Examining organizational learning in schools: The role of psychological safety, experimentation, and leadership that reinforces learning

This study draws upon theory and methods from the field of organizational behavior to examine organizational learning (OL) in the context of a large urban U.S. school district. We build upon prior literature on OL from the field of organizational behavior to introduce and validate three subscales that assess key dimensions of organizational learning that build upon and extend prior education research: psychological safety, experimentation, and leadership that reinforces learning. Data from 941 teachers across 60 schools in this urban district suggest that organizational learning is an underlying condition which is expressed by teacher perceptions of subfactors of psychological safety, experimentation, and leadership that reinforces learning. Implications for adopting the conceptual framework and methods employed in this research for studying organizational learning and school change are discussed

Wnt expression is not correlated with β-catenin dysregulation in Dupuytren's Disease

BACKGROUND: Dupuytren's contracture or disease (DD) is a fibro-proliferative disease of the hand that results in finger flexion contractures. Increased cellular β-catenin levels have been identified as characteristic of this disease. As Wnts are the most widely recognized upstream regulators of cellular β-catenin accumulation, we have examined Wnt gene expression in surgical specimens and in DD-derived primary cell cultures grown in two-dimensional monolayer culture or in three-dimensional FPCL collagen lattice cultures. RESULTS: The Wnt expression profile of patient-matched DD and unaffected control palmar fascia tissue was determined by a variety of complimentary methods; Affymetrix Microarray analysis, specific Wnt and degenerative primer-based Reverse Transcriptase (RT)-PCR, and Real Time PCR. Microarray analysis identified 13 Wnts associated with DD and control tissues. Degenerate Wnt RT-PCR analysis identified Wnts 10b and 11, and to a lesser extent 5a and 9a, as the major Wnt family members expressed in our patient samples. Competitive RT-PCR analysis identified significant differences between the levels of expression of Wnts 9a, 10b and 11 in tissue samples and in primary cell cultures grown as monolayer or in FPCL, where the mRNA levels in tissue > FPCL cultures > monolayer cultures. Real Time PCR data confirmed the down-regulation of Wnt 11 mRNA in DD while Wnt 10b, the most frequently isolated Wnt in DD and control palmar fascia, displayed widely variable expression between the methods of analysis. CONCLUSION: These data indicate that changes in Wnt expression per se are unlikely to be the cause of the observed dysregulation of β-catenin expression in DD

HER2-enriched subtype and novel molecular subgroups drive aromatase inhibitor resistance and an increased risk of relapse in early ER+/HER2+ breast cancer

BACKGROUND: Oestrogen receptor positive/ human epidermal growth factor receptor positive (ER+/HER2+) breast cancers (BCs) are less responsive to endocrine therapy than ER+/HER2- tumours. Mechanisms underpinning the differential behaviour of ER+HER2+ tumours are poorly characterised. Our aim was to identify biomarkers of response to 2 weeks’ presurgical AI treatment in ER+/HER2+ BCs. METHODS: All available ER+/HER2+ BC baseline tumours (n=342) in the POETIC trial were gene expression profiled using BC360™ (NanoString) covering intrinsic subtypes and 46 key biological signatures. Early response to AI was assessed by changes in Ki67 expression and residual Ki67 at 2 weeks (Ki672wk). Time-To-Recurrence (TTR) was estimated using Kaplan-Meier methods and Cox models adjusted for standard clinicopathological variables. New molecular subgroups (MS) were identified using consensus clustering. FINDINGS: HER2-enriched (HER2-E) subtype BCs (44.7% of the total) showed poorer Ki67 response and higher Ki672wk (p<0.0001) than non-HER2-E BCs. High expression of ERBB2 expression, homologous recombination deficiency (HRD) and TP53 mutational score were associated with poor response and immune-related signatures with High Ki672wk. Five new MS that were associated with differential response to AI were identified. HER2-E had significantly poorer TTR compared to Luminal BCs (HR 2.55, 95% CI 1.14–5.69; p=0.0222). The new MS were independent predictors of TTR, adding significant value beyond intrinsic subtypes. INTERPRETATION: Our results show HER2-E as a standardised biomarker associated with poor response to AI and worse outcome in ER+/HER2+. HRD, TP53 mutational score and immune-tumour tolerance are predictive biomarkers for poor response to AI. Lastly, novel MS identify additional non-HER2-E tumours not responding to AI with an increased risk of relapse

