Process Issues and Research Needs. Abstract. In light of the current policy context, early childhood educators are being asked to have a complex understanding of child development and early education issues and provide rich, meaningful educational experiences for all children and families in their care. Accountability for outcomes is high, and resources for professional support are limited. As such, the early education field needs well- conducted empirical studies on which to base professional development practices. In this paper, we offer research directions associated with the processes underlying professional development, including areas in need of investigation that can inform the early childhood education field in terms of how professional development efforts exert their influence and produce meaningful change in practitioners’ skills, behaviors, and dispositions. The paper highlights representative research from the professional development literature on its various forms/approaches and offers an agenda for research on the professional development process. Broad issues associated with the conduct of research on professional development, including considerations of professional development processes, participant characteristics, relationships, and sustainability are discussed. VARIABLE-FREQUENCY DRIVE A viable-frequency drive is an electronic controller that adjusts the speed of an electric motor by modulating the power being delivered. Variable-frequency drives provide continuous control, matching. GNU BASH shell reference manual. Readable online or optionally download in a variety of formats. The knowledge, skills, and practices of early childhood educators are important factors in determining how much a young child learns and how prepared that child is for entry into school. Early childhood educators are being asked to have deeper understandings of child development and early education issues; provide richer educational experiences for all children, including those who are vulnerable and disadvantaged; engage children of varying abilities and backgrounds; connect with a diverse array of families; and do so with greater demands for accountability and in some cases, fewer resources, than ever before. The importance of understanding the qualities of early childhood educators that contribute to optimal child learning and development has been heightened in recent years with the passage of the No Child Left Behind Act of 2. In probability and statistics, a Bernoulli process is a finite or infinite sequence of binary random variables, so it is a discrete-time stochastic process that takes only two values, canonically 0 and 1. Psychology Course Description E f f e c t i v e F a l l 2 0 1 3 AP Course Descriptions are updated regularly. Please visit AP Central Assumptions, Goals, and Objectives of Professional Development. At the surface, “professional development” in early childhood programs refers to a number of experiences that promote the education, training, and. PL 1. 07–1. 10) and its complement in early childhood policy, Good Start, Grow Smart. In this early childhood initiative, early learning guidelines serve as a framework for practice and assessment, and individuals caring for children are required to meet certain educational qualifications and receive professional development to enhance their abilities to support young children’s learning. Indeed, the professional development of practicing early childhood educators is considered critical to the quality of experiences afforded to children (Martinez- Beck & Zaslow, 2. In the face of increased attention to early childhood professional development in the practice and policy communities, there is a concomitant need for empirical efforts to examine what works for whom, within which contexts, and at what cost (Welch- Ross, Wolf, Moorehouse, & Rathgeb, 2. Research on early childhood professional development must go beyond basic questions that address caregiver characteristics (e. Rather, establishing a scientific endeavor of early childhood professional development requires building a body of theories and evidence about not only its forms (i. The early childhood field is at a place where professional development practice and craft knowledge require a larger and firmer platform of theoretical and empirical expertise, in order to guide planning and implementation of the ambitious kinds of school and child care reforms that are demanded in the current era of services expansion and accountability. Indeed, the field is acquiring a body of findings about the effects of various forms, levels, and organizations of professional development on early childhood educators’ knowledge base and skill sets (e. However, we need to know more about the dynamic and transactional teaching and learning processes underlying these effects as they function in real- world early childhood settings. For example, we need findings documenting personal theories of change, supportive relationships among participants, and practitioner acceptance/resistance to change. IBM SPSS predictive analytics software provides statistical analysis/reporting, predictive modeling, data mining, decision management/deployment, and big data analytics. Fundamentals of Control v . Precise control