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Anatomy is an important component in the vertical integration of basic science and clinical practice. Two common pedagogies are cadaveric dissection and examination of prosected specimens. Comparative studies mostly evaluate their immediate effectiveness. A randomized controlled trial design was employed to compare both the immediate and long-term effectiveness of dissection and prosection. Eighty third-year medical students undergoing their surgical rotation from the Yong Loo Lin School of Medicine were randomized into two groups: dissection and prosection. Each participated in a one-day hands-on course following a similar outline that demonstrated surgical anatomy in the context of its clinical relevance. A pre-course test was conducted to establish baseline knowledge. A post-course test was conducted immediately after and at a one-year interval to evaluate learner outcome and knowledge retention. A post-course survey was conducted to assess participant perception. Thirty-nine and thirty-eight participants for the dissection and prosection groups, respectively, were included for analysis. There was no significant difference between mean pre-course test scores between the dissection and prosection groups [12.6 (3.47) vs. 12.7 (3.16), P > 0.05]. Both the mean immediate [27.9 (4.30) vs. 24.9 (4.25), P < 0.05] and 1 year [23.9 (4.15) vs. 19.9 (4.05), P < 0.05] post-course test scores were significantly higher in the dissection group. However, when adjusted for course duration [dissection group took longer than prosection group (mean 411 vs. 265 min)], these findings were negated. There is no conclusive evidence of either pedagogy being superior in teaching surgical anatomy. Based on learner surveys, dissection provides a greater learner experience.

Binocular disparity provides one of the important depth cues within stereoscopic three-dimensional (3D) visualization technology. However, there is limited research on its effect on learning within a 3D augmented reality (AR) environment. This study evaluated the effect of binocular disparity on the acquisition of anatomical knowledge and perceived cognitive load in relation to visual-spatial abilities. In a double-center randomized controlled trial, first-year (bio)medical undergraduates studied lower extremity anatomy in an interactive 3D AR environment either with a stereoscopic 3D view (n = 32) or monoscopic 3D view (n = 34). Visual-spatial abilities were tested with a mental rotation test. Anatomical knowledge was assessed by a validated 30-item written test and 30-item specimen test. Cognitive load was measured by the NASA-TLX questionnaire. Students in the stereoscopic 3D and monoscopic 3D groups performed equally well in terms of percentage correct answers (written test: 47.9 ± 15.8 vs. 49.1 ± 18.3; P = 0.635; specimen test: 43.0 ± 17.9 vs. 46.3 ± 15.1; P = 0.429), and perceived cognitive load scores (6.2 ± 1.0 vs. 6.2 ± 1.3; P = 0.992). Regardless of intervention, visual-spatial abilities were positively associated with the specimen test scores ([eta squared] = 0.13, P = 0.003), perceived representativeness of the anatomy test questions (P = 0.010) and subjective improvement in anatomy knowledge (P < 0.001). In conclusion, binocular disparity does not improve learning anatomy. Motion parallax should be considered as another important depth cue that contributes to depth perception during learning in a stereoscopic 3D AR environment.

Understanding the factors associated with variation in the implementation of educational programs has emerged as a key research focus, in an effort to identify how promising programs can be scaled up across their targeted contexts. The current study explored demographic-related variation in program dosage using a novel source of implementation data from the treatment group in a randomized controlled trial (RCT) of Word Generation, a curriculum designed to support deep reading comprehension and academic language. Both student- and teacher/classroom-level predictors were associated with variation in the proportion of curricular activities students completed. We also evaluated how variation in treatment-group program dosage distinctively predicted growth on the RCT's key outcome measures of taught vocabulary words, academic language, and deep reading comprehension. We conclude that design and evaluation of future RCTs would benefit from procedures to predict implementation variation and its consequences prior to randomization.

