Instructional Protocol Research Articles

Improving reading comprehension with readers theater

Although readers theater has traditionally been recommended as a method for improving reading fluency, this 18-week quasi-experimental study examined the effects of a readers theater instructional protocol that updates and expands on traditional approaches by adding specific tasks that engage students in various reading comprehension and vocabulary activities. Because the students were not randomly assigned to either condition, propensity score matching was used to minimize potential bias between the groups. After the matching procedure, the overall total of second-grade students decreased from 145 to 76. A repeated-measures analysis of variance was conducted for all three measures. The results revealed statistically significant time effects on all three measures of the Gates-MacGinitie Reading Test, including decoding, word knowledge, and reading comprehension. Only the reading comprehension measure was qualified by an interaction effect, and the results favored the readers theater treatment group. Implications for instruction and future research are discussed.

18. Safety and efficacy of tranexamic acid use in posterior cervical decompression and fusion surgery

BACKGROUND CONTEXT Posterior cervical decompression and fusion (PCDF) involves substantial blood loss, resulting in blood transfusions and associated complications, such as infections, hypotension and organ damage. The antifibrinolytic tranexamic acid (TXA), an inhibitor of the activation of plasminogen, has been shown to be beneficial in multiple surgical procedures without any apparent increase in postoperative complications. However, only a few studies report on TXA utilization in cervical spine surgery and there is currently no literature detailing the short-term safety of its use in this setting. PURPOSE To evaluate the short-term safety and efficacy of tranexamic acid use in multilevel posterior cervical decompression and fusion surgery. STUDY DESIGN/SETTING Retrospective case-control study from a single academic institution. PATIENT SAMPLE Forty-seven patients were identified to have undergone PCDF at our institution by one surgeon, 19 with the utilization of a TXA protocol and 28 patients without. Inclusion criteria were adults (age ≥18 years) with cervical stenosis and/or spondylosis who underwent cervical posterior spinal fusion surgery of at least 2 levels. OUTCOME MEASURES Intraoperative and postoperative blood loss and incidence of adverse events, including myocardial infarction (MI), acute renal failure, stroke, seizure, deep vein thrombosis (DVT) and pulmonary embolism (PE) were evaluated in the perioperative period and at 1-month follow-up. METHODS From January 2015 to April 2018, 47 patients were identified to have undergone PCDF, 19 with the utilization of a TXA protocol at our institution. Inclusion criteria were adults (age ≥18 years) with cervical stenosis and/or spondylosis who underwent cervical posterior spinal fusion surgery of at least 2 levels. The incidence of adverse events, including myocardial infarction (MI), acute renal failure, stroke, seizure, deep vein thrombosis (DVT) and pulmonary embolism (PE) were evaluated in the perioperative period and at 1-month follow-up. RESULTS Based on the inclusion criteria, 39 patients were selected. Nineteen (49%) received TXA as per our instructional protocol and 20 (51%) did not. Postoperative blood was significantly reduced (453ml vs 701ml; p = 0.03) in the group that received TXA. There was also a significant reduction in duration of surgery associated with TXA use (269 min vs 328 min; p = 0.05). There were no cardiac or thromboembolic complications on the first 30 days after surgical intervention on the TXA group, but there was a transient atrial fibrillation on the standard group. There were no infections, seizure activity, epidural hematomas or renal complications reported in either group. CONCLUSIONS TXA use during PCDF is a safe, effective method to reduce postoperative blood loss. Considering the limited number of patients in this study, these results should be validated on a larger group of patients. FDA DEVICE/DRUG STATUS Unavailable from authors at time of publication.

Communication Partner Training to Increase Interactive Communication Using Augmentative and Alternative Communication: A Case Study

