Engineering Innovation and Design for STEM Teachers and the STEM Quality Framework

The backbone of economic growth in the United States relies on engineering innovation. However, engineering innovation cannot occur without engineers and scientists. Unfortunately however, many K-12 students do not have a good understanding of the engineering design process or the vast field of engineering. As a result, many students lose interest in math and science and do not pursue Science, Technology, Engineering and Math (STEM) fields. This paper will describe a unique partnership among the Teacher Education Program and School of Engineering at the University of Dayton (UD) and the Dayton Regional STEM Center (DRSC). This partnership initiated with the development of the STEM Education Quality Framework (SQF). The SQF resulted in a variety of educational tools, including a STEM curriculum template, that was implemented in the DRSC’s teacher professional development and curriculum development program entitled the STEM Fellow Program. The STEM Fellow program was modeled in a unique, NSF sponsored six week program for K-12 STEM teachers and pre-service teachers entitled Engineering Innovation and Design for STEM Teachers. The objective of the NSF sponsored project was to enhance the knowledge of teachers and pre-service teachers about engineering innovation and design, to empower them to provide their students inspirational engineering and innovation experiences as well as better inform their students of potential career fields and societal needs. During the initial pilot year, ten teachers and five pre-service teachers were placed on teams with an engineering student, engineering faculty and industrial mentor. The teams participated in a variety of activities including field trips, a guest speaker series, laboratory experiences, an introductory engineering innovation and design project as well as a more in-depth project provided by the industrial mentor. Evidence used to measure the efficacy of the program at meeting its objectives included both qualitative and quantitative measures. Results suggest that the initial program season was successful at meeting the program objectives

Bridging the Gap Between Engineering Design and PK-12 Curriculum Development Through the Use the STEM Education Quality Framework

This paper will describe a unique partnership among the Department of Teacher Education and School of Engineering at the University of Dayton (UD) and the Dayton Regional STEM Center (DRSC). This partnership resulted in the development of the STEM Education Quality Framework (SQF), a tool to guide educators in teaching, learning and refining STEM education. The SQF resulted in a variety of educational tools, including a STEM curriculum template, that was implemented in the DRSCs teacher professional development and curriculum development program entitled the STEM Fellow Program. The STEM Fellow program was later modeled in a unique, NSF sponsored six week program for K-12 STEM teachers and pre-service teachers entitled Engineering Innovation and Design for STEM Teachers. The objectives of this program were to enhance the knowledge of teachers about engineering innovation and design, to empower them to provide their students inspirational engineering and innovation experiences as well as better inform their students of potential career fields and societal needs. During the pilot year, ten teachers and five pre-service teachers were placed on teams with an engineering student, engineering faculty and industrial mentor. The teams participated in a variety of activities including an introductory engineering innovation and design project as well as a more in-depth design project provided by the industrial mentor. Results from both qualitative and quantitative assessment suggest that this program was successful at meeting the program objectives

From Exploration of Classism to Anticlassist Counseling: Implications for Counselors and Counselor Educators

Classism is a recently studied, but historically present, form of oppression. Despite much attention to inclusion of underrepresented clients in counseling literature, there has been little focus on the presence of classism in academic settings. In an effort to close this gap, a study of 202 individuals, aged 18 to 38, was conducted to explore the relationships among perceived classism, ethnicity, and socioeconomic status. Only 4.5% of the participants had never experienced any incidents of classism. African American individuals were more likely to experience interpersonal classism and working class/poor individuals were more likely to experience interpersonal and systemic classism. Recommendations for counselors, specifically, college counselors working with young adult students, facing classism are also discussed

Enhanced feedback interventions to promote evidence-based blood transfusion guidance and reduce unnecessary use of blood components:The AFFINITIE research programme including two cluster factorial RCTs

