Racialization of Urban Black Middle School Students from the Perspective of Middle School Teachers: A Phenomenological Study in Central and Southeast Michigan

Walden University College of Education and Human Sciences This is to certify that the doctoral dissertation by Bryan L. Spencer has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Michael Langlais, Committee Chairperson, Psychology Faculty Dr. Matthew Hertenstein, Committee Member, Psychology Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University 2025   Racialization of Urban Black Middle School Students from the Perspective of Middle School Teachers: A Phenomenological Study in Central and Southeast Michigan by Bryan L. Spencer MPhil, Walden University, 2023 MHSA, University of Michigan, 2005 BS, University of Michigan, 2003 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Developmental Psychology Walden University March 2025 Prior studies of racialization’s impact within the classroom focus on school institutional settings as mirroring societal marginalizations, presenting teachers as negotiating and navigating through presenting inequities to provide an academic experience for the marginalized student. This study recognizes the marginalizing aspects of societal inequities, yet probes into the meaning-making of the middle school teacher and explores understandings and descriptions of their classroom experiences with urban Black adolescents. This interview-based study explored these experiences by employing Crenshaw\u27s structural assignment allusion relative to critical race theory and Vygotsky\u27s socio-historical theory as providing background on racialization’s impact and dialogic intersubjectivity in proximal learning. The investigation into teacher meaning-making employed Moustakas\u27s phenomenological design to explore intuitions and intentions, producing codes, categories, and themes through phenomenological reduction. The results of this study indicated the prevalence of a sociological strand that connects society, school administration, classroom, and teacher proclivities, and revealed subthemes of variant Lifeworlds, prevailing Realizations, necessary Interactional Dimensions, and an ongoing Developmental Praxis. Summing that middle school teachers play a mediating and transformative role through negotiating and navigating implicit and explicit influences in their mission to provide a classroom experience that prioritizes positive, inclusive, and safe connections. The implications of this study expand beyond the classroom, as it addresses the importance of interactive dialogue, cultural understanding, and humility in bridging divides and producing meaningful connections. Racialization of Urban Black Middle School Students from the Perspective of Middle School Teachers: A Phenomenological Study in Central and Southeast Michigan by Bryan L. Spencer MPhil, Walden University, 2023 MHSA, University of Michigan, 2005 BS, University of Michigan, 2003 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Developmental Psychology Walden University March 2025 Dedication This study is dedicated to the presence and voice of the middle school teacher. As they embrace the responsibilities and developmental challenges within their own sensibilities and manage and embrace classrooms filled with unsure and developing adolescents, they find ways to reach the most vulnerable and contribute to the emergence of their transcendent possibilities. May their presence achieve the acclamation they deserve, and may their voices, filled with wisdom and understanding, resonate through systems and institutions to challenge what divides us and bring an understanding of what meaningful connections can ensure. Acknowledgments My first acknowledgment is thanks to God for giving me the strength to accomplish this task. It is said that through many tribulations, we enter the kingdom of God. Through difficulty, we access the kingdom that lies within us, and through these difficulties, we rely on what we have come to learn, to know, and to make a part of our strength collective. I acknowledge my committee chair, Dr. Mickey Langlais, for providing practical support and encouragement throughout this process. Your presence and voice have been invaluable as I have pursued and walked this transformative experience. To my secondary committee members, Dr. Matthew Hertenstein and Dr. Michelle Dunlap, our connection around this task was short, but your expertise and well-placed words of encouragement and validation were a significant part of my tapestry of strength. To my instructors at Walden University, my appreciation and love for what you do and have contributed to my journey will always have a resting place within my heart. To my family as you experienced this journey and watched through the years of difficulties, questioning, fatigue, and separation to the task. I hope that during these transformative years, and as we all struggled to comprehend this path, I have made you proud. To my friends and supporters in my community, at the downtown café, at the market and the market restaurant, the public health research building, the business hub, the banks, and the local stores, I thank you for your support. I felt you throughout and continue to feel you within my heart. I thank you all! Table of Contents List of Tables v List of Figures vi Chapter 1: Introduction to the Study 1 Introduction 1 