Letter Grade Research Articles

Impact of online courses and grading framework on student learning and motivation

Background: At our institution, the COVID-19 pandemic led to an abrupt change from traditional in-person instruction to remote teaching along with a concurrent change from letter grades to satisfactory/marginal/unsatisfactory grading. Objectives: The aims of this study were to explore the effects of changes in instructional delivery on students’ learning and retention of the material and to assess students’ motivation to learn. Methods: The study consisted of two phases. Phase 1 involved the administration of an academic motivation survey and a clinical pathology exam using online platforms. Phase 2 involved conducting a focus group to further explore student experiences during the change in course instruction. Results: The academic motivation survey revealed that both prior to and during the pandemic, the main drivers for student achievement were an interest in learning the content due to anticipated relevance in clinical practice, as well as a desire to master course goals. While the students predicted feeling more confident in their data interpretation ability in the traditionally taught topics vs. topics modified due to social distancing, the data from the content exam suggests that students showed better retention of topics taught in a modified manner. Lastly, the focus group revealed that participants perceived online learning to be more challenging due to the lack of in-person contact and increased frustration with technical issues. Conclusion: While moving courses online may make it more difficult to engage with the materials, peers, and instructors, there did not appear to be adverse effects on the overall student learning or content retention.

Score normalization for a university grades input system using a neural network

A university grades input system requires for professors to enter the normalized total scores for the letter grades and to input the scores from six fields such as Midterm, Final, Quiz which sum up to the total. All six fields have specified bounds which add up to 100. Professors should scale in the total scores to match up the letter grades and scale in every field of each student's original scores within the bounds to sum up to the scaled total score. We solve this problem by a novel design of simple shallow neural network.

Evaluation of a Lower-Resource-Dependent Tutoring Program Designed to Improve Introductory Psychology Performance

Supplemental Instruction (SI) is a peer tutoring system shown to increase course grades and reduce dropout, particularly for courses with significant failure/dropout rates. Unfortunately, such systems can place significant time and resource demands on faculty, SI personnel, and higher education institutions, all of which pose impediments to their adoption. Given this concern, an assessment of a less resource-taxing version of SI is presented. Across three sections of Introductory Psychology, 30%–42% of enrolled students attended at least one lower-resource group tutorial session. These students performed significantly better on course exams than did non-attendees, by as much as a letter grade. Further, those who attended more sessions earned higher final course grades. These performance differences do not appear to be due to selection bias; session attendance predicted grades on four of the five course exams, even after controlling for students’ academic ability and motivation. Students who did not participate cited time constraints as the primary reason. Those who did participate perceived most session activities as highly beneficial, especially completing a pre-session study guide and reviewing the answers in-session. Thus, the present tutoring program appears to represent an effective, efficient method of achieving desirable academic outcomes that students regard as worthwhile.

Variation in which key motivational and academic resources relate to academic performance disparities across introductory college courses

BackgroundDifferences in post-secondary academic outcomes along dimensions of gender, race/ethnicity, and socioeconomic status are a major concern. Few studies have considered differences in patterns of academic outcomes and underlying mechanisms driving disparities across different STEM disciplines. Using data from about 4000 undergraduates in introductory STEM courses at a large, urban university in the eastern United States, this study examines how differences in course grades by gender, race/ethnicity, and parent education vary in introductory chemistry, physics, and psychology courses. In addition, structural equation modeling techniques examine whether academic resources and discipline-specific motivational attitudes are important mediators of demographic differences in course grades.ResultsThis study finds that women have higher course grades than men on average in psychology, and men have marginally higher grades than women in physics. In addition, students whose race/ethnicity is represented or overrepresented in these courses (students who are White and or Asian) have higher course grades in chemistry and physics and marginally higher grades in psychology on average compared with underrepresented students (who are Black, Latinx, Native American, Pacific Islander, and or other racial/ethnic backgrounds). Further, first-generation college students have lower course grades in physics and psychology on average than students with a college-educated parent. The largest average differences in course performance are about half a full letter grade (e.g., the difference between a B and an A−). This study also finds that some demographic differences in physics and chemistry performance are linked to math resources whereas some disparities in psychology are more related to verbal resources. In addition, the results suggest discipline-specific self-efficacy is a motivational attitude associated with course performance in chemistry, physics, and psychology, while discipline-specific interest is only relevant in chemistry.ConclusionsOverall, the findings emphasize that there are demographic differences in post-secondary course performance on average, and academic resources and motivational attitudes help explain these differences. Importantly, the specific findings differ across chemistry, physics, and psychology. Understanding these pathways and how they are similar and different across disciplines within STEM is crucial for developing interventions aimed at attenuating disparities in post-secondary academic outcomes.