of level, temperature, pressure and flow is important in many. We are even farther behind in building a solid body of empirical information on the indirect but essential influence of professional development on child and family outcomes. The purpose of this paper is to offer important research directions associated with the processes underlying professional development – that is, areas in need of investigation that can inform the early childhood education field in terms of how professional development efforts exert their influence and produce meaningful change in practitioners’ skills, behaviors, and dispositions - - as compared to a meta- analysis or comprehensive review of the research literature on the effects of specific forms that professional development takes. We will start by articulating the assumptions, goals and objectives of professional development activities; and defining the forms common to early childhood professional development. This will be followed by a process research agenda that will allow us to unpack some critical features operating in the complex task of developing and promoting effective practice. Assumptions, Goals, and Objectives of Professional Development. At the surface, “professional development” in early childhood programs refers to a number of experiences that promote the education, training, and development opportunities for early childhood practitioners who do or will work with young children birth to age 8 years and their families. In this vein, professional development applies to a full range of activities that attempt to increase the knowledge base, skill set, or attitudinal perspectives brought to bear as a practitioner engages in home- visiting, parent education, child care, preschool education and/or kindergarten to third grade teaching or educational support services (Harvard Family Research Project, 2. Its ultimate, long- term goal is to facilitate the acquisition of specific learning and social- emotional competencies in young children, and in many cases, to promote important family- specific attitudes or abilities to support children’s learning and development. In other words, the desired long- term, indirect outcomes of all early childhood professional development initiatives involve enhancing children’s learning across cognitive, communicative, social- emotional, and behavioral domains (Guskey, 2. In a more immediate sense, professional development in early childhood takes place to accomplish two primary objectives. First, is it anticipated that professional development will advance the knowledge, skills, dispositions, and practices of early childhood providers in their efforts to educate children and support families. A second objective is to promote a culture for ongoing professional growth in individuals and systems (Candy, 1. Johnson & Johnson, 1. The first objective concerns the advancement of practitioner knowledge, skills, and dispositions (Katz, 1. Practitioner knowledge consists of facts, concepts, ideas, vocabulary, and related aspects of educational culture and best practice. Skills consist of units of action that occur in a relatively discrete period of time and that are observable or easily inferred. They are learned through direct instruction, modeling and imitation, trial and error, discovery, or other methods, and they are modified or improved through feedback, guidance, practice, repetition, drill, and continuous use. Finally, dispositions are prevailing tendencies to exhibit a pattern of behavior frequently, consciously, and voluntarily. The pattern of behavior is directed to a broad goal, rather than a limited short- term purpose. Dispositions are distinguished from skills in being broader in scope and including a motivation to be applied and put to use (in contrast, one can have a skill but no desire to use it). Benefits of professional development efforts that target knowledge, skills and dispositions may be expected in teachers’ interactions with children or families; teachers’ efforts to structure meaningful learning environments in the home or classroom; teachers’ use of specific curricula or teaching strategies for a particular group of children; or teachers’ use of a host of other specific behaviors or meaningful targets. The second objective of early childhood professional development involves sustaining high quality professional practices by enhancing systems and individuals to engage in activities that are self- sustaining and growth- producing. This involves ensuring that the responsibility for delivering effective services and facilitating ongoing growth and development among practitioners is transferred from a formal trainer (coach, consultant, group facilitator) to individuals and groups of professionals within early childhood settings. Imparting an ethic of responsibility for sustaining quality and ongoing growth and learning in practitioners first involves efforts to help individuals develop the skills and dispositions for self- regulated professional growth (Fleet & Patterson, 2. Paris & Winograd, 1. Riley & Roach, 2. Initially, professional development is expected to be an “outside- in” process wherein the information necessary for behavior change or professional growth comes from external authorities, imparted through lectures, readings, demonstrations, and verbal advice from peers, supervisors, coaches, or consultants. Later, however, professional development ideally progresses to becoming an “inside- out” process where individuals retain responsibility to direct their own ongoing growth and improvement through continued study of current and best practice and reflective personal goal- setting in collaboration with respected colleagues (Helm, 2. Wesley & Buysse, 2. Form and Process in Professional Development for Early Childhood Practitioners. ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. Intraoperative Considerations. Anesthetic Considerations: Recommendations. Class IAnesthetic management directed toward early postoperative extubation and accelerated recovery of low- to medium- risk patients undergoing uncomplicated CABG is recommended. Level of Evidence: B)Multidisciplinary efforts are indicated to ensure an optimal level of analgesia and patient comfort throughout the perioperative period. Level of Evidence: B)Efforts are recommended to improve interdisciplinary communication and patient safety in the perioperative environment (eg, formalized checklist- guided multidisciplinary communication). Level of Evidence: B)A fellowship- trained cardiac anesthesiologist (or experienced board- certified practitioner) credentialed in the use of perioperative transesophageal echocardiography (TEE) is recommended to provide or supervise anesthetic care of patients who are considered to be at high risk. Level of Evidence: C)Class IIa. Volatile anesthetic- based regimens can be useful in facilitating early extubation and reducing patient recall. Level of Evidence: A)Class IIb. The effectiveness of high thoracic epidural anesthesia/analgesia for routine analgesic use is uncertain. Level of Evidence: B)Class III: HARMCyclooxygenase- 2 inhibitors are not recommended for pain relief in the postoperative period after CABG. Level of Evidence: B)Routine use of early extubation strategies in facilities with limited backup for airway emergencies or advanced respiratory support is potentially harmful. Historically, the popularity of several anesthetic techniques for CABG has varied on the basis of their known or potential adverse cardiovascular effects (eg, cardiovascular depression with high doses of volatile anesthesia, lack of such depression with high- dose opioids, or coronary vasodilation and concern for a “steal” phenomenon with isoflurane) as well as concerns about interactions with preoperative medications (eg, cardiovascular depression with beta blockers or hypotension with angiotensin- converting enzyme . Independent of these concerns, efforts to improve outcomes and to reduce costs have led to shorter periods of postoperative mechanical ventilation and even, in some patients, to prompt extubation in the operating room (“accelerated recovery protocols” or “fast- track management”). High- dose opioid anesthesia with benzodiazepine supplementation was used commonly in CABG patients in the United States in the 1. Subsequently, it became clear that volatile anesthetics are protective in the setting of myocardial ischemia and reperfusion, and this, in combination with a shift to accelerated recovery or “fast- track” strategies, led to their ubiquitous use. As a result, opioids have been relegated to an adjuvant role. Despite their widespread use, volatile anesthetics have not been shown to provide a mortality rate advantage when compared with other intravenous regimens (Section 2. Optimal anesthesia care in CABG patients should include 1) a careful preoperative evaluation and treatment of modifiable risk factors; 2) proper handling of all medications given preoperatively (Sections 4. Attention should be directed at preventing or minimizing adverse hemodynamic and hormonal alterations that may induce myocardial ischemia or exert a deleterious effect on myocardial metabolism (as may occur during cardiopulmonary bypass . This requires close interaction between the anesthesiologist and surgeon, particularly when manipulation of the heart or great vessels is likely to induce hemodynamic instability. During on- pump CABG, particular care is required during vascular cannulation and weaning from CPB; with off- pump CABG, the hemodynamic alterations often caused by displacement or verticalization of the heart and application of stabilizer devices on the epicardium, with resultant changes in heart rate, cardiac output, and systemic vascular resistance, should be monitored carefully and managed appropriately. In the United States, nearly all patients undergoing CABG receive general anesthesia with endotracheal intubation utilizing volatile halogenated general anesthetics with opioid supplementation. Intravenous benzodiazepines often are given as premedication or for induction of anesthesia, along with other agents such as propofol or etomidate. Nondepolarizing neuromuscular- blocking agents, particularly nonvagolytic agents with intermediate duration of action, are preferred to the longer- acting agent, pancuronium. Use of the latter is associated with higher intraoperative heart rates and a higher incidence of residual neuromuscular depression in the early postoperative period, with a resultant delay in extubation. In