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Scholars note the multitude of ways that the continual shifts in the racial composition of schools affect students, but fewer studies consider the implications of such shifts for teachers. This study uses 3 years of data from an original survey of the 1800 largest school districts to examine the effect of segregation on teachers and their implementation of discipline policies. Specifically, it asks "do teachers in desegregated districts implement policies differently from their colleagues in segregated school districts?" The findings reveal that Black and Latino teachers in segregated school districts implement discipline policies more equitably than teachers in desegregated school districts. However, White teachers in segregated and desegregated school districts do not differ substantively in their implementation of discipline policies. The research holds implications for understanding the salience of school desegregation in shaping teachers' decisions and its role in contemporary discipline disproportionality.

As demographic groups' heterogeneity increases, questions emerge about how elected and unelected political representatives respond to such diversity. Representative bureaucracy scholarship suggests that representatives will rely on shared values and interests with clients of their demographic group to make decisions or implement policies that improve the group's status. However, differences in immigration histories, demographic characteristics, language, and discrimination experiences within racial and ethnic groups are points of diversion that could affect representation. We explore the relationship between race and ethnicity to understand how within-group differences may disrupt the traditional assumptions of representation. Centering on the experiences of Afro-Latinx students, we ask, What effect do within-group differences have on bureaucrat-client representation?" Afro-Latinx students share a racial identity with Black education bureaucrats and an ethnic identity with Latinx education bureaucrats but may also differ from both groups in their language acquisition, culture, norms, and interests. We find that Black representatives offer Afro-Latinx students substantive representation, while Latinx representatives do not when we consider their racial identity. The research holds implications for understanding the boundaries of representation and may offer insight into the importance of disaggregating groups in representation studies. [ABSTRACT FROM AUTHOR]

This article discusses the importance of social equity in public administration and the need to address inequities in government programs and services. It highlights various forms of inequities, such as gender-based disparities, hiring discrimination against the LGBTQ community, and differential access to government resources among racial and ethnic groups. The article emphasizes the role of the behavioral public administration movement in investigating questions of social equity at the micro-level, using theories from psychology and the behavioral sciences. The article also mentions a special issue of the International Public Management Journal that includes five research papers on equity and public administration. [Extracted from the article]

The literature on the link between passive and active representation is well established, but there is still some debate on why and how passive representation translates into active representation in some settings and not others. Some scholars suggest the salience of the policy issue and discretion to act yields a linkage between passive and active representation, while others contend researchers are simply identifying correlates of the two concepts not linkages. However, many studies miss the dynamic relationship between representation and the external environment, so this research explains the manner in which external, environmental pressures influence bureaucratic discretion and active representation. Interdependences between service organizations and the external environment can restrict bureaucratic discretion through resource dependence and cues of expectations and professional norms, or bureaucrats may use the relationship to enhance their discretion. Using an original dataset of the 1,800 largest U.S. school districts over two school terms, I compare the level of disparity in academic grouping across racial groups in two distinct external environments, racially balanced and imbalanced school districts, and find that minority bureaucrats use their discretion to improve the odds of minority students’ assignment to gifted education, but external, environmental control moderates the significance of active representation. The passive to active representation link is weakened based on the operating policy environment. This work offers some insight on the restrictions and limits to active representation, and the empirical findings hold implications for the governance of public organizations and the outcomes of public policies. [ABSTRACT FROM AUTHOR]

The implications of segregated education are well known for students, but fewer studies consider segregation's effect on school administrators and their enactment of school policies. This study explores the effect that de facto segregation has on administrative behavior and the implementation of discipline policies in schools. Specifically, it considers the socializing effect that segregation can have on administrators and consequently, its effect on student outcomes. Analyzing two years of data from an original survey of the 1,800 largest school districts, the findings reveal that overall, de facto segregation does not socialize administrators to implement policies differently, but it leads to substantively different policy outcomes. Minority administrators in segregated districts reduce the odds of suspension at a higher rate than administrators in desegregated school districts. Racial differences among administrators also emerge, suggesting that race, along with segregation, may play an important role in policy implementation. The research offers insight on the significance of contemporary segregation for both students and administrators. [ABSTRACT FROM AUTHOR]