Background: The language of the science curriculum is complex, even in the early grades. To communicate their scientific observations, children must produce complex syntax, particularly complement clauses (e.g., "I think it will float;" "We noticed that it vibrates"). Complex syntax is often challenging for children with developmental language disorder (DLD), and thus their learning and communication of science may be compromised. Aims: We asked whether recast therapy delivered in the context of a science curriculum led to gains in complement clause use and scientific content knowledge. To understand the efficacy of recast therapy, we compared changes in science and language knowledge in children who received treatment for complement clauses embedded in a first-grade science curriculum to two active control conditions (vocabulary + science, phonological awareness + science). Methods & Procedures: This 2-year single-site three-arm parallel randomized controlled trial was conducted in Delaware, USA. Children with DLD, not yet in first grade and with low accuracy on complement clauses, were eligible. Thirty-three 4-7-year-old children participated in the summers of 2018 and 2019 (2020 was cancelled due to COVID-19). We assigned participants to arms using 1:1:1 pseudo-random allocation (avoiding placing siblings together). The intervention consisted of 39 small-group sessions of recast therapy, robust vocabulary instruction or phonological awareness intervention during eight science units over 4 weeks, followed by two science units (1 week) taught without language intervention. Pre-/post-measures were collected 3 weeks before and after camp by unmasked assessors. Outcomes & Results: Primary outcome measures were accuracy on a 20-item probe of complement clause production and performance on ten 10-item unit tests (eight science + language, two science only). Complete data were available for 31 children (10 grammar, 21 active control); two others were lost to follow-up. Both groups made similar gains on science unit tests for science + language content (pre versus post, d = 2.9, p < 0.0001; group, p = 0.24). The grammar group performed significantly better at post-test than the active control group (d = 2.5, p = 0.049) on complement clause probes and marginally better on science-only unit tests (d = 2.5, p = 0.051). Conclusions & Implications: Children with DLD can benefit from language intervention embedded in curricular content and learn both language and science targets taught simultaneously. Tentative findings suggest that treatment for grammar targets may improve academic outcomes.

Background: Continued professional development (CPD) is required for updated skills and knowledge. This study evaluates the efficacy of a CPD programme for mainstream school teachers. Aims: In an 11-week intervention programme, speech-language therapists (SLTs) presented the participating teachers with whole-class teaching techniques aimed at creating a language and communication-supporting classroom environment. The effects of the intervention on the language development of the students in the teachers' classes were assessed. Methods & Procedures: A total of 211 first- and second-year students (M[subscript age] = 7;6, range = 6;5-8;9) underwent standardized language assessments of receptive and expressive language abilities before and after their teachers' participation in the CPD. The students were divided into intervention and delayed intervention groups to enable randomized intervention allocation. Linear mixed modelling was used to estimate the individual and interaction effects of group, time and demographic factors. Outcomes & Results: Significant effects of time, group and school, respectively, but no interaction between time and group indicates that while all students advanced between assessments, the progress was not attributable to the teachers' participation in the CPD. Conclusions & Implications: Results are discussed in light of those of recent studies of universal services to support optimal language development.

Background: Randomised trials have been on the rise in social policy over the last decade and a half, particularly in areas working with young people and vulnerable adults. Informed consent is an important principle for ethics committees governing research conducted by universities. Aims and objectives: We consider the arguments for and against opt-in consent by parents, and opt-out assent, when it comes to trials taking place, particularly in schools. Methods: We review what is known about this from a methodological standpoint. Findings: We find that extant evidence suggests that requiring opt-in consent, rather than assent, to participation, risks reducing the ethical standards of trials by minimising participation; and by potentially risking disclosure of sensitive information about a child's life to their parents. Moreover, there are important equity considerations, with more vulnerable groups likely to be excluded from research findings under an opt-in framework. Discussion and conclusion: We conclude that the ethical argument for assent rather than consent is compelling under some circumstances, and should be considered on a case-by-case basis. Precautions must always be taken to safeguard participants.

