674 research outputs found
Letter by Reeves Regarding Article, “Association Between Acute Statin Therapy, Survival, and Improved Functional Outcome After Ischemic Stroke: The North Dublin Population Stroke Study”
No full textHandbook for Learning-centred evaluation of Computer-facilitated learning projects in higher education
No full textThis handbook supports a project funded by the Australian Government Committee for University Teaching and Staff Development (CUTSD). The amended project title is “Staff Development in Evaluation of Technology-based Teaching Development Projects: An Action Inquiry Approach”.
The project is hosted by Murdoch University on behalf of the Australasian Society for Computers in Learning in Tertiary Education (ASCILITE), as a consortium of 11 universities.
The rationale of the project is to guide a group of university staff through the evaluation of a Computer-facilitated Learning (CFL1) project by a process of action inquiry and mentoring, supported by the practical and theoretical material contained in this handbook
Publishing and perishing: The critical importance of educational design research
No full textThe outcomes of educational systems continue to lag far behind expectations at all levels, primary, secondary, and tertiary. Meanwhile, the sheer amount of educational research published in refereed journals has expanded enormously. There is an obvious disconnect between the educational research papers published in professional journals or presented at academic conferences and any form of beneficial impact on the students, teachers, and other stakeholders in educational systems. This problem can be traced back to those professors and research supervisors engaged in the preparation of educational researchers who fail to convey to novice researchers important distinctions between the goals and methods of educational research. Educational design research provides a potentially viable alternative to the kind of educational research that is commonly conducted in the field of educational technology. Educational design research has the twin objectives of developing creative approaches to solving human teaching, learning, and performance problems while at the same time constructing a body of design principles that can guide future development efforts. This paper argues that a reconsideration of educational research approaches is crucial and that the time for greater uptake of educational design research is now
Using design principles to improve pedagogical practice and promote student engagement
No full textDesign principles are fundamental to the conduct of educational design research (or design-based research) studies, a research approach that is becoming more widely used in educational technology research and pedagogy. In this paper, we argue that design principles can be used to guide the design and development of learning environments in higher education that are based on sound practical and theoretical principles, and that can promote student engagement through innovative learning tasks. We review the use of design principles in educational research, and describe how these principles can be used to design and refine educational innovation and technology-based learning initiatives. The paper describes four phases of design-based research, together with examples of how existing principles can be analysed and used by teachers to inform the creation and dissemination of innovative solutions to educational problems
Assessing the impact of missing data on hospital performance profiling
No full textIschemic stroke is a leading cause of mortality, long-term disability, and high healthcare costs in the US. In light of this clinical and financial burden, the Centers for Medicare & Medicaid Services (CMS) has decided to incorporate ischemic stroke measures of 30-day mortality and hospital readmission into its current pay-for-performance program. This decision has come under intense scrutiny, as many clinicians and researchers believe that the current risk adjustment model is inadequate because it does not include a measure of stroke severity. Due to its well-documented importance in individual-level prediction, there is concern that excluding a measure of stroke severity from risk adjustment will lead to incorrect rankings of hospital performance, i.e. hospital profiling. However, administrative datasets used in CMS currently do not capture a measure of stroke severity, such as the National Institutes of Health Stroke Scale (NIHSS), and in clinical databases which capture NIHSS, it is frequently missing. Little work has been done to asses if the documentation of NIHSS is biased, and if so, what impact bias would have on hospital-level estimates of mortality. In this study, we analyzed data from ischemic stroke patients from an existing stroke registry to identify patterns and characteristics that predict NIHSS documentation at the patient- and hospital-level. Next, we tested for the presence of selection bias in patients with documented NIHSS using the Heckman Selection Model. Finally, using