From an historical and sociological perspective, ‘integrated care’ has emerged as part of institutional efforts to break up professional fiefdoms, especially of subspecialists entrenched in hospitals, and to reorganise services around clinically integrated pathways and services for the patients. It was the more enlightened part of what I have called the ‘buyers’ revolt’, which occurred in the 1980s when those who had long paid the bills (insurers, governments, employers) became so fed up by the waste, excesses, and variability of services delivered under professional dominance that they started to take forceful action w1x. This book is a masterpiece of historical work and organisational analysis of that revolt at its centre, the San Francisco Bay area.

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Institutional change and healthcare organizations: from professional dominance to managed care

https://link.springer.com/content/pdf/10.1057%2Fpalgrave.ap.5500015.pdf

The Macro Polity

Devolution and Choice in Education, the School, the State and the Market

Hierarchical Linear Models: Applications and Data Analysis Methods.Anthony S. Bryk , Stephen W. Raudenbush

This article provides a comprehensive summary of the English-language research and scholarship on homeschooling, organized into the categories of demographics, curriculum, academic achievement, socialization, law, relationships with public schools, transition to college/adulthood, and international homeschooling. The 351 texts used in this review were culled from virtually the entire universe of English-language academic texts on the topic—more than 1,400 in total. Scholarship was evaluated using three primary criteria: quality of scholarship, significance or influence, and distinctiveness of insight. This review sought to answer the following questions: What primary topics or themes are addressed in the literature? How effective are the methodology and analysis performed? What does the research reveal about homeschooling, and what questions remain unanswered?

/pdf/homeschooling-a-comprehensive-survey-of-the-research-47t73viubx.pdf

Homeschooling: A Comprehensive Survey of the Research

Cyber and home school charter schools have silently become a prominent part of the charter school movement. These alternative school models differ from conventional schools by relying on parents an...

Cyber and Home School Charter Schools: Adopting Policy to New Forms of Public Schooling

Recent findings show that students attending charter schools in the United States achieve at comparable or lower levels to those enrolled in regular public schools, perhaps due to uneven quality and disparities in the levels of resources acquired by charter schools. But little is known as to what state and local factors contribute to disparate levels of resources in the charter school sector. This article examines how local context, the charter school’s organizational form, and state policies may influence material and human resources obtained by charter schools and their capacity to innovate. We find marked differences among charter schools situated in different US states in terms of teacher qualities, student–staff ratios, length of the school day, and the propensity to unionize, drawing on data from the US Schools and Staffing Survey for the 1999/2000 school year. Charter schools rely less on uncredentialed teachers in states that more tightly regulate the sector, and state spending is associated with ...

Disparities in Charter School Resources--The Influence of State Policy and Community.

CHARTER SCHOOLS have become a significant movement in public education. Over the past decade, both the popularity of the reform and the number of charter schools founded have grown dramatically. Student enrollments increased by 130% from 1999 to 2003. (1) At present, an estimated 3,600 charter schools serve one million students in 41 states. (2) The rapid growth of charter schools has encouraged innovation and adaptability and facilitated the emergence of new models of schooling. Foremost among these are cyber charter schools. It is tempting to dismiss cyber charter schools as a trivial byproduct of a larger charter school movement. But preliminary analysis suggests the existence of a substantial demand for nonclassroom-based learning, especially among families frustrated by the stringent requirements of public education. In 2004, an estimated 68,000 students were enrolled in nonclassroom-based charter schools, accounting for 10% of the total charter school population. (3) Two primary forms of nonclassroom-based charter schools have emerged. Home-school charter schools closely mirror private home schools. Parents serve as the primary education authority and are responsible for keeping track of attendance, determining the length of the school day, setting curriculum goals, and monitoring peer interactions, student progress, and student achievement. (4) In contrast, cyber charter schools rely primarily on computer-based learning provided either in real time or through prepackaged lessons created by a third-party curriculum provider. Student performance is evaluated by the school, but family cooperation is required. Both organizational models have attracted large numbers of formerly home-schooled students. For example, approximately 60% of all Pennsylvania cyber charter students were formerly home schooled. (5) One reason for the appeal of cyber charters to this segment of the population is that state and local oversight of nonclassroom-based charters is minimal. A second reason is that teachers are expected to act as education consultants and to defer to parents' decisions in managing the processes of teaching and learning. When we consider that about 1.1 million students are home schooled each year, (6) it is clear that enrollment in cyber charter schools has the potential to increase dramatically. However, it is unclear whether cyber charter schools will be allowed to continue to operate as they are currently set up. Cyber charter schools have resulted from loosely defined charter school laws that have failed to explicitly identify permissible teaching and learning strategies. (7) As interest in charters has grown, policy makers have begun to question whether these schooling models go too far in defining what is both innovative and permissible within a public school system. Four distinct characteristics that separate cyber charters from traditional "brick-and-mortar" schools are at issue. 1. Learning occurs primarily outside of a classroom and often in isolation from peers. 2. Instruction is delivered through an alternative medium, usually a computer. 3. Schools enroll students who did not previously attend public schools, especially home-schoolers. 4. Schools do not conform to district enrollment lines and can draw students from across a given state. Combined, these four characteristics challenge current accountability structures and reduce oversight within public schooling. The difficulty of governing cyber charter schools has been demonstrated by several high-profile scandals. In Pennsylvania, more than 200 school districts refused to forward per-pupil funding allotments to the state's largest cyber charter, TEACH-Einstein Charter Academy, for failing to provide services and materials, including computers, Internet access, and learning materials. (8) The school's eventual closure affected over 2,500 students. In response to such events, legislatures in several states have begun adopting new policies aimed at strengthening oversight of cyber charter schools. …

