Developing an online direct-assessment competency-based Masters of Healthcare Administration: Insights, challenges, and lessons learned

In response to the increasing complexity in healthcare delivery environments, there is evidence from literature and the healthcare industry to indicate healthcare employers are seeking graduates in healthcare administration programs who have strong core competencies and proven problem solving skills. The purpose of this article is to describe the unique challenges and opportunities related to developing a direct-assessment, competency-based online Master’s in Healthcare Administration program. The United States Department of Education (2013) provided general guidelines for direct-assessment programs noting that, instead of measuring student learning via credit hours, learning is measured via direct assessment measures like “projects, papers, examinations, presentations, performances, and portfolios” (para. 4). In this model, credit hour or seat-time measurements are no longer used as proxies for learning. Instead, a single proxy is used: demonstration of competence through direct assessments. Direct assessments are not directly linked with course material or credit hour. Instead, learners demonstrate competency or mastery at their own pace, and progress through the academic program when they have demonstrated the ability to do so. The authors collaborated with employers, university faculty, and subject matter experts to develop a direct-assessment, competency-based Master’s in Healthcare Administration program for an online university that utilizes direct-assessment—allowing students to learn at their own pace and progress forward upon demonstrated mastery. The new program is aligned with healthcare employers’ need for graduates who have core professional competencies in the healthcare field, the educational requirements of the Association of University Programs in Health Administration (AUPHA) and the National Center for Healthcare Leadership (NCHL), and core professional competencies promoted by the American College of Healthcare Executives (ACHE). This program will seek accreditation from the Commission of Accreditation of Healthcare Management Education (CAHME) once all criteria for accrediting online programs are evaluated and assessed by Walden University. Within this article, the authors have summarized the history of competency-based education in healthcare administration and shared their insights regarding the future of this direct-assessment model

A Non-invasive Method of Measuring Respiration while Providing Wireless Power for Rodents with Implantable Devices

Respiratory measurements can be used as diagnostic and research tools. Spirometry is the gold standard for gaining these measurements, but is difficult to use in rodents as it requires an invasive procedure. Total Body Plethysmograpy (TBP) is a non-invasive way to measure respiration rates that does not cause stress to the rodent. In this system, the subject is encased in a solid, constant volume chamber with measurements determining the subject’s respiration. When using TBP in medical or research settings, challenges occur in powering devices within the TBP chamber as wires and other recording equipment compromise the airtightness of the chamber. Therefore, it is imperative to create a TBP chamber that provides wireless power for these purposes. To do so, subjects were placed in a cubic or cylindrical airtight chamber with one inflow and exhaust nozzle to control chamber pressure and provide a steady stream of fresh oxygen. Pressure readings from the inside of the chamber were taken at a rate of four samples per second. Tests were run from two minutes to three hours to encompass rodent activity. Tests were inconclusive for measuring respiration with the specific sensors used, and further research and testing is needed to perfect this method. Once the method is proven to work with the pressure sensors, it will be able to be paired with the MRC chasm and therefore implemented in other studies

Emission estimates of HCFCs and HFCs in California from the 2010 CalNex study

The CalNex 2010 (California Research at the Nexus of Air Quality and Climate Change) study was designed to evaluate the chemical composition of air masses over key source regions in California. During May to June 2010, air samples were collected on board a National Oceanic and Atmospheric Administration (NOAA) WP-3D aircraft over the South Coast Air Basin of California (SoCAB) and the Central Valley (CV). This paper analyzes six effective greenhouse gases - chlorodifluoromethane (HCFC-22), 1,1-dichloro-1-fluoroethane (HCFC-141b), 1-chloro-1,1-difluoroethane (HCFC-142b), 2-chloro-1,1,1,2-tetrafluoroethane (HCFC-124), 1,1,1,2- tetrafluoroethane (HFC-134a), and 1,1-difluoroethane (HFC-152a) - providing the most comprehensive characterization of chlorofluorocarbon (CFC) replacement compound emissions in California. Concentrations of measured HCFCs and HFCs are enhanced greatly throughout the SoCAB and CV, with highest levels observed in the SoCAB: 310 ± 92 pptv for HCFC-22, 30.7 ± 18.6 pptv for HCFC-141b, 22.9 ± 2.0 pptv for HCFC-142b, 4.86 ± 2.56 pptv for HCFC-124, 109 ± 46.4 pptv for HFC-134a, and 91.2 ± 63.9 pptv for HFC-152a. Annual emission rates are estimated for all six compounds in the SoCAB using the measured halocarbon to carbon monoxide (CO) mixing ratios and CO emissions inventories. Emission rates of 3.05 ± 0.70 Gg for HCFC-22, 0.27 ± 0.07 Gg for HCFC-141b, 0.06 ± 0.01 Gg for HCFC-142b, 0.11 ± 0.03 Gg for HCFC-124, 1.89 ± 0.43 Gg for HFC-134a, and 1.94 ± 0.45 Gg for HFC-152b for the year 2010 are calculated for the SoCAB. These emissions are extrapolated from the SoCAB region to the state of California using population data. Results from this study provide a baseline emission rate that will help future studies determine if HCFC and HFC mitigation strategies are successful. Key PointsHCFC and HFC emissions are calculated for the year 2010 for the SoCABEmissions are extrapolated to the state of CaliforniaEmissions are calculated using CalNex field measurements © 2013. American Geophysical Union. All Rights Reserved