computer simulations, we estimated the impact of missing NIHSS data on hospital profiling of 30-day mortality, under different assumptions about the prevalence and mechanism of missing NIHSS data. We found that patients with documented NIHSS were, in fact, a biased subsample of all ischemic stroke patients. Documentation of NIHSS was driven by a combination of patient-level and hospital-level factors. At the patient- and hospital-level, analyses suggested that patients with more severe strokes (i.e. increased NIHSS score) were better documented than patients with less severe strokes. These findings were confirmed using the Heckman Selection Model. However, in both analyses, we found that the amount of bias was modest. In computer simulations, we quantified the impact that missing data would have on the accuracy of hospital ischemic stroke profiling, under different assumptions about how NIHSS data was missing. Any effect of missing NIHSS mechanism was trumped by the impact of missingness on sample size. Because patients with missing NIHSS data were dropped from risk-adjustment models as documentation of NIHSS decreased, the accuracy of hospital risk-standardized mortality rates (RSMRs) estimated by the hierarchical logistic model deteriorated. All of our findings were substantially modified by the hospital ischemic stroke volume, with low volume hospital suffering the worst accuracy. These results are a reflection of the fact that the loss of sample size (either through the documentation rate or hospital volume), increases the amount of shrinkage in RSMR estimates, which makes any random noise more impactful on changes in RSMR. Overall, our findings raise concerns about the addition of NIHSS data into risk adjustment models for hospital-level ischemic stroke outcomes, and illustrate shortcomings in current methodologies used to profile hospitals. It is crucial that data used in risk adjustment for hospital profiling be documented with very high levels of completeness.Thesis (Ph. D.)--Michigan State University. Epidemiology, 2015Includes bibliographical references (pages 115-127
Essays on the economics of organ transplantation and hemodialysis
No full textChapter 1. The Effect of Broader Liver Sharing on Patient Outcomes and Offer Acceptance: This paper evaluates a liver allocation policy known as Share 35, which provides transplant candidates facing high mortality risks with priority for livers obtained from relatively distant geographic areas. Exploiting the variation in the access to liver transplants across transplant candidates, I show that increasing access to liver transplants is an effective way to reduce mortality rates. Although the policy is well-targeted, I find that the policy causes unintended effects on the quality of transplanted livers and transplant candidates' liver offer-acceptance incentives. Because the policy promotes liver sharing across areas, targeted candidates receive a lower quality of livers due to longer liver transportation times. However, those candidates receive a compensation on liver quality by receiving livers with better donor characteristics. To further understand the mechanism of the compensation, I develop a strategic liver search model and estimate the model with match-run data that contain offer-acceptance decision histories for all donated livers. I find that the policy enables targeted candidates to be more selective of liver and transfer some of their quality loss to others.Chapter 2. The Role of Kidney Allocation Policy in Addressing Kidney Shortages: I examine whether prioritizing certain types of transplant candidates in deceased-donor kidney allocation can increase the total number of kidney transplants. Transplant candidates strategically choose one of the two kidney sources, namely, deceased-donor and living-donor kidneys. While deceased-donor kidneys are available for all transplant candidates (similar to public goods), living-donor kidneys are only available for the designated recipients by the donors (similar to private goods). Using a regression discontinuity design, I show that transplant candidates are less likely to choose living-donor kidneys when they have better access to deceased-donor kidneys, which can be interpreted as a crowd-out effect. Furthermore, I find that the size of the effect varies substantially across race, blood type, and dialysis status of transplant candidates. The result implies that prioritizing transplant candidates, who are less prone to crowd-out, in deceased-donor kidney allocation could make policies designed to increase the number of deceased donors more effective.Chapter 3. The Strategic Location Choice of For-profit Hemodialysis Facilities in the U.S.: In the last chapter, I identify key factors related to the location choice of for-profit hemodialysis facilities using a dataset from the United States Renal Data System (USRDS) and structural methods. All patients with kidney failure need to receive hemodialysis treatment regularly and permanently. Because dialysis treatments are homogeneous across facilities, patients are likely to choose a treatment facility based on the distance from their homes. The strategic model introduced by Seim (2006) involves a static and incomplete information game among dialysis facilities for entry and positioning in a market. The estimation results show that in choosing an optimal location, a tradeoff occurs between local demand and competition with potential entrants.Thesis (Ph. D.)--Michigan State University. Economics, 2020Includes bibliographical reference
