Suchergebnisse

Determining the costs of special education in public and nonpublic settings is an important undertaking necessary for policy formulation and implementation. The Rehabilitation Act of 1973 (P.L. 93-112) and the Education for All Handicapped Children Act of 1975 (P.L. 94-142) require that all handicapped children receive a free, appropriate, publicly supported education. Further, P.L. 94-142 mandates: education in the least restrictive environment, a continuum of alternative placements, and that handicapped children in private schools be provided special education and related services at no cost to their parent(s) or guardian(s) provided that such children are referred or placed by the public agency. In the context of fiscal accountability, the issue of providing comparable services for the least amount of expenditure in special education has become a critical one. Local education agencies (LEAs) are continually faced with decisions of whether to pay for nonpublic placements of handicapped pupils or provide public placements often at the expense of starting new programs and services for a small number of pupils. To date, most LEAs have been unable to accurately analyze and compare these costs. This study developed a framework to be used for descriptive and comparative analysis of costs of public and nonpublic programs and services utilized for handicapped pupils. Borg's model of research and development procedures was used with modifications to include expert panel review at preliminary product development and product revision stages. The framework was tested in six LEAs within Virginia which represent county and city divisions in high, medium, and low population settings. Ten nonpublic day and residential programs utilized by the LEAs were selected for analysis. Analyzed public per-pupil costs by handicapping condition and environment were compared to the analyzed per-pupil costs to the LEA for nonpublic special education programs by handicapping condition and environment. The product of this study may assist LEAs in policy formulation and implementation concerning the placement of handicapped pupils. ; Ed. D.

Surge management is important to hospital operations, yet surge literature has mostly focused on the addition of resources (e.g., 25% more beds) during events like pandemics. Such views are limiting, as meeting surge demands requires hospitals to engage in practices tailored to a surge's unique contingencies. We argue that a dynamic view of surge management should include surge management capability, which refers to how resources are deployed to respond to surge contingencies. To understand this capability, we qualitatively studied five hospital systems experiencing multiple surges due to COVID-19 between April 2020 and March 2022. We develop a framework showing that managing surges involves preserving capacity, expanding capacity, smoothing capacity demand, and enabling surge management. We contribute to surge literature by identifying practices hospitals can adopt to address surges and offering a better understanding of surge conditions (e.g., degree of novelty) that make some surge management practices more appropriate than others.

PURPOSE: Clinical trials require significant resources, but benefits are only realized after trial completion and dissemination of results. We comprehensively assessed early discontinuation, registry results reporting, and publication by trial sponsor and subspecialty in urology trials. MATERIALS AND METHODS: We assessed trial registrations from 2007–2019 on ClinicalTrials.gov and publication data from PubMed®/MEDLINE®. Associations between sponsor or subspecialty with early discontinuation were assessed using Cox proportional hazards and results reporting or publication with logistic regression at 3 years after completion. RESULTS: Of 8,636 trials 3,541 (41.0%) were completed and 999 (11.6%) were discontinued. Of completed trials 26.9% reported results and 21.6% were published. Sponsors included academic institutions (53.1%), industry (37.1%) and the U.S. government (9.8%). Academic-sponsored (adjusted HR 0.81, 95% CI 0.69–0.96, p = 0.012) and government-sponsored trials (adjusted HR 0.62, 95% CI 0.49–0.78, p <0.001) were less likely than industry to discontinue early. Government-sponsored trials were more likely to report (adjusted OR 1.72, 95% CI 1.17–2.54, p = 0.006) and publish (adjusted OR 1.89, 95% CI 1.23–2.89, p = 0.004). Academic-sponsored trials were less likely to report (adjusted OR 0.65, CI:0.48–0.88, p = 0.006) but more likely to publish (adjusted OR 1.72, 95% CI 1.25–2.37, p <0.001). These outcomes were similar across subspecialties. However, endourology was more likely to discontinue early (adjusted HR 2.00, 95% CI 1.53–2.95, p <0.001), general urology was more likely to report results (adjusted OR 1.54, 95% CI 1.13–2.11, p = 0.006) and andrology was less likely to publish (adjusted OR 0.53, 95% CI 0.35–0.81, p = 0.003). CONCLUSIONS: Sponsor type is significantly associated with trial completion and dissemination. Government-sponsored trials had the best performance, while industry and academic-sponsored trials lagged in completion and results reporting, respectively. Subspecialty ...