Purpose The purpose of this clinical focus article was to assess the communication partner's (CP) perception regarding the effectiveness of a CP training model to support augmentative and alternative communication (AAC) use within a parent–adolescent dyad. Method This case study implements an adaptation of an 8-stage strategy instruction protocol for teaching aided language modeling across functional activities. Procedures for designing CP training to meet the specific needs of a particular CP and an individual using AAC (IUA) are offered. Pre- and posttraining questionnaires surveyed the CP's feelings and knowledge about using the AAC strategies and the IUA's AAC skill level. Results Quantitative and qualitative analyses of the CP's responses on the pre- and posttraining questionnaires revealed more confidence in supporting her son when using his device, increased knowledge of strategies to support AAC use, and increased understanding of the device operation. She also perceived that her son used his device more confidently and effectively in a variety of ways. Conclusion CP training that includes strategy instruction, along with practice and feedback, helps to increase the CP's and the IUA's understanding of the specific device and how to use it in more naturalistic, functional settings and situations. Since the CP's needs are similar across developmental and neurogenic groups, the direct strategy instruction described in this clinical focus article can be used by practicing clinicians working with pediatric or neurogenic populations to teach communication and operational skills. The results suggest that CP training should be included in treatment planning for speech-language pathologists working with individuals with complex communication needs who use AAC.

Walking endurance in multiple sclerosis: Meta-analysis of six-minute walk test performance

BackgroundThe 6-minute walk (6 MW) is the most commonly applied measure of endurance walking capacity in persons with multiple sclerosis (MS); however, we are not aware of a quantitative synthesis of 6 MW performance in MS. Research questionWe undertook a meta-analysis quantifying the overall magnitude of difference in 6 MW performance between MS and healthy controls (HCs), and then within MS as a function of disability status. We further examined possible moderator variables of 6 MW performance. MethodsThe systematic search was conducted for articles that included the 6 MW in persons with MS and involved comparison groups (i.e., HCs or MS disability subgroups (i.e., mild vs moderate-to-severe disability status)). The mean and standard deviation of the distance traveled during the 6 MW as well as sample sizes were entered into Comprehensive Meta-Analysis software and we estimated the overall effect size (Cohen’s d) using a random effects model and examined categorical variables as possible moderators (e.g., instruction protocol, provision of encouragement, method of distance measurement, and course description). ResultsThirty-four studies met inclusion criteria with a total sample size of 3204 persons (MS: 2683; HC: 521) yielding 42 total comparisons. Persons with MS walked a shorter distance than HCs (mean difference = –177.2 ± 19.1 m) with a large effect size (d = – 1.87). Persons with mild disability walked further than those with moderate-to-severe disability (mean difference = 185.19 ± 9.2 m) with a large effect (d = 1.83). The categorical variables of provision of encouragement and course layout moderated the effect of MS and course layout moderated the effect of disability status on 6 MW performance. SignificanceThis meta-analysis of 6 MW performance defines mean difference in 6 MW performance in MS compared with HCs and provides an estimate of the disease-related effect of MS on endurance walking capacity for application within clinical research and practice.

Short-term safety of tranexamic acid use in posterior cervical decompression and fusion surgery

Posterior cervical decompression and fusion (PCDF) can result in substantial blood loss, leading to blood transfusions and associated complications, such as infections, hypotension and organ damage. The antifibrinolytic tranexamic acid (TXA), an inhibitor of the activation of plasminogen, has been shown to be beneficial in multiple surgical procedures without any apparent increase in postoperative complications. However, there are only few studies reporting TXA utilization in cervical spine surgery and there is currently no literature detailing the short-term safety of its use in this setting. The purpose of our study is to determine the safety profile of TXA in posterior cervical decompression and fusion. From January 2015 to April 2018, 47 patients were identified to have undergone PCDF, 19 with the utilization of a TXA protocol at our institution. The incidence of adverse events was evaluated in the perioperative period and at 1 month follow-up. Of 39 patients, Nineteen (49%) received TXA as per our instructional protocol and 20 (51%) did not. Post-operative blood was significantly reduced (453 ml vs 701 ml; p = 0.03) in the group that received TXA. There was also a significant reduction in duration of surgery associated with TXA use (269 min vs 328 min; p = 0.05). There were no complications on the first 30 days after surgical intervention on the TXA group. TXA use during PCDF is a safe, effective method to reduce postoperative blood loss. Considering the limited number of patients in this study, these results should be validated on a larger group of patients.

Perceptions of Digital Assistants From Early Adopters Aged 55+

Voice-activated digital assistants have the potential to assist adults aging-in-place with a variety of everyday tasks and leisure activities. To understand this potential, semi-structured interviews were conducted to explore perceptions and attitudes from current adult users based on the models of the unified theory of acceptance and use of technology model. Several model factors were identified as influential in the initial and continued use of the digital assistants. Results indicate the need for an effective instructional protocol to promote successful interactions during the learning phase and for continued engagement with novel abilities of the digital assistants.