Background 4 Problem Statement 6 Purpose of the Study 8 Research Questions 8 Theoretical Foundation 8 Conceptual Framework 10 Nature of the Study 12 Definitions 13 Critical Race Theory 13 Critical Theory 14 Dialogic Interaction 15 Hegemonic Structures 15 Intersubjectivity 16 Meaning-Making 16 Proximal Learning 17 Racialization 17 Racial Realism 17 Reflexivity 18 Structural Assignment 18 Assumptions 18 Scope and Delimitations 20 Limitations 23 Significance 24 Summary 25 Chapter 2: Literature Review 28 Introduction 28 Establishing Identity and Belonging 30 Social Construction and Emotional Effect 31 Classroom Impact 32 Adding Critical Race Theory 33 Literature Search Strategy 35 Literature Gap 37 Theoretical Foundation 43 Conceptual Framework 47 Key Variables and Concepts 50 Summary and Conclusions 58 Chapter 3: Research Method 62 Introduction 62 Research Design and Rationale 64 Research Questions 67 Research Tradition 68 Role of Researcher 69 Participant Criteria 71 Data Collection Instrument 75 Procedures for Recruitment, Participation, and Data Analysis 78 Study’s Relationship Origin 79 Participation 80 Data Analysis 84 Trustworthiness 86 Ethical Considerations 90 Summary 91 Chapter 4: Results 97 Introduction 97 Setting 100 Demographics 101 Data Collection 103 Data Analysis 106 Initial Coding 107 Secondary Coding 111 Theme Development 117 Discrepancies 121 Evidence of Trustworthiness 122 Results 125 Effectual Racialization in the Classroom 126 Connection and Learning 127 Racial Pragmatism—Meaning Coalescence—Negotiation 129 Negotiation 129 Sociological Strand/Subthemes 131 The Teacher as a Disruptor 135 Summary 137 Chapter 5: Discussion, Conclusions, and Recommendations 143 Introduction 143 Interpretation of the Findings 146 Lifeworlds 147 Realizations 149 Interactional Dimensions 150 Developmental Praxis 152 Limitations of the Study 154 Recommendations 157 Implications 159 Conclusion 162 References 165 Appendix: Sample Letter 174 List of Tables Table 1. Participant Demographics 102 Table 2. Initial Codes 110 Table 3. Question 1: What Successes and Challenges Have You Experienced as a Teacher of Middle School Students? 111 Table 4. Secondary Codes 114 Table 5. Subthemes 117   List of Figures Figure 1. Conceptual Framework Mapping (Initial Coding) 108 Figure 2. Conceptual Framework Mapping (Secondary Coding) 113 Figure 3. Sociocultural Strand – Conceptual Framework Mapping 116 Figure 4. Interview Questions Representative Fit 120 Figure 5. Thematic Development 121 Chapter 1: Introduction to the Study Introduction The school environment of the urban Black middle school adolescent can lack the empowered elevation in interactional educational spaces while also providing nonvalidating experiences. Crenshaw’s (1995) emphasis on the impact of racialization elucidates the experiences of urban Black middle school students by presenting how the promotion of a socially constructed and assigned racial designation devalues, diminishes identity and elevation, and implants negative stereotypes of public and private regard. Removing these inhibiting factors in the school experiences of these children will require an approach that shifts away from the penchant to avoid conversations. Dialogue and critical analysis of these situations and contexts broaches assessments of meaning-making and developmental learning within the learning environment. This attention is necessary for the elevation of the urban Black middle school student. A reformed learning environment that benefits the most marginalized is aided by a teaching core that recognizes these students\u27 needs and can function from an advantageous position to influence change. The positioning of the middle school teacher as a mediator and transformer (Gray et al., 2018; Williams, 2018b) aids this development when the teacher reflects on how their meaning-making is influenced by pre-existing schemas of personal and professional import (Howard, 2020; Kramer & McKenzie, 2022; Narayanan, & Ordynans, 2022). Teacher training has given credence to the value of didactic interchange with students under Vygotsky\u27s concept of proximal learning (Mercer et al., 2019; Patterson, 2018; Sedova et al., 2016). However, expositions into the background influences of beliefs and values need illumination to reveal the impacts of both personal proclivities and professional teaching traditions. Engaging middle school teachers involves recognizing the benefits of their work and respecting the depth of commitment to the growth and development of their students. The current sociopolitical environment provides a challenging context from which to conduct their work (Nelson & Johnson, 2023; Williams, 2018b); however, what they accomplish in their positioning in the lives of adolescents is noteworthy. Interaction with the middle school teachers around this topic should embody the respect deserving of their work, and the related exploration should align with curiosity in the performance of this work. The phenomenon of racialization impacts the work of middle school teachers with marginalized adolescents (Ladson-Billings, 2009; Williams, 2018a; Williams, 2018b), and in this study, I explored this impact with awareness, curiosity, and respect for challenges encountered within the classroom experience and the school climate. This chapter includes a background description of how racialization imposes on the lives and experiences of