Final Report from the Models for Change Evaluation

Note: This evaluation is accompanied by an evaluation of the National Campaign for this initiative as well as introduction to the evaluation effort by MacArthur's President, Julia Stasch, and a response to the evaluation from the program team. Access these related materials here (https://www.macfound.org/press/grantee-publications/evaluation-models-change-initiative).Models for Change is an initiative of The John D. and Catherine T. MacArthur Foundationto accelerate juvenile justice reforms and promote fairer, more effective, and more developmentally appropriate juvenile justice systems throughout the United States. Between 2004 and 2014, the Foundation invested more than $121 million in the initiative, intending to create sustainable and replicable models of systems reform.In June 2013, the Foundation partnered with Mathematica Policy Research and the University of Maryland to design and conduct a retrospective evaluation of Models for Change. The evaluation focused on the core state strategy, the action network strategy, and the national context in which Models for Change played out. This report is a digest and synthesis of several technical reports prepared as part of the evaluation

A Guide to Point of Care Ultrasound Evaluation of Pneumonia

A patient presenting with fever, hypoxia, productive cough, and leukocytosis can be diagnosed with pneumonia without any imaging findings. However, we often rely on X-ray and computed tomography (CT) imaging to support the clinical diagnosis. Ultrasound is an effective imaging modality for identifying pneumonia without delay and radiation risks.1,2 A meta-analysis by Ye et al. in 2015 found that ultrasound diagnosis of pneumonia had a pooled sensitivity of 0.95 and a pooled specificity of 0.9, which is superior to X-ray imaging which had a pooled sensitivity of 0.77 and a similar pooled specificity of 0.9.3 This study used CT imaging as a gold standard for comparison

A Guide to Point of Care Ultrasound Lung and IVC Examination of a Volume Overloaded Patient

A patient presents with dyspnea, hypoxia, and lower extremity edema. Their history is notable for recent high salt intake and non-compliance with diuretics, and their lungs have rales bilaterally. Clinically, we can diagnose a heart failure exacerbation with pulmonary edema. However, we often rely on X-ray and computed tomography (CT) imaging to support the clinical diagnosis and explore the etiology of the hypoxia and dyspnea to narrow the differential. Ultrasound is an effective modality for identifying pulmonary edema and pleural effusions while at the same time ruling out other etiologies such as pneumonia and pneumothorax. With bedside point of care ultrasound (POCUS), there is no radiation risk and no delay in obtaining imaging. A systematic review and meta-analysis study by Maw et al. published in 2019 found that lung ultrasound diagnosis of pulmonary edema in the setting of clinical suspicion for acute decompensated heart failure had a pooled sensitivity of 0.88 and specificity of 0.9, which is superior to X-ray imaging which demonstrated a pooled sensitivity of 0.73 and a pooled specificity of 0.9.

A Guide to Point of Care Ultrasound Examination of Acute Decompensated Heart Failure

A patient presents with dyspnea on exertion, orthopnea, and lower extremity edema. They have a prior history of coronary artery disease and reported episodes of chest pain three months ago. They did not seek medical evaluation at the time and have had no chest pain recently. In this setting, there is a high clinical suspicion of heart failure with concern for ischemic heart disease. The gold standard for diagnosis of heart failure is a formal transthoracic echocardiogram. Bedside point of care ultrasound (POCUS) is a tool that can provide essential information without delay in diagnosis

A Guide to Point of Care Ultrasound Examination of a Pericardial Effusion

A patient presents with pleuritic chest pain, dyspnea, and a recent viral illness. They have no prior cardiac or pulmonary history. Their X-ray on admission demonstrates no pulmonary findings and an enlarged cardiac silhouette, and their EKG is low voltage with electrical alternans. Ultrasound is an effective modality for identifying pericardial effusion and cardiac tamponade while at the same time evaluating for other causes, such as heart failure. Often patients with symptomatic pericardial ef fusion present with non-specific symptoms. While a “formal” transthoracic echocardiogram remains the gold standard for diagnosis, a bedside point of care ultrasound (POCUS) cardiac evaluation can significantly decrease the time to diagnosis and trigger an order for an urgent “formal” echocardiogram.1 A retrospective study by Hanson and Chan in 2021 found that POCUS led to an expedited average time to diagnosis of 5.9 hours compared to \u3e12 hours with other imaging. Those with a symptomatic pericardial effusion identified by POCUS had a significantly decreased time to treatment; time to pericardiocentesis of 28.1 hours compared to \u3e 48 hours with other diagnostic modalities.

