James Cowan

Excavating the Teacher Pipeline Teacher Preparation Programs and Teacher Attrition

We analyze the placement and attrition patterns of teachers by preparation programs and document large differences in the rate at which teachers exit both their schools and the profession. These differences are robust to within-school comparisons. Moreover, assumptions about turnover and the persistence of program effects prove important for predicting the likely changes in student achievement that would result from varying the proportion of graduates from the most and least effective programs within a state.

Early ART initiation among HIV-positive pregnant women in central Mozambique: a stepped wedge randomized controlled trial of an optimized Option B+ approach

BackgroundDespite effective prevention strategies and increasing investments in global health, maternal to child transmission (MTCT) of HIV remains a significant problem globally, especially in sub-Saharan Africa. In 2012, there were 94,000 HIV-positive pregnant women in Mozambique. Approximately 15% of these women transmitted HIV to their newborn infants, resulting in nearly 14,000 new pediatric HIV infections that year. To address this issue, in 2013, the Mozambican Ministry of Health implemented the World Health Organization-recommended “Option B+” strategy in which all newly diagnosed HIV-positive pregnant women are counseled to initiate combination anti-retroviral therapy (ART) immediately upon diagnosis regardless of CD4 count and to continue treatment for life. Given the limited experience with Option B+ in sub-Saharan Africa, few rigorous pragmatic trials have studied this new treatment strategy.MethodsThis study utilizes an initial formative research process involving patient and health care provider interviews and focus groups, workforce assessments, value stream mapping, and commodity utilization assessments to understand the strengths and weaknesses in the current Option B+ care cascade. The formative research is intended to guide identification and prioritization of key workflow modifications and the development of an enhanced adherence and retention package. These two components are bundled into a defined intervention implemented and evaluated across six health facilities utilizing a stepped wedge randomized controlled trial study design. The overall objective of this trial is to develop and test a pilot intervention in central Mozambique to implement the new Option B+ guidelines with high fidelity and increase the proportion of HIV-positive pregnant women in target antenatal clinics (ANC) who start ART prior to delivery and are retained in care.DiscussionThis pragmatic study utilizes research strategies that have the potential to meaningfully improve the Option B+ care cascade in central Mozambique and to decrease the MTCT of HIV. This trial is designed to identify critical low-cost improvement strategies that can be bundled into a defined intervention. If this intervention has a measurable impact, it can be rapidly scaled up to other ANC in Mozambique and sub-Saharan Africa.Trial registrationClinicalTrials.gov: NCT02371265.

Clinical Impact and Cost-effectiveness of Xpert MTB/RIF Testing in Hospitalized Patients With Presumptive Pulmonary Tuberculosis in the United States

Summary In hospitalized patients with presumptive pulmonary tuberculosis in a low-burden setting such as the United States, GeneXpert MTB/RIF molecular testing can reduce the duration of airborne infection isolation and is comparably sensitive, more specific, and more cost-effective than smear microscopy.

National Board Certification and Teacher Effectiveness: Evidence From Washington State

ABSTRACT We study the effectiveness of teachers certified by the National Board for Professional Teaching Standards (NBPTS) in Washington State, which has one of the largest populations of National Board-Certified Teachers (NBCTs) in the nation. Based on value-added models in math and reading, we find that NBPTS-certified teachers are about 0.01–0.05 student standard deviations more effective than non-NBCTS with similar levels of experience. Certification effects vary by subject, grade level, and certification type, with greater effects for middle school math certificates. We find mixed evidence that teachers who pass the assessment are more effective than those who fail, but that the underlying NBPTS assessment score predicts student achievement.

How Much of A "Running Start" Do Dual Enrollment Programs Provide Students?

We study a popular dual enrollment program in Washington State, “Running Start” using a new administrative database that links high school and postsecondary data. Conditional on prior high school performance, we find that students participating in Running Start are more likely to attend any college but less likely to attend four-year colleges in the year after high school graduation. Additionally, we find evidence that data limitations common to previous studies of dual enrollment have substantial impacts on the estimates of dual enrollment on college outcomes.

Mycotic aneurysm of the abdominal aorta caused by Haemophilus influenzae type f

Prior to the advent of the Haemophilus influenzae type b vaccine, invasive infections due to H. influenzae type f were rarely described. However, the epidemiology of H. influenzae is changing. While the incidence of invasive infections due to H. influenzae is declining in children, such infections are becoming more common in adults, particularly in the elderly. Here, we report an unusual case of infective aortic aneurysm caused by H. influenzae type f that underlines the emerging clinical relevance and pathogenic capability of this organism.

Stepped-Wedge Cluster Randomized Controlled Trial to Promote Option B+ Retention in Central Mozambique

Background: This randomized trial studied performance of Option B+ in Mozambique and evaluated an enhanced retention package in public clinics. Setting: The study was conducted at 6 clinics in Manica and Sofala Provinces in central Mozambique. Methods: Seven hundred sixty-one pregnant women tested HIV+, immediately initiated antiretroviral (ARV) therapy, and were followed to track retention at 6 clinics from May 2014 to May 2015. Clinics were randomly allocated within a stepped-wedge fashion to intervention and control periods. The intervention included (1) workflow modifications and (2) active patient tracking. Retention was defined as percentage of patients returning for 30-, 60-, and 90-day medication refills within 25–35 days of previous refills. Results: During control periods, 52.3% of women returned for 30-day refills vs. 70.8% in intervention periods [odds ratio (OR): 1.80; 95% confidence interval (CI): 1.05 to 3.08]. At 60 days, 46.1% control vs. 57.9% intervention were retained (OR: 1.82; CI: 1.06 to 3.11), and at 90 days, 38.3% control vs. 41.0% intervention (OR: 1.04; CI: 0.60 to 1.82). In prespecified subanalyses, birth before pickups was strongly associated with failure—women giving birth before ARV pickup were 33.3 times (CI: 4.4 to 250.3), 7.5 times (CI: 3.6 to 15.9), and 3.7 times (CI: 2.2 to 6.0) as likely to not return for ARV pickups at 30, 60, and 90 days, respectively. Conclusions: The intervention was effective at 30 and 60 days, but not at 90 days. Combined 90-day retention (40%) and adherence (22.5%) were low. Efforts to improve retention are particularly important for women giving birth before ARV refills.

Who Chooses Incentivized Pay Structures? Exploring the Link Between Performance and Preferences for Compensation Reform in the Teacher Labor Market

We report on research examining the revealed preferences of teachers in Denver Public Schools who were given the opportunity to select between remaining on a traditional salary schedule and opting into one of the nation’s high-profile pay reform systems, Denver’s Professional Compensation System for Teachers. The incentive structure creates differential earnings risk for teachers according to their experience and measured effectiveness as well as their staffing assignment and school. We find that teachers are generally responsive to the eligibility criteria, but many teachers who would have earned more under the new system chose not to participate.