Continuous improvement research gets $2.5M grant

Researchers in the Learning Research and Development Center (LRDC) have been awarded a $2.5 million grant to partner with the LRDC’s Institute for Learning and the Tennessee Department of Education to test and refine a training model that supports teachers transitioning into teaching the common core state standards.

These standards are a national initiative aimed at increasing the quality of education in English language arts and mathematics. In the training model, coaches are trained in common core teaching and coaching methods, then work closely with teachers in a small number of schools to assist the teachers with implementing the new methods.

The grant, awarded by the U.S. Department of Education’s Institute of Education Sciences, will support a three-year effort in which the Pitt research team will evaluate the model by using “continuous improvement research” — a strategy pioneered in the business and health care sectors at companies such as Toyota, and which is gaining momentum in the education field. The new approach calls for the researchers to conduct frequent evaluations of the coaching work in Tennessee, incorporating coaches’ feedback and other data to make rapid ongoing changes to the program to improve the overall process.

Said the LRDC’s Jennifer Lin Russell, principal researcher and faculty member in learning sciences and policy in the School of Education: “Typical research can go on for years before there is any feedback to educators. This research model is different. We don’t just drop in, collect data and leave. We have deep engagement with practitioners. We are supporting improvement along the way.”

During the project, continuous improvement cycles will each last about four months, Russell said. Each cycle will be launched with in-person network meetings between the research team and the coaches. Monthly phone conferences will allow the coaches to provide feedback, and researchers to tweak their model, on an even more frequent basis. Along with participating in meetings and telephone conferences, coaches will work with researchers by keeping logs, audiotapes and other records of their coaching conversations for the researchers to analyze.

Russell’s team is beginning its work this summer. The first two years of the three-year project will entail working with a group of 30 coaches to train them in common core-aligned coaching practices. The coaches then will train math teachers who are implementing new math teaching methods in their classrooms. These coaches will relay feedback from the teachers, serving as a critical conduit between the teachers and the researchers.

At the end of the second year, the research team will review the changes that were made during the continuous improvement cycles and then use a refined model to train a new group of coaches. They will conduct a formal pilot study with the results of the refined model being tracked and compared to the results of a group receiving “business as usual” coaching.

Russell said hands-on coaching has become a popular model for states implementing the common core state standards because it is designed to help implement the standards under varying conditions, including differing levels of teacher knowledge and experience, differences in past curricula, and differing levels of support available to teachers.

“This is moving beyond the thinking that there is a single solution for all sites,” said Russell. “There are strategies that work better under different conditions. Tennessee is a state with a commitment to the common core state standards and significant momentum around implementation.”

Co-investigator Mary Kay Stein, a faculty member of learning sciences and policy in education, notes that the common core state standards stand to be a game changer in education: “At no other time in our nation’s history have so many individuals and organizations agreed on the direction for change in America’s classrooms. Although there are lots of pieces to work out, there is no doubt that Tennessee is one of the states that has grasped the significance of this moment and is leading the way toward supporting teachers to be able to teach in more focused and cognitively demanding ways.”

This grant builds on recent collaborations between Pitt educational researchers and Tennessee’s Department of Education. In 2013, faculty in Russell’s department received a pair of grants for projects in the state: a $1.5 million grant from the National Science Foundation to study instructional quality, teachers’ access to resources and student achievement across Tennessee and a $25,000 William T. Grant Foundation grant to study the performance of students in grades 3-10 on a pair of statewide assessment tests.

A team from Pitt’s Institute for Learning also partnered with that state’s education department last year to train more than 900 Tennessee coaches in the common core state standards using institute-developed materials.

In addition, the Tennessee Department of Education has conducted summer trainings for teachers over the past three years using a “common core Coaching Model” developed in partnership with the University. Russell’s new project aims to extend this initiative by deepening the training of mathematics coaches and building a network of highly trained coaches that can be expanded over time to reach across the entire state.

Other co-investigators from LRDC and education are Richard Correnti and Lindsay Clare Matsumura, along with Institute for Learning fellow Victoria Bill.

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Texts cut binge drinking in young adults

Using text messaging to collect drinking data and to offer immediate feedback and support to young adults discharged from emergency rooms has reduced the number of drinks they later consumed and the number of binge-drinking episodes, according to a new School of Medicine study.