urban Black middle school children in the school environment. Societal racialization can be reproduced within an insensitive, culturally unaware, or dismissive school environment. Belongingness, acceptability, and validation are sacrificed in a system that encourages stereotype threat, decreases motivation to achieve, and subverts cultural identity. Indeterminant of the prevailing climate, the teacher enters with inset beliefs, values, interpretations, cultural backgrounds, and professional training that may or may not have prepared them for the challenges of engaging and successfully teaching marginalized students. In consideration of the variant possibilities, this chapter includes allusions to associated reflections, involved intentions, and intuitions within the purposed goals and research questions intended to prompt conversations producing rich and interactive detail. The chapter continues beyond the goals and questions and includes a presentation of the alignment with a theoretical framework that posits critical race theory (CRT) and sociocultural theory as explaining structural inhibitions imposed by racialization and the possibilities within proximal learning through didactic interchange between teachers and students. The conceptual framework posits a socialization impression throughout, as the social construction of racialization poses boundaries for urban Black students and complications for teachers; however, the social aspects in proximal learning help to build connectedness and inclusivity between the students and teachers. I built on these frameworks in this chapter by exposing the qualitative tradition and phenomenological design to explore the teacher-student dynamic as impacted by racialization. The meaning-making within the relationships is a subject of detailed conversation, emerges in various ways within the study prompts, and was captured in the analysis, representing reflective and reflexive thought, descriptions, and understandings of concepts and transcendental themes. To add common understanding to this presentation, this first chapter includes definitions of outstanding points of emphasis, followed by assumptions made as a function of this study. Scope and delimitations broaden the study discussion and place boundaries on the study\u27s emphasis. This chapter concludes with limitations, social significance, and what can be possible going forward. This chapter also includes an overview of various points of emphasis in the development and progression of this study, as the following chapters include further delineation and synthesis. The following chapter includes an investigation of the research literature on this topic and the process of defining the gap within the research. Background Racialization impacts the belongingness, identity, sense of safety, and achievement of urban Black students. The social assignment of racialization diminishes the contributions, the narratives, and the individualized life view of marginalized populations (Crenshaw, 1995; Delgado & Stefancic, 2017; Mims & Williams, 2020). This positioning denigrates to a demoralized and subservient positioning that negatively impacts hopes and individualized trajectories. These impacts are translated into the school experience of urban Black middle school students when a school climate mimics disparaging biases and assignments seen and experienced in the larger society (Byrd, 2017; Darling-Hammond & Depaoli, 2020; Griffin et al., 2017). Howard (2020) pointed to stereotype threat as becoming a demeaning outcome in this environment as the student spirals into this dismissive assignment, and this position becomes traumatizing as safety and belongingness are sacrificed for the sanctioning of stereotypes and biases (Kramer & McKenzie, 2022). The reflection and reflexivity of the teacher become a vital intervening force within this dynamic. The middle school teacher intervenes during this already chaotic developmental time for adolescents (Erikson, 1963) and interposes a mediatorial and transformative presence (Gray et al., 2018) in the educational world of the student. The value that the individual middle school teacher brings cannot be understated, and the understanding of what they add contributes value to the directionality of all students (Sedova et al., 2018; Wiig et al., 2018), especially for marginalized students under the impact of racialization (Ladson-Billings, 2009; Logan et al., 2018; Mercer & Littleton, 2007; Williams, 2018a). This value represents the gap that requires greater illumination. Ladson-Billings (2009) and Williams (2018a) pointed to the value of sociocultural connection with students, emphasizing Black students who suffer under racialized assignments. Kramer and McKenzie (2022) expanded this understanding of the need for a safe environment with the input of sensitive, thoughtful, and flexible teachers. This experience illustrates value in dialogue between the student and teacher, which is a focus in proximal learning and a point of reference in teacher professional training (Mercer et al., 2019; Mercer & Littleton, 2007; Sedova et al., 2016; Vygotsky, 1978). However, the point of a more in-depth illumination looks at the conscious and unconscious meaning-making that contributes to the understanding and dialogue from the teacher toward the student\u27s needs. This intention and intuition include professional