Research in the UK suggests that multi-componential interventions focusing on language and pre-literacy skills can improve children's reading and language skills. However, simple translations of such programmes may not produce equivalent effects in diverse communities. The reasons for this are multi-faceted and include factors beyond the rationale and content of the intervention programmes themselves. Understanding these factors is critical for creating programmes that will generalise across settings. In this review, we reflect upon challenges encountered in two reading and language intervention programmes in South America to identify community and cultural contextual factors that can influence the implementation and scalability of educational programmes. We use our findings to develop an education-specific framework to guide the development and implementation of high-quality evidence-based approaches to language and literacy intervention. Our model guides implementation practices in diverse contexts and stresses the importance of the evidence-base and communication.

It is not uncommon for randomised trials in education to have the performance of sample members in national examinations as their primary outcome. In many cases, examination results are available as summary measures only. Taking the example of GCSE examination results in England, this paper shows that using summary measures of an underlying score or mark, such as exam grade, complicates the design of trials and can lead to underpowered studies. Simple simulations are used to explore the consequences of powering trials to detect a difference assuming grade or summary measures are the only outcome metric available, where the effects of an intervention are primarily captured in the unknown mark or score distribution. The analysis draws on data that relate the entire distribution of marks in English language and mathematics examinations to grades. Recommendations are made in order to address this problem.

Public higher education is chronically under-funded in developing countries, making private investment necessary for human capital development. We investigate if information provision mobilizes support for private investment in public higher education by employing an online RCT in Afghanistan. We find that information cues impact respondents' support for how education should be financed. Respondents that received information about the current amount of funding devoted to different levels of education (including tuition amounts for private tertiary programs), became more partial to prioritizing public funding for primary and secondary education over tertiary education but also became more supportive of tuition introduction in public universities.

Cluster randomized trials (CRTs) are commonly used to evaluate educational interventions, particularly their effectiveness. Recently there has been greater emphasis on using these trials to explore cost-effectiveness. However, methods for establishing the power of cluster randomized cost-effectiveness trials (CRCETs) are limited. This study develops power computation formulas and statistical software to help researchers plan two- and three-level CRCETs. We illustrate the application of our formulas and software for the designs of CRCETs and discuss the influence of sample size, nesting effects, covariates, and the covariance between cost and effectiveness measures on the statistical power of cost-effectiveness estimates.

Randomized controlled trials have proliferated in education, in part because they provide an unbiased estimator for the causal impact of interventions. It is increasingly recognized that many such trials in education have low power to detect an effect if indeed there is one. However, it is less well known that low powered trials tend to systematically exaggerate effect sizes among the subset of interventions that show promising results (p < [alpha]) We conduct a retrospective design analysis to quantify this bias across 22 such promising trials, finding that the estimated effect sizes are exaggerated by an average of 52% or more. Promising trial bias can be reduced ex-ante by increasing the power of the trials that are commissioned and guarded against ex-post by including estimates of the exaggeration ratio when reporting trial findings. Our results also suggest that challenges around implementation fidelity are not the only reason that apparently successful interventions often fail to subsequently scale up. Instead, the effect from the initial promising trial may simply be exaggerated.

Evidence-based education aims to support policy makers choosing between potential interventions. This rarely involves considering each in isolation; instead, sets of evidence regarding many potential policy interventions are considered. Filtering a set on any quantity measured with error risks the "winner's curse": conditional on selecting higher valued measures, the measurement likely overestimates the latent value. This article explains the winner's curse, illustrates it for one constrained and complete set of educational trials--the UK's Education Endowment Foundation's projects, where evidence is summarized with standardized effect size--and shows the results of adjusting for the curse on this set. This analysis suggests selecting policies for higher effect size can result in substantial effect size inflation and in some cases order reversals: one intervention ranking above another on estimated effect size but below it when adjusted. The issue has implications for evaluation programs, power analyses, and policy decisions. For example, even in the absence of other problems with interpreting effect size, it can help explain why policies tend to deliver less than promised.

