Supporting Evidence-Informed Teaching in Biomedical and Health Professions Education Through Knowledge Translation: An Interdisciplinary Literature Review

PHENOMENON: The purpose of “systematic” reviews/reviewers of medical and health professions educational research is to identify best practices. This qualitative paper explores the question of whether systematic reviews can support “evidence informed” teaching, and contrasts traditional systematic reviewing with a knowledge-translation approach to this objective. APPROACH: Degrees of Freedom Analysis is used to examine the alignment of systematic review methods with educational research and the pedagogical strategies and approaches that might be considered with a decision-making framework developed to support valid assessment. This method is also used to explore how knowledge translation can be used to inform teaching and learning. FINDINGS: The nature of educational research is not compatible with most (11/14) methods for systematic review. The inconsistency of systematic reviewing with the nature of educational research impedes both the identification and implementation of ‘best-evidence’ pedagogy and teaching. This is primarily because research questions that do support the purposes of review do not support educational decision-making. By contrast to systematic reviews of the literature, both a Degrees of Freedom Analysis (DOFA) and knowledge translation (KT) are fully compatible with informing teaching using evidence. A DOFA supports the translation of theory to a specific teaching or learning case, so could be considered a type of KT. The DOFA results in a test of alignment of decision options with relevant educational theory and KT leads to interventions in teaching or learning that can be evaluated. Examples of how to structure evaluable interventions are derived from a knowledge-translation approach that are simply not available from a systematic review. INSIGHTS: Systematic reviewing of current empirical educational research is not suitable for deriving or supporting best practices in education. However, both “evidence-informed” and scholarly approaches to teaching can be supported as knowledge translation projects, which are inherently evaluable and can generate actionable evidence about whether the decision or intervention worked for students, instructors, and the institution. A Degrees of Freedom Analysis can also support evidence- and theory-informed teaching to develop an understanding of what works, why, and for whom. Thus, knowledge translation, but not systematic reviewing, can support decision-making around pedagogy (and pedagogical innovation) that can also inform new teaching and learning initiatives; it can also point to new avenues of empirical research in education that are informed by, and can inform, theory

A social pedagogical intervention to support children in care:Back on Track

This paper focuses on an intervention project, Back on Track (BoT), implemented as a part of the Resilience Revolution: HeadStart Blackpool (RR:HS) programme in the UK. Whilst it is a famous family holiday resort, Blackpool is also one of the most deprived towns in England. This makes life challenging for young people (YP) to maintain wellbeing and reach their potential. Blackpool also has an above average and growing proportion of children in care. They are at a higher risk of developing mental health difficulties and of being permanently excluded from school. BoT aimed to support fostered children who have been referred by schools or social workers to the project for having emotional and behavioural struggles. As a consequence of their difficulties, they were at risk of permanent exclusion from the school. The intervention was grounded in a social pedagogical approach and Resilient Therapy. Resilience Coaches (i.e., wellbeing practitioners) had the role of enhancing communication between YP, family, social care, and school, whilst working with YP to co-produce coping strategies. Between November 2016 and June 2021, 39 YP (61.5% male) aged 10 to 15 (M = 12.74, SD = 1.60) received BoT support over a period lasting between 4 months to 2.5 years (M = 14 months, SD = 6.8 months). Using a mixed-methods design, this paper explored the BoT implementation. YP completed questionnaires before and after BoT. Triangulation interviews were conducted with a randomly selected YP, foster parent and the Resilience Coach. Results showed the benefit of equipping YP with ‘resilient moves’ and joining up systems to work together and better support YP and families. YP reported reduced difficulties, improved strengths (i.e., prosocial behaviour) and educational outcomes. This helped build resilience and reduce the risk of permanent exclusions from school. Policy and practice implications for children in care are discussed

Bounce Forward:A School-Based Prevention Programme for Building Resilience in a Socioeconomically Disadvantaged Context