Designing Translingual Pedagogies: Exploring Pedagogical Translation through a Classroom Teaching Experiment

This study examined how middle-grades language arts teachers learned to integrate a small-group collaborative translation activity into their teaching practice. We discuss what we call pedagogical translation as an emergent social practice, in which translation routines that are familiar to multilingual students may be leveraged toward instructional goals in a mainstream language arts class. The data were drawn from a classroom teaching experiment iteration of a larger design-based research study, whose goal is to create a fully developed instructional protocol useful to all teachers in linguistically diverse language arts classrooms, but especially teachers with limited or emerging proficiencies in languages other than English. We position pedagogical translation as a paradigm case of translingual pedagogy—instructional approaches designed to leverage the full range of emerging bilinguals’ linguistic resources—and we focus our analysis on the agentive participation of teachers as they integrate new translingual routines into their instructional practice. Using a conjecture mapping procedure, we describe the evolution of an instructional theory for how pedagogical translation can be leveraged toward literacy learning objectives. We present qualitative narratives describing how participating teachers made locally situated design choices that meshed new routines with existing instructional practice, documenting trajectories of teacher participation as agentive designers of translingual pedagogy.

Modeling Framework Used to Analyze and Describe Junctional Tourniquet Skills

Medical educators have acknowledged the importance of simulation training in developing procedural skills. While simulation training in other disciplines has benefitted from evaluations of users' skill acquisition, the majority of medical training simulators continue to be developed from overly simplified descriptions of procedures, such as techniques prescribed by existing instructional material. Our objective was to use a modeling framework to characterize the skill of various users in applying junctional tourniquets in order to design an effective training simulator. We recorded 46 medical first responders performing training exercises applying a junctional tourniquet and used coded video and sensor data to identify the hierarchy of actions they performed in the process. The model provides several insights into trainee performance, such as the way in which advanced users perform more tasks in parallel, or areas where advanced users employ situational awareness to identify ways they can deviate from recommended protocol to improve outcomes. The model successfully identifies variations in tourniquet application technique that correlates with improvement on clinically relevant metrics including application speed, pressure applied, and tourniquet placement stability. This methodology can improve medical training simulations by indicating changes during the course of learning a new task, such as helpful deviations from instructional protocol.

A new method of text information hiding based on open channel

Text is one of most constantly and widely used information carriers. Comparing with several other carriers, a new method of text information hiding based on open channel has been put forward in the article. The public normal text has been used to transmit information directly without any changes in order to hide it. At the same time, this hidden information negotiates with the intended recipient to produce the session key. The text including the location of hidden information and including the associated hidden rules delivers information through the session key. Besides, this method avoids stenographic testing used by attackers unless they break the session key, which ensures the hidden information's safety. The instruction protocol of hidden information serves as basic tool in proposed method. In the paper, the idea of the implicit authentication in the MTI protocol families (key agreement protocol constructed by Matsumoto, Takashima and Imai) derives from an identity-based protocol without pairing. Moreover, this proposed protocol is provably-secured in CK model (Canettikrawczyk model) for text information hiding.

The Use of Remote Monitoring to Increase Staff Fidelity of Protocol Implementation When Working with Adults with Autism

With the increase of individuals with autism spectrum disorder (ASD) leaving the public school systems with centralized training environments, there needs to be innovation in supporting staff who will find themselves working in various community environments with adolescent or adult learners. Staff training and ongoing supervision is important for enhancing student skill acquisition and long-term maintenance of important life skills. Current day technology has been shown to be effective in augmenting staff training and supervision efforts. The purpose of the current study was to use existing FaceTime® technology to conduct remote live supervision of staff participants who were in the community with adult learners engaged in various learning tasks. Staff were trained on specific instructional protocols to implement, and the staff trainers, miles away, watched and listened to the training being delivered by the staff to the adult participants. When staff made implementation errors, the staff trainer corrected by speaking through the smartphone. Results showed that staff improved their fidelity of implementing the training protocols when distance feedback was provided. The results of this study provide more evidence that distance supervision of staff works and is another available method for training and supervising staff.