Temporal Patterns of Physical Activity in Youth
No full textThe health benefits of habitual physical activity (PA) in youth are well-established through several sources of research. Despite the known benefits, surveillance studies at the population level suggest that less than one-quarter (24%) of youth 6 to 17 years of age participate in 60 minutes of physical activity every day. Additionally, previous literature has shown that PA behaviors developed as a child may track into adulthood. Taken together, these facts highlight the importance of examining children\u2019s (6\u201311 yrs.) and adolescents\u2019 (12\u201317 yrs.) PA and studying different PA promotion strategies in greater depth to determine how, when and where children are being active or are more likely to be active. By doing so, researchers may be able to effectively promote PA in youth moving forward, and help children develop healthy lifestyle habits early so that they can take these habits with them into adulthood. The majority of the existing literature on PA focuses on time spent in specific PA intensity levels (light, moderate, or vigorous), or simply on total daily PA, with very little research examining the temporal patterns of PA. Evaluating temporal patterns of PA supports the notion that all people, youth included, may follow distinct patterns in their PA within a day and/or over the course of the days, weeks, months, and seasons. Therefore, the purpose of this dissertation is twofold. First, to identify and summarize the existing literature on temporal patterns of PA in youth, and second, to make suggestions for future research to identify optimal times to improve PA promotion strategies and eventually, the overall health of our youth. This dissertation is comprised of three separate manuscripts. Manuscript 1 is a systematic literature review to examine and summarize all aspects of temporal patterns in youth PA. Patterns examined in this review included within-day PA (n=13; 43.3%), day-to-day PA (n=7; 22.5%), longitudinal PA (n=2; 6.7%), weekday PA only (n=2;6.7%), weekday vs. weekend PA (n=15; 30%), PA Compensation (n=12; 40%), and PA Synergy (n=3; 10%). Findings suggest that studies examining the temporal patterns of PA in youth have largely varying results (age, sex, setting etc.). Manuscript 2 is a study which aimed to identify temporal patterns during the school day and participant characteristics that may be associated with higher levels of PA in a PA intervention in girls from urban, low SES areas with a high percentage of racial/ethnic minorities during a PA intervention. Kendall\u2019s tau revealed significant correlations (p<0.001) for average MVPA min/hr between all four time periods, with the strongest correlation occurring between after-school and evening time periods (\u1ad=0.563, p<0.001), Results showed that girls\u2019 PA levels, in general, rose and fell throughout the day, while girls who were more active relative to their peers remained more active and those who were relatively inactive stayed inactive. Manuscript 3 is a study which examined PA during an after-school program to identify patterns and predictive participant characteristics of PA behavior. Results showed that every minute increase in average afterschool moderate-to-vigorous PA (MVPA) min/hr at baseline was associated with a corresponding additional 3.90 minutes of MVPA min/hr during the PA club (
f=3.90 \ub1 0.31, p<0.001). No participant characteristics were found to be predictive of PA behavior. This dissertation underscores the need for a better understanding of temporal patterns, provides insight into how the school day structure is a driving force in the activity level of youth, and highlights the need for appropriate promotional strategies and innovative school-based interventions to increase overall PA levels, with the end goal being to help children become healthy, active adults.Thesis (Ph.D.)--Michigan State University. Kinesiology - Doctor of Philosophy, 2023Includes bibliographical reference
ANALYZING THE QUALITY OF PREHOSPITAL STROKE CARE IN MICHIGAN : LEVERAGING A STATE-WIDE STROKE REGISTRY TO QUANTIFY VARIATION IN EMS CARE AND IDENTIFY PREHOSPITAL PERFORMANCE METRICS ASSOCIATED WITH OPTIMAL DOWNSTREAM CARE
