The changing role of the secondary principal in the United States: An historical perspective

This paper reviews the historical development of the secondary principalship in the US and examines how the current role of the principal is a result of historical forces. The authors consider a preferred future for the principalship and present recommendations for change.     

Using Simulation and Patient Role Play to Teach Electrocardiographic Rhythms to Physical Therapy Students

Purpose

The aims of the study were to differentiate: (1) physical therapy (PT) students’ preferred method for learning electrocardiographic (ECG) recognition utilizing standardized patient (SP) and human patient simulation (HPS) approaches, (2) the impact of HPS or SP on confidence in interpreting ECG, and 3) the effect of HPS or SP on students’ ability to make clinical decisions based upon ECG interpretation.

Methods

“Three educational methods were employed to teach ECG recognition to two different years of novice PT students enrolled in a cardiopulmonary physical therapy class. First, all students had a traditional lecture on ECG. Following the lecture, two problem-based learning (PBL) approaches were utilized. One approach used a SP and paper ECG strips, and the second approach utilized HPS with simulated ECG monitoring.”¹ Following the two PBL approaches, a post instructional survey regarding the learning experiences was conducted. Following instruction, each cohort (n = 24, n = 29) of PT students was given a mixed methods survey about their experience.

Results

Survey return rate amongst both cohorts was 77%. Independent sample of individual cohort and paired t-tests of combined data comparing HPS to SP revealed a strong preference for HPS (p = 0.003 (2008 cohort) and p = 0.0001 (2010 cohort)) and combined cohort (p = 0.0001). There were no significant differences in responses between cohorts or preference between the HPS method and the use of SP and HPS combined. Additionally, 75% of respondents either strongly agreed or agreed that they felt confident with their skill in ECG interpretation as presented with HPS or SP. 90% either strongly agreed or agreed that they understood how the ECG relates to patient treatment. Summative assessment utilizing HPS revealed that students were competent in their performance in ECG recognition and clinical decision making related to patient treatment.¹

Conclusion

Data support that HPS was the preferred method to improve student confidence in ECG recognition and interpretation.Key Words: human patient simulation, electrocardiography, critical care management, educational technology     

Comparison of heart rate monitoring with indirect calorimetry for energy expenditure evaluation

PurposeThe purpose of this study was to compare established methods with newly-developed methods for estimating the total energy expenditure (TEE).MethodsThe study subjects comprised 46 individuals, including 16 middle-aged men (mean age 51.4 years), 14 middle-aged women (mean age 49.9 years) and 16 young women (mean age 19.1 years). The TEE was estimated from 24-h heart rate (HR) data using newly-developed software (MoveSense HRAnalyzer 2011a, RC1, Suunto Oy, Vantaa, Finland), and was compared against the TEE determined using doubly labeled water (DLW). Agreement between the two methods was analyzed using Bland and Altman plots.ResultsThe HR method yielded similar TEE values as the DLW method at the group level, with an average of 8.6 kcal/day in the difference in the mean, but with large individual variations. Forty-four (96%) out of 46 subjects fell within ±2SD of the mean difference in TEE comparisons, and there was no tendency towards under- or over-estimation.ConclusionOur results indicate that the current software using HR analysis for the estimation of daily TEE needs further development for use with free-living individuals.     

Child protection and justice systems processing of serious child abuse and neglect cases

OBJECTIVE: The aim of this study was to examine the trajectory of cases through four systems: child protection, law enforcement, the dependency courts, and the criminal courts. METHOD: This study focused on a county selected from a 41-county telephone survey conducted for the National Incidence Study of Child Abuse and Neglect (NIS-3). For this analysis prospective samples were drawn from law enforcement (n=225) and the county child protection (CPS) agency (n=225) and followed through in-depth case tracking across all agencies and through both the dependency and criminal court systems. RESULTS: The percentage of CPS cases opened in dependency court was similar to prior studies (29%), but the acceptance and prosecution rates were much higher--92% of the cases referred from CPS, including many cases of physical abuse. Compared to referrals from CPS to law enforcement (93%), few cases were referred from law enforcement to CPS (17%). Anecdotally, case referral patterns appeared to be influenced by communication patterns and mutual positive regard, regardless of the collaborative protocols in place. One of the most instructive findings was the degree of difficulty in tracking cases across organizations and the types of obstacles that impeded success. Disorganization was not an issue, rather internal structures set up to facilitate intra-organizational processing were the same structures that actually impeded cross-organizational case finding. CONCLUSIONS: It is not sufficient to rely on the existence of multi-disciplinary teams or Child Advocacy Centers to ensure collaboration. More attention to daily tasks and activities as well as the nature and quality of communication is warranted. On the technical side, use of common case identifiers on cases that are cross-referred is strongly recommended. Future studies should broaden the scope of inquiry to include the consequences of all case trajectories, rather than solely focusing on the justice system.