This article provides evidence about predictive relationships between features of community college interventions and their impacts on student progress. This evidence is based on analyses of student-level data from large-scale randomized trials of 39 (mostly) community college interventions. Specifically, the evidence consistently indicates that impacts tend to be larger as the number of intervention components increases and with the degree to which interventions promote full-time enrollment in fall and spring and/or summer enrollment. Less consistent evidence suggests that impacts tend to be larger for interventions that increase advising, tutoring, and, to a lesser extent, financial support. These results provide food for thought about the design of future community college innovations to be tested by researchers or tried by practitioners. [For the corresponding grantee submission, see ED625375.]

Psychotic-like experiences (PLEs) are common throughout childhood, and the presence of these experiences is a significant risk factor for poor mental health later in development. Given the association of PLEs with a broad number of mental health diagnoses, these experiences serve as an important malleable target for early preventive interventions. However, little is known about these experiences across childhood. While these experiences may be common, longitudinal measurement in non-clinical settings is not. Therefore, in order to explore longitudinal trajectories of PLEs in childhood, we harmonized three school-based randomized control trials with longitudinal follow-up to identify heterogeneity in trajectories of these experiences. In an integrative data analysis (IDA) using growth mixture modeling, we identified three latent trajectory classes. One trajectory class was characterized by persistent PLEs, one was characterized by high initial probabilities but improving across the analytic period, and one was characterized by no reports of PLEs. Compared to the class without PLEs, those in the improving class were more likely to be male and have higher levels of aggressive and disruptive behavior at baseline. In addition to the substantive impact this work has on PLE research, we also discuss the methodological innovation as it relates to IDA. This IDA demonstrates the complexity of pooling data across multiple studies to estimate longitudinal mixture models.

Students who engage in challenging behavior should receive preventive and intervening supports and services in general education settings based on their individual needs. These supports are necessary for students to be successful in school, yet preservice teachers receive limited education and training in both classroom and behavior management. As such, the purposes of this study were to identify the effects of an online behavior management training on newly graduated elementary education teachers immediately after completing their teacher preparation programs and to explore their perceptions regarding the training. A randomized-controlled trial was used, with 39 participants in the intervention group and 44 participants in the waitlist-control group. Results indicated participants in the intervention group showed a statistically significant increase in both knowledge and self-efficacy compared with participants in the waitlist-control group, and insignificant gains in their ability to analyze the use of behavior management strategies. Participants reported feeling the training was highly effective and were eager to implement the strategies with their future students.

Previous randomized-controlled trials have shown that a peer learning group intervention for career preparation can have positive effects on adolescent career management and the transition to post-comprehensive education in secondary schools. However, this earlier evidence of efficacy has been found by intervention studies that have implemented the method intensively. Earlier studies suggest that tailoring implementation strategies to fit organizational processes may offer opportunities to improve the sustainability and scalability of evidence-based practices. In this study, the implementation of the career preparation intervention was integrated into the school curriculum as a part of regular career counselling, lengthening the delivery timeframe of the intervention programme and using the schools' own guidance counsellors as intervention providers. We conducted a conceptual replication study to investigate how effectively the adapted intervention programme enhanced perceived career preparation skills by carrying out a new cluster randomized-controlled trial among 1068 pupils. Linear mixed models showed that the effect of peer learning sessions on career choice preparedness was positive in comparison to that in the control group. The result suggests that the adapted intervention programme preserved its identifiable positive effects, although dismissing intensive delivery features somewhat reduced the effect size. These study results have implications for school-based career counselling interventions as schools seek to identify evidence-based methods that are cost-efficient and may be integrated into regular school routines.

