LOUDER THAN WORDS: VOICING, SOUNDING, AND LISTENING TO DEAFNESS IN A QUIET PLACE

LOUDER THAN WORDS: VOICING, SOUNDING, AND LISTENING TO DEAFNESS IN A QUIET PLAC

A Mixed Methods Case Study Exploring the Outcomes of Implementing a Digital Learning Management System In A Fourth Grade Language Arts Classroom

Classrooms of today are in continual flux and state and local mandates are constantly reforming the curriculum in order to help prepare students to compete in a global society; in addition, advancements in technology have greatly impacted today’s students and how they learn as well as the way teachers instruct. As educators, we need to recognize what our students need to become successful citizens in today’s society, which often requires students to be critical evaluators of various types of information and requires them to become literate across a wide range of literacies. Not only is it critical that classroom teachers instruct students in the effective use of technology and the new literacies, but it is also important that teachers understand the impact that the technology revolution has had on economically disadvantaged students. The purpose of this mixed-methods study was to explore how the effective integration of information and communication technologies helps identify and develop the skills and behaviors to support the new literacies in a fourth grade classroom of economically disadvantaged students and to better understand the opportunities for access to technology among these students. The study revealed that these skills include participating in on-line discussions, searching for information on-line, sharing created files, engagement in multimedia websites, use of various types of language, exploring Internet browsers, and exploring word processing applications. This research sought to understand the levels of learning that were encouraged through the discussions and tasks. The levels of learning were based on Bloom’s taxonomy and identified the level of cognitive complexity of each discussion and task. The researcher revealed that many of the discussions and tasks did require higher level thinking skills. Finally, this research study sought to understand the access and use of the Internet by economically disadvantaged students in informal environments. Through survey research, the data described a lack of Internet access and usage among the economically disadvantaged students in this study. Additionally, the data revealed that when the students in this research study used the Internet they typically accessed games, videos, sites of personal interest, and CRCT practice sites

Setting the Stage for Success: Empowering At-Risk Students

Teachers and school leaders will gain an understanding of how students in an inner city, Title I elementary school have used goal setting, data tracking, and leadership habits to empower their learning and set the stage for student success. Participants will also learn how these practices have enabled students to participate in student led parent conferences to share their personal learning and growth

Development of a RN Clinical Coach program to improve retention of ICU residents and fellows

Development of a RN Clinical Coach program to improve retention of ICU residents and fellowsBackground:The COVID-19 pandemic caused contributed to significant increases in ICU nurse turnover. To restore the ICU nursing workforce and rebuild a healthy work environment, evidence-based strategies are needed to provide social support and ongoing clinical skills development for large cohorts of ICU residents and fellows.Purpose:The purpose of the Clinical Coach program was to increase retention of ICU residents and fellows and foster a healthy work environment at a ministry in Southern California.Methods:In September 2021 the ICU manager at Providence Saint Joseph Medical Center (PSJMC) hired 18 RN residents (n=11) and fellows (n=7) as the January 2022 cohort. Acknowledging the challenges of such a large cohort, the manager brainstormed with her team to identify innovative strategies to ensure their success. A literature review was conducted to identify factors contributing to successful transition into ICU nursing practice. Evidence demonstrated the most important factor was having a designated support person. The Clinical Nurse Transition Program at Yale New Haven Health system was identified as an exemplar for a similar program at PSJMC. A team of PSJMC ICU nurses and leaders met with the Yale New Haven team to learn about their program and later convened to develop a program with the resources available locally. The team adopted the American Nurses’ Association Healthy Work Environment (HWE) Model as the theoretical framework for the program. The HWE model consists of six standards: skilled communication, true collaboration, effective-decision making, appropriate staffing, authentic leadership, and meaningful recognition. Six experienced preceptors were selected and trained to become clinical coaches to advance the HWE model and support the new nurses. In May 2022, the January cohort completed their formal preceptorship and began independent practice. At that time, the clinical coaches stepped in, providing up to four hours each weekly of dedicated time on the unit with the new nurses. During the encounters, the coaches provided at the elbow clinical support and debriefing on past challenging experiences. Visits were structured to reinforce clinical skills and address the HWE standards. The coaches submitted a brief report on the coaching sessions to a REDCap instrument that could be used to track encounters and identify common trends.Results:More than 250 coaching sessions from three cohorts have been recorded in 2022.100% of RN residents and 85% of RN fellows from the January cohort have been retained.Conclusion:The Clinical Coach program has contributed to retention of RN residents and fellows. New ICU nurses are at risk for becoming overwhelmed and leaving the clinical setting, exacerbating existing staffing challenges.Experienced preceptors may be key resources to support the ongoing clinical and social needs of new nurses after preceptorship.Implications for practiceInpatient units with limited preceptor resources who must onboard large cohorts of new nurses should consider partnering with experienced preceptors to identify unit-specific clinical and unit culture needs and develop a similar program for their specialties. The healthy work environment model provides a structured approach for coach/new nurse encounters

