Lesson Plan: An Agenda for Change in American Higher Education

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Perspectives of 12th grade students, their families, and school officials related to affordability and accessibility of the West Virginia PROMISE Scholarship program at Logan High School

With only 14% of West Virginia\u27s population over 25 years old possessing a bachelor\u27s degree, the lack of a skilled workforce often thwarted state legislators\u27 attempts to attract new industry to the state\u27s struggling economy. To address workforce qualification concerns, state educational stakeholders implemented a merit-based scholarship program with average requirements in 2002. The West Virginia PROMISE (Providing Real Opportunities for Maximizing In-state Student Excellence) Scholarship Program goals include encouraging high school students to work harder, and to entice more graduates to attempt post-secondary work at in-state institutions.;This qualitative study was designed to discover the perceptions of five high school seniors and their families who qualified for the PROMISE Scholarship. Interviews were conducted to gather data about family perceptions of college, educational and economic opportunity, and the PROMISE Scholarship in their college decision-making processes. Using an emergent design, additional data was collected from school personnel about programs mentioned as influential to family decision-making processes. Collected data was analyzed using a constant-comparative method.;Study findings indicated that students are working harder to earn the PROMISE Scholarship. The findings also reveal factors influencing family decisions to attempt post-secondary work such as perceptions of their community, college, the benefits of attaining a college degree, and the financial importance of the availability of the PROMISE Scholarship. There were also indications that school programs were influential factors.;Implications of study findings for West Virginia educational stakeholders indicate concern over the continued funding of the program by study participants. There was also evidence of a lack of understanding of program rationale. It was also evident that more research needs to be conducted as the program continues to discover the eventual career paths and locations of PROMISE graduates. Additional research should also be conducted on students and families choosing not to take advantage of the scholarship program to attempt post-secondary work

Strategic Shift to a Diagnostic Model of Care in a Multi-Site Group Dental Practice.

BackgroundDocumenting standardized dental diagnostic terms represents an emerging change for how dentistry is practiced. We focused on a mid-sized dental group practice as it shifted to a policy of documenting patients' diagnoses using standardized terms in the electronic health record.MethodsKotter's change framework was translated into interview questions posed to the senior leadership in a mid-size dental group practice. In addition, quantitative content analyses were conducted on the written policies and forms before and after the implementation of standardized diagnosis documentation to assess the extent to which the forms and policies reflected the shift. Three reviewers analyzed the data individually and reached consensuses where needed.ResultsKotter's guiding change framework explained the steps taken to 97 percent utilization rate of the Electronic Health Record and Dental Diagnostic Code. Of the 96 documents included in the forms and policy analysis, 31 documents were officially updated but only two added a diagnostic element.ConclusionChange strategies established in the business literature hold utility for dental practices seeking diagnosis-centered care.Practical implicationsA practice that shifts to a diagnosis-driven care philosophy would be best served by ensuring that the change process follows a leadership framework that is calibrated to the organization's culture

Allogeneic morphogenetic protein vs. recombinant human bone morphogenetic protein-2 in lumbar interbody fusion procedures: a radiographic and economic analysis

