Ghetto Education

The important role of education in America is evidenced in compulsory school attendance laws enshrined in state constitutions and codes; it is made apparent in the vigorous and often heated debate over education reform at the state and national level; and it is endorsed in the powerful rhetoric of our highest court. However, something has gone terribly wrong in the American system of public education. Two systems of public education have emerged—one for the privileged and one for the poor. Under this paradigm, education equity, the promise of Brown v. Board of Education, remains unfulfilled. For the privileged, who are wealthy and mostly white, public education works just fine. Students graduate with the knowledge, ability, and ambition to achieve success across multiple domains. The poor, who are mostly urban and from historically oppressed groups, not only live in the ghetto of life but are also receiving a ghetto education. The pervasiveness of ghetto education is especially troubling in a post-racial America because it harkens back to the Jim Crow era, when black youth regularly received substandard education in segregated schools all across the country. Then, public education was targeted by the NAACP through institutional reform litigation because of the important role segregated, unequal education played in perpetuating the legal regime of racial subordination. Now, although there is significant data documenting an ever-widening achievement gap divided along lines of race and class, the discussion around education reform often skirts a frank assessment of the underlying causes of this gap. This Article addresses these underlying causes, which amount to ghetto education when grouped together. In Part I, I focus on the historical context of public education, which has important implications for my proposed reforms and policy initiatives. Part II examines the ghetto education phenomenon in its component parts and looks at how these components affect student socialization in detrimental ways. Part III argues for the constitutionalization of education equality. I set forth a national legislative agenda that includes the creation of a fundamental right to education and the repeal of No Child Left Behind

Striving toward team-based continuity: provision of same-day access and continuity in academic primary care clinics

Abstract Background An important goal of the patient-centered medical home is increasing timely access for urgent needs, while maintaining continuity. In academic primary care clinics, meeting this goal, along with training medical residents and associated professionals, is challenging. Methods The aim of this study was to understand how academic primary care clinics provide continuity to patients requesting same-day access and identify factors that may affect site-level success. We conducted qualitative interviews from December 2013–October 2014 with primary care leadership involved with residency programs at 19 Veterans Health Administration academically-affiliated medical centers. Interview recordings were transcribed verbatim. To analyze the data, we created comprehensive, structured transcript summaries for each site. Site summaries were then entered into NVivo 10 software and coded by main categories to facilitate within-case and cross-case analyses. Themes and patterns across sites were identified using matrix analysis. Results Interviewees found it challenging to provide continuity for same-day in-person visits. Most sites took a team-based approach to ensure continuity and provide coverage for same-day access, notably using NPs, PAs, and RNs in their coverage algorithms. Further, they reported several adaptations that increased multiple types of continuity for walk-in patients, urgent care between in-person visits, and follow-up care. While this study focused on longitudinal continuity, both by individual PCPs or by a team of professionals, informational continuity and continuity of supervision, as well as, to a lesser extent, relational and management continuity, were also addressed in our interviews. Finally, most interviewees reported clinic intention to provide patient-centered, team-based care and a robust educational experience for trainees, and endeavored to structure their clinics in ways that align these two missions. Conclusions In contending with the tension between providing continuity and educating new clinicians, clinics have re-conceptualized continuity as team-based, creating alternative strategies to same-day visits with a usual provider, coupled with communication strategies. Understanding the effect of these strategies on different types of continuity as well as patient experience and outcomes are key next steps in the further development and dissemination of effective models for improving continuity and the transition to team-based care in the academic clinic setting.https://deepblue.lib.umich.edu/bitstream/2027.42/148210/1/12913_2019_Article_3943.pd