The Effects of Project-Based Learning (PBL) Approach on the Achievement and Efficacy of High School Mathematics Students: A Longitudinal Study Investigating the Effects of the PBL Approach in Mathematics Education

Abstract Project-Based Learning (PBL) is a teaching method that is significantly different from the conventional classroom teaching; however, the positive effects of PBL have not been clearly established. This longitudinal study investigates the effect of Project-Based Learning on secondary mathematics' students in order to determine both academic skill development and motivational factors that affect learning. Motivational factors to be measured include self-regulation, self-efficacy, and learning strategies. Unlike previous studies conducted in conventional school environments, this study is conducted on a dedicated project-based high school, where PBL is not being used as additional or supplemental teaching, but as a whole curriculum. This study provides the opportunity for teachers to reflect on the effectiveness of this pedagogical approach to mathematics teaching and learning. Because this study's participants represent a wide range of mathematical abilities and demographic diversity, it may bring clarity on controversial issues regarding the benefits of PBL on certain populations. Specifically, PBL has been shown to work well with students who already have a deep conceptual knowledge of the subject matter, but it may be less effective with those possessing only surface knowledge (Vernon & Blake, 1993; Dochy, Segers, van den bossche, & Gijbels, 2003). In addition, the benefits of PBL on low SES students are debated Keywords: PBL, mathematics, education This study follows 8th and 9th graders through high school graduation, thus providing teachers with a solid picture of the developmental process of learning secondary mathematics through PBL

A governance model for integrated primary/ secondary care for the health-reforming first world: results of a systematic review

Internationally, key health care reform elements rely on improved integration of care between the primary and secondary sectors. The objective of this systematic review is to synthesise the existing published literature on elements of current integrated primary/secondary health care. These elements and how they have supported integrated healthcare governance are presented.A systematic review of peer-reviewed literature from PubMed, MEDLINE, CINAHL, the Cochrane Library, Informit Health Collection, the Primary Health Care Research and Information Service, the Canadian Health Services Research Foundation, European Foundation for Primary Care, European Forum for Primary Care, and Europa Sinapse was undertaken for the years 2006-2012. Relevant websites were also searched for grey literature. Papers were assessed by two assessors according to agreed inclusion criteria which were published in English, between 2006-2012, studies describing an integrated primary/secondary care model, and had reported outcomes in care quality, efficiency and/or satisfaction.Twenty-one studies met the inclusion criteria. All studies evaluated the process of integrated governance and service delivery structures, rather than the effectiveness of services. They included case reports and qualitative data analyses addressing policy change, business issues and issues of clinical integration. A thematic synthesis approach organising data according to themes identified ten elements needed for integrated primary/secondary health care governance across a regional setting including: joint planning; integrated information communication technology; change management; shared clinical priorities; incentives; population focus; measurement - using data as a quality improvement tool; continuing professional development supporting joint working; patient/community engagement; and, innovation.All examples of successful primary/secondary care integration reported in the literature have focused on a combination of some, if not all, of the ten elements described in this paper, and there appears to be agreement that multiple elements are required to ensure successful and sustained integration efforts. Whilst no one model fits all systems these elements provide a focus for setting up integration initiatives which need to be flexible for adapting to local conditions and settings

RadioImmunotherapy for adenoid cystic carcinoma: a single-institution series of combined treatment with cetuximab