BACKGROUND: Since the introduction of rhBMP-2 (Infuse®) in 2002, surgeons have had an alternative substitute to autograft and its related donor site morbidity. Recently, the prevalence of reported adverse events and complications related to the use of rhBMP-2 has raised many ethical and legal concerns for surgeons. Additionally, the cost and decreasing reimbursement landscape of rhBMP-2 use have required identification of a viable alternative. Osteo allogeneic morphogenetic protein (OsteoAMP®) is a commercially available allograft-derived growth factor rich in osteoinductive, angiogenic, and mitogenic proteins. This study compares the radiographic fusion outcomes between rhBMP-2 and OsteoAMP allogeneic morphogenetic protein in lumbar interbody fusion spine procedures. METHODS: Three hundred twenty-one (321) patients from three centers underwent a transforaminal lumbar interbody fusion (TLIF) or lateral lumbar interbody fusion (LLIF) procedure and were assessed by an independent radiologist for fusion and radiographically evident complications. The independent radiologist was blinded to the intervention, product, and surgeon information. Two hundred and twenty-six (226) patients received OsteoAMP with autologous local bone, while ninety-five (95) patients received Infuse with autologous local bone. Patients underwent radiographs (x-ray and/or CT) at standard postoperative follow-up intervals of approximately 1, 3, 6, 12, and 18 months. Fusion was defined as radiographic evidence of bridging across endplates, or bridging from endplates to interspace disc plugs. Osteobiologic surgical supply costs were also analyzed to ascertain cost differences between OsteoAMP and rhBMP-2. RESULTS: OsteoAMP produced higher rates of fusion at 6, 12, and 18 months (p ≤ 0.01). The time required for OsteoAMP to achieve fusion was approximately 40% less than rhBMP-2 with approximately 70% fewer complications. Osteobiologic supply costs were 80.5% lower for OsteoAMP patients (73.7% lower per level) than for rhBMP-2. CONCLUSIONS: Results of this study indicate that OsteoAMP is a viable alternative to rhBMP-2 both clinically and economically when used in TLIF and LLIF spine procedures

Quality of health care surveillance systems: review and implementation in the Swiss setting.

Quality of health care has been a subject of attention for many years in the USA and in Europe. Since the introduction of the new federal law on insurance in 1996 it has evolved to a progressively more important issue within the Swiss health care system. In this review, some theoretical concepts of quality of health care, variations, and surveillance systems are explored. Examples of quality of health care surveillance systems that have been developed successfully in the USA, in Canada, in Australia, and in Europe are discussed. They all demonstrate the interest in creating a large range of quality indicators in the surveillance system and in evaluating hospital performance using a benchmark approach. Currently, the measurement of quality with appropriate indicators is a subject of intense debate between the Swiss Hospitals Association (H+) and the Swiss Health Insurance Consortium (Santésuisse). Examples of existing surveillance systems in Switzerland are the Outcome Verein in Zurich and the quality of care program of the Canton of Valais. The FoQual association has also contributed to the debate by reviewing six indicators, which could be used nationally for a healthcare surveillance system. In this debate it is important to stress that ideal quality indicators intended for use as measures of quality in Swiss hospitals need to be both appropriate and valid. Only indicators that fulfil these conditions should be integrated in a Swiss health care surveillance system. Priority needs to be given to quality indicators and methods with the highest level of evidence and with a solid scientific basis

Reduction of the size of datasets by using evolutionary feature selection: the case of noise in a modern city

Smart city initiatives have emerged to mitigate the negative effects of a very fast growth of urban areas. Most of the population in our cities are exposed to high levels of noise that generate discomfort and different health problems. These issues may be mitigated by applying different smart cities solutions, some of them require high accurate noise information to provide the best quality of serve possible. In this study, we have designed a machine learning approach based on genetic algorithms to analyze noise data captured in the university campus. This method reduces the amount of data required to classify the noise by addressing a feature selection optimization problem. The experimental results have shown that our approach improved the accuracy in 20% (achieving an accuracy of 87% with a reduction of up to 85% on the original dataset).Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech. This research has been partially funded by the Spanish MINECO and FEDER projects TIN2016-81766-REDT (http://cirti.es), and TIN2017-88213-R (http://6city.lcc.uma.es)

Assessing Medical Room Behavior During Infants’ Painful Medical Procedures: The Measure of Adult and Infant Soothing and Distress (MAISD)

This study evaluated the Measure of Adult and Infant Soothing and Distress (MAISD) for examining infant, parent, and nurse behavior during infants’ immunizations. Videotapes of 62 infants, parents, and nurses during immunizations were coded. Concurrent validity and reliability for the MAISD were demonstrated. The scale revealed that infants displayed predominately distress, and adults exhibited primarily reassurance. Parents’ and nurses’ distractions were positively related to infants’ engaging in distraction, and parents’ and nurses’ reassurance was positively associated with infant distress. There appear to be avenues in which to intervene to teach parents and nurses how to best behave to help infants during their painful medical events