Background: This systematic review investigated the state of intervention science on programs that promote healthy intimate relationship skills and sexual health for autistic youth (i.e., healthy intimacy). Methods: Using PRISMA guidelines, we reviewed randomized controlled trials (RCTs) published in 2010 or later that enrolled [less than or equal to] 1 autistic adolescent participant. Results: Of 1934 articles returned, three met inclusion criteria: Supporting Teens with Autism on Relationships, Tackling Teenage Training, and Peers Engaged in Effective Relationships-Decision-Making. All increased content knowledge and one improved social/ behavioral functioning. Conclusion: We identified three RCT-supported interventions for autistic youth that teach healthy intimacy skills. Comparative effectiveness research on these programs would benefit the field.

This randomized controlled trial (NCT03889821) examined Mindfulness Based Stress Reduction (MBSR) in conjunction with the Parent-implemented Early Start Denver Model (P-ESDM). A previous report described improved metrics of parental distress (Weitlauf et al. in Pediatrics 145(Supplement 1):S81-S92, 2020). This manuscript examines child outcomes. 63 children with ASD (< 36 months) and their parents received 12 P-ESDM sessions. Half of parents also received MBSR. Longitudinal examination of whole sample means revealed modest improvements in autism severity, cognitive, and adaptive skills. There was not a significant time × group interaction for children whose parents received MBSR. Future work should examine more proximal markers of child or dyadic change to enhance understanding of the impact of providing direct treatment for parents as part of early intervention initiatives.

With the increasing demand for evidence-based research on teacher effectiveness and improving student achievement, more impact studies are being conducted to examine the effectiveness of professional development (PD) interventions. Cluster randomized trials (CRTs) are often carried out to assess PD interventions that aim to improve both teacher and student outcomes. Due to the different design parameters (i.e., intraclass correlation and R[superscript 2]) and benchmark effect sizes associated with the student and teacher outcomes, two power analyses are necessary for planning CRTs that aim to detect both teacher and student effects in one study. These two power analyses are often conducted separately without considering how design choices to power the study to detect student effects may affect design choices to power the study to detect teacher effects and vice versa. In this study, we consider strategies to maximize the efficiency of the study design when both student and teacher effects are of primary interest.

The concept of evidence, the demand for evidence-based practice and decision-making has for years dominated educational research. Concomitantly, the randomized controlled trials (RCT) that originally gained ground within the field of medicine have become the gold standard for empirical research and political reform within educational sciences, at least in Scandinavia. Nevertheless, proponents of such an approach have not fully explored the consequences of evidence-based methods, in particular the double-blind, placebo-controlled clinical trial. What is the equivalent to the placebo-effect in education and how does research in educational sciences deal with this effect? The concept of placebo is arguably as close as medicine gets to acknowledging the psychoanalytic concept of the unconscious and unconscious knowledge. With the concept of transference, psychoanalysis offers a useful exploration of the processes and mechanisms leading to the placebo effects.

This study conducted a randomized trial to examine the efficacy of the Boys Town In-Home Family Services (IHFS) program for families of high-risk youth. Participants were recruited from a state helpline for families struggling with poor family functioning and child emotional or behavioral issues. Consent was obtained for 300 of which 152 were randomly assigned to participate in IHFS for 3-4 months and 148 were assigned to the services as usual comparison group. For the families in the treatment group, 18% did not participant in the intervention, and 66% of families received 20 or more service hours. Parent report data were collected at intake, post, as well 6 and 12 months after post data collection. Data were collected on constructs such as caregiver strain, family functioning, parenting, family resources, and parent report of child behavior. Piecewise analyses of the intake to post data indicated significantly greater reductions in caregiver strain for the treatment condition. Given the conservative corrections for the use of multiple tests, no other measures demonstrated significant differences. For the piecewise model of the maintenance phase, there were no significant differences between groups aside from caregiver strain that showed a significant improvement for the comparison condition. Supplementary dose-response analyses indicated that for most families there was an ideal dosage of about 25-75 hr to bring about the largest improvements in caregiver strain, parenting skills, and child behavior.