Grading Principles in Pandemic-Era Learning: Recommendations and Implications for Secondary School Leaders

As the COVID-19 pandemic unfolded in K-12 education, school leaders quickly pivoted from prioritizing continuous instruction and technology access to the output, grades. In response to these unprecedented times, secondary schools utilized “do no harm” grading methods, such as freezing previous grades and replacing letter grades with pass-fail. The purpose of this essay is to describe grading principles that secondary school leaders should consider during future pandemic era learning, and to suggest implications based upon previous literature.

Improving Students’ Study Habits and Course Performance With a “Learning How to Learn” Assignment

How can instructors help students adopt effective learning strategies? In this study, students in a large introductory psychology class completed a “learning how to learn” assignment in which they read one of four randomly assigned empirical articles about the utility of a learning strategy (i.e., distributed practice, rereading, practice testing, or forming mental images) and wrote a paper summarizing, analyzing, and applying the article’s findings. Students relied significantly less on low-utility strategies and significantly more on moderate and high-utility strategies at the end of the semester than at the beginning. Furthermore, students who completed this assignment outperformed their peers in a control semester of the same course, improving by about one-third of a letter grade. Suggestions for effective implementation of a similar assignment are presented.

Grade inflation in restaurant hygiene inspections: Repeated interactions between inspectors and restaurateurs

Restaurant hygiene grading schemes are considered exemplars of targeted transparency policies. We investigate the impact of an administrative design feature found in many schemes: repeated interactions between health inspectors and restaurateurs. Data was analyzed from 336,208 inspections of 27,119 restaurants conducted by 493 inspectors from 2000 to 2010 by the Los Angeles Department of Public Health (LADPH). The findings associate repeated interactions with higher public letter grades, and these grades drop with the assignment of a new inspector. Specifically, a one-unit increase in the logged number of visits by a prior inspector is associated with a 71% increased chance the restaurant will be downgraded to a lower letter grade upon the arrival of a new inspector. Exploiting an inspection protocol change in 2007, we also find that inspectors with more repeated visits to a restaurant are more likely to code a higher number of compliant rules as “Not Observed,” thereby possibly avoiding potential violations and corresponding penalties. Analysis of subsequent consumer complaints filed with the local health department shows that a one-unit increase in repeated inspector-restaurateur interactions is associated with an 10% increase in the likelihood of a consumer complaint, suggesting a public health impact. Coupled with prior evidence, the study demonstrates that administrative and design features of targeted transparency policies can impact the information provided to the public and potentially affect health outcomes.

Psychometric Evaluation of the TIC Grade, a Self-Report Measure to Assess Youth Perceptions of the Quality of Trauma-Informed Care They Received.

Agencies and clinical practices are beginning to provide trauma-informed care (TIC) to their clients. However, there are no measures to assess clients' perceptions of and satisfaction with the TIC care they have received. A 20-item questionnaire, the TIC Grade, was developed, based on the National Center for Trauma-Informed Care principles of TIC, to assess the patient or client perception of the TIC provided in settings that serve adolescents and emerging adults. The goal of this project was to evaluate the psychometric properties of the TIC Grade instrument and to make recommendations for use of the full measure and its short form-an overall letter grade. The TIC Grade questionnaire was administered to youth over the age of 18 years from four community partners providing care to vulnerable young adults. Potential participants were offered questionnaires at the end of their visit. Those interested in participating left their completed anonymous questionnaire in a locked box to maintain confidentiality. Questionnaires were collected from 100 respondents; 95 were complete enough to include in analyses for psychometric evaluation. The findings of this project support the reliability and usability of the 20-item TIC Grade measure to assess youth's perceptions of the quality of TIC they received. This TIC-specific, behaviorally worded client report measure can assist service delivery organizations to assess their success at implementing TIC and to identify areas where further staff training and support are needed.