Arkansas Teacher Supply

There have been widespread reports of an impending teacher shortage crisis in the U.S. for more than 30 years. In the U.S., there are claims of a widespread national shortage while research indicates teacher shortages are specific to certain subjects and schools. Part of the reason for the conflicting accounts is how shortage is identified and what information is used to assess it. In this study, we test whether a uniform teacher shortage exists across the state of Arkansas. We hypothesize that, rather than a universal shortage, teacher shortages are more likely to occur in certain regions and subjects. We examine the characteristics of districts with the most favorable teaching supply using descriptive and multivariate analysis of data collected from district surveys along with administrative data. In this study, “supply” is defined as the ratio of applications to vacancies. This is the third study to use application information to identify teacher supply, and the first to assess teacher supply in this way. Results indicate teacher supply is unequally distributed across the state. We find district size, region, and urbanicity appear to drive supply. Teacher supply is most favorable for large districts with student enrollments greater than 3,500, districts in the Northwest, and suburban and city districts

Geographical variation in cancer survival in England, 1991–2006: an analysis by Cancer Network

BACKGROUND: Reducing geographical inequalities in cancer survival in England was a key aim of the Calman-Hine Report (1995) and the NHS Cancer Plan (2000). This study assesses whether geographical inequalities changed following these policy developments by analysing the trend in 1-year relative survival in the 28 cancer networks of England. METHODS: Population-based age-standardised relative survival at 1 year is estimated for 1.4 million patients diagnosed with cancer of the oesophagus, stomach, colon, lung, breast (women) or cervix in England during 1991-2006 and followed up to 2007. Regional and deprivation-specific life tables are built to adjust survival estimates for differences in background mortality. Analysis is divided into three calendar periods: 1991-5, 1996-2000 and 2001-6. Funnel plots are used to assess geographical variation in survival over time. RESULTS: One-year relative survival improved for all cancers except cervical cancer. There was a wide geographical variation in survival with generally lower estimates in northern England. This north-south divide became less marked over time, although the overall number of cancer networks that were lower outliers compared with the England value remained stable. Breast cancer was the only cancer for which there was a marked reduction in geographical inequality in survival over time. CONCLUSION: Policy changes over the past two decades coincided with improved relative survival, without an increase in geographical variation. The north-south divide in relative survival became less pronounced over time but geographical inequalities persist. The reduction in geographical inequality in breast cancer survival may be followed by a similar trend for other cancers, provided government recommendations are implemented similarly

Identifying risk factors for L'Hermitte's sign after IMRT for head and neck cancer.

BACKGROUND L’Hermitte’s sign (LS) after chemoradiotherapy for head and neck cancer appears related to higher spinal cord doses. IMRT plans limit spinal cord dose, but the incidence of LS remains high. METHODS 117 patients treated with TomoTherapy™ between 2008 and 2015 prospectively completed a side-effect questionnaire (VoxTox Trial Registration: UK CRN ID 13716). Baseline patient and treatment data were collected. Radiotherapy plans were analysed; mean and maximum spinal cord dose and volumes receiving 10, 20, 30 and 40 Gy were recorded. Dose variation across the cord was examined. These data were included in a logistic regression model. RESULTS 42 patients (35.9%) reported LS symptoms. Concurrent weekly cisplatin did not increase LS risk (p = 0.70, OR = 1.23 {95%CI 0.51 – 2.34}). Of 13 diabetic participants (9 taking metformin), only 1 developed LS (p = 0.025, OR = 0.13 {95%CI 0.051 – 3.27}). A refined binary logistic regression model showed that patients receiving unilateral radiation (p = 0.019, OR = 2.06 {95%CI 0.15 – 0.84}) were more likely to develop LS. Higher V40Gy (p = 0.047, OR = 1.06 {95%CI 1.00 – 1.12}), and younger age (mean age 56.6 vs 59.7, p = 0.060, OR = 0.96 {95%CI 0.92 – 1.00}) were associated with elevated risk of LS, with borderline significance. CONCLUSIONS In this cohort, concomitant cisplatin did not increase risk, and LS incidence was lower in diabetic patients. Patient age and dose gradients across the spinal cord may be important factors