During drug development, a biomarker is sometimes identified as separating a patient population into those with more and those with less benefit from evaluated treatments. Consequently, later studies might be targeted, while earlier ones are performed in mixed patient populations. This poses a challenge in evidence synthesis, especially if only aggregated data are available. Starting from this scenario, we investigate three commonly used network meta-analytic estimation methods, the naive estimation approach, the stand-alone analysis, and the network meta-regression. Additionally, we adapt and modify two methods, which are used in evidence synthesis to combine randomized controlled trials with observational studies, the enrichment-through-weighting approach, and the informative prior estimation. We evaluate all five methods in a simulation study with 32 scenarios using bias, root-mean-squared-error, coverage, precision, and power. Additionally, we revisit a clinical data set to exemplify and discuss the application. In the simulation study, none of the methods was observed to be clearly favorable over all investigated scenarios. However, the stand-alone analysis and the naive estimation performed comparably or worse than the other methods in all evaluated performance measures and simulation scenarios and are therefore not recommended. While substantial between-trial heterogeneity is challenging for all estimation approaches, the performance of the network meta-regression, the enriching-through weighting approach and the informative prior approach was dependent on the simulation scenario and the performance measure of interest. Furthermore, as these estimation methods are drawing slightly different assumptions, some of which require the presence of additional information for estimation, we recommend sensitivity-analyses wherever possible.

Network meta-analysis is a popular method to synthesize the information obtained in a systematic review of studies (e.g., randomized clinical trials) involving subsets of multiple treatments of interest. The dominant method of analysis employs within-study information on treatment contrasts and integrates this over a network of studies. One advantage of this approach is that all inference is protected by within-study randomization. By contrast, arm-based analyses have been criticized in the past because they may also recover inter-study information when studies are modeled as random, which is the dominant practice, hence violating the principle of concurrent control, requiring treated individuals to only be compared directly with randomized controls. This issue arises regardless of whether analysis is implemented within a frequentist or a Bayesian framework. Here, we argue that recovery of inter-study information can be prevented in an arm-based analysis by adding a fixed study main effect. This simple device means that it is possible to honor the principle of concurrent control in a two-way analysis-of-variance approach that is very easy to implement using generalized linear mixed model procedures and hence may be particularly welcome to those not well versed in the more intricate coding required for a contrast-based analysis.

We conducted a systematic review to identify randomized controlled trials (RCTs) and single case research design (SCRD) studies of children with autism spectrum disorder that evaluate the effectiveness of responsivity intervention techniques for improving prelinguistic and/or language outcomes. Mean effect sizes were moderate and large for RCTs (33 studies; g = 0.36, 95% CI [0.21, 0.51]) and SCRD (34 studies; between-case standardized mean difference = 1.20, 95% CI [0.87, 1.54]) studies, respectively. Visual analysis (37 studies) revealed strong evidence of a functional relation for 45% of the opportunities and no evidence for 53%. Analyses of moderator effects and study quality are presented. Findings provide support for responsivity intervention strategies with more robust support for context-bound outcomes than more generalized outcomes.

Parents of children with ASD (N = 86; mean age 44.8 months; 67 boys) were randomized to either WHO Caregiver Skills Training (CST) delivered in public health settings in Italy or enhanced treatment-as-usual. Primary blinded outcomes were 3-months post-intervention change scores of autism severity and engagement during caregiver-child interaction. CST was highly acceptable to caregivers and feasibly delivered by trained local clinicians. Intention-to-treat analysis showed a large and significant effect on parent skills supporting joint engagement and a smaller significant effect on flow of interaction. Expected changes in child autism severity and joint engagement did not meet statistical significance. Analysis of secondary outcomes showed a significant effect on parenting stress, self-efficacy, and child gestures. Strategies to improve the effectiveness of CST are discussed.