94 Language Discrepancies in the Emergency Department: A Retrospective Chart Review for Quality Improvement

Language discrepancies in medicine are known barriers on the quality of care that patients receive, and very few studies have investigated this from the standpoint of the emergency department (ED). Discharge instructions in the ED are an important piece of this care and can lead to better understanding of their health. Therefore, the goal of this study is to determine if providing discharge instructions in the patient’s primary language improves the quality of care. ED return visits or bounce backs, (<72hrs, and 72hrs - 30-day return visits) were utilized as a surrogate marker for quality care. We conducted a retrospective chart review of patients evaluated between July 2017 to November 2017 in an academic-based, urban ED who self reported Spanish as their primary language during registration (Spanish-speaking patients). 1,364 charts were reviewed, and 999 of these patients were discharged. We compared the discharged Spanish-speaking patients (SSP) who received English discharge instructions (E-DI) to discharged SSPs who received Spanish discharge instructions (S-DI). Patients were excluded if they did not receive discharge instructions or left without being seen. Time to return visit was recorded from each patient and divided into 2 categories: less than 72 hours and 72 hours - 30 days. Other metrics recorded include age, sex, race, chief complaint, length of stay, and patients who left without being seen (LWBS). This data was recorded into a secure database for demographic stratification and analysis using odds ratios from generalized estimating equation multivariate models. In total, 971 charts were included in the data analysis. A significantly smaller number of patients received S-DI (14.1% received S-DI and 85.9% received E-DI) and 1.8% of Spanish-speaking patients left without being seen. There was no significant difference in return visits in total (< 72 hours combined with 72 hours - 30 days) with an odds ratio 1.08 (95% CI 0.640 to 1.828). Further, there was no significant difference of return visits broken down into their categories (<72 hour bounce backs OR 1.24, 95% CI of 0.539 - 2.852; 72hrs to 30-day bounce backs OR 0.99, 95% CI of 0.525 - 1.886). Patients who reported Spanish as their primary language were more likely to receive their discharge instructions in English. Despite this fact, we found no significant difference in return visits in Spanish-speaking patients who received S-DI compared to those who received E-DI. This may suggest that the reasons patients return are multifactorial and not solely related to language difference. However, if the 72-hour return rates trend continued, a higher sample size would suggest decreased rates of return in those who receive S-DI. This data also highlights the importance of health care workers education in language discrepancies, as well as the need for improved discharge instruction formats and protocols.

Profiling Potential Plagiarizers: A Mastery Learning Instructional Technique to Enhance Competency

Despite university policies and classroom procedures designed to deter student plagiarism, upper-division students seemed to be violating the rules in growing numbers. Recent research suggested that student plagiarism results from a complex mix of factors, including a need for instruction, but offers little guidance regarding effective teaching methodologies. The authors developed and tested an instructional protocol and concluded that a mastery learning approach provides an effective method for reducing student plagiarism.

Central Venous Catheter Confirmation by Ultrasonography: A Novel Instructional Protocol.

Ultrasound (US)-only confirmation of central venous catheter (CVC) placement has proven to be accurate and fast when compared with the current standard chest radiograph. This procedure depends on the detection of appropriately timed atrial bubbles during central line flushing, called the rapid atrial swirl sign (RASS). The most obvious barrier to increasing the use of this technique is appropriate education and training; therefore, we proposed a novel educational approach to training emergency department (ED) physicians in the confirmation of CVC location using US and then tested its effectiveness. Using an online educational model, participants were taught the background and procedural steps to confirm CVC placement using US. Subsequently, they were asked to use this knowledge to place central lines in simulation and confirm them using US. They were tested with various scenarios, including correctly and incorrectly placed lines. Their accuracy was measured, and a survey was used to assess their satisfaction with the training and applicability to practice. A total of 47 ED physicians completed the online training module and 24 completed the simulation testing that followed. Results showed 100% accuracy in detecting appropriately timed RASS (<2 seconds), delayed RASS (>2 seconds), and no RASS in simulation. All of the participants "agreed" or "strongly agreed" that the didactic and simulation sessions improved their understanding of US confirmation of central line placement. The use of US to confirm central line placement can be effectively taught to ED physicians using short didactic and simulation-based training. This is a reasonable approach to integrate this protocol into practice, and allow for more widespread use of this emerging technique.