Disclosure policies in inspection programs: The role of specific deterrence

In inspection programs, policies of disclosing inspection performance promote greater compliance via general deterrence—i.e., by increasing the expected cost of regulatory violations. Yet, despite their growing popularity as regulatory aids, an unexamined matter is how specific deterrence – deterrence that follows from receiving punishment – might influence the effectiveness of disclosure policies. In Las Vegas, Nevada, food-service health inspections are scored numerically. Using a simple grading scale, scores are then coarsened into letter grades which restaurants must prominently display. There is, however, a wrinkle to this grading scale: establishments committing the same violation in consecutive inspections are downgraded one letter. By virtue of this downgrade rule, punishment assignment varies among identically scored inspections. Relative to establishments with identical sequences of prior inspection scores, I find that restaurants are assessed 17%–27% fewer demerits following a downgrade. This substantial specific deterrence effect has important implications for the design of disclosure policies; particularly, regarding the coarsening of numeric scores into letter grades.

Relative impacts of different grade scales on student success in introductory physics

In deciding on a student's grade in a class, an instructor generally needs to combine many individual grading judgments into one overall judgment. Two relatively common numerical scales used to specify individual grades are the 4-point scale (where each whole number 0-4 corresponds to a letter grade) and the percent scale (where letter grades A through D are uniformly distributed in the top 40% of the scale). This paper uses grading data from a single series of courses offered over a period of 10 years to show that the grade distributions emerging from these two grade scales differed in many ways from each other. Evidence suggests that the differences are due more to the grade scale than to either the students or the instructors. One major difference is that the fraction of students given grades less than C- was over 5 times larger when instructors used the percent scale. The fact that each instructor who used both grade scales gave more than 4 times as many of these low grades under percent scale grading suggests that the effect is due to the grade scale rather than the instructor. When the percent scale was first introduced in these courses in 2006, one of the authors of this paper, who is also one of the instructors in this data set, had confidently predicted that any changes in course grading would be negligible. They were not negligible, even for this instructor.

Culture transformation by stealth: Leveraging incremental change to revamp the curriculum

Introduction Reshaping an existing education program from traditional structures and processes into competency-based medical education (CBME) is formidable. Emory University School of Medicine applied organizational change theory to introduce CBME into an established MD program by employing ‘sustainable innovation’, which introduces change incrementally. Methods Implementation of CBME began with the identification of core institutional values. Using the sustainable innovation approach, the first change was adoption of new program outcomes and student performance expectations. There were few changes that occurred to the structure of required courses and clerkships. This intentional approach allowed stakeholders to familiarize themselves with CBME prior to full implementation. Results Existing assessment processes remained intact while the faculty was trained for innovative assessment uses. For example, the assessment process was augmented by tagging all exam items using a controlled taxonomy and students’ performance was linked longitudinally. Using sustainable innovation allowed time for data collection and evaluation throughout the implementation of CBME. Discussion Representing student achievement according to competencies, rather than as letter grades, is perceived as revolutionary by many stakeholders. Employing sustainable, incremental innovation facilitated stakeholder buy-in to the underlying principles of CBME. Fostering a new organizational culture will be the ‘rate-limiting factor’ for full implementation of CBME.

Predicting cataract operative time in the real world.

We read with interest the recent publication by McKay et al. on the use of preoperative clinical variables for predicting cataract operative time.1 Although improved operating room utilization is a worthwhile endeavor that can improve healthcare productivity and save costs, it seems that several aspects relating to the data analysis preclude any real-world conclusions from being drawn. The first aspect of concern is the exclusion of cases primarily attended by a resident, which typically take longer regardless of any high-risk preoperative characteristics. The second and more important aspect is the fact that the authors adjusted their results for the surgeon's years of experience or identity, an adjustment that does not occur in real life. As reported by McKay et al., the strongest predictor of operative time was the identity of the surgeon. One might assume that cases with high-risk preoperative characteristics will be assigned to more experienced physicians. In a real-world setting, therefore, high-risk cases operated on by experienced surgeons and low-risk cases operated on by less-experienced surgeons might take similar amounts of time. To test this hypothesis, after receiving approval from the Institutional Review Board, we used a retrospective real-life registry-based cohort of consecutive cataract surgeries performed between August 2016 and April 2019 at the Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland. At this institution, all operating surgeons were specialists with varying degrees of experience, and cases were assigned based on the preoperative risk assessment to a surgeon based on the level of expertise. Included were 4752 cases in which operative time, preoperative clinical variables, and the surgeon’s identity were recorded. The mean age of the patients was 74.1 ± 10.1 years, and 59% were women. The results show that preoperative clinical variables had a minimal impact on operative time. These included the existence of pseudoexfoliation (21.4 ± 10.2 minutes vs 20.8 ± 11.9 minutes, P = .274), poor mydriasis (21.4 ± 9.9 minutes vs 20.7 ± 12.1 minutes, P = .196), and higher than “simple” preoperative grade according to the referral letter (grades 2 or 3 out of 3; 21.2 ± 12.3 vs 19.6 ± 9.4, P < .001). This is presumably due to surgeon selection. Indeed, when incorporating these variables into a linear regression analysis accounting for the surgeon's identity, all these preoperative variables become significantly predictive of operative time (all P < .001), similar to the results of the study by McKay et al. Predicting cataract operative time is complex. In a real-world setting, social and behavioral aspects come into play, which are challenging to incorporate in a statistical analysis. In our experience, surgeon selection plays an important role, which primarily serves to counteract the effect of high-risk preoperative patient characteristics. Using high-risk preoperative characteristics in a straightforward way to determine operating room utilization might, therefore, not work in clinical practice. We agree with McKay et al. that this is an important and pertinent issue and worthy of further discussion.