Socioeconomic status is a strong predictor of normative development and well-being in young people. It is well-known that growing up in a socioeconomically disadvantaged context may lead to negative outcomes, both in childhood and in adulthood. Early intervention and prevention programmes are crucial for building resilience and improving health, well-being and equity. Bounce Forward is a school-based prevention programme implemented in Blackpool, a town in the United Kingdom facing multiple challenges. It was part of a whole town resilience approach and nascent global social movement known as the "Resilience Revolution." Between 2017 and 2019, the programme was delivered in all Year 5 classes at every primary school in Blackpool (n school = 36), reaching out to 3,134 students (ages 9-10; 50.4% male). The programme aimed to increase resilience in young people by building knowledge and skills about mental health and resilience through 10 sessions. In the current study, we longitudinally examined a range of protective factors, which are relevant to young people's resilience, as well as their mental health outcomes at three time points: before they participated in Bounce Forward, at the end of the programme, and 3-5 months later, when they started Year 6. The current sample included 441 Year 5 students (54.2% male) from 11 primary schools in Blackpool. Nineteen teaching staff also participated in the study and provided qualitative data regarding the impact of the programme on their students. Results showed improvement in some areas of young people's resilience after taking part in Bounce Forward. We also identified gender differences in several protective factors, indicating that boys may need further support. Teaching staff highlighted improvements in various areas; and also observed that their students have been using the strategies that they learnt from the programme. Altogether, findings suggested that young people benefitted from Bounce Forward. The programme is sustainable, offering a free to download teacher resource pack that allows schools to self-deliver it

‘Times that by 100’: Student learning from international practicum

International placements are uncommon for Aotearoa New Zealand social work students compared with many other countries. In 2015 five students undertook a 10-week placement in Cambodia. This article explores the students’ perspectives on the skills, knowledge and capabilities required for international placements. The findings from this study indicate that questions remain as to whether the associated challenges outweigh the advantages of international placement experiences. We recommend that working with tertiary institutions from countries with more established international placement programmes may be one way of addressing some of the challenges and advancing international placements for Aotearoa New Zealand students

HIV Cure Strategies: How Good Must They Be to Improve on Current Antiretroviral Therapy?

Background: We examined efficacy, toxicity, relapse, cost, and quality-of-life thresholds of hypothetical HIV cure interventions that would make them cost-effective compared to life-long antiretroviral therapy (ART). Methods: We used a computer simulation model to assess three HIV cure strategies: Gene Therapy, Chemotherapy, and Stem Cell Transplantation (SCT), each compared to ART. Efficacy and cost parameters were varied widely in sensitivity analysis. Outcomes included quality-adjusted life expectancy, lifetime cost, and cost-effectiveness in dollars/quality-adjusted life year ($/QALY) gained. Strategies were deemed cost-effective with incremental cost-effectiveness ratios <$100,000/QALY. Results: For patients on ART, discounted quality-adjusted life expectancy was 16.4 years and lifetime costs were $591,400. Gene Therapy was cost-effective with efficacy of 10$54,000. Chemotherapy was cost-effective with efficacy of 88%, relapse rate 0.5%/month, and cost $12,400/month for 24 months. At$150,000/procedure, SCT was cost-effective with efficacy of 79% and relapse rate 0.5%/month. Moderate efficacy increases and cost reductions made Gene Therapy cost-saving, but substantial efficacy/cost changes were needed to make Chemotherapy or SCT cost-saving. Conclusions: Depending on efficacy, relapse rate, and cost, cure strategies could be cost-effective compared to current ART and potentially cost-saving. These results may help provide performance targets for developing cure strategies for HIV

