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This essay details what we, three White teacher-researchers, learned about how one class of fourth grade children interacted with signs such as castles, forts, and walls through a three-day improvisational workshop aimed at fostering critical literacy skills. Theories and methods of improvisational theatre offer a distinct way to approach critical literacy, especially the racialization of particular signs and symbols. Although we do not explicitly take up race with the children in our study, our work contributes to the broader field of critical Whiteness studies because we conceptualize forts, castles, and walls as symbols of racial power in the imagination. Castles, forts, and walls are pervasive signs for children in the United States and, subsequently, inform the ways children imagine themselves in social hierarchies prevalent in the U.S. Using qualitative methodologies, we collected and analyzed field notes, interviews, and audio/video recordings of the workshop to construct patterns in our data. We present findings of how the children interacted specifically to one symbol at length - the castle -- because of its salience in the data. Although our findings are only tentative due the short duration of the study, we believe they will generate new insights for future research in critical literacy.

OBJECTIVE: To assess differences in longitudinal profiles for 30-day risk-adjusted readmission rates in skilled nursing facilities (SNFs) associated with Penn Medicine;s Lancaster General Hospital (LGH) that implemented an interventional analytics (IA) platform vs other LGH facilities lacking IA vs other SNFs in Pennsylvania vs facilities in all other states. STUDY DESIGN: Retrospective longitudinal analysis of CMS readmissions data from 2017 through 2022, and cross-sectional analysis using CMS quality metrics data. METHODS: CMS SNF quality performance data were aggregated and compared with risk-adjusted readmissions by facility and time period. Each SNF was assigned to a cohort based on location, referral relationship with LGH, and whether it had implemented IA. Multivariable mixed effects modeling was used to compare readmissions by cohort, whereas quality measures from the fourth quarter of 2022 were compared descriptively. RESULTS: LGH profiles differed significantly from both state and national profiles, with LGH facilities leveraging IA demonstrating an even greater divergence. In the most recent 12 months ending in the fourth quarter of 2022, LGH SNFs with IA had estimated readmission rates that were 15.24, 12.30, and 13.06 percentage points lower than the LGH SNFs without IA, Pennsylvania, and national cohorts, respectively (all pairwise P < .0001). SNFs with IA also demonstrated superior CMS claims-based quality metric outcomes for the 12 months ending in the fourth quarter of 2022. CONCLUSIONS: SNFs implementing the studied IA platform demonstrated statistically and clinically significant superior risk-adjusted readmission rate profiles compared with peers nationally, statewide, and within the same SNF referral network (P < .0001). A more detailed study on the use of IA in this setting is warranted. [ABSTRACT FROM AUTHOR]

Employing descriptive and interpretive analyses of classroom videos and focus group data, this study details how the provision of choice was enacted in instruction, and the subsequent messages students perceived. Participants included six teachers (fourth to eighth grade) and 114 students (age X-bar = 11.28 years, 60% African American). Survey data indicated students perceived high levels of choice in the focal classrooms (Time 1 X-bar = 3.32, SD = 0.91; Time 2 X-bar = 3.25, SD = 0.94). Results suggest five differentiating dimensions of providing choice: strategy, pace, format, topic, and mobility as well as differences in the structure of how choice was provided--a single event versus a generative sequence of autonomy-supportive adolescent-teacher interactions. Analysis of student focus group transcripts indicated the enactment of choice communicated messages around trust, respect, and worth that influenced student engagement. Overall, results suggest the provision of choice can be a context for meeting young adolescents' developmental needs and fostering students' motivational resources.

Engineering byDesign™ (EbD) provides teachers and students with reflective, formative, and comprehensive summative assessment tools throughout the curriculum. Each lesson, unit, and course is created with a list of essential questions that are meant to guide students to a deeper understanding of national standards across the STEM domains (STL, Common Core, NGSS). Yet, one reality remains evident: the nation, states, school districts, administrators, and teachers must provide clear, accurate, and bias-free evidence of student learning. Through ITEEA's STEM Center for Teaching and Learning (STEM CTL) Technology and Engineering Assessment Coalition (TEAC), teachers can continue to do what they do best: Teach.

We examine adolescents' interpretations of instructional interactions to understand the academic and developmental implications of pedagogy for urban youth of color. In doing so, we seek to advance existing knowledge regarding student engagement in two ways--enhancing the ecological validity of such theories and making the links to teacher practice explicit. Urban youth of color (N= 28) were recruited from two urban high schools in Pittsburgh, Pennsylvania, and two youth development programs in Saint Paul and Minneapolis, Minnesota. The following three emergent findings summarize engagement-relevant interpretations of instructional interactions made by the adolescents in our study: (a) feeling heard in class, (b) going all in, and (c) taking students seriously.