Implementing non-traditional assessment strategies in teacher preparation: Opportunities and challenges

Assessment and grading in higher education have traditionally focused on “A” through “F”, or point-based alpha-numeric letter grades and subjective, independent grading systems. Despite the ubiquity of this system, there are no universal guidelines on how to assess student learning on that scale. What can be problematic about “the way things have always been” is that students are frequently de-humanized; higher education faculty often focus on compliance and authoritarian teaching rather than engaging in the learning process alongside the students. In contrast, some faculty members have explored non-traditional assessment practices in their coursework to enhance the learning process and improve individualized student support. This article offers strategies for implementing non-traditional assessments, specifically mediated office hours, mastery learning, and ungrading strategies are addressed.

Abstract A108: Longitudinal trends in distant metastasis at diagnosis in a racially diverse cohort of prostate cancer patients: 1990-2017

Abstract Introduction: Concerns for overdetection and overtreatment of clinically insignificant PCa have led to changes in PSA screening recommendations. In 2008, the US Preventive Services Task Force (USPSTF) gave PSA screening a “Grade D” recommendation for older men (≥ 75 years), and in 2012 this was extended to men of all ages. In 2017, a draft of revised guidelines was released, elevating the letter Grade to C for men aged 55-69 years. Yet three compelling studies have revealed increases in the diagnosis of metastatic PCa (mPCa) in US men. The primary aim of this study was to examine time trends in mPCa at time of diagnosis, over a 25+ year study period, in a racially diverse longitudinal cohort with equal access to health care. Methodology: The Center for Prostate Disease Research (CPDR) Multi-Center National Database was the source of patients for this study. Men under suspicion for PCa who underwent TRUS-guided biopsy for PCa detection were eligible for enrolment into this database. This study focused on those with biopsy-confirmed PCa between January 1, 1990-December 31, 2017. Trends in mPCa at the time of diagnosis were examined for the overall cohort, as well as stratified by race (AA and CA) and patient age at CaP diagnosis (&amp;lt;75 years versus ≥75 years). Poisson regression with a log link function was used to estimate annual percent change (APC) in mPCa at diagnosis, as a proportion of all newly diagnosed PCa per annum. Multivariable logistic regression was used to model predictors of mPCa at diagnosis as a function of PSA screening intensity prior to CaP detection and patient race. Results: A total of 15,660 subjects met the study criteria, of whom 560 (2.8%) presented with mPCa. The decline in APC over time for the overall cohort was statistically significant (APC = -7.7%, p &amp;lt;0.0001). When APCs were computed for across race, both AA and CA patients were observed to have statistically significant declines over time in APCs (-10.2%, p&amp;lt;0.0001 and -7.1 %, p &amp;lt;0.0001, respectively). However, these declines were comparable across race (p=0.07). When stratified by age group, patients ≥75 years had a smaller magnitude of decline in APC compared to those &amp;lt;75 years (-2.7%, p&amp;lt;0.0001 and -9.2%, p&amp;lt;0.0001, respectively), though these declines did not differ significantly by age group (p=0.56). In multivariable analysis, both the number of prior PSA screenings (OR≥4 vs. None = 0.42, CI=0.29, 0.61, p &amp;lt;0.0001) but not self-reported race (ORAA vs. CA=1.1, CI=0.83, 1.36, p=0.65) predicted mPCa. Conclusions: In this longitudinal, racially diverse cohort with equal health care access, significant declines in mPCa at diagnosis were observed over a 25+ year study period. This is contrast to other recent studies that have demonstrated increases in mPCa following changes in USPSTF guidelines. There was, however, a difference in the magnitude of decrease in oldest patients (≥75 years) compared to younger men (&amp;lt;75 years) that may have been influenced by changes in PSA screening recommendations. Continued attention to shifts in mPCa at diagnosis is needed. Citation Format: Jennifer Cullen, John McCauley, Huai-ching Kuo, Yongmei Chen, Sean Stroup, John Musser, Christopher Porter, Timothy Brand, Kevin Rice, Shiv Srivastava, Inger Rosner, Grace Lu-ao. Longitudinal trends in distant metastasis at diagnosis in a racially diverse cohort of prostate cancer patients: 1990-2017 [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A108.