Cyber Charter Schools: Can Accountability Keep Pace with Innovation?:

Perspectives on Cyber and Homeschool Charters


 Introduction Breast cancer (BC) is the most frequent neoplasm in Colombia, with mortality rate increasing in past decade. The expected 5-year overall survival (OS) is < 80%, being the Latin American country with the worst prognosis. 2 factors related to this are higher frequency of advanced stages and higher frequency of aggressive tumor subtypes.Neoadjuvant chemotherapy (NACT), and ypCR, have demonstrated impact on the risk of relapse and death. This trial describes the characteristics, treatment patterns, clinical outcomes, and ypCR after NACT in a cohort of Colombian BC patients.
 Methods We included BC adult patients treated with NACT in 3 institutions in Colombia. Clinical, sociodemographic, and outcome variables were retrieved retrospectively from clinical charts. Univariate, bivariate and time-to-event analyses were performed. A partition survival tree was performed to explore interactions between variables. Statistical analyses were done in R software.The protocol was approved by the IRC and EC of Fundación Cardioinfantil and Hospital Militar Central.
 Results We included 312 patients treated between 2013 and 2019. 50.9% were ER and/or PgR positive, 28.5% HER2 positive and 20.5% triple negative breast cancer (TNBC). 75.9% of the patients had a LABC. TNBC patients were younger (median age 46 years), premenopausal (58%), had higher Ki67 index (Ki67 ≥ 20%= 91%), and a higher tumor grade (Grade 3= 56.7%). Most of the patients (91.7%), received Doxorubicin + Cyclophosphamide, and Taxanes (97.8%), 76.6% of TNBC patients received Carboplatin. Breast conserving surgery was performed in 53.7% of the patients, and only 38.9% received immediate breast reconstruction. 88.5% of the patients were treated with adjuvant radiotherapy. The ypCR rate was 34.6% and was achieved more frequently in HER2 positive subtype. The ypCR rates in TBNC were higher in patients treated with carboplatin (55% vs 20%, p=0.02). Other factors related to ypCR were high Ki67 (p= 0.0005) and higher tumor grade (p= 0.0034). Most of the relapses were distant (14.1%), with only 1.9% of local relapse rate. Table No 1 summarizes clinical outcomes. With a median follow up of 4.9 years, the 5 year OS was 88.2%. Clinical stage at diagnosis (p= 0.01); node involvement (p= 0.0014); ER (p= 0.0032); PgR (p= 0.0069); HER2 (p= 0.0334); phenotype (p=0.0145); type of surgery (p< 0.0001); ypCR (p=0.003); and relapse (p= < 0.00001) were related with OS. We did not found differences in the 5 year OS between stage II and III patients (87.8% vs 88%). The 5 year OS did not differ between ypCR and ypCR-IS (94.2% vs 93%). The relapse rate was 3.7% in ypCR vs 22.1% in non ypCR patients (p< 0.00001). The 5 year OS rate was 94.3% for ypCR and 85% for non ypCR patients (p= 0.0059). When analyzed by phenotype, ypCR was only related to risk of death among TNBC (p= 0.011). We perform a partition survival tree, identifying 6 subgroups with different OS behaviors: TNBC and non TBNC; low proliferative and high proliferative; early stage and locally advanced stage.
 Discussion We found an increased number of LABC. The ypCR rate was higher than described elsewhere, explained by higher proportion of TNBC and HER2 enriched tumors and differences in treatment selection in subgroups. In the TNBC subgroup the use of carboplatin was associated with higher ypCR. ypCR was related with risk of death and relapse, but with statistical significance for OS only in the TNBC population. This study offers a baseline characteristic of NACT BC cohort, that will allow us to design and implement strategies to improve outcomes in early and LABC.
 Table 1: Treatment outcomes by phenotype.
 Citation Format: William Mantilla, Maria-Fernanda Gonzalez, Sebastian Rojas, Mariana Borras-Osorio, Nicolas Molano-Gonzalez, Joaquin Guerra, Isabel Munevar, Diego Moran. Pathological complete response (ypCR) in early and locally advanced breast cancer (LABC) patients treated with neoadjuvant chemotherapy in a middle-income country. Results from a real-world historical cohort. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-06-03.

Abstract P4-06-03: Pathological complete response (ypCR) in early and locally advanced breast cancer (LABC) patients treated with neoadjuvant chemotherapy in a middle-income country. Results from a real-world historical cohort

Maria-Fernanda Gonzalez

Papers

Cyber and Home School Charter Schools: Adopting Policy to New Forms of Public Schooling

Disparities in Charter School Resources--The Influence of State Policy and Community.

Cyber Charter Schools: Can Accountability Keep Pace with Innovation?:

Perspectives on Cyber and Homeschool Charters

Abstract P4-06-03: Pathological complete response (ypCR) in early and locally advanced breast cancer (LABC) patients treated with neoadjuvant chemotherapy in a middle-income country. Results from a real-world historical cohort