training, experience, beliefs, values, and sociocultural background. The phenomenon of racialization provides an impactful point of reference that showcases the inner workings of the experienced teacher in the service of a distinctly marginalized population. Students at the adolescent developmental stage undergo many changes that are cognitively, emotionally, and biologically based, and the addition of racially motivated marginalization adds another level of challenges. The teachers\u27 meaning-making plays a definitive role in how they respond to marginalized students and what they can bring to alleviate suffering and promote safety and a positive learning environment. The middle school teacher who recognizes the value of positive sociocultural interchange as a function of their personal and professional demeanor can nurture a safe and inclusive climate for all students (Howard, 2020; Kramer & McKenzie, 2022; Mercer & Littleton, 2007). The middle school teacher can stand at the crossroads as a mediator, educational translator, and personal confidante for marginalized students of color and an informer for administrative change. Problem Statement Black middle-school children from urban environments often face struggles in the classroom. Their presentations often need to be understood, as their behavioral responses, when seen as negative, are interpreted to measure their competence. These misunderstandings can affect the teachers\u27 appraisal and approach and the student\u27s performance (Zaff et al., 2016). Howard (2020) and Mims and Williams (2020) pointed to institutional structures as invalidating factors in the cultural identity of Black students and as barriers to their motivation to achieve. Marchante et al. (2022) employed the stage–environment fit theory to explain how achievement can be affected when an environment is not suited to the students\u27 developmental needs. Marraccini et al. (2022) further presented this dynamic by positing anecdotal evidence in the responses of Black and Latino students to how they feel about discrimination as adversely affecting their experiences within the school system. Students with sociocultural backgrounds promoting meaning-making and behaviors that do not match the expectations of the dominant group, experience demeaning and invalidating messaging that inhibits their learning trajectories within the classroom. Kramer and McKenzie (2022) alluded to the trauma that can occur in such situations as an outgroup status is enforced and reinforced, inferring an assigned status and dearth of belongingness (Mims & Williams, 2020; Palese & Schmid Mast, 2022; Williams, 2018b). When considering the developmental period of adolescents, these occurrences can be significantly impactful. These situations also present difficulties for teachers as they navigate the students\u27 meaning-making with their meaning-making (Logan et al., 2018; Narayanan & Ordynans, 2022; Rødnes et al., 2021). Professional teacher training can meet and explain some of these conflicts; however, teachers\u27 sociocultural beliefs and values relative to their societal backgrounds and experiences require exploration and reflection to work through the origins of intuitions and assumptions. Assumptions made on behaviors or presentations in institutional settings that lack cultural and contextual understanding bear more relevance to social norms as they represent expectations from the dominant group (Crenshaw, 1995; Kramer & McKenzie, 2022; Mims & Williams, 2020). These judgments are often made from appraisals of a racialized context that lack understanding and appreciation of cultural differences and contexts (Byrd, 2015; Howard, 2020; Mims & Williams, 2020), reinforcing biases that assign deficient and diminished status to those not fitting in based on their racial status (Crenshaw, 1995). This assignment and its impact on marginalized students necessitate exploring and understanding the meaning-making of middle school teachers of urban Black adolescents and how they approach racialization in the school system and navigate its effects upon these students. Purpose of the Study I addressed two purposes in this interview-based study. The first was the exploration of the perspectives of middle school teachers concerning their experiences with the racialization of urban Black middle school adolescents. The second purpose was to explore teacher perspectives concerning the coalescing of student and teacher meaning-making toward addressing racialization and revealing possible solutions. I also explored the mediatorial and translational position of the middle school teacher in support of these students\u27 development and educational trajectory. Research Questions The research questions that I asked in this study were: • How do middle school teachers experience the effects of racialization? • How do the meaning-making of teachers and urban Black middle school students coalesce and differ around racialization? • What solutions do middle school teachers offer for mediating the effects of racism on the learning trajectories of urban Black middle school students? Theoretical Foundation The theoretical basis for this study was Vygotsky\u27s social historical theory (Vygotsky, 1978) and Crenshaw\u27s structural assignment allusion relative to CRT (Crenshaw, 1995). Both theories draw from Horkheimer\u27s critical theory on elevating social consciousness instead of the un