Diet Quality, Swallow Function, and Health-Related Quality of Life Among People with Parkinson’s Disease

Abstract Objectives To describe the diet quality, swallow function, and disease burden of people with Parkinson's disease (PwPD) and explore the relationship between diet quality, swallow function, and health related quality of life (HRQOL). Methods A convenience sample of twenty PwPD participated in this study. They completed various measures including: height and weight, two 24-h recalls, a time swallow test and a self-reported HRQOL questionnaire. Body mass index (BMI, kg/m2) were calculated from height and weight. Healthy Eating Index (HEI)-2015, a mean to assess dietary quality, was calculated from two 24-h dietary recalls. Total and component HEI-2015 scores were examined and interpreted using the graded approach (grades A-F). Radar graphs were constructed to provide visual representation of overall HEI-sores and component scores. A time swallow test assessed swallow function. The 39-item Parkinson's Disease Questionnaire (PDQ-39) assessed PD-specific HRQOL across 8 dimensions; the higher the score the lower the HRQOL. Descriptives were reported as mean ± standard deviation, frequencies, and percentages. Correlations were used to examine associations between outcome variables. Results The majority of PwPD were male (65%). The mean age was 69.7 ± 9.2 years and average time since diagnosis was 7.6 ± 5.4 years. The average BMI score was 27.1 ± 5.4 kg/m2. Mean HEI scores were 58.3 ± 12.4, translating to an F, consistent with average HEI scores for Americans. The majority (75%) had a letter grade of F or D. Mean timed swallow speed was 14.4 ± 8.4 total mL/second. However, 8 (40%) had time swallow speeds of &amp;lt;10 mL/seconds indicating a swallowing problem may be present. The mean of PDQ-39 scores were 22.0 ± 15.9 (range of 3.1–50.0). The PDQ-39 dimensions with the highest mean score were related to body discomfort (30.4 ± 28.0) and cognition (30.9 ± 21.9). There was no association between HEI scores, swallow speed, and PDQ-39 scores. Conclusions Findings indicate that although PwPD have poor diet quality, experience swallowing issues early in disease progression, they had a high HQROL overall. There was no association between these outcome variables. The results of this study can be used by nutrition experts to ensure PwPD's health longevity, which can help avoid eventual nursing home placement or extensive healthcare needs. Funding Sources There was no external funding for this study.

Results from Hong Kong’s 2019 report card on physical activity for children and youth with special educational needs

Background/ObjectiveThe Active Healthy Kids 2019 Hong Kong Report Card on Physical Activity for Children and Youth with Special Educational Needs (SEN) provides evidence-based assessments for nine indicators of physical activity behaviors and related sources of influence for 6- to 17-year-olds with SEN in Hong Kong. This is the first Report Card for this population group in Hong Kong. MethodsThe best available data between 2008 and 2019 were reviewed by a panel of experts. Following the Active Healthy Kids Global Alliance (AHKGA) development process, letter grades were assigned to nine indicators (Overall Physical Activity, Organized Sport Participation, Active Play, Active Transportation, Sedentary Behaviors, Family & Peers, School, Community & Environment, and Government Strategies & Investments). ResultsTwo behavior indicators (Overall Physical Activity: F; Sedentary Behaviors: D+) and two contextual indicators (School: B; Government Strategies & Investments: C-) were assigned a letter grade. The remaining indicators including Organized Sport Participation, Active Play, Active Transportation, Family & Peers, and Community & Environment were not graded due to insufficient data. ConclusionsA majority of children and youth with SEN in Hong Kong are physically inactive and have a high level of sedentary behaviors. Schools are ideal settings to promote physical activity for this population. There is a need to develop a comprehensive surveillance system to monitor this population, assess efforts to improve the grades, and promote physical activity opportunities for children and youth with SEN.

