Connecting through Composition: Critical Intersections in Middle School Multimodal Writing

University of Minnesota Ph.D. dissertation. May 2019. Major: Education, Curriculum and Instruction. Advisor: Cynthia Lewis. 1 computer file (PDF); viii, 228 pages.Classroom writing practices exist in a complex social environment where students present identities to each other through the texts they create and their interactions (Pandya, Z., 2015; Dyson, 2018; Snaza & Lensmire, 2006). Recognizing this complexity, writing practices in schools have changed over time. Practices have shifted from a traditional focus on technical skills of writing, to a writing workshop model, emphasizing student choice of topics and opportunities to share. Critical writing pedagogy emerged in response to the workshop model’s perspective of students bringing a single identity to a neutral writing process. However, traditional writing practices are pervasive in schools and there is a need for research that draws attention to classrooms where teachers implement critical writing pedagogy (Furman, 2017). This yearlong critical ethnographic study describes seventh grade students’ writing processes at the intersection of critical writing pedagogy and multimodality, and considers how students’ social identities as writers and peer relations around writing are mediated by literacy practices within the classroom. Drawing on mediated discourse analysis (MDA) (Scollon & Scollon, 2004; Norris & Jones, 2005) to examine moment-to-moment actions and interactions, this study traces a routine journal writing practice where students regularly enter into critical dialogue. An analysis focused on resemiotization (Norris & Jones, 2005) highlights how students’ learning and interactions shift throughout this classroom practice. In addition, this study utilizes trajectories and timescales (Scollon & Scollon, 2004) to look at how two literacy events draw on this journal practice in similar ways while unfolding differently in relation to the specific surroundings of each moment. Finally, this study draws on MDA’s view of agency to consider the ways the classroom teacher navigates intersecting discourses in order to implement these critical and multimodal writing practices in the classroom. This work has implications for how we view writing practices and students as they engage in composing and sharing. It calls for a view of students as writers who are making choices about when and how they write and engage in dialogue based on the complex surroundings of a moment. This view shifts attention away from an idea that students either have or lack abilities and instead focuses on the possibilities of teachers to create and reflect on spaces where students choose to engage in meaningful writing and dialogue

Healthy Ageing in Europe:Prioritizing Interventions to improve Health Literacy

Background: Health literacy (HL) is low for 40-50% of the population in developed nations, and is strongly linked to many undesirable health outcomes. Older adults are particularly at risk. The Irohla project systematically created a large inventory of HL interventions targeting adults age 50+, to support practical production of policy and practice guidelines for promoting health literacy in European populations. Methods: We comprehensively surveyed international scientific literature, grey literature and other sources (published 2003+) for implemented HL interventions that involved older adults. Studies were screened for eligibility criteria and further selected for aspects important in European public health policy, including priority diseases, risk factors and vulnerable target groups. Interventions were prioritised using a multiple criteria tool to select final interventions that also featured strong evidence of efficacy and a broad range of strategies. Results: From nearly 7000 written summaries, 1097 met inclusion criteria, of which 233 were chosen for scoring and ranking. Of these, 7 had the highest multi-criteria scores. Eight more articles were selected based on rounded criteria including a high multi-criteria score as well as elements of innovation. Final selections were 18 articles describing 15 programmes. Conclusions: 15 promising intervention projects that feature strong evidence of efficacy among important diseases or risk factors and vulnerable groups, or that had success with elements of innovation were identified. These programmes have multiple positive attributes which could be used as guidance for developing innovative intervention programmes to trial on European older adults. They provide evidence of efficacy in addressing high priority diseases and risk factors

Methodological review: quality of randomized controlled trials in health literacy

Background: The growing move towards patient-centred care has led to substantial research into improving the health literacy skills of patients and members of the public. Hence, there is a pressing need to assess the methodology used in contemporary randomized controlled trials (RCTs) of interventions directed at health literacy, in particular the quality (risk of bias), and the types of outcomes reported. Methods: We conducted a systematic database search for RCTs involving interventions directed at health literacy in adults, published from 2009 to 2014. The Cochrane Risk of Bias tool was used to assess quality of RCT implementation. We also checked the sample size calculation for primary outcomes. Reported evidence of efficacy (statistical significance) was extracted for intervention outcomes in any of three domains of effect: knowledge, behaviour, health status. Demographics of intervention participants were also extracted, including socioeconomic status. Results: We found areas of methodological strength (good randomization and allocation concealment), but areas of weakness regarding blinding of participants, people delivering the intervention and outcomes assessors. Substantial attrition (losses by monitoring time point) was seen in a third of RCTs, potentially leading to insufficient power to obtain precise estimates of intervention effect on primary outcomes. Most RCTs showed that the health literacy interventions had some beneficial effect on knowledge outcomes, but this was typically for less than 3 months after intervention end. There were far fewer reports of significant improvements in substantive patient-oriented outcomes, such as beneficial effects on behavioural change or health (clinical) status. Most RCTs featured participants from vulnerable populations. Conclusions: Our evaluation shows that health literacy trial design, conduct and reporting could be considerably improved, particularly by reducing attrition and obtaining longer follow-up. More meaningful RCTs would also result if health literacy trials were designed with public and patient involvement to focus on clinically important patient-oriented outcomes, rather than just knowledge, behaviour or skills in isolation