Comparison of the talk test and percent heart rate reserve for exercise prescription

Exercise intensity is traditionally prescribed using %HRmax, %HRR, %VO2max, or %VO2R. Recently, the Talk Test (TT) has been proposed as an alternative method to guide exercise intensity. However, it is unknown if prescribing exercise intensity solely using the TT can provoke training responses that are comparable to traditional guidelines. This study compared the responses to training using either the TT or %HRR. Forty-four subjects (17 males and 27 females: age=20.4±3.02 years; body height=170.5±9.79 cm; body weight=71.9±13.63 kg) completed an incremental maximal cycle ergometer test, were stratified by VO2max and gender, and randomly assigned to training groups guided by either %HRR (n=20) or the TT (n=24). Both groups completed 40-minute training sessions three days per week for 10 weeks. In the HRR group, exercise intensity was targeted (per ACSM guidelines) at 40-59% HRR for weeks 1-4, 50-59% HRR for weeks 5-8, and 60-79% HRR for weeks 9-10. In the TT group, exercise intensity was targeted at the highest power output (PO) that still allowed for comfortable speech. Changes in VO2max, peak power output (PPO), VO2 at ventilatory threshold (VT), and PO at VT were compared between the groups using two-way ANOVA with repeated measures. There were significant (p0.05) interaction effect. Guiding exercise prescription using the TT is a simple and effective method for prescribing exercise intensity and elicits improvements in exercise performance that are comparable to the traditional %HRR guidelines

Reviews

The following publications have been reviewed by the mentioned authors;Technology Education for Teachers - reviewed by Bill GoddardUnderstanding Design and Technology Key Stage 2 & 3 - reviewed by Melanie FasciatoElectronics Tasks and Assignments - reviewed by Trevor TaylorOutline Scheme of Work 'Working towards Capability' - reviewed by Bill GoddardCADpius - reviewed by Les PorterTechnology 1 - reviewed by Richard AgerDigital Electronics - reviewed by David FosterAn Introduction to Usability - reviewed by Anne RiggsHow do they do that? - reviewed by Jonty KinsellaD & T Routes: Graphic Products - reviewed by George AsquithD & T Routes: Textiles - reviewed by Jillian MellorD & T Routes: Resistant Materials - reviewed by Chris SnellD & T Routes: Food - reviewed by Margaret JepsonD & T Routes: Control Products - reviewed by Chris WoodD & T Routes: Core Book - reviewed by Jenny JupeD & T Routes: Teacher's Resource - reviewed by Jenny Jup

Moderators, Mediators, and Prognostic Indicators of Treatment With Hip Arthroscopy or Physical Therapy for Femoroacetabular Impingement Syndrome: Secondary Analyses From the Australian FASHIoN Trial.

BACKGROUND Although randomized controlled trials comparing hip arthroscopy with physical therapy for the treatment of femoroacetabular impingement (FAI) syndrome have emerged, no studies have investigated potential moderators or mediators of change in hip-related quality of life. PURPOSE To explore potential moderators, mediators, and prognostic indicators of the effect of hip arthroscopy and physical therapy on change in 33-item international Hip Outcome Tool (iHOT-33) score for FAI syndrome. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Overall, 99 participants were recruited from the clinics of orthopaedic surgeons and randomly allocated to treatment with hip arthroscopy or physical therapy. Change in iHOT-33 score from baseline to 12 months was the dependent outcome for analyses of moderators, mediators, and prognostic indicators. Variables investigated as potential moderators/prognostic indicators were demographic variables, symptom duration, alpha angle, lateral center-edge angle (LCEA), Hip Osteoarthritis MRI Scoring System (HOAMS) for selected magnetic resonance imaging (MRI) features, and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) score. Potential mediators investigated were change in chosen bony morphology measures, HOAMS, and dGEMRIC score from baseline to 12 months. For hip arthroscopy, intraoperative procedures performed (femoral ostectomy ± acetabular ostectomy ± labral repair ± ligamentum teres debridement) and quality of surgery graded by a blinded surgical review panel were investigated for potential association with iHOT-33 change. For physical therapy, fidelity to the physical therapy program was investigated for potential association with iHOT-33 change. RESULTS A total of 81 participants were included in the final moderator/prognostic indicator analysis and 85 participants in the final mediator analysis after exclusion of those with missing data. No significant moderators or mediators of change in iHOT-33 score from baseline to 12 months were identified. Patients with smaller baseline LCEA (β = -0.82; P = .034), access to private health care (β = 12.91; P = .013), and worse baseline iHOT-33 score (β = -0.48; P < .001) had greater iHOT-33 improvement from baseline to 12 months, irrespective of treatment allocation, and thus were prognostic indicators of treatment response. Unsatisfactory treatment fidelity was associated with worse treatment response (β = -24.27; P = .013) for physical therapy. The quality of surgery and procedures performed were not associated with iHOT-33 change for hip arthroscopy (P = .460-.665 and P = .096-.824, respectively). CONCLUSION No moderators or mediators of change in hip-related quality of life were identified for treatment of FAI syndrome with hip arthroscopy or physical therapy in these exploratory analyses. Patients who accessed the Australian private health care system, had smaller LCEAs, and had worse baseline iHOT-33 scores, experienced greater iHOT-33 improvement, irrespective of treatment allocation