Assessment Practices of Albanian & Italian Teachers in English Classrooms

Language assessment policies in Albania and Italy have impact on assessment practices of English teachers. This study describes Albanian and Italian secondary school English teachers’ classroom assessment practices in ELL classes. It was conducted using qualitative method design with 48 secondary school English teachers as respondents, practically 24 from Albania and 24 from Italy who participated in an interview and observation to clarify their practices on classroom assessment. The study found that secondary school English teachers in both countries Albania and Italy used assessment for learning as the main purpose of assessment. The majority of secondary school English teachers in Italy prepared and made their own assessment, while secondary school English teachers in Albania used items from published textbooks as their primary sources for constructing assessment items. English teachers of both countries used written comments for providing feedback. Total score test and a letter grade were the highest percentage methods for providing summative assessment for both secondary school English teachers in Albania and Italy.

An overview of the use of placards and the potential benefits for British Columbians

Background: Environmental Health Officers (EHOs) are responsible for assessing the risk that food establishments pose to the public through regular inspections. The results of these inspections are then posted online for the public to view in British Columbia (BC). However, cities such as Toronto and New York City, have adopted the use of placards that are visibly placed at each food establishment, as well as posting the results online. The purpose of the placards is to provide a quick method for the public to ascertain the safety of food establishments. The use of placards has been shown to increase the compliance of food operators, as well as play a role in reducing foodborne illnesses. The purpose of this study was to determine if British Columbians would like to have the results of health inspections displayed on a placard in food establishments, in addition to them being posted online. Methods: An online, self-administered survey was created on SurveyMonkey Canada and distributed to residents of BC through Facebook and Reddit. The survey took approximately five minutes to complete and responses were collected over a nine-day period. The data was then analyzed using NCSS software. Results: From the 176 respondents, it was determined that approximately 44% of people knew about health inspection reports being posted online in BC, however, only 33% of people have visited health authority websites to view the inspections. 93% of the respondents would like to see a placard system implemented in BC. Furthermore, 72% of respondents would like to see a letter grade ranking of placards as opposed to a more general “Pass”, Conditional Pass” or “Closed” system. Results indicated a statistically significant association between the desire for a placard system and selecting a restaurant to eat at (p=0.000). Whether or not one views an online inspection report had no bearing on whether a placard system was desired. (p = 0.231). There is no association between age of BC residents and the preference for placards in BC (p = 0.618). However, there was an association between the age of respondents and knowledge of online reports of health inspections (p = 0.008), indicating that younger people are less likely to know about online health inspections that older populations. Conclusion: The results of this research study indicated that residents of BC overwhelmingly support the use of placards. BC residents would also like to see a letter grade placard system implemented. Although BC residents would like to see placards in food establishments, further research is required to assess what food operators, as well as other EHOs, think about implementing a placard system in place in food establishments.&#x0D;

Student Achievement Factors in a College Introductory Computer Course

ABSTRACT Custom software was used to collect data for 416 students over multiple semesters of a college introductory computer transfer course. The objective was to quantitatively identify achievement factors and corresponding actions to be taken to improve student achievement. Student activity data were exam review time, time spent on assignments, attendance, and Student Response System (SRS) use. Data on specific student skills were obtained from answers to assessment questions. Regression analysis shows that attendance, SRS use, time spent on assignments, and time spent on exam reviews do not significantly affect achievement. Score on assessment questions requiring basic math skill and score on questions requiring skill in observation and written explanation of classroom demonstrations do significantly affect achievement. So does score on questions repeated from one exam to the next, but contrary to intuition, the overall effect of these repeated questions is to lower student achievement. A regression model using only these three factors plus percentage of assignments done predicts student achievement to within half a letter grade. Improving student skill in basic math provides the greatest opportunity to improve student achievement. Successful and unsuccessful students are exclusive groups; unsuccessful students are not “partially” successful.

Preterm Birth: Two Startling Trends, One Call to Action.

In July 2019, the Centers for Disease Control and Prevention released data for 2018 that indicated a rise in preterm births (birth at <37 weeks' gestation). This increase marks the fourth consecutive year that the United States has seen an increase in infants born too soon or too small. March of Dimes examined these data for its annual report card, giving the nation a "C" letter grade for this dismal outcome. This rise coincides with an ongoing increase in pregnancy-related death, the rate of which has more than doubled over the last 25 years in the United States. Racial and ethnic minorities suffer inequitably. Women of color are up to 50% more likely to give birth prematurely. Black, American Indian, and Alaska Native women are 2 to 3 times more likely to die from pregnancy-related causes than white women. A new approach is needed to address these crises. That approach must consider a range of population-based systems-level solutions.