19 research outputs found
Opening Doors to Student Success: A Synthesis of Findings From an Evaluation at Six Community Colleges
Summarizes findings from Opening Doors Demonstration programs to raise college completion rates through financial incentives, instructional reforms, including learning communities, and enhancements in targeted student services such as academic counseling
Recommended from our members
School Closure as a Strategy to Remedy Low Performance
This brief investigates whether closing schools and transferring students for the purpose of remedying low performance is an option educational decision makers should pursue. The authors draw on a relatively limited evidence base that consists of peer-reviewed research studies and well-researched policy reports.
The authors conclude that school closures as a strategy for remedying student achievement in low-performing schools is a high-risk/low-gain strategy that fails to hold promise with respect to either student achievement or non-cognitive well-being. It causes political conflict and incurs hidden costs for both districts and local communities, especially low-income communities of color that are deferentially affected by school closings. It stands to reason that in many instances, students, parents, local communities, district and state policymakers may be better off investing in persistently low-performing schools rather than closing them
Recommended from our members
Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.
Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (nâ=â143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (nâ=â152), or no hydrocortisone (nâ=â108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (nâ=â137), shock-dependent (nâ=â146), and no (nâ=â101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707
Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19
IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19.
Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19.
DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 nonâcritically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022).
INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (nâ=â257), ARB (nâ=â248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; nâ=â10), or no RAS inhibitor (control; nâ=â264) for up to 10 days.
MAIN OUTCOMES AND MEASURES The primary outcome was organ supportâfree days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes.
RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ supportâfree days among critically ill patients was 10 (â1 to 16) in the ACE inhibitor group (nâ=â231), 8 (â1 to 17) in the ARB group (nâ=â217), and 12 (0 to 17) in the control group (nâ=â231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ supportâfree days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively).
CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes.
TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570
Recommended from our members
Exploring the Power of a Paradigm: Going Backstage with Policy Influencers in the Education Accountability Debate
For decades, the U.S. has experimented with accountability policy for public schools as a way to improve academic achievement and to draw attention to student inequalities. Accountability as a solution to the problems facing schools has become so widespread that it arguably has become a âpolicy paradigmâ. A policy paradigm is a framework of ideas and standards that shape the way policymakers and influencers think about how to define a policy problem, how they think about goals, the instruments they rely on to solve the policy problem, and the expected results. A policy paradigm also includes important moral ideas about human nature, motivation, who is to blame for the policy problem, or ideas about who deserves what resources in society. A paradigm can become so universal that the core policy and moral ideas become common sense and simply taken-for-granted. Accountability arguably reached paradigmatic status in education with the culmination of the federal No Child Left Behind (NCLB) legislation in 2001, which thrust the regulatory force of the federal government on individual states and their respective school systems. From its inceptions, NCLB had inherent âbugsâ in its design that led to unintended consequences for the schools. Most notably, the former law set an overly ambitious goal to close the achievement gap in 13 short years in the absence of capacity building. Some states reduced the cognitive complexity of statewide tests to comply with federal benchmarks while individual schools began to focus on basic skills and âteach to the testâ in order to âgameâ the system and avoid possible sanctions. In addition, NCLB made very little progress on its goal to close the academic achievement gap; academic achievement on the National Assessment of Educational Progress (NAEP) actually declined in the first years of implementing NCLB. In December 2015, Congress and President Obama responded to the unintended consequences with a more flexible federal policy designâthe Every Student Succeeds Actâthat shifted many of the goal setting and accountability functions back to the states, giving states flexibility to select their own policy designs and tools to regulate school and student performance. What happens to a paradigm in that situation? Does it begin to lose legitimacy and fracture, or is it somehow maintained? The goal of this research project was to capture the ideas of influential state-level policy thinkers and opinion leaders following the collapse of NCLB to determine whether the accountability