No full textIntroduction: Acute stroke is a debilitating condition responsible for substantial morbidity and mortality and for which the efficacy of treatment is highly time dependent. As such, emergency medical services (EMS) are a key link in the stroke \u201cchain of recovery.\u201d However, studies of EMS stroke care are limited and suggest a high degree of variability in care. Methods: This analysis utilized linked data from state-level EMS and stroke registries in Michigan to perform an audit of EMS compliance with 6 performance measures derived from clinical guidelines, determine factors contributing to variability in compliance, and examine associations between EMS performance and downstream stroke care.Results: Among 5708 EMS-transported stroke cases identified between January 2018 and July 2019, compliance with performance measures varied widely. Patients with subarachnoid hemorrhage, those with very low or high stroke severity, and those who presented later tended to receive less compliant EMS care and there was substantial group-level variability between EMS agencies. In multivariable models, compliance with each of the EMS performance measures was associated with early CT acquisition in the Emergency Department. EMS stroke recognition and hospital prenotification were also associated with the odds of receiving timely acute ischemic stroke treatment with alteplase.Conclusions: EMS compliance with recommended practices for stroke was variable in Michigan and is influenced by both patient-level and EMS agency-level factors. EMS compliance with performance measures also predicts favorable stroke care following hospital arrival.Thesis (M.S.)--Michigan State University. Epidemiology - Master of Science, 2021Includes bibliographical reference
Associations of four PROMIS self-efficacy for managing chronic conditions measures and the patient activation measure (PAM) among acute stroke survivors : an analysis of the Michigan Stroke Transitions Trial (MISTT) data
No full text"BACKGROUND: Successful stroke transitions rely on effective self-management abilities to address stroke deficits and to prevent recurrent stroke. Patient activation and self-efficacy (confidence) are two behavioral constructs that influence successful self-management and are associated with healthier lifestyles and better health outcomes. OBJECTIVE: This cross-sectional, secondary analysis of the Michigan Stroke Transitions Trial aimed to determine the associations between 4 PROMIS self-efficacy (SE) measures [managing medications and treatment, activities of daily living, emotions, and social interactions] and the Patient Activation Measure (PAM). METHODS: Self-reported outcomes were collected 7-days after returning home. PAM measures skill, knowledge, and confidence to manage health and healthcare, while PROMIS SE measures confidence across 4 unique domains. Independent associations of patient characteristics with each PROMIS SE and PAM were determined using a staged multivariable regression model-building approach. Finally, multivariable regression between each PROMIS SE and PAM were explored along with confounding and interaction effects. Variables significantly associated with both SE and PAM were considered as confounders and moderators. Age and education were forced into all models. RESULTS: For 180 patients mean PAM scores were 64.5 (SD: 16) and SE T-scores were near the standard mean of 50 except for SE for managing daily activities (43.5, SD: 7.5). PAM was positively correlated with each SE measure (r=0.28 to r=0.46). Only perceived emotional support and post-stroke disability were associated with both PAM and SE. Emotional support attenuated the association between all SE domains and PAM, whereas post-stroke disability only affected SE for managing daily activities. After adjusting for potential confounders, SE for managing daily activities was no longer associated with PAM. No significant interactions were found. CONCLUSIONS: During acute stroke recovery, PROMIS SE and PAM are associated. It is important to account for perceived support and disability. Longitudinal MISTT analyses will explore mediation effects to help inform causal associations between demographic, clinical, and psychosocial factors, intervention effects, and outcomes."--Page ii.Thesis (M.S.)--Michigan State University. Epidemiology, 2019Includes bibliographical references (pages 114-124
Resurrecting the Anonymous: An Introduction To Mary Steele, the Author of Danebury and The Power of Friendship, A Tale with Two Odes by a Young Lady
No full textPublished anonymously in 1779 Danebury, or the Power of Friendship, a Tale with Two Odes, has retained its anonymity for over two centuries. Evidence found in the Reeves and Steele Collections housed at Angus Library; Regents Park College, Oxford identifies the author as Mary Steele, a provincial young woman with a Nonconformist background who was an active participant in a literary coterie that included other published authors such as Mary Scott, Anne Steele, and Hannah More. Drawing upon the work of Marjorie Reeves as well as the original manuscripts contained in the Reeves and Steele collections, this thesis provides the first in depth discussion of Mary Steeles published work and the role her literary circle of friends and acquaintances and her Nonconformist background played in shaping her poetry
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