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Redefining the Instructional Leader: Principals' Use of Process and Outcome Measures of Teacher Quality

Recent innovations in teacher evaluation include the development of standards-based frameworks for observational evaluations of teacher practice and development of test-based measures of teacher effectiveness. These tools raise questions about how best to identify good teaching, about the roles of both evaluations and principals in improving teaching, and about the relationship between school context and teacher evaluation. This qualitative study examines principals’ understanding and use of a test-based ranking of teacher quality—the Academic Growth over Time (AGT) ranking—and a standards-based observation framework—the Teaching and Learning Framework (TLF)—in the Los Angeles Unified School District. Findings suggest principals believed outcomes matter, but harbored concerns about what AGT rankings actually measured. In addition, principals felt AGT rankings provided little information about how to improve teaching. Some were concerned that in low-scoring schools, the AGT rankings might reinforce test-focused instruction in ways that disadvantaged students. Principals preferred the TLF because it was more comprehensive than previous observation tools, helped teachers evaluate their practice against clearly defined expectations, and helped principals improve instruction. Though principals used the TLF to assign teachers ratings, they primarily described it as a tool to improve the quality of teaching in their buildings. Principals noted that the TLF process placed heavy demands on the time of teachers and principals, and expressed concern about how they could sustain high-quality implementation of the TLF when they had to use it at scale. Most principals noted cases where the AGT rankings indicated a different reality about a teacher’s effectiveness than what the principals expected, based on classroom observations. How principals reconciled discrepancies varied. Principals in higher-scoring schools were more likely to discount test-based measures and more likely to emphasize the professional capability of their staff as an asset. The findings suggest principals’ use of evaluation tools is mediated by their confidence in the tools and their own leadership, by how useful they feel the tools are, and by their own school contexts. In addition, this study suggests that the unique burdens of persistent socioeconomic and racial segregation may hamper local efforts to implement promising practices at some sites

Exploring barriers to implementing an E.M.S. Naloxone leave behind program

This project explored potential barriers to implementing an EMS Naloxone leave behind program in the greater Chattanooga area. EMS providers were surveyed on knowledge & attitudes related to opioid use & Naloxone administration

Overall survival following mastectomy and breast conserving surgery with adjuvant radiotherapy for early breast cancer:meta-analysis

BackgroundBreast conserving surgery with adjuvant radiotherapy (BCS+RT) and mastectomy are currently offered as equivalent surgical options for early breast cancer based onrandomised trials dating from the 1980s. Breast cancer treatment, however has evolved and recent observational studies suggest a survival advantage for BCS+RT. A systematic review and meta-analysis was undertaken to summarise the contemporary evidence regarding survival following BCS+RT and mastectomy in women with early breast cancer. MethodsA systematic search of Medline, CENTRAL and EMBASE identified studies published 01/01/2000-18/12/2023 comparing overall survival after BCS+RT and mastectomy in patients with unilateral stage I-III breast cancer was undertaken. Studies evaluating neoadjuvant chemotherapy, rare breast cancer subtypes and studies in specific breast cancer populations were excluded. ROBINS-I was used to assess risk of bias with the overall certainty of evidence assessed using GRADE. Studies without critical risk of bias were included in a quantitative meta-analysis. Results From 11,750 abstracts, 110 eligible studies were identified, of which 29 were at critical risk of bias and excluded; 42 were excluded due to overlapping study populations. Thirty-six observational studies reported survival outcomes in 909,077 patients (362,390 mastectomy and 546,687BCS+RT). The pooled hazard ratio was 0.72 (95% 3 confidence interval 0.68–0.75, p&lt;0.001) demonstrating improved overall survival for patients undergoing BCS+RT. The overall certainty of the evidence was very low.ConclusionThis meta-analysis provides evidence to suggest a survival advantage for women undergoing BCS+RT for early breast cancer compared with mastectomy. Although these results should be interpreted with caution, they should be shared with patients to support informed surgical decision-making