No abstract

We conducted a randomized, controlled pilot trial to evaluate the feasibility of providing subspecialty care via telemedicine for patients with Parkinson's disease residing in a remote community located approximately 130 miles from an academic movement disorders clinic. Study participants were randomized to receive telemedicine care with a movement disorder specialist at the University of Rochester or to receive their usual care. Participants in the telemedicine group received three telemedicine visits over six months. Feasibility, as measured by the completion of telemedicine visits, was the primary outcome measure. Secondary measures were quality of life, patient satisfaction, and clinical outcomes. Ten participants residing in the community were randomized to receive telemedicine care (n = 6) or their usual care (n = 4). Four nursing home patients were assigned to telemedicine. Those receiving telemedicine completed 97% (29 of 30) of their telemedicine visits as scheduled. At the study's conclusion, 13 of 14 study participants opted to receive specialty care via telemedicine. Compared with usual care, those randomized to telemedicine had significant improvements in quality of life (3.4 point improvement vs. 10.3 point worsening on the Parkinson's Disease Questionnaire 39; P = 0.04) and motor performance (0.3 point improvement vs. 6.5 point worsening on the Unified Parkinson's Disease Rating Scale, motor subscale; P = 0.03). Relative to baseline, nursing home patients experienced trends toward improvement in quality of life and patient satisfaction. Providing subspecialty care via telemedicine for individuals with Parkinson's disease living remotely is feasible.

Recent scholarship suggests the importance of school district offices in supporting reform. These studies provide strategies for building relations between central offices and sites in order to improve change efforts. However, what is frequently overlooked is that organizational reform efforts are socially constructed. Therefore, examining the underlying reform-related social networks may provide insight into how relational structures support or constrain efforts at reform. This longitudinal case study draws upon social network analysis and interviews to examine the reform-related knowledge, advice, and innovation network structures of central office and site leaders in a district facing sanction for underperformance and engaging a districtwide reform. Findings indicate that over time, the networks increased the number of superficial interactions, and more frequent exchanges remained unchanged, resulting in a centralized network structure.

The federal No Child Left Behind Act and previous performance-based accountability policies are based on a theoretical assumption that sanctions will motivate school staff to perform at higher levels and focus attention on student outcomes. Using data from Chicago, this article draws on expectancy and incentive theories to examine whether motivation levels changed as a result of accountability policies and the policy mechanisms that affected teacher motivation. Through a combination of qualitative and quantitative data, the authors found that the value teachers placed on their professional status and their goals for students focused and increased their effort, but low morale had the potential to undercut the sustainability of teachers’ responses.

Author Biographies: Kara S. Finnigan is an associate professor of educational policy at the Warner School of Education of the University of Rochester. Finnigan's research focuses on accountability policies, organizational learning, district reform, social network analysis, and school choice, with an emphasis on urban contexts. Alan J. Daly is an associate professor at the University of California, San Diego. His research interests include urban district reform, accountability policy, and organizational change examined through the intersection of social network and learning theories.