Cost-Effectiveness of Genotype Testing for Primary Resistance in Brazil

Objective: HIV genotype-resistance testing can help identify more effective antiretroviral treatment (ART) regimens for patients, substantially increasing the likelihood of viral suppression and immune recovery. We sought to evaluate the cost-effectiveness of genotype-resistance testing before first-line ART initiation in Brazil. Design: We used a previously published microsimulation model of HIV disease (CEPAC-International) and data from Brazil to compare the clinical impact, costs, and cost-effectiveness of initial genotype testing (Genotype) with no initial genotype testing (No genotype). Methods: Model parameters were derived from the HIV Clinical Cohort at the Evandro Chagas Clinical Research Institute and from published data, using Brazilian sources whenever possible. Baseline patient characteristics included 69% male, mean age of 36 years (SD, 10 years), mean CD4 count of 347 per microliter (SD, 300/µL) at ART initiation, annual ART costs from 2012 US $1400 to US$13,400, genotype test cost of US $230, and primary resistance prevalence of 4.4$12,300. Results: Compared with No genotype, Genotype increased life expectancy from 18.45 to 18.47 years and reduced lifetime cost from US $45,000 to$44,770; thus, in the base case, Genotype was cost saving. Genotype was cost-effective at primary resistance prevalence as low as 1.4% and remained cost-effective when subsequent-line ART costs decreased to 30% of baseline value. Cost-inefficient results were observed only when simultaneously holding multiple parameters to extremes of their plausible ranges. Conclusions: Genotype-resistance testing in ART-naive individuals in Brazil will improve survival and decrease costs and should be incorporated into HIV treatment guidelines in Brazil

Validation and Calibration of a Computer Simulation Model of Pediatric HIV Infection

Background: Computer simulation models can project long-term patient outcomes and inform health policy. We internally validated and then calibrated a model of HIV disease in children before initiation of antiretroviral therapy to provide a framework against which to compare the impact of pediatric HIV treatment strategies. Methods: We developed a patient-level (Monte Carlo) model of HIV progression among untreated children 1,300 untreated, HIV-infected African children. Results: In internal validation analyses, model-generated survival curves fit IeDEA data well; modeled and observed survival at 16 months of age were 91.2% and 91.1%, respectively. RMSE varied widely with variations in CD4% parameters; the best fitting parameter set (RMSE = 0.00423) resulted when CD4% was 45% at birth and declined by 6%/month (ages 0-3 months) and 0.3%/month (ages >3 months). In calibration analyses, increases in IeDEA-derived mortality risks were necessary to fit UNAIDS survival data. Conclusions: The CEPAC-Pediatric model performed well in internal validation analyses. Increases in modeled mortality risks required to match UNAIDS data highlight the importance of pre-enrollment mortality in many pediatric cohort studies

Skunk River Review Autumn 1994, vol 6

https://openspace.dmacc.edu/skunkriver/1009/thumbnail.jp

Investigation of the synthesis, activation, and isosteric heats of CO₂ adsorption of the isostructural series of metal-organic frameworks M₃(BTC)₂ (M = Cr, Fe, Ni, Cu, Mo, Ru)

The synthesis, activation, and heats of CO₂ adsorption for the known members of the M₃(BTC)₂ (HKUST-1) isostructural series (M = Cr, Fe, Ni, Zn, Ni, Cu, Mo) were investigated to gain insight into the impact of CO₂–metal interactions for CO₂ storage/separation applications. With the use of modified syntheses and activation procedures, improved BET surface areas were obtained for M = Ni, Mo, and Ru. The zero-coverage isosteric heats of CO₂ adsorption were measured for the Cu, Cr, Ni, Mo, and Ru analogues and gave values consistent with those reported for MOFs containing coordinatively unsaturated metal sites, but lower than for amine functionalized materials. Notably, the Ni and Ru congeners exhibited the highest CO₂ affinities in the studied series. These behaviors were attributed to the presence of residual guest molecules in the case of Ni₃(BTC)₂(Me₂NH)₂(H₂O) and the increased charge of the dimetal secondary building unit in [Ru₃(BTC)₂][BTC].Massachusetts Institute of Technology. Energy Initiative (Seed Fund