addition, low concentrations of volatile anesthetic usually are administered via the venous oxygenator during CPB, facilitating amnesia and reducing systemic vascular resistance. Outside the United States, alternative anesthetic techniques, particularly total intravenous anesthesia via propofol and opioid infusions with benzodiazepine supplementation with or without high thoracic epidural anesthesia, are commonly used. The use of high thoracic epidural anesthesia exerts salutary effects on the coronary circulation as well as myocardial and pulmonary function, attenuates the stress response, and provides prolonged postoperative analgesia. In the United States, however, concerns about the potential for neuraxial bleeding (particularly in the setting of heparinization, platelet inhibitors, and CPB- induced thrombocytopenia), local anesthetic toxicity, and logistical issues related to the timing of epidural catheter insertion and management have resulted in limited use of these techniques. Their selective use in patients with severe pulmonary dysfunction (Section 6. Although meta- analyses of randomized controlled trials (RCTs) of high thoracic epidural anesthesia/analgesia in CABG patients (particularly on- pump) have yielded inconsistent results on morbidity and mortality rates, it does appear to reduce time to extubation, pain, and pulmonary complications. Of interest, although none of the RCTs have reported the occurrence of epidural hematoma or abscess, these entities occur on occasion. Finally, the use of other regional anesthetic approaches for postoperative analgesia, such as parasternal block, has been reported. Over the past decade, early extubation strategies (“fast- track” anesthesia) often have been used in low- to medium- risk CABG patients. These strategies allow a shorter time to extubation, a decreased length of intensive care unit (ICU) stay, and variable effects on length of hospital stay. Immediate extubation in the operating room, with or without markedly accelerated postoperative recovery pathways (eg, “ultra- fast- tracking,” “rapid recovery protocol,” “short- stay intensive care”) have been used safely, with low rates of reintubation and no influence on quality of life. Observational data suggest that physician judgment in triaging lower- risk patients to early or immediate extubation works well, with rates of reintubation < 1%. Certain factors appear to predict fast- track “failure,” including previous cardiac surgery, use of intra- aortic balloon counterpulsation, and possibly advanced patient age. Provision of adequate perioperative analgesia is important in enhancing patient mobilization, preventing pulmonary complications, and improving the patient's psychological well- being. The intraoperative use of high- dose morphine (4. The safety of nonsteroidal anti- inflammatory agents for analgesia is controversial, with greater evidence for adverse cardiovascular events with the selective cyclooxygenase- 2 inhibitors than the nonselective agents. A 2. 00. 7 AHA Scientific statement presented a stepped- care approach to the management of musculoskeletal pain in patients with or at risk for coronary artery disease (CAD), with the goal of limiting the use of these agents to patients in whom safer therapies fail. In patients hospitalized with unstable angina (UA) and non–ST- elevation myocardial infarction (NSTEMI), these agents should be discontinued promptly and reinstituted later according to the stepped- care approach. In the setting of cardiac surgery, nonsteroidal anti- inflammatory agents previously were used for perioperative analgesia. A meta- analysis of 2. Subsequently, 2 RCTs, both studying the oral cyclooxygenase- 2 inhibitor valdecoxib and its intravenous prodrug, parecoxib, reported a higher incidence of sternal infections in 1 trial and a significant increase in adverse cardiovascular events in the other. On the basis of the results of these 2 studies (as well as other nonsurgical reports of increased risk with cyclooxygenase- 2–selective agents), the U. S. Food and Drug Administration in 2. CABG. 5. 0 The concurrent administration of ibuprofen with aspirin has been shown to attenuate the latter's inhibition of platelet aggregation, likely because of competitive inhibition of cyclooxygenase at the platelet- receptor binding site. Observational analyses in patients undergoing noncardiac surgery have shown a significant reduction in perioperative death with the use of checklists, multidisciplinary surgical care, intraoperative time- outs, postsurgical debriefings, and other communication strategies. Such methodology is being used increasingly in CABG patients. In contrast to extensive literature on the role of the surgeon in determining outcomes with CABG, limited data on the influence of the anesthesiologist are available. Of 2 such reports from single centers in the 1. Cardiac anesthesiologists, in collaboration with cardiologists and surgeons, have implemented national training and certification processes for practitioners in the use of perioperative TEE (Section 2. Accreditation of cardiothoracic anesthesia fellowship programs from the Accreditation Council for Graduate Medical Education was initiated in 2.
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