<p>Abstract</p> <p>Background</p> <p>Local control in adjuvant/definitive RT of adenoid cystic carcinoma (ACC) is largely dose-dependent. However, some clinical situations do not allow application of tumouricidal doses (i.e. re-irradiation) hence radiation sensitization by exploitation of high endothelial growth factor receptor (EGFR)-expression in ACC seems beneficial. This is a single-institution experience of combined radioimmunotherapy (RIT) with the EGFR-inhibitor cetuximab.</p> <p>Methods</p> <p>Between 2006 and 2010, 9 pts received RIT for advanced/recurrent ACC, 5/9 pts as re-irradiation. Baseline characteristics as well as treatment parameters were retrieved to evaluate efficacy and toxicity of the combination regimen were evaluated. Control rates (local/distant) and overall survival were calculated using Kaplan-Meier estimation.</p> <p>Results</p> <p>Median dose was 65 Gy, pts received a median of 6 cycles cetuximab. RIT was tolerated well with only one °III mucositis/dysphagia. Overall response/remission rates were high (77,8%); 2-year estimate of local control was 80% hence reaching local control levels comparable to high-dose RT. Progression-free survival (PFS) at 2 years and median overall survival were only 62,5% and 22,2 mo respectively.</p> <p>Conclusion</p> <p>While local control and treatment response in RIT seems promising, PFS and overall survival are still hampered by distant failure. The potential benefit of RIT with cetuximab warrants exploration in a prospective controlled clinical trial.</p

Maternal Postpartum Distress and Childhood Overweight

OBJECTIVE: We investigated associations between maternal postpartum distress covering anxiety, depression and stress and childhood overweight. METHODS: We performed a prospective cohort study, including 21,121 mother-child-dyads from the Danish National Birth Cohort (DNBC). Maternal distress was measured 6 months postpartum by 9 items covering anxiety, depression and stress. Outcome was childhood overweight at 7-years-of age. Multiple logistic regression analyses were performed and information on maternal age, socioeconomic status, pre-pregnancy BMI, gestational weight gain, parity, smoking during pregnancy, paternal BMI, birth weight, gestational age at birth, sex, breastfeeding and finally infant weight at 5 and 12 month were included in the analyses. RESULTS: We found, that postpartum distress was not associated with childhood risk of overweight, OR 1.00, 95%CI [0.98-1.02]. Neither was anxiety, depression, or stress exposure, separately. There were no significant differences between the genders. Adjustment for potential confounders did not alter the results. CONCLUSION: Maternal postpartum distress is apparently not an independent risk factor for childhood overweight at 7-years-of-age. However, we can confirm previous findings of perinatal determinants as high maternal pre-pregnancy BMI, and smoking during pregnancy being risk factors for childhood overweight

Developmental and evolutionary assumptions in a study about the impact of premature birth and low income on mother–infant interaction

In order to study the impact of premature birth and low income on mother–infant interaction, four Portuguese samples were gathered: full-term, middle-class (n=99); premature, middle-class (n=63); full-term, low income (n=22); and premature, low income (n=21). Infants were filmed in a free play situation with their mothers, and the results were scored using the CARE Index. By means of multinomial regression analysis, social economic status (SES) was found to be the best predictor of maternal sensitivity and infant cooperative behavior within a set of medical and social factors. Contrary to the expectations of the cumulative risk perspective, two factors of risk (premature birth together with low SES) were as negative for mother–infant interaction as low SES solely. In this study, as previous studies have shown, maternal sensitivity and infant cooperative behavior were highly correlated, as was maternal control with infant compliance. Our results further indicate that, when maternal lack of responsiveness is high, the infant displays passive behavior, whereas when the maternal lack of responsiveness is medium, the infant displays difficult behavior. Indeed, our findings suggest that, in these cases, the link between types of maternal and infant interactive behavior is more dependent on the degree of maternal lack of responsiveness than it is on birth status or SES. The results will be discussed under a developmental and evolutionary reasonin

Conceptual comparison of constructs as first step in data harmonization: Parental sensitivity, child temperament, and social support as illustrations

This article presents a strategy for the initial step of data harmonization in Individual Participant Data syntheses, i.e., making decisions as to which measures operationalize the constructs of interest - and which do not. This step is vital in the process of data harmonization, because a study can only be as good as its measures. If the construct validity of the measures is in question, study results are questionable as well. Our proposed strategy for data harmonization consists of three steps. First, a unitary construct is defined based on the existing literature, preferably on the theoretical framework surrounding the construct. Second, the various instruments used to measure the construct are evaluated as operationalizations of this construct, and retained or excluded based on this evaluation. Third, the scores of the included measures are recoded on the same metric. We illustrate the use of this method with three example constructs focal to the Collaboration on Attachment Transmission Synthesis (CATS) study: parental sensitivity, child temperament, and social support. This process description may aid researchers in their data pooling studies, filling a gap in the literature on the first step of data harmonization. • Data harmonization in studies using combined datasets is of vital importance for the validity of the study results. • We have developed and illustrated a strategy on how to define a unitary construct and evaluate whether instruments are operationalizations of this construct as the initial step in the harmonization process. • This strategy is a transferable and reproducible method to apply to the data harmonization process