Lead author Brian Suffoletto, an emergency medicine faculty member, and his colleagues designed the trial, funded by the Emergency Medicine Foundation (EMF), the granting arm of the American College of Emergency Physicians. It will examine whether mobile phone text messaging — ever-present among college students — could be used to effectively collect drinking data, deliver feedback and change drinking behavior in young adults.

The findings will be published in the Annals of Emergency Medicine in August and are online now.

Said Suffoletto: “Each day in the U.S., more than 50,000 adults ages 18-24 visit hospital emergency departments, and up to half have hazardous alcohol-use patterns. More than a third of them report current alcohol abuse or dependence. The emergency department provides a unique opportunity to screen young adults for drinking problems and to intervene to reduce future risk.”

In the study, the researchers conducted a randomized trial of a text messaging-based program involving 765 young adults who were discharged from four urban emergency departments in western Pennsylvania.

Participants were randomized to three groups. One received a series of standard, automated text-message queries each week about their drinking plans for the weekend, with a follow-up report on their actual consumption.

If they reported anticipating a heavy drinking day (more than five drinks during any 24-hour period for men and more than four for women), participants received a text message expressing concern about those levels and asking if they would be willing to set a goal to reduce drinking for the week.

Those who said yes then received messages expressing positive reinforcement and strategies for cutting down.

Those who refused to set goals received a text message encouraging them to reflect on the decision (for example, “It’s OK to have mixed feelings about reducing your alcohol use. Consider making a list of all the reasons you might want to change.”).

A second group received a text-message query about total alcohol consumption but did not receive a pre-weekend message or feedback. The control group did not receive any text messages.

At three months, participants who were exposed to the text-message intervention had decreased their drinking occasions by 1-2 per month from their baseline of 3-4. Nearly 15 percent of the intervention group reported no drinking occasions at all.

The assessment-only group, however, increased drinking over the course of the study, which is inconsistent with prior studies showing a reduction in drinking in patients who undergo assessments, the researchers noted. They speculated that the frequent text messaging might have raised the awareness of alcohol use by the participants and improved the accuracy of their responses.

“There is a lot of talk about mobile health intervention but not a lot of evidence,” said Suffoletto. “This is one of the first to test mobile intervention and demonstrate the impact it can have in helping patients make healthy decisions. Emergency departments could implement a similar automated program at a minimal cost and possibly save the lives of young adults nationwide.”

Co-authors of the study were medicine faculty Clifton Callaway, Jeff Kristan, Kevin H. Kim, Peter M. Monti and Duncan B. Clark.

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Study of deadly lung injury gets  NIH funding

Pitt researchers have received  $2.17 million from the National Heart, Lung and Blood Institute, part of the National Institutes of Health (NIH), to study the prevention and early treatment of acute lung injury.

Also known as acute respiratory distress syndrome (ARDS), acute lung injury is a deadly condition that causes the lung to fail in critically ill patients either directly through injury to the lung, such as pneumonia, or indirectly related to another illness.

Said study co-lead investigator Donald M. Yealy, chair of the Department of Emergency Medicine in the School of Medicine: “Many serious illnesses harm the lung, even when that illness starts elsewhere in the body. A trauma patient may develop ARDS as a result of blood loss or treatments. Severe infection, even outside of the lung, is also a major trigger.”

Yealy and co-lead investigator Derek C. Angus, chair of the Department of Critical Care Medicine, are members of the steering committee for the Pennsylvania region of the multi-center Prevention and Early Treatment of Acute Lung injury (PETAL) network. The network, which includes emergency physicians and critical care specialists, will conduct clinical trials to prevent, treat and improve the outcome of patients with ARDS.

Said Angus: “Our goal is to recognize the onset of ARDS and treat it before it can do serious harm to the lung.”

Other collaborating and clinical PETAL centers include Penn State University-Hershey Medical Center, University of Colorado, University of California-San Francisco, Harvard, Tufts, University of Washington-Seattle, University of Utah-Intermountain Health Center, Wake Forest, Vanderbilt, Mount Sinai Medical Center, University of Michigan, Cleveland Clinic and Ohio State.

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Cystic fibrosis could be 2 diseases

Cystic fibrosis (CF) could be considered two diseases, one that affects multiple organs including the lungs and one that doesn’t affect the lungs at all, according to a multicenter team led by researchers at the School of Medicine.