Background: Blood transfusion is a common but costly treatment. Repeated national audits in the UK suggest that up to one-fifth of transfusions are unnecessary when judged against recommendations for good clinical practice. Audit and feedback seeks to improve patient care and outcomes by comparing clinical care against explicit standards. It is widely used internationally in quality improvement. Audit and feedback generally has modest but variable effects on patient care. A considerable scope exists to improve the impact that audit and feedback has, particularly through head-to-head trials comparing different ways of delivering feedback. Objectives: The AFFINITIE (Development & Evaluation of Audit and Feedback INterventions to Increase evidence-based Transfusion practIcE) programme aimed to design and evaluate enhanced feedback interventions, within a national blood transfusion audit programme, to promote evidence-based guidance and reduce the unnecessary use of blood components. We developed, piloted and refined two feedback interventions, ‘enhanced content’ and ‘enhanced follow-on’ (workstream 1), evaluated the effectiveness and cost-effectiveness of the two feedback interventions compared with standard feedback practice (workstream 2), examined intervention fidelity and contextual influences (workstream 3) and developed general implementation recommendations and tools for other audit and feedback programmes (workstream 4). Design: Interviews, observations and documentary analysis in four purposively sampled hospitals explored contemporary practice and opportunities for strengthening feedback. We developed two interventions: ‘enhanced content’, to improve the clarity and utility of feedback reports, and ‘enhanced follow-on’, to help hospital staff with action-planning (workstream 1). We conducted two linked 2 × 2 factorial cross-sectional cluster-randomised trials within transfusion audits for major surgery and haematological oncology, respectively (workstream 2). We randomised hospital clusters (the organisational level at which hospital transfusion teams operate) to enhanced or standard content or enhanced or standard follow-on. Outcome assessment was masked to assignment. Decision-analytic modelling evaluated the costs, benefits and cost-effectiveness of the feedback interventions in both trials from the perspective of the NHS. A parallel process evaluation used semistructured interviews, documentary analyses and web analytics to assess the fidelity of delivery, receipt and enactment and to identify contextual influences (workstream 3). We explored ways of improving the impact of national audits with their representatives (workstream 4). Setting and participants: All NHS hospital trusts and health boards participating in the National Comparative Audit of Blood Transfusions were invited to take part. Among 189 hospital trusts and health boards screened, 152 hospital clusters participated in the surgical audit. Among 187 hospital trusts and health boards screened, 141 hospital clusters participated in the haematology audit. Interventions: ‘Enhanced content’ aimed to ensure that the content and format of feedback reports were consistent with behaviour change theory and evidence. ‘Enhanced follow-on’ comprised a web-based toolkit and telephone support to facilitate local dissemination, planning and response to feedback. Main outcome measures: Proportions of acceptable transfusions, based on existing evidence and guidance and algorithmically derived from national audit data. Data sources: Trial primary outcomes were derived from manually collected, patient-level audit data. Secondary outcomes included routinely collected data for blood transfusion. Results: With regard to the transfusions in the major surgery audit, 135 (89%) hospital clusters participated from 152 invited. We randomised 69 and 66 clusters to enhanced and standard content, respectively, and 68 and 67 clusters to enhanced and standard follow-on, respectively. We analysed a total of 2222 patient outcomes at 12 months in 54 and 58 (enhanced and standard content, respectively) and 54 and 58 (enhanced and standard follow-on, respectively) hospital clusters. With regard to the haematology audit, 134 hospital clusters (95%) participated from 141 invited. We randomised 66 and 68 clusters to enhanced and standard content, respectively, and 67 clusters to both enhanced and standard follow-on. We analysed a total of 3859 patient outcomes at 12 months in 61 and 61 (enhanced and standard content, respectively) and 63 and 59 (enhanced and standard follow-on) hospital clusters. We found no effect of either of the enhanced feedback interventions in either trial across all outcomes. Incremental enhanced intervention costs ranged from £18 to £248 per site. The enhanced feedback interventions were dominated by the standard intervention in cost-effectiveness analyses. The interventions were delivered as designed and intended, but subsequent local engagement was low. Although the enhancements were generally acceptable, doubts about the credibility of the blood transfusion audits undermined the case for change. Limitations: Limitations included the number of participating clusters; loss to follow-up of trial clusters, reducing statistical power and validity; incomplete audit and cost data contributing to outcome measures; participant self-selection; reporting; missing data related to additional staff activity generated in response to receiving feedback; and recall biases in the process evaluation interviews. Conclusions: The enhanced feedback interventions were acceptable to recipients but were more costly and no more effective than standard feedback in reducing unnecessary use of blood components, and, therefore, should not be recommended on economic grounds. Future work: We have demonstrated the feasibility of embedding ambitious large-scale rigorous research within national audit programmes. Further head-to-head comparisons of different feedback interventions are needed in these programmes to identify cost-effective ways of increasing the impact of the interventions

