Exploring the variability in how educators attend to science classroom interactions

Many researchers assert educators must develop a shared instructional vision in order for schools to be effective. While this research tends to focus on educators' alignment around goals of science classrooms, I argue that we can't assume that educators agree on what they see when they look at science classrooms. In this dissertation, I explore the variability in what teachers and leaders notice in science classroom episodes and how they reason about what they notice. I ground my studies in real classroom practice: a videotaped lesson in the first study and a live classroom observation in the second. In Chapter 2, I discuss the importance of grounding discussions about teaching and learning in classroom artifacts, a commitment that motivates my dissertation: educators may have a shared vision when discussing teaching and learning in the abstract but disagree about whether that vision is being realized in a classroom. I then describe and analyze the video clip I used in my interviews, highlighting moments that I consider to be good teaching and learning. In Chapter 3, I present my first study, in which I showed this episode to 15 different science teachers, science instructional leaders, and principals. I found that participants attended to many different features in the episode, which led to significant disagreement about what is happening in the episode. Additionally, I found that these differences in attention corresponded to differences in how participants were framing the activity of watching the clip. In Chapter 4, I explore the attentional variability of one science instructional leader, Valerie, in multiple contexts. In addition to interviewing Valerie about the videotaped lesson, I also observed Valerie engage in an "observation cycle" with a teacher. Even though Valerie is quite skilled at attending to student thinking in some contexts, I found that Valerie's attention is strongly context-dependent and gets pulled away from students' scientific thinking when she uses a district mandated form. Finally, in Chapter 5 I summarize my findings and describe the implications my work has for both research and practice

EPA 9—Collaborate as a Member of an Interprofessional Team: a Short Communication from the AAMC Core EPAs for Entering Residency Pilot Schools

Members of the Association of American Medical Colleges Core Entrustable Professional Activities (EPAs) for Entering Residency Pilot worked to conceptualize how graduates might be entrusted for EPA 9: Collaborate as a member of an interprofessional team. Through an iterative group process informed by the literature and application to local curriculum and clinical experiences, we drafted a developmental framework and curriculum mapping tool. Ultimately, entrustment requires assessment in clinical settings. Nonetheless, teamwork and communication skills that are relevant to future entrustment can be taught and assessed in pre-clinical contexts such as small groups to ensure students are on an entrustment trajectory

A Qualitative Evaluation of Mental Health Clinic Staff Perceptions of Barriers and Facilitators to Treating Tobacco Use

Introduction: Veterans with mental health disorders smoke at high rates, but encounter low rates of tobacco treatment. We sought to understand barriers and facilitators to treating tobacco use in VA mental health clinics. Methods: This qualitative study was part of a trial evaluating a telephone care coordination program for smokers using mental health services at six VA facilities. We conducted semi-structured interviews with 14 staff: 12 mental health clinic staff working at the parent study\u27s intervention sites (n = 6 psychiatrists, three psychologists, two social workers, one NP), as well as one psychiatrist and one psychologist on the VA\u27s national tobacco advisory committee. Interviews were transcribed and inductively coded to identify themes. Results: Five barriers themes emerged: (1) competing priorities, (2) patient challenges/resistance, (3) complex staffing/challenging cross-discipline coordination, (4) mixed perceptions about whether tobacco is a mental health care responsibility, and (5) limited staff training/comfort in treating tobacco. Five facilitators themes emerged: (1) reminding mental health staff about tobacco, (2) staff belief in the importance of addressing tobacco, (3) designating a cessation medication prescriber, (4) linking tobacco to mental health outcomes and norms, and (5) limiting mental health staff burden. Conclusions: VA mental health staff struggle with knowing that tobacco use is important, but they face competing priorities, encounter patient resistance, are conflicted on their role in addressing tobacco, and lack tobacco training. They suggested strategies at multiple levels that would help overcome those barriers that can be used to design interventions that improve tobacco treatment delivery for mental health patients. Implications: This study builds upon the existing literature on the high rates of smoking, but low rates of treatment, in people with mental health diagnoses. This study is one of the few qualitative evaluations of mental health clinic staff perceptions of barriers and facilitators to treating tobacco. The study results provide a multi-level framework for developing strategies to improve the implementation of tobacco treatment programs in mental health clinics

Thermocline management of stratified tanks for heat storage

Stratified tanks are useful for maximising the thermal energy efficiency of non-continuous and semi-continuous processes. Liquid at two or more dissimilar temperatures is stored within the same tank to provide a buffer for variations in heating and cooling loads. Control of the thermocline between the hot and cold fluid regions is needed to minimise thermocline growth and maximise operation of the storage tank. An experimental programme using a scale model of an industrial stratified tank (aspect ratio 3.5) and Perspex tank (aspect ratio 8.2) is reported. The behaviour and growth of the hot-cold thermocline under various operating conditions is presented. A siphoning method to re-establish the thermocline without interrupting the use of the tank is tested. Siphoning of the thermocline region from either 20%, 50% or 80% of the tank height is an effective strategy for uninterrupted interface re-establishment. However, the rate and position of siphoning and the load balance of the exit streams are critical variables for minimising the time for effective re-establishment of the two temperature zones

Telephone care coordination for smokers in VA mental health clinics: protocol for a hybrid type-2 effectiveness-implementation trial