Outdoor Smoke-Free Policies in Maine

Incontrovertible evidence of the deadly impacts from both direct tobacco use and environmental exposure to tobacco smoke has led to the institution of smoking bans, first in indoor venues and, more recently, in some outdoor area. This article reviews the science behind smoking bans as well as the history and policy implications of smoking bans with an emphasis on the experience in Maine. As examples we focus on recent outdoor smoking bans in South Portland (parks and beaches) and smoke-free campus rules at a Maine hospital (Franklin Memorial Hospital) and a part of the University of Maine system (University of Southern Maine). Our conclusions highlight the interconnections among federal, state, municipal, and public institutional efforts to limit smoking and suggest pathways by which smoke-free areas can be expanded in Maine and elsewhere

Longitudinal, population-based study of racial/ethnic differences in colorectal cancer survival: impact of neighborhood socioeconomic status, treatment and comorbidity

<p>Abstract</p> <p>Background</p> <p>Colorectal cancer, if detected early, has greater than 90% 5-year survival. However, survival has been shown to vary across racial/ethnic groups in the United States, despite the availability of early detection methods.</p> <p>Methods</p> <p>This study evaluated the joint effects of sociodemographic factors, tumor characteristics, census-based socioeconomic status (SES), treatment, and comorbidities on survival after colorectal cancer among and within racial/ethnic groups, using the SEER-Medicare database for patients diagnosed in 1992–1996, and followed through 1999.</p> <p>Results</p> <p>Unadjusted colorectal cancer-specific mortality rates were higher among Blacks and Hispanic males than whites (relative rates (95% confidence intervals) = 1.34 (1.26–1.42) and 1.16 (1.04–1.29), respectively), and lower among Japanese (0.78 (0.70–0.88)). These patterns were evident for all-cause mortality, although the magnitude of the disparity was larger for colorectal cancer mortality. Adjustment for stage accounted for the higher rate among Hispanic males and most of the lower rate among Japanese. Among Blacks, stage and SES accounted for about half of the higher rate relative to Whites, and within stage III colon and stages II/III rectal cancer, SES completely accounted for the small differentials in survival between Blacks and Whites. Comorbidity did not appear to explain the Black-White differentials in colorectal-specific nor all-cause mortality, beyond stage, and treatment (surgery, radiation, chemotherapy) explained a very small proportion of the Black-White difference. The fully-adjusted relative mortality rates comparing Blacks to Whites was 1.14 (1.09–1.20) for all-cause mortality and 1.21 (1.14–1.29) for colorectal cancer specific mortality. The sociodemographic, tumor, and treatment characteristics also had different impacts on mortality within racial/ethnic groups.</p> <p>Conclusion</p> <p>In this comprehensive analysis, race/ethnic-specific models revealed differential effects of covariates on survival after colorectal cancer within each group, suggesting that different strategies may be necessary to improve survival in each group. Among Blacks, half of the differential in survival after colorectal cancer was primarily attributable to stage and SES, but differences in survival between Blacks and Whites remain unexplained with the data available in this comprehensive, population-based, analysis.</p

Correction to: Cluster identification, selection, and description in Cluster randomized crossover trials: the PREP-IT trials

An amendment to this paper has been published and can be accessed via the original article

Book Review: Tutoring Matters

This short essay reviews, Tutoring Matters, by Chin, Rabow, and Estrada (2011)

Impact of benzodiazepines and polysubstance status on repeat non-fatal drug overdoses

Research has shown that benzodiazepines and mental health disorders can increase the likelihood of repeat overdose, but researcher have not explored this association in Tennessee (TN). We examined benzodiazepines, polysubstance overdose status with/without benzodiazepines, and mental health comorbidities with repeat overdose using statewide data in TN. This study analyzed TN hospital discharge data on nonfatal overdoses for patients ages 18–64 from 2012 to 2016 for 21,066 patients with an initial inpatient visit and 36,244 patients with an initial outpatient visit. The study assessed each patient at one year after initial overdose to determine likelihood of repeat overdose. We used a Cox proportional hazards model to compute hazard ratios (HRs) and 95% confidence intervals (CIs) to determine the factors associated with repeat nonfatal overdose. Repeat overdose rates, by one year after index overdose, were 12.9% of the sample for inpatients and 13.9% of the sample for outpatients. The visit factors (overdose characteristics and comorbidities determined from the initial visit) that the study found to be independently associated with repeat overdoses among inpatients were polysubstance status (HR: 0.88, 95% CI 0.78–0.99), benzodiazepine/polysubstance interaction (HR: 1.29, 95% CI 1.02–1.64), and presence of any mental health disorder (HR: 1.28, 95% CI: 1.18–1.39). For outpatients, the benzodiazepine/polysubstance interaction (HR: 1.21, 95% CI 1.01–1.44) was significant without adjusting for demographic factors. We found evidence that benzodiazepine/polysubstance status and mental health disorders were associated with repeat overdose for inpatients, and that benzodiazepine/polysubstance status was associated with repeat overdose for outpatients. Findings support the need to include polysubstance status and mental health in overdose prevention efforts