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Evaluations of public programs in many fields reveal that different types of programs— or different versions of the same program—vary in their effectiveness. Moreover, a program that is effective for one group of people might not be effective for other groups, and a program that is effective in one set of circumstances may not be effective in other circumstances. This paper presents a conceptual framework for research on such variation in program effects and the sources of this variation. The framework is intended to help researchers—both those who focus mainly on studying program implementation and those who focus mainly on estimating program effects—see how their respective pieces fit together in a way that helps to identify factors that explain variation in program effects, and thereby support more systematic data collection. The ultimate goal of the framework is to enable researchers to offer better guidance to policymakers and program operators on the conditions and practices that are associated with larger and more positive effects. © 2014 by the Association for Public Policy Analysis and Management.

Nationwide, graduation rates at community colleges are discouragingly low. This randomized experiment provides evidence that graduation rates can be increased dramatically. The City University of New York’s (CUNY) Accelerated Study in Associate Programs (ASAP) is a comprehensive, integrated, 3-year program that has an estimated 18 percentage point effect on 3-year graduation rates, increases 6-year graduation rates by an estimated 10 percentage points, and helps students graduate more quickly. Graduation effect estimates of this magnitude are exceptional in randomized experiments conducted in higher education, offering hope of what is possible when serving low-income students.

Most community college students are referred to developmental education courses to build basic skills. These students often struggle in these courses and college more broadly. CUNY Start is a prematriculation program for students assessed as having significant remedial needs. CUNY Start students delay matriculation for one semester and receive time-intensive instruction in math, reading, and writing with a prescribed pedagogy delivered by trained teachers. The program aims to help students complete remediation and prepare for college-level courses. This article describes the results of an experiment at four community colleges (n ~ 3,800). We estimate that over 3 years, including one semester that students spent in the program and two-and-a-half years after the program was complete, CUNY Start substantially increased college readiness, slightly increased credit accumulation, and modestly increased graduation rates (by increasing participation in CUNY's highly effective Accelerated Study in Associate Programs [ASAP]).

Community colleges play a vital role in postsecondary education, enrolling more than one in every three postsecondary students. While their importance has grown over the past 50 years, their students' success rates remain low. Consequently, community college stakeholders are searching with mounting urgency for approaches that increase students' success rates. \"Learning communities\" are one popular strategy. This article describes the results of one of the largest (n ≈ 7,000) independent randomized trials in higher education history—an evaluation of the effectiveness of learning communities for students in developmental education at six community colleges throughout the United States. The estimated overall average effects of learning communities are positive, although quite modest.

Background Atrial fibrillation (AF) occurs in about 27% to 40% of post cardiac surgery patients. AF following coronary artery bypass graft surgery (CABG) is associated with a two-fold increase in morbidity and mortality. Various demographic risk factors and medications have been studied to predict the occurrence of this arrhythmia. The role of angiotensin related medications on the occurrence of AF in CABG patients is not determined. Methods Retrospective clinical and statistical analysis was made of all the patients who had undergone CABG surgery at Lehigh Valley Hospital during the years 2005 and 2006. Patients with chronic AF and those undergoing valvular surgery with CABG were excluded. Statistic analysis included chi-square test for categorical and student t-test for continuous variables. Results 757 patients (560 males and 197 females) were studied. AF occurred in 19% of the patients. Age (70.5 vs. 65.1, p < 0.005. OR per year of age: 1.02, 95%CI: 1.018-1.023) and presence of hypertension (OR: 1.92, 95%CI: 1.086-3.140, p = 0.025) were significantly associated with occurrence of AF. Neither ARBs (OR: 0.78, 95%CI: 0.431-1.410, p = 0.41) nor ACE inhibitors (OR: 1.01, 95%CI: 0.753-1.608, p = 0.63) reduced the occurrence of post operative AF. Patients with post operative AF had a significantly longer hospital stay (9.5 +/- 5.4 days vs. 6.9 +/- 4.3 days, p = 0.001). Conclusions Advanced age and presence of hypertension were independent predictors of post-CABG AF. Patients with post operative AF had significantly longer hospital stay. Neither ARBs nor ACE inhibitors were associated with reduction of post-surgical AF. Further studies are needed to better delineate the role of angiotensin related medications on reduction of post-surgical AF.

