperglycemia are relatively less known. Further, hyperglycemic effects on adrenergic response is not widely investigated. We used excised ventricular tissues from mice to record trans-membrane potentials during a variety of pacing protocols to investigate cellular/tissue level electrophysiological effects of acute hyperglycemia and adrenergic stimulation (1µM Isoproterenol, a β-adrenergic agonist). A custom program was used to compute action potential durations (APD), maximal rates of depolarization (dv/dtmax), and action potential amplitudes (APA) from the recorded trans-membrane potentials. From these computed measures, electrical restitution and alternans threshold were quantified. Restitution was quantified using the Standard Protocol (SP; basic cycle length BCL= 200ms), Dynamic Protocol (DP; 200-40ms or until blockade) and a novel diastolic interval (DI) control protocol with Sinusoidal Changes in DI. Results from 6 mice show that acute hyperglycemia causes prolongation of the APD. Effects of adrenergic stimulation during acute hyperglycemia were partially blunted compared with non-hyperglycemic state, i.e. hyperglycemia minimized the decrease in APD that was produced by adrenergic stimulation. Similar, but less consistent (across animals) effects were seen in other electrophysiological parameters such as alternans threshold. These results show that acute hyperglycemia may itself alter cellular level electrophysiology of myocytes and importantly, modify adrenergic response. These results suggest that in addition to long term re-modeling that occurs in diabetes, acute changes in glucose levels also affect electrical function and further may contribute to systemically observed changes in diabetes by blunting adrenergic response. Therefore, further investigation into the electrophysiological effects of acute changes in glucose levels are warranted.

The use of Response to Intervention, more commonly referred to as RTI has become more prevalent as school systems look to find ways of bridging the opportunity gap and provide support those students who are not successful in their attempts to access the general education curriculum. More research is needed in order to have a better understanding of not only how schools implement RTI, but also how they utilize data, monitor student progress and help to ensure fidelity of implementation. The purpose of this study was to examine and explain how one elementary school with a high quality RTI program implemented Response to Intervention while keeping all three essential components in consideration. The findings demonstrate that the subject elementary school combined several elements of Response to Intervention and in turn, created their own version of a hybrid RTI model that utilized components from both the standard protocol model and the problem-solving model. In order to monitor student progress, universal screeners were utilized several times throughout the year for both reading and math. Reading was also monitored through running records, PALS Quick Checks, Orton Gillingham assessments, and exit tickets, whereas Math utilized formative assessments, anecdotal notes, and exit tickets to track student progress. Each math and reading CLT met weekly to engage in dialogue around student data. An important finding is that the subject elementary school made RTI implementation decisions around what was best for their students, which allowed for a more flexible and adaptable approach. The system utilized targeted individual student needs and helped to ensure that ALL students had access to the necessary supports that would help to ensure student success. / Doctor of Education / As schools continue to face increasing demands, including how to meet the needs of students with diverse academic backgrounds, they have been charged with exploring new ways and methods of ensuring that students are successful in their attempts to access the general education curriculum. Response to Intervention, more commonly referred to as RTI, has become more widely used in school systems as they continue to work to ensure student success for all. RTI is seen as a tool to help accurately identify students who have a learning disability (Ciolfi and Ryan, 2011), however more research is needed in order to have a better understanding of how schools implement RTI, as well as how they utilize the data collected and monitor student progress. This qualitative case study analyzes how one subject elementary school implemented RTI, how they utilized data, as well as how they monitored the progress of their students.

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