It is Not All Fun and Games: Breaking News Consumption on Snapchat

Snapchat is a camera and ephemeral messaging application popular among young adults. Due to its self-destructing content and playful features, Snapchat is often associated with more trivial uses. However, the platform has added functionality to support consumption of news. To understand how users perceive and interact with news content on Snapchat, we conducted semi-structured interviews with 19 users of the platform, focusing on their use of Snapchat during breaking news events, including the 2016/2017 US presidential election and inauguration. Through the lens of Network Gatekeeping, our research explains how users consume breaking news content on Snapchat. We unpack users’ ambiguous perceptions of news reliability on Snapchat, and demonstrate how this contrasts with traditional news consumption. Our research also describes how users’ mental models of how Snapchat works—specifically their theories about how the platform curates news content—shape their judgments of reliability, media bias and authenticity

Design of MARQUIS2: study protocol for a mentored implementation study of an evidence-based toolkit to improve patient safety through medication reconciliation.

BackgroundThe first Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals. We sought to implement the MARQUIS toolkit in more diverse hospitals, incorporating lessons learned from MARQUIS1.MethodsMARQUIS2 is a pragmatic, mentored implementation QI study which collected clinical and implementation outcomes. Sites implemented a revised toolkit, which included interventions from these domains: 1) best possible medication history (BPMH)-taking; 2) discharge medication reconciliation and patient/caregiver counseling; 3) identifying and defining clinician roles and responsibilities; 4) risk stratification; 5) health information technology improvements; 6) improved access to medication sources; 7) identification and correction of real-time discrepancies; and, 8) stakeholder engagement. Eight hospitalists mentored the sites via one site visit and monthly phone calls over the 18-month intervention period. Each site's local QI team assessed opportunities to improve, implemented at least one of the 17 toolkit components, and accessed a variety of resources (e.g. implementation manual, webinars, and workshops). Outcomes to be assessed will include unintentional medication discrepancies per patient.DiscussionA mentored multi-center medication reconciliation QI initiative using a best practices toolkit was successfully implemented across 18 medical centers. The 18 participating sites varied in size, teaching status, location, and electronic health record (EHR) platform. We introduce barriers to implementation and lessons learned from MARQUIS1, such as the importance of utilizing dedicated, trained medication history takers, simple EHR solutions, clarifying roles and responsibilities, and the input of patients and families when improving medication reconciliation

Epigenetic regulation of Dlg1, via Kaiso, alters mitotic spindle polarity and promotes intestinal tumourigenesis

Both alterations to the epigenome and loss of polarity have been linked to cancer initiation, progression and metastasis. It has previously been demonstrated that loss of the epigenetic reader protein Kaiso suppresses intestinal tumourigenesis in the Apc+/min mouse model, in which altered polarity plays a key role. Thus, we investigated the link between Kaiso deficiency, polarity and suppression of intestinal tumourigenesis. We used Kaiso deficient mice to conditionally delete Apc within the intestinal epithelia and demonstrated up-regulation of the spindle polarity genes Dlg1 and Dlgap1. To understand the role of Dlg1 we generated Villin-creApc+/minDlg1flx/flx Kaiso-/y mice to analyse gene expression, survival, tumour burden and spindle orientation. In vivo analysis of the Dlg1 deficient intestine revealed improper orientation of mitotic spindles and a decreased rate of cellular migration. Loss of Dlg1 decreased survival in Apc+/min mice, validating its role as a tumour suppressor in the intestine. Significantly the increased survival of Apc+/minKaisoy/- mice was shown to be dependent on Dlg1 expression. Taken together this data indicates that maintenance of spindle polarity in the intestinal crypt requires appropriate regulation of Dlg1 expression. As Dlg1 loss leads to incorrect spindle orientation and a delay in cells transiting the intestinal crypt. We propose that the delayed exit from the crypt increases the window in which spontaneous mutations can become fixed, producing a 'tumour-permissive' environment, without an increase in mutation rate. Implications: Loss of mitotic spindle polarity delays the exit of cells from the intestinal crypt and promotes a tumourigenic environment

Prostate bed and organ-at-risk deformation: Prospective volumetric and dosimetric data from a phase II trial of stereotactic body radiotherapy after radical prostatectomy.