Local-Oscillator Noise Coupling in Balanced Homodyne Readout for Advanced Gravitational Wave Detectors

The second generation of interferometric gravitational wave detectors are quickly approaching their design sensitivity. For the first time these detectors will become limited by quantum back-action noise. Several back-action evasion techniques have been proposed to further increase the detector sensitivity. Since most proposals rely on a flexible readout of the full amplitude- and phase-quadrature space of the output light field, balanced homodyne detection is generally expected to replace the currently used DC readout. Up to now, little investigation has been undertaken into how balanced homodyne detection can be successfully transferred from its ubiquitous application in table-top quantum optics experiments to large-scale interferometers with suspended optics. Here we derive implementation requirements with respect to local oscillator noise couplings and highlight potential issues with the example of the Glasgow Sagnac Speed Meter experiment, as well as for a future upgrade to the Advanced LIGO detectors.Comment: 7 pages, 5 figure

Effects of static and dynamic higher-order optical modes in balanced homodyne readout for future gravitational waves detectors

With the recent detection of Gravitational waves (GW), marking the start of the new field of GW astronomy, the push for building more sensitive laser-interferometric gravitational wave detectors (GWD) has never been stronger. Balanced homodyne detection (BHD) allows for a quantum noise (QN) limited readout of arbitrary light field quadratures, and has therefore been suggested as a vital building block for upgrades to Advanced LIGO and third generation observatories. In terms of the practical implementation of BHD, we develop a full framework for analyzing the static optical high order modes (HOMs) occurring in the BHD paths related to the misalignment or mode matching at the input and output ports of the laser interferometer. We find the effects of HOMs on the quantum noise limited sensitivity is independent of the actual interferometer configuration, e.g. Michelson and Sagnac interferometers are effected in the same way. We show that misalignment of the output ports of the interferometer (output misalignment) only effects the high frequency part of the quantum noise limited sensitivity (detection noise). However, at low frequencies, HOMs reduce the interferometer response and the radiation pressure noise (back action noise) by the same amount and hence the quantum noise limited sensitivity is not negatively effected in that frequency range. We show that the misalignment of laser into the interferometer (input misalignment) produces the same effect as output misalignment and additionally decreases the power inside the interferometer. We also analyze dynamic HOM effects, such as beam jitter created by the suspended mirrors of the BHD. Our analyses can be directly applied to any BHD implementation in a future GWD. Moreover, we apply our analytical techniques to the example of the speed meter proof of concept experiment under construction in Glasgow. We find that for our experimental parameters, the performance of our seismic isolation system in the BHD paths is compatible with the design sensitivity of the experiment

Demonstration of a switchable damping system to allow low-noise operation of high-Q low-mass suspension systems

Low mass suspension systems with high-Q pendulum stages are used to enable quantum radiation pressure noise limited experiments. Utilising multiple pendulum stages with vertical blade springs and materials with high quality factors provides attenuation of seismic and thermal noise, however damping of these high-Q pendulum systems in multiple degrees of freedom is essential for practical implementation. Viscous damping such as eddy-current damping can be employed but introduces displacement noise from force noise due to thermal fluctuations in the damping system. In this paper we demonstrate a passive damping system with adjustable damping strength as a solution for this problem that can be used for low mass suspension systems without adding additional displacement noise in science mode. We show a reduction of the damping factor by a factor of 8 on a test suspension and provide a general optimisation for this system.Comment: 5 pages, 5 figure