The Institute of Medicine, the American Society of Clinical Oncology, and the European Society of Medical Oncology promote a multidisciplinary approach for the treatment of cancer. Stage III non-small-cell lung cancer (NSCLC) represents a heterogeneous group of diseases necessitating coordination of care among medical, radiation, and surgical oncology. The optimal care of stage III NSCLC underscores the need for a multidisciplinary approach. From tumor registry data, we identified all cases of stage III NSCLC seen at Lehigh Valley Health Network between March 2010 and March 2013. The care received by patients when seen in the thoracic multidisciplinary clinic (MDC) was compared with the care received when not seen in the thoracic MDC. All patients seen in the MDC, compared to <50% of patients seen outside the MDC, were evaluated by more than one physician prior to beginning the treatment. Time to initiate treatment was shorter in MDC patients than in non-MDC patients. Patients seen in the MDC had a greater concordance with clinical pathways. A greater percentage of patients seen in the thoracic MDC had pathologic staging of their mediastinum. Patients seen in the MDC were more likely to receive all of their care at Lehigh Valley Health Network. Multidisciplinary care is essential in the treatment of patients with stage III NSCLC. Greater utilization of MDCs for this complex group of patients will result in more efficient coordination of care, pretreatment evaluation, and therapy, which in turn should translate to improve patients' outcomes.

While homophobia is commonly characterized as individual and personal prejudice, this collection of essays instead explores homophobia as a transnational political phenomenon. Contributors theorize homophobia as a distinct configuration of repressive state-sponsored policies and practices with their own causes, explanations, and effects on how sexualities are understood and experienced in a range of national contexts. The essays include a broad range of geographic cases, including Cameroon, Ecuador, Iran, Lebanon, Poland, Singapore, and the United States.

Background Immunotherapy in the treatment of metastatic melanoma and renal cell carcinoma can produce durable therapeutic responses, which may improve survival. We aimed to identify clinical characteristics and biomarkers associated with response to high-dose interleukin-2 therapy (IL-2) in patients with metastatic melanoma and renal cell carcinoma treated at an academic community hospital. Patients/Methods We retrospectively analyzed clinical variables and biomarkers of 50 consecutive metastatic melanoma or renal cell carcinoma patients treated at our institution with IL-2 during 2004 – 2012. We evaluated clinical characteristics: metastatic sites of disease, prior therapies, number of IL-2 doses per cycle, response duration, autoimmune phenomena, and peak fever, as well as laboratory biomarkers: baseline LDH, platelet nadir, and baseline and highest absolute lymphocyte count (ALC). Survival outcomes were calculated using Kaplan-Meier curves. Results Variables differing between responders (clinical benefit group) and non-responders (no clinical benefit group) in metastatic melanoma included platelet nadir during treatment (p = 0.015), autoimmune phenomena (p = 0.049), and in renal cell carcinoma, platelet nadir (p = 0.026). There were no significant differences between number of doses of IL-2 received per cycle and response in either cancer subtype. Clinical benefit occurred in 25% of patients (9/36) when IL-2 was given as first-line therapy. Median overall survival for the clinical benefit group from the initiation of IL-2 to death or last follow-up was 61 months versus 17 months for the no clinical benefit group (p < 0.001) for metastatic melanoma. In renal cell carcinoma overall survival for clinical benefit patients was 48 months versus 17 months. No treatment-related deaths occurred. Conclusions High-dose IL-2 can be safely administered by an experienced team in a non–intensive care oncology unit. The clinical benefit group developed autoimmune phenomena (melanoma patients), lower platelet nadir, and on average, received the same number of IL-2 doses as the no clinical benefit group, suggesting a response relationship to the patient’s baseline immune status. Further investigation of immune predictors of response may be useful to select appropriate patients for this therapy.

As test-based educational accountability has moved to the forefront of national and state education policy, so has the desire for better measures of school performance. No Child Left Behind’s (NCLB) status and safe harbor measures have been criticized for being unfair and unreliable, respectively. In response to such criticism, in 2005 the federal government announced the Growth Model Pilot Program, which permits states to useprojection models(a type of growth model) in their accountability systems. This article uses historical longitudinal data from a large school district to empirically show the inaccuracy of one state’s projection model, to demonstrate how projection models are very similar to NCLB’s original status measure, and to contrast projection models with value-added models. As policy makers debate the reauthorization of NCLB, this research can provide guidance on ways to improve the current measurement of school performance.