Seeking consensus: Defining foundational concepts for a graduate level introductory program evaluation course.

Existing scholarship indicates a wide range of variance and inconsistency in how evaluation is taught in introductory-level graduate courses between and across instructors and universities and within programs. The purpose of this study was to empirically explore faculty, student, and employers' perceptions of what should be included in a graduate level introductory course on program evaluation. The researchers used a mixed methods approach (survey and focus group) to build consensus on and articulate key elements of an introductory evaluation course, as well as the approximate amount of time that stakeholders feel should be invested in each topic area. The results suggested consistency among stakeholders, suggesting the topics covered could form the basis for an introductory course that is consistent across instructors, programs, and institutions.

Exploring Predictors of Bullying and Victimization of Students with Autism Spectrum Disorder (ASD): Findings from NLTS 2012.

Research suggests that bullying victimization occurs at higher rates among students with autism spectrum disorder (ASD) than among their typically-developing peers. This study used data from the National Longitudinal Transition Study 2012 to explore differences in student and family characteristics between students with ASD and students with all other special education disability categories. The study also examined characteristics serve as predictors of bullying and victimization. Students with ASD were found to have greater difficulties with communication and social skills, as well as less-robust sense of themselves and their abilities than students with all other disabilities. Race, household income, social and communication skills, and self-concept were found to be associated with higher rates of bullying and victimization.

Pedagogical considerations for the teaching of evaluation.

Pedagogy and andragogy refer to the philosophical and empirical assumptions that instructors make about what and how people learn. These assumptions guide much of the subsequent instructional design process, including learning objectives, learning experiences, assessment techniques, and more. Most of the existing literature in evaluator education is descriptive in nature, and there has been limited attention to research on pedagogy specific to evaluation or identification of effective practices for teaching evaluation. As a result, we know very little about the theoretical or practical pedagogy of evaluation. As a first step in understanding this pedagogy, this article first synthesizes relevant concepts, principles of learning, and models of instructional design principles of learning developed in the field of education. The authors then offer case examples of how these ideas, principles, models, and pedagogies apply to five evaluation-specific courses.

The current state of evaluator education: A situation analysis and call to action.

Education is critically important for the maintenance and growth of programme evaluation and its emergence as a profession. This position paper presents evaluator education as an initiative and provides a foundation for its evaluation. In it, the authors use Stufflebeam's Context, Input, Process, and Product (CIPP) model to frame a review of the literature and practice. We follow this analysis of the current state of evaluator education in formal settings, with discussion of its implications, and directions for future research and action. Our analysis suggests that there is much work to be done to understand the needs for evaluator education, to delineate standards for quality in both education and practice, to identify the inputs and processes most effective for addressing those needs, and to document its ultimate impacts. The paper provides a call to action for improving the quality, consistency, and integrity of this important work.

Comparison of the history and physical examination for hip osteoarthritis and lumbar spinal stenosis.

BACKGROUND: Leg pain associated with walking is sometimes incorrectly attributed to hip osteoarthritis (OA) or lumbar spinal stenosis (LSS). PURPOSE: This study compared physicians' values of signs and symptoms for diagnosing and differentiating hip OA and LSS to their clinical utility. STUDY DESIGN/SETTING: Musculoskeletal physicians were surveyed with online questionnaires. Patients were recruited from hip and spine specialty practices. PATIENT SAMPLE: Seventy-seven hip OA and 79 LSS patients. OUTCOME MEASURES: Signs and symptoms of hip OA and LSS. METHODS: Fifty-one of 66 invited musculoskeletal physicians completed online surveys about the values of 83 signs and symptoms for diagnosing hip OA and LSS. Of these, the most valued 32 symptoms and 13 physical examination items were applied to patients with symptomatic hip OA or LSS. Positive likelihood ratios (+LR) were calculated for each items' ability to differentiate hip OA from LSS, with a +LR>2 set as indicating usefulness for favoring either diagnosis. Positive LRs were compared with surveyed physicians' values for each test. RESULTS: All symptoms were reported by some patients with each diagnosis. Only 11 of 32 physician-valued symptoms were useful for discriminating hip OA from LSS. Eight symptoms favored hip OA over LSS: groin pain (+LR=4.9); knee pain (+LR=2.2); pain that decreased with continued walking (+LR=3.9); pain that occurs immediately with walking (+LR=2.4); pain that occurs immediately with standing (+LR=2.1); pain getting in/out of a car (+LR=3.3); pain with dressing the symptomatic leg (+LR=3.1); and difficulty reaching the foot of the symptomatic leg while dressing (+LR=2.3). Three symptoms favored LSS over hip OA: pain below the knee (+LR=2.3); leg tingling and/or numbness (+LR=2.7); and some pain in both legs (+LR=2.5). Notable symptoms that did not discriminate hip OA from LSS included: pain is less while pushing a shopping cart (+LR=1.0); back pain (+LR=1.1); weakness and/or heaviness of leg (+LR=1.1); buttocks pain (+LR=1.2); poor balance or unsteadiness (+LR=1.2); pain that increased with weight-bearing on the painful leg (+LR=1.3), and step to gait on stairs (+LR=1.7). Consistent with physicians' expectations, 7 of 13 physical examination items strongly favored hip OA over LSS: limited weight-bearing on painful leg when standing (+LR=10); observed limp (+LR=9); and painful and restricted range-of-motion with any of five hip maneuvers (+LR range 21-99). Four of five tested neurological deficits (+LR range 3-8) favored the diagnosis of LSS over hip OA. CONCLUSIONS: There is substantial crossover of symptoms between hip OA and LSS, with some physician-valued symptoms useful for differentiating these disorders whereas others were not. Physicians recognize the value of the examination of gait, the hip, and lower extremity neurological function for differentiating hip OA from LSS. These tests should be routinely performed on all patients for which either diagnosis is considered. Awareness of these findings might reduce diagnostic errors.