paradigm was still seen as a viable solution to solving education inequalities. I chose to study state-level policy influencers who could shape the public debate with new ideas about how to solve the problem of school inequality following the demise of NCLB. I targeted influencers who could entertain doubts, reflect critically, and think âoutside the boxâ. By studying influencers, I could test the strength or weakness of the paradigm.All told, 65 leading policy influencers and opinion leadersâ45 from California and 20 from Tennesseeâwere sampled to reveal a spectrum of thinking about how to go about solving the problem of student and school inequalities. I interviewed a cross-section of influencers involved in the accountability debate in each state. I identified influential state elected and appointed officials, academics, journalists and bloggers, civil rights activists, community organizers, and members of the business community to understand how they thought about accountability policy and alternative policy ideas in the aftermath of NCLB. The main thrust of the findings reveals that the accountability paradigm is firmly in tact but has stretched across different institutional venues. Some influencers preferred a Local Control and Professional Model of accountability that put trust in school professionals and local communities to solve the problem of school inequality. The policy influencers within this cluster shared a nurturing and trusting Humanist moral narrative that played out in their policy ideas. Others desired a State Control Model of accountability. These influencers turned to the state as a problem solver for inequality in society. Thinkers within this cluster shared a Structuralist moral narrative and were weary of the âdangers of localismâ and distrustful of human nature. They thought that without a collective body of governance (such as the state), narrow-mindedness, bias, and discrimination would take root in local politics and further inequalities in schools. Lastly, other influencers supported a Market Control Model of accountability. Market control thinkers firmly believed that students would be better served if âfailingâ schools were pushed to an alternative institutional environment by the state, or if students and families could exit low-performing schools by exercising school choice. Three very distinct moral narratives supported the market model of accountability. Social Justice Entrepreneurs saw reality through the lens of historic inequalities, racial oppression, and institutional exclusion, and they saw the marketplace as an exit from low-performing schools that kept poor and minority students locked into cycles of intergenerational poverty. They believed in the power of individual agency and were drawn to policy ideas like charters and vouchers because they reinforced the individualâs ability to act. Paternalists had a very different moral narrative. To them, standards of appropriate behavior, rule setting, external pressure, and discipline were important dimensions of their moral outlook. To overcome the shortcomings of âfailingâ schools, they believed in the disciplinary aspects of the state and market to create conditions for school improvement. Lastly, there was a moral narrative of the Empiricists, who tried to rationalize their beliefs and values with technical language from the accountability paradigm. They turned to data and empirical research to make sense of consequences, school choice, and state takeover policies without delving into narratives of systemic inequalities or the complexity of the relationship between poverty and low performance
Recommended from our members
Exploring the Power of a Paradigm: Going Backstage with Policy Influencers in the Education Accountability Debate
For decades, the U.S. has experimented with accountability policy for public schools as a way to improve academic achievement and to draw attention to student inequalities. Accountability as a solution to the problems facing schools has become so widespread that it arguably has become a âpolicy paradigmâ. A policy paradigm is a framework of ideas and standards that shape the way policymakers and influencers think about how to define a policy problem, how they think about goals, the instruments they rely on to solve the policy problem, and the expected results. A policy paradigm also includes important moral ideas about human nature, motivation, who is to blame for the policy problem, or ideas about who deserves what resources in society. A paradigm can become so universal that the core policy and moral ideas become common sense and simply taken-for-granted. Accountability arguably reached paradigmatic status in education with the culmination of the federal No Child Left Behind (NCLB) legislation in 2001, which thrust the regulatory force of the federal government on individual states and their respective school systems. From its inceptions, NCLB had inherent âbugsâ in its design that led to unintended consequences for the schools. Most notably, the former law set an overly ambitious goal to close the achievement gap in 13 short years in the absence of capacity building. Some states reduced the cognitive complexity of statewide tests to comply with federal benchmarks while individual schools began to focus on basic skills and âteach to the testâ in order to âgameâ the system and avoid possible sanctions. In addition, NCLB made very little progress on its goal to close the academic achievement gap; academic achievement on the National Assessment of Educational Progress (NAEP) actually declined in the first