Wake County Public School System

Few studies on care transitions following acute stroke have evaluated whether referral to community-based rehabilitation occurred as part of discharge planning. Our objectives were to describe the extent to which patients discharged home were referred to community-based rehabilitation and identify the patient, hospital, and community-level predictors of referral. We examined data from 40 North Carolina hospitals that participated in the COMPASS (Comprehensive Post-Acute Stroke Services) cluster-randomized trial. Participants included adults discharged home following stroke or transient ischemic attack (N=10 702). In this observational analysis, COMPASS data were supplemented with hospital-level and county-level data from various sources. The primary outcome was referral to community-based rehabilitation (physical, occupational, or speech therapy) at discharge. Predictor variables included patient (demographic, stroke-related, medical history), hospital (structure, process), and community (therapist supply) measures. We used generalized linear mixed models with a hospital random effect and hierarchical backward model selection procedures to identify predictors of therapy referral. Approximately, one-third (36%) of stroke survivors (mean age, 66.8 [SD, 14.0] years; 49% female, 72% White race) were referred to community-based rehabilitation. Rates of referral to physical, occupational, and speech therapists were 31%, 18%, and 10%, respectively. Referral rates by hospital ranged from 3% to 78% with a median of 35%. Patient-level predictors included higher stroke severity, presence of medical comorbidities, and older age. Female sex (odds ratio, 1.24 [95% CI, 1.12-1.38]), non-White race (2.20 [2.01-2.44]), and having Medicare insurance (1.12 [1.02-1.23]) were also predictors of referral. Referral was higher for patients living in counties with greater physical therapist supply. Much of the variation in referral across hospitals remained unexplained. One-third of stroke survivors were referred to community-based rehabilitation. Patient-level factors predominated as predictors. Variation across hospitals was notable and presents an opportunity for further evaluation and possible targets for improved poststroke rehabilitative care. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02588664.

Several studies have confirmed that many of the lateral pipes in typical collection systems have reached their life expectancy and are either failing and/or contributing large amounts of infiltration and/or inflow (I/I) to the main sewer pipeline. In response, technology providers developed a number of products and technologies to line and seal lateral pipes and their connections to the mainline sewer. Lateral pipes often have multiple bends, diameter changes, offset joints, cracks, deposits, and roots, which create considerable challenges when lining or sealing. The lateral pipe connection to the sewer main also poses problems due to leaks, cracks, and poor alignment often created by improper connection procedures. Trenchless rehabilitation can address these issues while minimizing the impact to property owners and sewer providers. These technologies also provide an effective service life through proven, tested materials, and refined installation procedures to meet owner expectations.

Many observational studies of causal effects occur in settings with clustered treatment assignment. In studies of this type, treatment is applied to entire clusters of units. For example, an educational intervention might be administered to all the students in a school. We develop a matching algorithm for multilevel data based on a network flow algorithm. Earlier work on multilevel matching relied on integer programming, which allows for balance targeting on specific covariates but can be slow with larger data sets. Although we cannot directly specify minimal levels of balance for individual covariates, our algorithm is fast and scales easily to larger data sets. We apply this algorithm to assess a school-based intervention through which students in treated schools were exposed to a new reading program during summer school. In one variant of the algorithm, where we match both schools and students, we change the causal estimand through optimal subset matching to better maintain common support. In a second variant, we relax the common support assumption to preserve the causal estimand by only matching on schools. We find that the summer intervention does not appear to increase reading test scores. In a sensitivity analysis, however, we determine that an unobserved confounder could easily mask a larger treatment effect.

Positive parenting has been identified as a potential protective factor for vulnerable children who experience homelessness; unfortunately, many parents experiencing homelessness struggle to provide the consistent warmth and appropriate discipline their children need. This study was designed to examine the opinions of parents residing in shelters about a brief evidence-based parenting seminar, Triple P-Positive Parenting Program. We used a mixed-methods sequential explanatory design using quantitative and qualitative methods. In phase I, we analyzed extant quantitative data on parents’ satisfaction with Triple P seminars via a survey administered following 66 seminars. Results showed the 284 sheltered parents’ ratings of satisfaction were even more positive than ratings of a convenience sample of 128 parents who attended Triple P seminars delivered in agencies that served parents having parenting challenges. In phase II, we explored sheltered parents’ views more deeply via qualitative data derived from 16 parents who attended a focus group immediately following three seminars. Results were integrated across methods and indicated that parents held generally positive views of Triple P, but when given the opportunity to discuss the seminars, they recommended many revisions to the content and some revisions to the methods of delivery. Most of their suggestions were made in response to the specific parenting challenges they faced while parenting in a crowded, highly structured shelter environment. Recommendations for adapting seminars for parents living in shelters and suggestions for future research are provided.

This case study describes a library outreach effort to university staff members employed by the campus child care center. Authors planned an instructional session to introduce child care staff members to library resources, focusing on the curriculum collection as a source of supplemental materials for classrooms. Surveys were administered before and after the workshop to gauge changes in participants' awareness of library resources and comfort level using the library. Results based on descriptive statistics and qualitative data indicated a significant increase in participants’ awareness of and comfort using campus library resources and services. The authors encourage similar efforts within other academic communities and provide examples of potential partnerships.

Advanced math coursework can affect college and labor market outcomes, yet discretionary placement policies can lead to differential access at key points in the college preparatory pipeline. We examine a targeted approach to course assignment that uses prior test scores to identify middle school students deemed qualified for a college preparatory math sequence. Accelerated math placement of relatively low-skilled middle schoolers increases the fraction later enrolling in Precalculus by one-seventh, and by over one-third for female and non-low income students. Acceleration increases college readiness and intentions to pursue a bachelor's degree. Course placement rules based on objective measures can identify students capable of completing rigorous coursework but whom discretionary systems might overlook.

This study investigates the effect of word study instruction on the orthographic knowledge of college students enrolled in a developmental reading course. Results revealed significantly greater improvement in orthographic knowledge in students who received word study instruction when compared with those in a control group, suggesting that the word study approach was effective for these students. Because of the influence of orthographic knowledge on spelling, writing and reading, additional research is merited to examine how word study intervention impacts the reading behaviours and academic achievement of college students enrolled in developmental education courses.

Hedge funds sometimes use mathematical techniques to capture the short-term volatility of stocks and perhaps other types of securities. This sort of strategy resembles market making and is sometimes considered a form of statistical arbitrage. This study shows that for the universe of large-capitalization U.S. stocks, even quite naive techniques can achieve remarkably high information ratios. The methods used are quite general and should be applicable also to other asset classes.

This paper describes a university–school collaboration that resulted in the creation and implementation of a field-based teacher education program. Key features of this program included immersion in the field, integrated curriculum, supported reflection, and technology integration. After describing the development and implementation of the program, we discuss the results stemming from systematic reflection on the significance of the experience.