Background: Patients newly initiated on opioids (OP), benzodiazepines (BZD), and antipsychotics (AP) during hospitalization are often prescribed these on discharge. Implications of this practice on outcomes remains unexplored., Objective: To explore the prevalence and risk factors of new initiation of select OP, BZD and AP among patients requiring in-patient stays. Test the hypothesis that new prescriptions are associated with higher odds of readmission or death within 28 days of discharge., Design: Single center retrospective cohort study., Setting and Participants: Patients admitted to a tertiary-level medical center with either a primary diagnosis of RT-PCR positive for COVID-19 or high index of clinical suspicion thereof., Intervention: None., Main Outcome and Measures: Exposure was the new initiation of select common OP, BZD, and AP which were continued on hospital discharge. Outcome was a composite of 28-day readmission or death following index admission. Multivariable logistic regression was used to assess patient mortality or readmission within 28 days of discharge associated with new prescriptions at discharge., Results: 1319 patients were included in the analysis. 11.3% (149/1319) were discharged with a new prescription of select OP, BZD, or AP either alone or in combination. OP (110/149) were most prescribed followed by BZD (41/149) and AP (22/149). After adjusting for unbalanced confounders, new prescriptions (adjusted odds ratio: 2.44, 95% confidence interval: 1.42-4.12; p = .001) were associated with readmission or death within 28 days of discharge. One in nine patients admitted with a diagnosis of COVID-19 or high clinical suspicion thereof were discharged with a new prescription of either OP, BZD or AP. New prescriptions were associated with higher odds of 28-day readmission or death. Strengthening medication reconciliation processes focused on these classes may reduce avoidable harm., (© 2024 Society of Hospital Medicine.)

Background: Adaptive support ventilation (ASV) is a partially closed-loop ventilation mode that adjusts tidal volume (V T ) and breathing frequency (f) to minimize mechanical work and driving pressure. ASV is routinely used but has not been widely studied in ARDS., Methods: The study was a crossover study with randomization to intervention comparing a pressure-regulated, volume-targeted ventilation mode (adaptive pressure ventilation [APV], standard of care at Beth Israel Deaconess Medical Center) set to V T 6 mL/kg in comparison with ASV mode where V T adjustment is automated. Subjects received standard of care (APV) or ASV and then crossed over to the alternate mode, maintaining consistent minute ventilation with 1-2 h in each mode. The primary outcome was V T corrected for ideal body weight (IBW) before and after crossover. Secondary outcomes included driving pressure, mechanics, gas exchange, mechanical power, and other parameters measured after crossover and longitudinally., Results: Twenty subjects with ARDS were consented, with 17 randomized and completing the study (median P aO 2 /F IO 2 146.6 [128.3-204.8] mm Hg) and were mostly passive without spontaneous breathing. ASV mode produced marginally larger V T corrected for IBW (6.3 [5.9-7.0] mL/kg IBW vs 6.04 [6.0-6.1] mL/kg IBW, P = .035). Frequency was lower with patients in ASV mode (25 [22-26] breaths/min vs 27 [22-30)] breaths/min, P = .01). In ASV, lower respiratory-system compliance correlated with smaller delivered V T /IBW (R 2 = 0.4936, P = .002). Plateau (24.7 [22.6-27.6] cm H 2 O vs 25.3 [23.5-26.8] cm H 2 O, P = .14) and driving pressures (12.8 [9.0-15.8] cm H 2 O vs 11.7 [10.7-15.1] cm H 2 O, P = .29) were comparable between conventional ventilation and ASV. No adverse events were noted in either ASV or conventional group related to mode of ventilation., Conclusions: ASV targeted similar settings as standard of care consistent with lung-protective ventilation strategies in mostly passive subjects with ARDS. ASV delivered V T based upon respiratory mechanics, with lower V T and mechanical power in subjects with stiffer lungs., Competing Interests: Drs Baedorf Kassis and Talmor disclose a relationship with Hamilton Medical. The remaining authors have disclosed no conflicts of interest., (Copyright © 2022 by Daedalus Enterprises.)