Real wages and monetary policy: A DSGE approach

Economists have long investigated the cyclical behavior of real wages in order to draw inferences regarding the relative stickiness of prices and wages. Recent studies have adopted techniques intended to identify monetary shocks and examined the response of real wages and output or employment to such shocks. A finding that real wages are procyclical in response to a positive monetary policy shock, for example, is taken as evidence that prices are stickier than wages. In this paper, we show that factors other than wage and price stickiness affect the response of real wages to a monetary policy shock. Accordingly, examining the response of real wages is not enough to sort out the relative stickiness of prices and wages. We use two prominent DSGE models to help us address this issue. These models incorporate both sticky wages and prices but in different ways. The first model (Huang, Liu, and Phaneuf, American Economic Review, 2004) is relatively simple and is not intended for policy analysis. Its relative simplicity allows us to approach the issues both analytically and through simulations. The second model (Smets and Wouters, American Economic Review, 2007) is a relatively complex model of the U.S. economy with many frictions and intended to be useful for policy analysis. Because of its complexity, we must rely principally on simulation exercises. Using these models we offer robust evidence that the real wage response to monetary policy is affected in important ways by properties of the economy other than stickiness of wages and prices, such as the importance of intermediate goods in the production process and the size of key elasticities. Consequently, we cannot appropriately infer the relative stickiness of wages and prices from examining only the response of real wages to a monetary policy shock

Real wages and monetary policy: A DSGE approach

Economists have long investigated the cyclical behavior of real wages in order to draw inferences regarding the relative stickiness of prices and wages. Recent studies have adopted techniques intended to identify monetary shocks and examined the response of real wages and output or employment to such shocks. A finding that real wages are procyclical in response to a positive monetary policy shock, for example, is taken as evidence that prices are stickier than wages. In this paper, we show that factors other than wage and price stickiness affect the response of real wages to a monetary policy shock. Accordingly, examining the response of real wages is not enough to sort out the relative stickiness of prices and wages. We use two prominent DSGE models to help us address this issue. These models incorporate both sticky wages and prices but in different ways. The first model (Huang, Liu, and Phaneuf, American Economic Review, 2004) is relatively simple and is not intended for policy analysis. Its relative simplicity allows us to approach the issues both analytically and through simulations. The second model (Smets and Wouters, American Economic Review, 2007) is a relatively complex model of the U.S. economy with many frictions and intended to be useful for policy analysis. Because of its complexity, we must rely principally on simulation exercises. Using these models we offer robust evidence that the real wage response to monetary policy is affected in important ways by properties of the economy other than stickiness of wages and prices, such as the importance of intermediate goods in the production process and the size of key elasticities. Consequently, we cannot appropriately infer the relative stickiness of wages and prices from examining only the response of real wages to a monetary policy shock

Real wages and monetary policy: A DSGE approach

Economists have long investigated the cyclical behavior of real wages in order to draw inferences regarding the relative stickiness of prices and wages. Recent studies have adopted techniques intended to identify monetary shocks and examined the response of real wages and output or employment to such shocks. A finding that real wages are procyclical in response to a positive monetary policy shock, for example, is taken as evidence that prices are stickier than wages. In this paper, we show that factors other than wage and price stickiness affect the response of real wages to a monetary policy shock. Accordingly, examining the response of real wages is not enough to sort out the relative stickiness of prices and wages. We use two prominent DSGE models to help us address this issue. These models incorporate both sticky wages and prices but in different ways. The first model (Huang, Liu, and Phaneuf, American Economic Review, 2004) is relatively simple and is not intended for policy analysis. Its relative simplicity allows us to approach the issues both analytically and through simulations. The second model (Smets and Wouters, American Economic Review, 2007) is a relatively complex model of the U.S. economy with many frictions and intended to be useful for policy analysis. Because of its complexity, we must rely principally on simulation exercises. Using these models we offer robust evidence that the real wage response to monetary policy is affected in important ways by properties of the economy other than stickiness of wages and prices, such as the importance of intermediate goods in the production process and the size of key elasticities. Consequently, we cannot appropriately infer the relative stickiness of wages and prices from examining only the response of real wages to a monetary policy shock

Audible Image Description as an Accommodation in Statewide Assessments for Students with Visual and Print Disabilities.