Control of Postoperative Nausea and Vomiting in Oral and Maxillofacial Surgery Patients with Isopropyl Alcohol: A Prospective Randomized Clinical Trial.

The present study was undertaken to evaluate the effectiveness of inhaled 70% isopropyl alcohol (IPA) in controlling postoperative nausea and vomiting (PONV) in oral and maxillofacial surgery patients undergoing surgery under general anesthesia (GA). This was a prospective, randomized, case-controlled study done on 208 maxillofacial surgery patients operated under GA. Patient's demographic data, APFEL score for risk of PONV, duration of surgery and duration of anesthesia were recorded preoperatively. The test arm of the study received inhalation of 70% IPA every half an hour in the postoperative period for 8h along with ondansetron 4mg i.v. every 6h. The control arm received only ondansetron 4mg i.v. every 6h. Both the groups followed the same preoperative and postoperative instruction and drug protocol except the test drug. PONV was recorded using the simplified PONV intensity score and VAS. The scores were analyzed with Mann-Whitney test with <0.05 considered significant. The groups were similar with regard to age (p=0.083), BMI (p=0.1.00), sex (p=0.379), type of surgery (p=0.504), duration of anesthesia (p=0.621), duration of surgery (p=0.515) and APFEL score (p=0.687). IPA inhalation group achieved significantly better simplified PONV scores and VAS scores at 4h (p=0.000), 6h (p=0.000) and 8h (p=0.000). PONV control at 2h was similar to the control group. Inhalation of 70% IPA every half an hour was associated with significant PONV control in maxillofacial surgery patients undergoing surgery under GA.

Comparison of Cardiopulmonary Resuscitation Quality Between Standard Versus Telephone-Basic Life Support Training Program in Middle-Aged and Elderly Housewives

For cardiac arrests witnessed at home, the witness is usually a middle-aged or older housewife. We compared the quality of cardiopulmonary resuscitation (CPR) performance of bystanders trained with the newly developed telephone-basic life support (T-BLS) program and those trained with standard BLS (S-BLS) training programs. Twenty-four middle-aged and older housewives without previous CPR education were enrolled and randomized into two groups of BLS training programs. The T-BLS training program included concepts and current instruction protocols for telephone-assisted CPR, whereas the S-BLS training program provided training for BLS. After each training course, the participants simulated CPR and were assisted by a dispatcher via telephone. Cardiopulmonary resuscitation quality was measured and recorded using a mannequin simulator. The primary outcome was total no-flow time (>1.5 seconds without chest compression) during simulation. Among 24 participants, two (8.3%) who experienced mechanical failure of simulation mannequin and one (4.2%) who violated simulation protocols were excluded at initial simulation, and two (8.3%) refused follow-up after 6 months. The median (interquartile range) total no-flow time during initial simulation was 79.6 (66.4-96.9) seconds for the T-BLS training group and 147.6 (122.5-184.0) seconds for the S-BLS training group (P < 0.01). Median cumulative interruption time and median number of interruption events during BLS at initial simulation and 6-month follow-up simulation were significantly shorter in the T-BLS than in the S-BLS group (1.0 vs. 9.5, P < 0.01, and 1.0 vs. 10.5, P = 0.02, respectively). Participants trained with the T-BLS training program showed shorter no-flow time and fewer interruptions during bystander CPR simulation assisted by a dispatcher.

Preparing Teachers for English Learners: Integrating Academic Language and Community Service Projects

ABSTRACTIn this article we highlight elements of culturally and linguistically responsive pedagogy that prepare teachers to work with English Learners (ELs) from a variety of backgrounds. Specifically, we focus on the learning experiences and practices of one secondary social studies teacher to explore promising practices with ELs and effective teacher preparation strategies. This article highlights two specific strategies used by the teacher: the intentional integration of academic language instruction through sheltered instructional observation protocol (SIOP) and community-engaged service learning. The findings suggest that the teacher improved his EL instruction, specifically within the context of his social studies curricula, and his experiences and reflections offer insights for teacher educators who seek to better prepare in-service and preservice teachers to serve ELs and their families.