BACKGROUND: This paper describes an innovative protocol for a type-II hybrid effectiveness-implementation trial that is evaluating a smoking cessation telephone care coordination program for Veterans Health Administration (VA) mental-health clinic patients. As a hybrid trial, the protocol combines implementation science and clinical trial methods and outcomes that can inform future cessation studies and the implementation of tobacco cessation programs into routine care. The primary objectives of the trial are (1) to evaluate the process of adapting, implementing, and sustaining a smoking cessation telephone care coordination program in VA mental health clinics, (2) to determine the effectiveness of the program in promoting long-term abstinence from smoking among mental health patients, and (3) to compare the effectiveness of telephone counseling delivered by VA staff with that delivered by state quitlines. METHODS/DESIGN: The care coordination program is being implemented at six VA facilities. VA mental health providers refer patients to the program via an electronic medical record consult. Program staff call referred patients to offer enrollment. All patients who enroll receive a self-help booklet, mailed smoking cessation medications, and proactive multi-call telephone counseling. Participants are randomized to receive this counseling from VA staff or their state\u27s quitline. Four primary implementation strategies are being used to optimize program implementation and sustainability: blended facilitation, provider training, informatics support, and provider feedback. A three-phase formative evaluation is being conducted to identify barriers to, and facilitators for, program implementation and sustainability. A mixed-methods approach is being used to collect quantitative clinical effectiveness data (e.g., self-reported abstinence at six months) and both quantitative and qualitative implementation data (e.g., provider referral rates, coded interviews with providers). Summative data will be analyzed using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. DISCUSSION: This paper describes the rationale and methods of a trial designed to simultaneously study the clinical effectiveness and implementation of a telephone smoking cessation program for smokers using VA mental health clinics. Such hybrid designs are an important methodological design that can shorten the time between the development of an intervention and its translation into routine clinical care

The Biomedical Entrepreneurship Skills Development Program for the Advancement of Research Translation: Foundations of Biomedical Startups course, metrics, and impact

Abstract Background/Objective: A growing number of biomedical doctoral graduates are entering the biotechnology and industry workforce, though most lack training in business practice. Entrepreneurs can benefit from venture creation and commercialization training that is largely absent from standard biomedical educational curricula. The NYU Biomedical Entrepreneurship Educational Program (BEEP) seeks to fill this training gap to prepare and motivate biomedical entrepreneurs to develop an entrepreneurial skill set, thus accelerating the pace of innovation in technology and business ventures. Methods: The NYU BEEP Model was developed and implemented with funding from NIDDK and NCATS. The program consists of a core introductory course, topic-based interdisciplinary workshops, venture challenges, on-line modules, and mentorship from experts. Here, we evaluate the efficacy of the core, introductory course, “Foundations of Biomedical Startups,” through the use of pre/post-course surveys and free-response answers. Results: After 2 years, 153 participants (26% doctoral students, 23% post-doctoral PhDs, 20% faculty, 16% research staff, 15% other) have completed the course. Evaluation data show self-assessed knowledge gain in all domains. The percentage of students rating themselves as either “competent” or “on the way to being an expert” in all areas was significantly higher post-course (P < 0.05). In each content area, the percentages of participants rating themselves as “very interested” increased post-course. 95% of those surveyed reported the course met its objectives, and 95% reported a higher likelihood of pursuing commercialization of discoveries post-course. Conclusion: NYU BEEP can serve as a model to develop similar curricula/programs to enhance entrepreneurial activity of early-stage researchers

An intervention to improve care and reduce costs for high-risk patients with frequent hospital admissions: a pilot study

<p>Abstract</p> <p>Background</p> <p>A small percentage of high-risk patients accounts for a large proportion of Medicaid spending in the United States, which has become an urgent policy issue. Our objective was to pilot a novel patient-centered intervention for high-risk patients with frequent hospital admissions to determine its potential to improve care and reduce costs.</p> <p>Methods</p> <p>Community and hospital-based care management and coordination intervention with pre-post analysis of health care utilization. We enrolled Medicaid fee-for-service patients aged 18-64 who were admitted to an urban public hospital and identified as being at high risk for hospital readmission by a validated predictive algorithm. Enrolled patients were evaluated using qualitative and quantitative interview techniques to identify needs such as transportation to/advocacy during medical appointments, mental health/substance use treatment, and home visits. A community housing partner initiated housing applications in-hospital for homeless patients. Care managers facilitated appropriate discharge plans then worked closely with patients in the community using a harm reduction approach.</p> <p>Results</p> <p>Nineteen patients were enrolled; all were male, 18/19 were substance users, and 17/19 were homeless. Patients had a total of 64 inpatient admissions in the 12 months before the intervention, versus 40 in the following 12 months, a 37.5% reduction. Most patients (73.3%) had fewer inpatient admissions in the year after the intervention compared to the prior year. Overall ED visits also decreased after study enrollment, while outpatient clinic visits increased. Yearly study hospital Medicaid reimbursements fell an average of $16,383 per patient.</p> <p>Conclusions</p> <p>A pilot intervention for high-cost patients shows promising results for health services usage. We are currently expanding our model to serve more patients at additional hospitals to see if the pilot's success can be replicated.</p> <p>Trial registration</p> <p>Clinicaltrials.gov Identifier: <a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1292096">NCT01292096</a></p

Skunk River Review Fall 1995, Vol 7

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