This transcendental phenomenology centers on the perceptions and experiences of New Americans from Africa and Asia who attended high schools in a smaller urban area located in North Dakota. Using Anderson et al.’s (2014) ecology of inclusive education (EIE), we identify environmental factors that promoted or undermined inclusive education experiences for the New Americans in our study. Themes include: collaborative and welcoming EL teachers, differences between mainstream and EL classes and teachers, problematic experiences with school administrators, valued connections with American peers, and balancing family responsibilities with school. Implications for policy and practice that support the inclusion of New Americans in all schools are provided, including ways to disrupt bias in schools and approaches to providing supports for New Americans and their families.
Background Repeat imaging for trauma patients is common in rural health care systems after transfer to a tertiary trauma center which subjects patients to increased radiation, excess costs, and delays to definitive care. A previous retrospective review at our regional trauma center found that pre-transfer CT scans were frequently performed with little change in management. To improve this rate, additional emphasis was placed on (1) best imaging practices during Rural Trauma Team Development Courses (RTTDC), (2) management feedback during regional trauma case reviews, and (3) implementation of practice management guidelines for an inter-provider telehealth system. Methods Two hundred consecutive adult trauma patients transferred to a regional trauma center were retrospectively evaluated after trauma system improvements were implemented and compared to the previous cohort in the same system as identified by the regional trauma database. Results 140 (70%) had a pre-transfer CT scan compared to 152 (77.2%) in the prior study ( P = .0112). Additionally, 52 (37.1%) of those with pre-transfer CT scans had at least one repeat scan on arrival which decreased from (55.3%) in the prior study ( P < .0001). The most common reason for repeat CT scans was incomplete initial imaging. Those with a repeat scan were more likely to have a head injury (51.9% vs 35.8%, P = .0413). Discussion With regional trauma system maturation and implementation of internal telemedicine guidelines, there was a statistically significant decrease in both pre-transfer as well as repeat CT scans in a rural trauma system. Additional research exploring patient outcomes and cost savings is recommended.
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