The Psychological Sense of School Membership (PSSM) scale has been used widely to measure adolescent perceptions of sense of school belonging in research investigating associations between the relational quality of educational contexts and motivational and achievement outcomes. Previous research examining the factor structure of the PSSM scale consistently identifies a factor named perception of rejection that consists of only negatively worded items. This study extends previous research by considering potential method effects associated with negatively worded items. Exploratory and confirmatory factor analyses of a diverse U.S. high school sample ("N" = 890) identified three substantive factors--"identification and participation in school," "perception of fitting in among peers," and "generalized connection to teachers." Our investigation determined the presence of method effects in this scale, and such method effects are best represented with a common negative wording factor.

A multidisciplinary body of literature has established that students' affective relationships with teachers are associated with important academic and developmental outcomes. In this article, we explored late adolescents' active interpretations of what we call "being known" in high school. Distinct from a generalized perception of the school environment, namely, sense of school belonging, the concept of being known may provide a cohesive and efficient framework for understanding the intersections of developmental tasks, psychosocial perceptions, and effective teaching. Our focus group data with adolescents ("M" = 16.65 years old, "N" = 77) yielded three robust findings (a) moving beyond "just teach" teacher relationships; (b) providing instrumental support; and (c) engaging a benefit-of-the-doubt treatment of students. We examined each of these key themes to probe how connectedness is created or undermined through the moment-by-moment experiencing of relational structures characterized by students' perceptions of being known by adults in an educational context.

In urban secondary schools where underpreparation and dropping out are real world concerns, students understand that their relationships with teachers affect their learning. Using descriptive coding and thematic analysis of focus group data, we explore adolescents' perceptions of the "bridges" that foster and the "barriers" that inhibit supportive relationships with teachers, and the boundary expectations that function as both. The characteristics of supportive student-teacher relationships identified by youth participants suggest a number of teacher practices capable of meeting adolescents' developmental needs and, as such, are likely to positively influence adolescents' developmental and academic trajectories.

Adolescents' sense of belonging in high school may serve a protective function, linking school-based relationships to positive youth outcomes. To advance the study of sense of belonging, we conducted a mixed method, factor analytic study (Phase 1 focus groups, N = 72; Phase 2 cross-sectional survey, N = 890) to explore the multidimensionality of the sense of belonging construct. Findings suggest that adolescents' sense of belonging involves four distinct school-experience factors: Generalized connection to teachers; connection to a specific teacher; identification and participation in official school-sanctioned activities; and perception of fitting in with peers. Future research should investigate the validity of the proposed sense of belonging subdimensions and longitudinally examine the form and function of disparate adolescent school-based relationships in relation to academic engagement or disengagement processes. (Contains 5 tables, 1 footnote and 2 figures.)

Adopting a constructivist perspective of adolescent development, we argue adolescents' perceptions of "being known" reflect teachers' authentic recognition of adolescents' multiple emerging identities. As such, adolescent perceptions of being known are a distinct factor associated with high school students' engagement in school. A mixed method approach (Phase 1 focus groups, N = 72, Phase 2 cross sectional survey, N = 890) guided the development and testing of an Adolescent Perception of Being Known Scale (A-PBKS). Here, we report on item development, item performance, convergent, divergent, and predictive validity as well as measurement invariance. We conclude the paper by outlining the promise research studying instructional moves through a developmental lens has for understanding teaching and learning in urban high schools. (Contains 8 tables and 1 footnote.)

Background: In 2018, Philadelphia identified an outbreak of new human immunodeficiency virus (HIV) infections among persons who inject drugs (PWID). Although conventional HIV surveillance systems capture individual-level behavioral risk, they are not able to capture the social and environmental factors contributing to rapid transmission.Methods: HIV surveillance data were used to assess demographic, clinical, and behavioral factors for PWID with HIV diagnosed during 2017 and 2018. Social factors such as homelessness, disruption of encampments, and trends in sexual behaviors, drug use and syringe availability among PWID were captured through National HIV Behavioral Surveillance, routine hepatitis and sexually transmitted infection surveillance, and shelter and homeless outreach data.Results: In 2018, there were 71 new infections among PWID, an increase of 115% since 2016. During this time, opioid overdose deaths peaked at 59 deaths per 100 000 persons, 85% of which involved the use of fentanyl. While overall reported homelessness increased, rates of those living unsheltered rose by 13%. The Philadelphia Department of Public Health identified increased injection frequency, encampment closures, and lack of syringe access as promoters of continued HIV transmission.Conclusion: The use of conventional surveillance methods only is inadequate for determining HIV risk during outbreaks. Incorporation of individual and aggregate level data on social and environmental determinants is necessary to develop effective outbreak response interventions. [ABSTRACT FROM AUTHOR]