Our review explores the effectiveness of resilience interventions on improving resilience, reducing depressive symptoms, and overcoming stress symptoms among higher education students. We conducted a systematic search in 10 electronic English and Chinese language databases. Twenty-nine randomized, controlled trials (RCTs) met the inclusion criteria and were included in this review. Effect sizes from 25 RCTs were calculated for meta-analysis and metaregression. The results of a random effects model reveal that resilience interventions are effective in improving resilience with small effect size (g = 0.32, 95% CI [0.15, 0.49]), reducing depressive symptoms with small effect size (g = 0.25, 95% CI [0.06, 44]), and overcoming stress (g = 0.22, 95% CI [0.08, 0.32]). Subgroup analyses conclude that effect sizes of resilience interventions comprising skills that enhance social competency are statistically significantly larger than those of interventions without. In addition, the effect sizes are larger when resilience interventions used synchronous communication and delivered through a mixture of didactic and dialectic approaches. Metaregression reveals that trials rated with low scores in the Medical Education Research Study Quality Instrument considerably influence scores in resilience. Our meta-analysis supports the use of resilience interventions as a universal prevention strategy among higher education students. This review ends with implications for practice and directions for further research on developing resilience interventions.

Little research has been conducted to assess which specific databases should be searched when performing a systematic review (SR) on acupuncture. The current study aimed to identify key databases and the optimal database combination to retrieve randomized controlled trials (RCTs) on acupuncture for inclusion in SRs. A systematic search for SRs in the field of acupuncture was conducted in order to identify target databases and RCTs were extracted from the SRs that had searched all target databases. The proportions of SRs that had achieved 100%, 95%, or 90% recall of RCTs and the total recall of RCTs in various combinations of target databases were calculated. Sensitivity analysis was performed on those SRs that included 10 or more RCTs. CNKI, WanFang, VIP, PubMed, CENTRAL and Embase were regarded as target databases. A total of 4349 acupuncture RCTs were extracted from 286 SRs. Searching all six target databases retrieved 99.3% of all RCTs while 99.1% were recalled by searching the combination of CNKI, WanFang, PubMed and CENTRAL. There were no significant differences on total recall of RCTs (p = 0.549) or in the proportion of SRs with 90% recall of RCTs (97.2% vs. 97.6%; p = 0.794) between searching the above four and the full six target databases. Most results were similar in the sensitivity analysis. The combined retrieval power of CNKI, WanFang, PubMed and CENTRAL was considered an efficient choice to retrieve acupuncture RCTs included in SRs.

Randomised controlled trials of cancer treatments typically report progression free survival (PFS) and overall survival (OS) outcomes. Existing methods to synthesise evidence on PFS and OS either rely on the proportional hazards assumption or make parametric assumptions which may not capture the diverse survival curve shapes across studies and treatments. Furthermore, PFS and OS are not independent; OS is the sum of PFS and post-progression survival (PPS). Our aim was to develop a non-parametric approach for jointly synthesising evidence from published Kaplan-Meier survival curves of PFS and OS without assuming proportional hazards. Restricted mean survival times (RMST) are estimated by the area under the survival curves (AUCs) up to a restricted follow-up time. The correlation between AUCs due to the constraint that OS > PFS is estimated using bootstrap re-sampling. Network meta-analysis models are given for RMST for PFS and PPS and ensure that OS = PFS + PPS. Both additive and multiplicative network meta-analysis models are presented to obtain relative treatment effects as either differences or ratios of RMST. The methods are illustrated with a network meta-analysis of treatments for stage IIIA-N2 non-small cell lung cancer. The approach has implications for health economic models of cancer treatments, which require estimates of the mean time spent in the PFS and PPS health-states. The methods can be applied to a single time-to-event outcome, and so have wide applicability in any field where time-to-event outcomes are reported, the proportional hazards assumption is in doubt, and survival curve shapes differ across studies and interventions.