Impact of Solitary Involved Lymph Node on Outcome in Localized Cancer of the Esophagus and Esophagogastric Junction

Node-positive esophageal cancer is associated with a dismal prognosis. The impact of a solitary involved node, however, is unclear, and this study examined the implications of a solitary node compared with greater nodal involvement and node-negative disease. The clinical and pathologic details of 604 patients were entered prospectively into a database from1993 and 2005. Four pathologic groups were analyzed: node-negative, one lymph node positive, two or three lymph nodes positive, and greater than three lymph nodes positive. Three hundred and fifteen patients (52%) were node-positive and 289 were node-negative. The median survival was 26 months in the node-negative group. Patients (n = 84) who had one node positive had a median survival of 16 months (p = 0.03 vs node-negative). Eighty-four patients who had two or three nodes positive had a median survival of 11 months compared with a median survival of 8 months in the 146 patients who had greater than three nodes positive (p = 0.01). The survival of patients with one node positive [number of nodes (N) = 1] was also significantly greater than the survival of patients with 2–3 nodes positive (N = 2–3) (p = 0.049) and greater than three nodes positive (p < 0001). The presence of a solitary involved lymph node has a negative impact on survival compared with node-negative disease, but it is associated with significantly improved overall survival compared with all other nodal groups

The role of informal dimensions of safety in high-volume organisational routines:an ethnographic study of test results handling in UK general practice

Abstract Background The handling of laboratory, imaging and other test results in UK general practice is a high-volume organisational routine that is both complex and high risk. Previous research in this area has focused on errors and harm, but a complementary approach is to better understand how safety is achieved in everyday practice. This paper ethnographically examines the role of informal dimensions of test results handling routines in the achievement of safety in UK general practice and how these findings can best be developed for wider application by policymakers and practitioners. Methods Non-participant observation was conducted of high-volume organisational routines across eight UK general practices with diverse organisational characteristics. Sixty-two semi-structured interviews were also conducted with the key practice staff alongside the analysis of relevant documents. Results While formal results handling routines were described similarly across the eight study practices, the everyday structure of how the routine should be enacted in practice was informally understood. Results handling safety took a range of local forms depending on how different aspects of safety were prioritised, with practices varying in terms of how they balanced thoroughness (i.e. ensuring the high-quality management of results by the most appropriate clinician) and efficiency (i.e. timely management of results) depending on a range of factors (e.g. practice history, team composition). Each approach adopted created its own potential risks, with demands for thoroughness reducing productivity and demands for efficiency reducing handling quality. Irrespective of the practice-level approach adopted, staff also regularly varied what they did for individual patients depending on the specific context (e.g. type of result, patient circumstances). Conclusions General practices variably prioritised a legitimate range of results handling safety processes and outcomes, each with differing strengths and trade-offs. Future safety improvement interventions should focus on how to maximise practice-level knowledge and understanding of the range of context-specific approaches available and the safeties and risks inherent in each within the context of wider complex system conditions and interactions. This in turn has the potential to inform new kinds of proactive, contextually appropriate approaches to intervention development and implementation focusing on the enhanced deliberation of the safety of existing high-volume routines