Background: Bystander CPR before the arrival of EMS is a major factor in out of hospital cardiac arrest (OHCA) survival. To recruit trained bystanders, mobile phone-based alert systems have been developed, but their limitations are not well understood.Objective: We investigated the effects of landscape features on the capabilities of the PulsePoint CPR dispatch platform in Allegheny County, Pennsylvania. We hypothesized that landscape features would reduce walkable area within dispatch zones and that larger alert radii could mitigate these effects.Methods: CPR alert location data were obtained from the Allegheny County 911 PulsePoint deployment from July 2016-2019 (n = 1100). PulsePoint, a smartphone-based citizen CPR dispatch platform, alerts volunteers to public OHCAs within 400 m. Digital maps of alerts were generated for walkability analysis using the image Labeler MATLAB polygon tool. Unwalkable areas were labeled, classified into five categories, and quantified.Results: Of the 1100 events analyzed, encompassing 212 mi2, 357 (32.45%) had no impediments to walkability. Within a 400 m radius of partially impeded events, the median proportion of obstructed area was 0.2250 (Min: 0.0005, Max: 0.8338, IQR: 0.3004, Sx: 0.1923). When the alert radius was expanded to 468 m, the median increased to 0.2336 (Min: 0.0016, Max: 0.8597, IQR: 0.3064, Sx: 0.1950). The percentages of total unwalkable area by each category were: terrain (54.286%), water (24.674%), road w/o crosswalk (11.3197%), railroad (7.4100%), private property (2.3102%).Conclusions: In this region, most PulsePoint alerts had unwalkable areas, mostly from terrain and water. Contrary to our initial hypotheses, moderately increasing dispatch radius did not improve walkability. [ABSTRACT FROM AUTHOR]

The main objective of this study was to determine the demographic, geographic and socioeconomic characteristics of men who have sex with men (MSM) in Philadelphia that were associated with having a recent HIV test. We used data from the National HIV Behavioral Surveillance System (NHBS) surveys from 2011 and 2014 among MSM in Philadelphia, with the outcome of interest of having received an HIV test in the past twelve months. Of 1043 HIV-negative MSM, 70.2% had an HIV test. Multivariable analysis showed that seeing a medical provider (aOR: 1.73; p = .0039) or having heard of PrEP (aOR: 2.24; p < .0001) was associated with recent HIV testing. Those participants forty-five years of age or older (aOR 0.40, p = .0001) and those with Medicaid had lower rates of HIV testing (aOR 0.48, p = .002). Although over 80% of participants had seen a medical provider in the past year, only 50% had been offered an HIV test by a provider. Optimizing HIV testing through the expansion and increased awareness of PrEP, especially among older MSM, is critical. Further research is needed to delineate barriers that prevent MSM from utilizing medical providers for HIV testing and for those with Medicaid from receiving HIV testing. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Understanding how school personnel can best support students' development of communication skills around feelings is critical to long-term health outcomes. The measurement of emotion socialization in schools facilitates future research in this area; we review existing measures of emotion socialization to assess their applicability to school-based health studies. METHODS A content analysis of four emotion socialization measures was conducted. Inclusion criteria included: high frequency of use in prior research, established documentation of validity and reliability, and sufficient description of measurement procedures. RESULTS Four dimensions emerged as particularly salient to a measure's future relevance and applicability to school-based health studies: (1) methods of measurement; (2) mode and agent of socialization; (3) type of emotion; and (4) structure versus function of socializing behavior. CONCLUSION Future measurement strategies should address (1) the structures of emotion socializing processes; (2) diverse socializing agents such as teachers, peers, and administrators; (3) the intended functions of such processes; (4) student perceptions of and responses to such processes; and (5) the complex interactions of these factors across contexts. Strategies attending to these components will permit future studies of school-based emotion socializing processes to determine how they enhance health and reduce health risks. [ABSTRACT FROM AUTHOR]

Objectives: The impact of a syringe services program (SSP) policy on risk behaviors and its durability are not as well studied as the impact of the SSPs themselves. We examined whether trends in syringe sharing among persons who inject drugs (PWID) were associated with changes to syringe access policies in 3 US cities: Denver, New Orleans, and Philadelphia. Methods: PWID were surveyed through National HIV Behavioral Surveillance System surveys in each city in 2005, 2009, 2012, and 2015. We assessed changes in syringe sharing from 2005 to 2015 by city. We used multivariable stepwise logistic regression analysis to measure the associations among syringe sharing and injection works sharing, time, and SSP access. Results: From 2005 to 2015, syringe sharing decreased significantly from 49.1% to 33.1% in Denver (P <.001), increased significantly from 32.0% to 50.5% in New Orleans (P <.001), and remained unchanged in Philadelphia (30.4% to 31.5%; P =.87). Compared with persons who obtained syringes from any nonsterile source, the adjusted odds of syringe sharing among PWID were significantly lower in each city if syringes were obtained from sterile sources only: Denver adjusted odds ratio (aOR) = 0.23 (95% confidence interval [CI], 0.18-0.30; New Orleans aOR = 0.26 (95% CI, 0.19-0.35), and Philadelphia aOR = 0.43 (95% CI, 0.33-0.57). Conclusions: The lowest proportion of PWID reporting syringe sharing was in Philadelphia, which has a long-standing legal SSP. Implementation of a legal SSP in Denver in 2012 corresponded to a decrease in sharing, whereas the lack of a legal SSP in New Orleans corresponded to an increase in sharing. Universal long-term access to legal SSPs could further the progress made in HIV prevention among PWID. [ABSTRACT FROM AUTHOR]