Introduction:Although image description has been identified as an accommodation for presentations conducted in the classroom, only a few U.S. states have approved it for use in high-stakes assessments. This study examined the use of audible image description as an assessment accommodation for students with visual and print disabilities by investigating student comprehension under multiple conditions. Methods: Students in three western states in grades three through eight who had visual (n= 117) or print (n= 178) disabilities participated in an abbreviated test constructed of retired assessment questions in English language arts, mathematics, and science, that were aligned with each state's instructional standards, under conditions with and without standardized description of graphic images. The study used a within-subjects block design to collect and compare comprehension data under conditions where audible image description was both used and not used in an abbreviated test. Results: Results indicated that students who read braille were more likely to respond correctly under the audible image description condition, and students with visual and print disabilities who used print were equally likely to respond correctly regardless of condition. Discussion: Braille readers were more likely to obtain a correct answer when audible image description accompanied the question. Audible image description did not affect the likelihood of a correct response from students with print disabilities or students with visual disabilities who read print. Implications for practitioners: Audible image description is an accommodation that may help braille readers perform better on tests. Although the Partnership for Assessment of Readiness for College and Careers (PARCC) and Smarter Balanced consortia are taking steps to include image (or picture) descriptions in their assessment accommodations, teachers may want to develop a standard method for describing images and familiarize their braille readers to the strategy by including it in instruction and in classroom tests. Readers are referred to the National Center on Accessible Media’s online guidelines for image description

Biomarker-guided antibiotic stewardship in suspected ventilator-associated pneumonia (VAPrapid2) : a randomised controlled trial and process evaluation

Background Ventilator-associated pneumonia is the most common intensive care unit (ICU)-acquired infection, yet accurate diagnosis remains difficult, leading to overuse of antibiotics. Low concentrations of IL-1β and IL-8 in bronchoalveolar lavage fluid have been validated as effective markers for exclusion of ventilator-associated pneumonia. The VAPrapid2 trial aimed to determine whether measurement of bronchoalveolar lavage fluid IL-1β and IL-8 could effectively and safely improve antibiotic stewardship in patients with clinically suspected ventilator-associated pneumonia. Methods VAPrapid2 was a multicentre, randomised controlled trial in patients admitted to 24 ICUs from 17 National Health Service hospital trusts across England, Scotland, and Northern Ireland. Patients were screened for eligibility and included if they were 18 years or older, intubated and mechanically ventilated for at least 48 h, and had suspected ventilator-associated pneumonia. Patients were randomly assigned (1:1) to biomarker-guided recommendation on antibiotics (intervention group) or routine use of antibiotics (control group) using a web-based randomisation service hosted by Newcastle Clinical Trials Unit. Patients were randomised using randomly permuted blocks of size four and six and stratified by site, with allocation concealment. Clinicians were masked to patient assignment for an initial period until biomarker results were reported. Bronchoalveolar lavage was done in all patients, with concentrations of IL-1β and IL-8 rapidly determined in bronchoalveolar lavage fluid from patients randomised to the biomarker-based antibiotic recommendation group. If concentrations were below a previously validated cutoff, clinicians were advised that ventilator-associated pneumonia was unlikely and to consider discontinuing antibiotics. Patients in the routine use of antibiotics group received antibiotics according to usual practice at sites. Microbiology was done on bronchoalveolar lavage fluid from all patients and ventilator-associated pneumonia was confirmed by at least 104 colony forming units per mL of bronchoalveolar lavage fluid. The primary outcome was the distribution of antibiotic-free days in the 7 days following bronchoalveolar lavage. Data were analysed on an intention-to-treat basis, with an additional per-protocol analysis that excluded patients randomly assigned to the intervention group who defaulted to routine use of antibiotics because of failure to return an adequate biomarker result. An embedded process evaluation assessed factors influencing trial adoption, recruitment, and decision making. This study is registered with ISRCTN, ISRCTN65937227, and ClinicalTrials.gov, NCT01972425. Findings Between Nov 6, 2013, and Sept 13, 2016, 360 patients were screened for inclusion in the study. 146 patients were ineligible, leaving 214 who were recruited to the study. Four patients were excluded before randomisation, meaning that 210 patients were randomly assigned to biomarker-guided recommendation on antibiotics (n=104) or routine use of antibiotics (n=106). One patient in the biomarker-guided recommendation group was withdrawn by the clinical team before bronchoscopy and so was excluded from the intention-to-treat analysis. We found no significant difference in the primary outcome of the distribution of antibiotic-free days in the 7 days following bronchoalveolar lavage in the intention-to-treat analysis (p=0·58). Bronchoalveolar lavage was associated with a small and transient increase in oxygen requirements. Established prescribing practices, reluctance for bronchoalveolar lavage, and dependence on a chain of trial-related procedures emerged as factors that impaired trial processes