Background: Few therapies exist to treat severe COVID-19 respiratory failure once it develops. Given known diffuse pulmonary microthrombi on autopsy studies of COVID-19 patients, we hypothesized that tissue plasminogen activator (tPA) may improve pulmonary function in COVID-19 respiratory failure., Methods: A multicenter, retrospective, observational study of patients with confirmed COVID-19 and severe respiratory failure who received systemic tPA (alteplase) was performed. Seventy-nine adults from seven medical centers were included in the final analysis after institutional review boards' approval; 23 were excluded from analysis because tPA was administered for pulmonary macroembolism or deep venous thrombosis. The primary outcome was improvement in the PaO 2 /FiO 2 ratio from baseline to 48 h after tPA. Linear mixed modeling was used for analysis., Results: tPA was associated with significant PaO 2 /FiO 2 improvement at 48 h (estimated paired difference = 23.1 ± 6.7), which was sustained at 72 h (interaction term p  < 0.00). tPA administration was also associated with improved National Early Warning Score 2 scores at 24, 48, and 72 h after receiving tPA (interaction term p  = 0.00). D-dimer was significantly elevated immediately after tPA, consistent with lysis of formed clot. Patients with declining respiratory status preceding tPA administration had more marked improvement in PaO 2 /FiO 2 ratios than those who had poor but stable (not declining) respiratory status. There was one intracranial hemorrhage, which occurred within 24 h following tPA administration., Conclusions: These data suggest tPA is associated with significant improvement in pulmonary function in severe COVID-19 respiratory failure, especially in patients whose pulmonary function is in decline, and has an acceptable safety profile in this patient population., (© 2022 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).)

Background: Pulmonary vascular microthrombi are a proposed mechanism of COVID-19 respiratory failure. We hypothesized that early administration of tissue plasminogen activator (tPA) followed by therapeutic heparin would improve pulmonary function in these patients., Research Question: Does tPA improve pulmonary function in severe COVID-19 respiratory failure, and is it safe?, Study Design and Methods: Adults with COVID-19-induced respiratory failure were randomized from May14, 2020 through March 3, 2021, in two phases. Phase 1 (n = 36) comprised a control group (standard-of-care treatment) vs a tPA bolus (50-mg tPA IV bolus followed by 7 days of heparin; goal activated partial thromboplastin time [aPTT], 60-80 s) group. Phase 2 (n = 14) comprised a control group vs a tPA drip (50-mg tPA IV bolus, followed by tPA drip 2 mg/h plus heparin 500 units/h over 24 h, then heparin to maintain aPTT of 60-80 s for 7 days) group. Patients were excluded from enrollment if they had not undergone a neurologic examination or cross-sectional brain imaging within the previous 4.5 h to rule out stroke and potential for hemorrhagic conversion. The primary outcome was Pao 2 to Fio 2 ratio improvement from baseline at 48 h after randomization. Secondary outcomes included Pao 2 to Fio 2 ratio improvement of > 50% or Pao 2 to Fio 2 ratio of ≥ 200 at 48 h (composite outcome), ventilator-free days (VFD), and mortality., Results: Fifty patients were randomized: 17 in the control group and 19 in the tPA bolus group in phase 1 and eight in the control group and six in the tPA drip group in phase 2. No severe bleeding events occurred. In the tPA bolus group, the Pao 2 to Fio 2 ratio values were significantly (P < .017) higher than baseline at 6 through 168 h after randomization; the control group showed no significant improvements. Among patients receiving a tPA bolus, the percent change of Pao 2 to Fio 2 ratio at 48 h (16.9% control [interquartile range (IQR), -8.3% to 36.8%] vs 29.8% tPA bolus [IQR, 4.5%-88.7%]; P = .11), the composite outcome (11.8% vs 47.4%; P = .03), VFD (0.0 [IQR, 0.0-9.0] vs 12.0 [IQR, 0.0-19.0]; P = .11), and in-hospital mortality (41.2% vs 21.1%; P = .19) did not reach statistically significant differences when compared with those of control participants. The patients who received a tPA drip did not experience benefit., Interpretation: The combination of tPA bolus plus heparin is safe in severe COVID-19 respiratory failure. A phase 3 study is warranted given the improvements in oxygenation and promising observations in VFD and mortality., Trial Registry: ClinicalTrials.gov; No.: NCT04357730; URL: www., Clinicaltrials: gov., (Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)