Osteopathic manipulative treatment in pregnant women.

Pregnant women experience extensive physiologic and structural changes during pregnancy that affect their daily functioning. The addition of osteopathic manipulative treatment (OMT) to the standard care of pregnant women has been hypothesized to enhance homeostasis and improve quality of life as the body adapts to these changes. Specifically, it has been postulated that OMT can ease pain in pregnant women by eliminating somatic dysfunction and maintaining proper structure. Also, through the viscerosomatic connection, the hemodynamic changes of the maternal body can be controlled, the duration of labor reduced, and the complications of labor avoided. The author reviews the available literature on the use and effectiveness of OMT during pregnancy.

Musculoskeletal dysfunction and drop foot: diagnosis and management using osteopathic manipulative medicine.

Drop foot arises from dysfunction within the anatomic, muscular, or neurologic aspects of the lower extremity. The authors describe a patient with drop foot who had a compressed common peroneal nerve caused by posterior fibular head dysfunction. One 15-minute session of osteopathic manipulative treatment resolved the patient's symptoms. It is important for physicians to use osteopathic manipulative medicine to diagnosis and manage this condition, particularly when it results from fibular head dysfunction.

Vascularized thymic lobe transplantation in a pig-to-baboon model: a novel strategy for xenogeneic tolerance induction and T-cell reconstitution.

BACKGROUND: This laboratory has previously demonstrated the induction of allogeneic tolerance by vascularized thymic lobe (VTL) transplantation in miniature swine. We report here our initial attempt to induce tolerance by VTL transplantation in the clinically relevant, discordant, pig-to-baboon model of xenotransplantation. METHODS: Six baboons received xenografts of hDAF VTLs. Four of these baboons also received omental thymic tissue implants. All recipients were treated with an immunosuppressive conditioning regimen that included thymectomy, splenectomy, extracorporeal immunoadsorption of anti-alpha Gal antibodies, and T-cell depletion. Two control baboons received sham operations, of which one also received 5x10 hDAF porcine thymocytes/kg intravenously. RESULTS: Transplanted VTL grafts supported early thymopoiesis of recipient-type immature thymocytes, and facilitated engraftment of nonvascularized thymic omental implants. Recipients of the VTL grafts demonstrated donor-specific unresponsiveness in MLR assays, development of peripheral CD45RAhigh/CD4 double positive (DP) cells, and positive cytokeratin staining of thymic stroma in the grafts for 2 months following xenotransplantation. The control baboons did not show these markers of thymic reconstitution. The eventual return of Gal natural antibodies led to the destruction of graft epithelial cells and the rejection of all VTL grafts by 3 months posttransplantation. CONCLUSIONS: VTL transplantation from hDAF swine to baboons induced early thymopoiesis in the recipients and donor-specific cellular unresponsiveness in vitro. When coupled with additional strategies aimed at silencing humoral rejection, VTL transplantation may significantly prolong xenograft survival and result in long-term tolerance.

Thrombotic microangiopathic glomerulopathy in human decay accelerating factor-transgenic swine-to-baboon kidney xenografts.

Models of pig-to-baboon xenografting were examined to identify the mechanisms and pathologic characteristics of acute humoral xenograft rejection (AHXR). Thymus and kidney (composite thymokidney) from human decay accelerating factor-transgenic swine were transplanted into baboons (n = 16) that were treated with an immunosuppressive regimen that included extracorporeal immunoadsorption of anti-alphaGal antibody and inhibition of complement activation. Morphologic and immunohistochemical studies were performed on protocol biopsies and graftectomy samples. All renal xenografts avoided hyperacute rejection. However, graft rejection coincided with the increase of anti-alphaGal antibody in the recipient's circulation. The 16 xenografts studied were divided into two groups dependent on the rapid return (group 1) or gradual return (group 2) of anti-alphaGal antibody after immunoadsorption. In group 1 (n = 6), grafts were rejected to day 27 with development of typical AHXR, characterized by marked interstitial hemorrhage and thrombotic microangiopathy in the renal vasculature. In group 2 (n = 10), grafts also developed thrombotic microangiopathy affecting mainly the glomeruli by day 30 but also showed minimal evidence of interstitial injury and hemorrhage. In the injured glomeruli, IgM and C4d deposition, subsequent endothelial cell death and activation with upregulation of von Willebrand factor and tissue factor, and a decrease of CD39 expression developed with the formation of fibrin-platelet multiple microthrombi. In this model, the kidney xenografts, from human decay accelerating factor-transgenic swine, in baboons undergo AHXR. In slowly evolving AHXR, graft loss is associated with the development of thrombotic microangiopathic glomerulopathy. Also, anti-alphaGal IgM deposition and subsequent complement activation play an important role in the mechanism of glomerular endothelial injury and activation and the formation of multiple microthrombi.