PURPOSE: Stereotactic body radiotherapy (SBRT) in the post-prostatectomy setting is investigational. A major concern is the deformable prostate bed clinical target volume (CTV) and the closely juxtaposed organs-at-risk (OARs). We report a volumetric and dosimetric analysis of kilovoltage cone-beam CT (CBCT) data from the first 18 patients enrolled on a phase II trial of post-prostatectomy SBRT. With instructions on bladder filling and rectal preparation, we hypothesized acceptable CTV coverage while minimal overdosing to OARs could be achieved. METHODS: All patients received 5 fractions of 6-6.8 Gy to the prostate bed. CBCT were taken prior to and halfway through each fraction. CTV and OARs were contoured for each CBCT. Changes in inter- and intra-fraction volume and dose were calculated. Relative changes in CTV V95%, bladder V32.5 Gy, and rectal V32.5 Gy and V27.5 Gy were evaluated. RESULTS: Interfraction CTV volume remained stable, with median change +5.69% (IQR -1.73% to +9.84%). CTV V95% exhibited median change -0.74% (IQR -9.15% to -0.07%). Volumetric and dosimetric changes were minor from interfraction rotation and intrafraction motion. CTV V95% was ≥93% in 13 of 18 (72%) patients; in the remaining five, median change was -14.09% (IQR -16.64% to -13.56%). Interfraction CTV volume change was significantly larger among patients with CTV V95% <93% (+25.04% vs. +2.85%, p = 0.002). CONCLUSIONS: With specific bladder and rectum filling protocols, CTV underdosing and overdosing to bladder and rectum are avoided in majority of patients. Changes in CTV shape may account for the underdosing that may be observed

The interplay between chromosome stability and cell cycle control explored through gene–gene interaction and computational simulation

Chromosome stability models are usually qualitative models derived from molecular-genetic mechanisms for DNA repair, DNA synthesis, and cell division. While qualitative models are informative, they are also challenging to reformulate as precise quantitative models. In this report we explore how (A) laboratory experiments, (B) quantitative simulation, and (C) seriation algorithms can inform models of chromosome stability. Laboratory experiments were used to identify 19 genes that when over-expressed cause chromosome instability in the yeast Saccharomyces cerevisiae. To better understand the molecular mechanisms by which these genes act, we explored their genetic interactions with 18 deletion mutations known to cause chromosome instability. Quantitative simulations based on a mathematical model of the cell cycle were used to predict the consequences of several genetic interactions. These simulations lead us to suspect that the chromosome instability genes cause cell-cycle perturbations. Cellcycle involvement was confirmed using a seriation algorithm, which was used to analyze the genetic interaction matrix to reveal an underlying cyclical pattern. The seriation algorithm searched over 1014 possible arrangements of rows and columns to find one optimal arrangement, which correctly reflects events during cell cycle phases. To conclude, we illustrate how the molecular mechanisms behind these cell cycle events are consistent with established molecular interaction maps

A qualitative analysis of an electronic health record (EHR) implementation in an academic ambulatory setting

Objectives To determine pre-implementation perspectives of institutional, practice and vendor leadership regarding best practice for implementation of two ambulatory electronic health records (EHRs) at an academic institution. Design Semi-structured interviews with ambulatory care network and information systems leadership, medical directors, practice managers and vendors before EHR implementation. Results were analysed using grounded theory with ATLAS.ti version 5.0. Measurements Qualitative data on perceived benefits of EHRs as well as facilitators and barriers to successful implementation. Results Interviewees perceived data accessibility, quality and safety measurement, improvement and reporting as benefits of EHR use. Six themes emerged for EHR implementation best practice: effective communication; successful system migration; sufficient hardware, technical equipment, support and training; safeguards for patient privacy; improved efficiency; and a sustainable business plan. Conclusions Achieving the benefits of EHRs identified by our interviewees depends on successful implementation and use. Further identification of best implementation practices for EHRs is required, given the financial and clinical consequences of poor implementation