years of implementing NCLB. In December 2015, Congress and President Obama responded to the unintended consequences with a more flexible federal policy designâthe Every Student Succeeds Actâthat shifted many of the goal setting and accountability functions back to the states, giving states flexibility to select their own policy designs and tools to regulate school and student performance. What happens to a paradigm in that situation? Does it begin to lose legitimacy and fracture, or is it somehow maintained? The goal of this research project was to capture the ideas of influential state-level policy thinkers and opinion leaders following the collapse of NCLB to determine whether the accountability paradigm was still seen as a viable solution to solving education inequalities. I chose to study state-level policy influencers who could shape the public debate with new ideas about how to solve the problem of school inequality following the demise of NCLB. I targeted influencers who could entertain doubts, reflect critically, and think âoutside the boxâ. By studying influencers, I could test the strength or weakness of the paradigm.All told, 65 leading policy influencers and opinion leadersâ45 from California and 20 from Tennesseeâwere sampled to reveal a spectrum of thinking about how to go about solving the problem of student and school inequalities. I interviewed a cross-section of influencers involved in the accountability debate in each state. I identified influential state elected and appointed officials, academics, journalists and bloggers, civil rights activists, community organizers, and members of the business community to understand how they thought about accountability policy and alternative policy ideas in the aftermath of NCLB. The main thrust of the findings reveals that the accountability paradigm is firmly in tact but has stretched across different institutional venues. Some influencers preferred a Local Control and Professional Model of accountability that put trust in school professionals and local communities to solve the problem of school inequality. The policy influencers within this cluster shared a nurturing and trusting Humanist moral narrative that played out in their policy ideas. Others desired a State Control Model of accountability. These influencers turned to the state as a problem solver for inequality in society. Thinkers within this cluster shared a Structuralist moral narrative and were weary of the âdangers of localismâ and distrustful of human nature. They thought that without a collective body of governance (such as the state), narrow-mindedness, bias, and discrimination would take root in local politics and further inequalities in schools. Lastly, other influencers supported a Market Control Model of accountability. Market control thinkers firmly believed that students would be better served if âfailingâ schools were pushed to an alternative institutional environment by the state, or if students and families could exit low-performing schools by exercising school choice. Three very distinct moral narratives supported the market model of accountability. Social Justice Entrepreneurs saw reality through the lens of historic inequalities, racial oppression, and institutional exclusion, and they saw the marketplace as an exit from low-performing schools that kept poor and minority students locked into cycles of intergenerational poverty. They believed in the power of individual agency and were drawn to policy ideas like charters and vouchers because they reinforced the individualâs ability to act. Paternalists had a very different moral narrative. To them, standards of appropriate behavior, rule setting, external pressure, and discipline were important dimensions of their moral outlook. To overcome the shortcomings of âfailingâ schools, they believed in the disciplinary aspects of the state and market to create conditions for school improvement. Lastly, there was a moral narrative of the Empiricists, who tried to rationalize their beliefs and values with technical language from the accountability paradigm. They turned to data and empirical research to make sense of consequences, school choice, and state takeover policies without delving into narratives of systemic inequalities or the complexity of the relationship between poverty and low performance
Recommended from our members
State Policy Strategies for Narrowing the Gender Wage Gap
#MeToo and #TimesUp protests about the treatment of women in the workplace have brought renewed attention to gender pay equity. This brief looks at three legislative solutions that aim to close the gap by increasing pay transparency and pushing employers to set salaries to the position, not the history of the person doing the job
Recommended from our members
State Policy Strategies for Narrowing the Gender Wage Gap
#MeToo and #TimesUp protests about the treatment of women in the workplace have brought renewed attention to gender pay equity. This brief looks at three legislative solutions that aim to close the gap by increasing pay transparency and pushing employers to set salaries to the position, not the history of the person doing the job
Recommended from our members
Earned Income Tax Credit (EITC) Update: California Expansion, Federal Inaction
The Earned Income Tax Credit (EITC) is now the primary anti-poverty program in the U.S., but it has not kept up with wage stagnation. Berkeley faculty recently proposed an increase in the federal EITC, California has adopted an expansion of its own state EITC, and Congress passed a tax bill that fails to help EITC recipients