Complex data structures are ubiquitous in psychological research, especially in educational settings. In the context of randomized controlled trials, students are nested in classrooms but may be cross-classified by other units, such as small groups. Furthermore, in many cases only some students may be nested within a unit while other students may not. Such instances of partial nesting requires a more flexible framework for estimating treatment effects so that the model coefficients are correctly estimated. Although several recommendations have been offered to the field on handling partially nested data, few are comprehensive in their treatment of manifest and latent variables in the context of partial nesting, full nesting, and cross-classification. The present study introduces n-level structural equation modeling (SEM) as a flexible measurement and analytic framework for the estimation of treatment effects for complex data structures that frequently present in randomized controlled trials. In this tutorial, we explore how the notation of n-level SEM allows for parsimonious model specification whether data are observed or latent and in the presence of partial nested or cross-classified designs. By using the xxm package in R, the advantage of using n-level SEM framework is demonstrated through five examples for single outcome manifest variables, as in the traditional multilevel model, as well as latent applications as in multilevel SEM.

Although extensive research exists on vocabulary instruction during book reading in preschool classroom, comparatively little research has been conducted on vocabulary exposure in classroom play contexts and child vocabulary outcomes. The purpose of this study was to examine Head Start teacher and child vocabulary use in dyadic play sessions and the relation between teachers' vocabulary use and children's vocabulary outcomes. One Enhanced Milieu Teaching (EMT) session for each of 53 teacher-child dyads was transcribed and coded for teacher use of target and sophisticated vocabulary, use of teacher strategies to support vocabulary development, and child use of vocabulary. Descriptive data indicate variability for both teacher and child vocabulary use in the play sessions. Both teacher total number of vocabulary words and vocabulary supports were significantly related to child vocabulary use within sessions. Implications for practice are discussed.

The Grade 2 learner results of the Early Grade Reading Study (EGRS) randomised control trial (RCT) in the North West province showed that the structured pedagogic intervention model that included instructional coaching, lesson plans, and quality learning materials was more cost-effective than a similar intervention model that excluded coaching. These results are read against the growing body of literature that questions the value of RCTs in identifying mechanisms of change. For this reason, two small-scale qualitative case studies were undertaken to identify the difficulty in detecting workings of classroom practice that RCTs cannot show. Three mechanisms of change: the organisation of space, time, and implementation of routines drawn from the work of Foucault, were analysed to interpret observed changes to teacher practice and some of the weaknesses in the EGRS programme.

This article reports the results of a randomized control trial of a semester-long intervention designed to promote ninth-grade science students' use of text-based investigation to create explanatory models of biological phenomena. The main research question was whether the student participants in the intervention outperformed the students in the control classes, as assessed by several measures of comprehension and application of information to modeling biological phenomena not covered in the instruction. A second research question examined the impact on the instructional practices of the teachers who implemented the intervention. Multilevel modeling of outcome measures, controlling for preexisting differences at individual and school levels, indicated significant effects on the intervention students and teachers relative to the controls. Implications for classroom instruction and teacher professional development are discussed.

We report here the type of problems and solutions that 38 school teams reported during a randomized wait-list controlled trial of one problem-solving approach (Team Initiated Problem Solving [TIPS]). The experimental results from that analysis are reported elsewhere. The purpose of this article is to summarize companion descriptive data from this analysis and suggest implications for school personnel and education researchers. Data for this analysis come from direct observation of team meetings for 38 elementary school teams in Oregon and North Carolina as they each met on four different occasions over an 18-month period to manage the behavioral supports in their schools. Our focus was on the types of problems the teams identified, the precision with which problems were identified (what behavior, who, where, when, why), the features of solutions that were developed, the extent to which solutions were perceived as being implemented, and the extent to which solutions were perceived as resulting in improved student outcomes. The most common solutions focused on varying forms of changing organizational systems. Teams were not likely to measure if their solution had been implemented or was effective prior to receiving TIPS training.