No Silver Bullet: L2 Collocation Instruction in an Advanced Spanish Classroom

Author(s): Jensen, Eric Carl | Abstract: Many contemporary second language (L2) instructional materials feature collocation exercises; however, few studies have verified their effectiveness (Boers, Demecheleer, Coxhead, a Webb, 2014) or whether these exercises can be utilized for target languages beyond English (Higueras Garcia, 2017). This study addresses these issues by investigating whether Laufer a Girsai’s (2008) instructional protocol of contrastive analysis and translation (CAT) is effective for teaching collocations in an advanced Spanish course. 25 verb-noun collocations were selected from course readings. A CAT group completed collocation workshops following Laufer a Girsai’s protocol. A control group encountered the target collocations in course texts but received no explicit collocation instruction. A third group received form-focused instruction (FFI) consisting of non-contrastive vocabulary exercises. Results indicated that both CAT and FFI groups demonstrated significantly increased collocation knowledge, whereas the Control Group learned very few target collocations. Differences in learning gains between the CAT and FFI groups were not significant. These results suggest that (a) any exercise that leads students to cognitively engage with the forms and meanings of targeted collocations will lead to their acquisition, and that (b) without some form of explicit instruction, most students will not independently acquire collocations in an advanced language course.

The classroom observation protocol for socioscientific issue-based instruction: development and implementation of a new research tool

Background: For the past decade, science educators have been exploring the use of Socio-scientific Issues (SSI) as contexts for science teaching and learning, and research indicates that doing so can support significant learning gains. However, research related to how teachers take up the practice of SSI-based instruction is far more limited, due in part to a lack of tools for use in this kind of research.Purpose: The focus of this research is development and testing of a new classroom observation protocol specifically designed for SSI-based instructional contexts.Design and methods: Development of this SSI-Observation Protocol (SSI-OP) took place in four distinct phases: review of existing protocols and SSI-based instruction frameworks, writing and revision of protocol items, initial testing of the draft protocol, and soliciting feedback from SSI experts.Sample: Following the four stages of SSI-OP development, we progressed to a series of field tests. The field tests were conducted with three different samples. The first sample was an experienced (10 + years) high school biology teacher and one of her honors biology classes. The second sample consisted of seven Turkish Pre-service Science Teachers (PST) participating in a science methods course. The third sample included two Thai PST from a field experience course embedded within a teacher education program.Results: The final version of the protocol addressed five dimensions of SSI-based instructional activities: focus of instruction, teaching moves, role of teacher, role of students, and classroom environment.Conclusions: The SSI-OP could be used in a variety of ways for research including documentation of current practices, impacts of professional development and/or curricula on teaching practices, and changes in teaching over time. We offer the SSI-OP as a new tool with the potential to contribute to science teacher education and research that may advance the teaching and learning of science through SSI.

Revitalizing Strategy Instruction

The national focus on teacher accountability and the resulting emphasis on raising the bar for teacher evaluations challenge teachers of students with learning disabilities (LD) to rethink instructional design and delivery. In response to these challenges, this article introduces a two-part protocol for planning and teaching strategy instruction to elementary education students with LD being educated in classrooms alongside their grade-level peers. The rationale, research background, detailed implementation information, and concrete examples of how the protocol was integrated into lesson planning are provided. The protocol is offered as a framework for teachers and schools looking to increase the effectiveness of instruction through the use of evidence-based methods.

Analogy motor learning by young children: a study of rope skipping

Research in psychology suggests that provision of an instruction by analogy can enhance acquisition and understanding of knowledge. Limited research has been conducted to test this proposition in motor learning by children. The purpose of the present study was to examine the feasibility of analogy instructions in motor skill acquisition by children. Thirty-two children were randomly assigned to one of the two instruction protocols: analogy and explicit instruction protocols for a two-week rope skipping training. Each participant completed a pretest (Lesson 1), three practice sessions (Lesson 2–4), a posttest and a secondary task test (Lesson 5). Children in the analogy protocol displayed better rope skip performance than those in the explicit instruction protocol (p < .001). Moreover, a cognitive secondary task test indicated that children in the analogy protocol performed more effectively, whereas children in the explicit protocol displayed decrements in performance. Analogy learning may aid children to acquire complex motor skills, and have potential benefits related to reduced cognitive processing requirements.