The research, published online in PLOS Genetics, showed that nine variants in the gene associated with cystic fibrosis can lead to pancreatitis, sinusitis and male infertility, but leave the lungs unharmed.

People with CF inherit from each parent a severely mutated copy of a gene called CFTR, which makes a protein that forms a channel for the movement of chloride molecules in and out of cells that produce sweat, mucus, tears, semen and digestive enzymes, said co-senior investigator David Whitcomb, chief of gastroenterology, hepatology and nutrition in the School of Medicine. Without functional CFTR channels, secretions become thick and sticky, causing problems such as the chronic lung congestion associated with CF.

“There are other kinds of mutations of CFTR, but these were deemed to be harmless because they didn’t cause lung problems,” Whitcomb said. “We examined whether these variants could be related to disorders of the pancreas and other organs that use CFTR channels.”

Co-senior author Min Goo Lee, of Yonsei University College of Medicine in Seoul, Korea, conducted tests of CFTR in pancreatic cell models and determined that a molecular switch inside the cell called WINK1 made CFTR channels secrete bicarbonate rather than chloride molecules.

“Pancreas cells use CFTR to secrete bicarbonate to neutralize gastric acids,” Whitcomb said. “When that doesn’t happen, the acids cause the inflammation, cyst formation and scarring of severe pancreatitis.”

The research team found nine CFTR gene variants associated with pancreatitis after testing nearly 1,000 patients with the disease and a comparable number of healthy volunteers. They also learned that each variant could impair the WINK1 switch to prevent CFTR from becoming a bicarbonate-secreting channel.

Co-senior author Ivet Bahar, Distinguished Professor and John K. Vries Chair of Computational Biology in the School of Medicine, built a computer model of the CFTR protein’s structure and determined that all the nine variants alter the area that forms the bicarbonate transport channel, thus impairing secretion of the molecule.

“It turns out that CFTR-mediated bicarbonate transport is critical to thin mucus in the sinuses and for proper sperm function,” Whitcomb said. “When we surveyed pancreatitis patients, there was a subset who said they had problems with chronic sinusitis. Of men over 30 who said they had tried to have children and were infertile, nearly all had one of these nine CFTR mutations.”

He added that identification of the mechanisms that cause the conditions make it possible to develop treatments, as well as to launch trials to determine if medications that are used by CF patients might benefit those who do not have lung disease, but who carry the other mutations.

The team included researchers from the Mayo Clinic, Brigham and Women’s Hospital, and other members of the North American Pancreatitis Study Group.

The study was supported by NIH; the Ministry for Health & Welfare, Republic of Korea, and Brain Korea 21 Project for Medical Sciences, Seoul.

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Telemedicine effective for international cardiac care

After studying more than 1,000 pediatric consultations offered in Latin America through telemedicine, researchers at Children’s Hospital found that physicians in those countries were highly satisfied with Children’s service and believed telemedicine had improved patient outcomes.

The study was led by Ricardo A. Muñoz, chief of the Cardiac Intensive Care Division at Children’s and faculty member in critical care medicine, pediatrics and surgery in the School of Medicine. Results were published online in Telemedicine and e-Health.

The study showcased Children’s multicenter experience in telemedicine at three hospitals in Colombia and one in Mexico from July 2011 to June 2013. Children’s physicians provided 1,040 consultations for 476 patients, with a real-time intervention taking place in 23 percent of those encounters, including echocardiography and pharmacologic therapy. In 6 percent of the teleconsultations, a different diagnosis was suggested based on the interpretation of cardiac or imaging studies.

The patients seen by Children’s e-cardiac intensive care units were selected by local physicians. Relevant patient data were provided in a secure database and telemedicine hardware was used for real-time consultations.

Based on anonymous surveys of physicians participating at the international centers, 96 percent of respondents reported being satisfied or highly satisfied with the telemedicine service, while 58 percent rated the promptness and time dedicated by the tele-intensivist as very high. Physicians reported that they changed their clinical practice sometimes in relation to the telemedicine encounters.

Experts from Children’s oversee international programs and provide consultations in Cali, Bucaramanga and Medellin, all in Colombia, as well as in Mexico City, Mexico.

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