Skip to main content
eScholarship
Open Access Publications from the University of California

Scholarly Works (18 results)

  • Thesis
  • Peer Reviewed
UC Berkeley Electronic Theses and Dissertations (2016)

Science education reform efforts stress the importance of engaging students in authentic inquiry practices to promote the development of self-sufficient and independent learning skills. Independent learners are able to accurately evaluate their own understanding and make informed decisions that can productively advance their learning. The ability to assess one’s own thinking to identify and address weaknesses or gaps in understanding is especially critical for successful learning, during which new information must be integrated with existing prior ideas, experiences and knowledge. The design-based research discussed in this dissertation investigates the impact of an inquiry instructional model that utilizes explanation and reflection as metacognitive learning scaffolds to promote more reflective and self-directed independent learning through choice-making. A choice-based inquiry instructional model allows for more flexible instruction by offering customizable, student-determined inquiry paths that can adapt to and provide support for learners with different starting levels of prior knowledge and experiences.

The dissertation consists of two separate but intersecting components. The first section of the document details my research work on the iterative design, development, pilot testing and refinement of Investigating Seasons, a web-based online inquiry curriculum unit for high school students. Seasons incorporates multiple dynamic visualizations and extensive instructional scaffolding to support students in collecting, evaluating, making sense of and integrating their diverse ideas for explaining seasonal temperature changes. Dynamic visualizations embedded within the curriculum function as critical learning opportunities for students to encounter important normative ideas and test their pre-existing beliefs. Supporting instructional scaffolds promoting explanation and reflection encourage students to monitor, evaluate and refine their changing repertoire of ideas as they proceed through the unit. Carefully designed curricular materials can help to guide students in reconciling their ideas from multiple sources towards formulating a more coherent and normative explanation for seasons. In addition, the use of instructional technologies such as dynamic visualizations (i.e., student-driven scientific models designed for learning) can provide students with interactive opportunities for conducting “hands-on” inquiry investigations that encourage the reflection upon and revision of conceptual understandings.

The second part of the dissertation presents the collective findings from two classroom comparison studies (choice versus no-choice) that I conducted to investigate the effect of a learner-directed, choice-guided model of inquiry on students’ conceptual learning and understanding about the seasons. Both studies were implemented using the iteratively refined Investigating Seasons curriculum unit and visualizations. Study results indicate that the two conditions benefited equally from instruction, regardless of condition. However, a consistent trend was seen of students in the choice group exhibiting possibly greater learning benefits across a number of different outcome measures (this trend was not observed for the no-choice students). These study findings, taken together with the known motivational and affective advantages of choice already documented in the literature, provide a promising indication of the instructional value of choice for supporting students in pursuing reflective, independent and unique inquiry learning trajectories.

    Cover page: Designing Technology-Enhanced Science Inquiry Instruction to Scaffold Student Choice Through Explanation and Reflection
    • Article
    • Peer Reviewed
    UC San Francisco Previously Published Works (2023)

    Background

    Successful transitions of care require communication between inpatient and outpatient physicians. The discharge summary is the main communication tool used by physicians during these transitions.

    Objective

    With the goal of improving care transitions, we explored primary care physicians (PCPs) perspectives on characteristics of high-quality discharge summaries.

    Design

    We conducted semi-structured individual interviews in this qualitative study and surveyed participants for sociodemographic characteristics.

    Participants

    PCPs were recruited from multiple health systems in California.

    Approach

    An interview guide was created by the study authors to solicit PCPs' experiences with discharge summaries and perspectives on four discharge summary templates previously used by large health systems. Interviews were transcribed verbatim and qualitative data were analyzed interactively through thematic analysis.

    Key results

    Twenty PCPs participated in interviews lasting an average of 35 min (range 26-47 min). Sixty percent were female. Most (70%) had trained in internal medicine (IM); 5% had trained in both IM and pediatrics and 25% in family medicine. Some (45%) participants practiced both inpatient and outpatient medicine; 55% had exclusively outpatient practices. Half worked in university-affiliated clinics, 15% community clinics, 15% public health clinics, 5% private practice, and 15% multiple clinic types. Many PCPs (65%) had been in practice for ≥ 10 years. Participants reported multiple concerns with typical discharge summaries, including frustration with lengthy documents containing information irrelevant to outpatient care. Suggested recommendations included beginning the discharge summary with action items, clear identification of incidental findings requiring follow-up, specifying reasons for any medication changes, and including dates for treatment regimens rather than expected duration of treatment. Participants highlighted the importance of feedback to trainees to assist in crafting succinct discharge summaries containing relevant information.

    Conclusion

    Clinical training programs and healthcare systems must optimize discharge summaries for PCPs to achieve goals of providing high-quality care that improves population health.
      Creative Commons 'BY' version 4.0 license
      • Article
      • Peer Reviewed
      UC Berkeley Previously Published Works (2020)
      With the widespread adoption of the Next Generation Science Standards (NGSS), science teachers and online learning environments face the challenge of evaluating students' integration of different dimensions of science learning. Recent advances in representation learning in natural language processing have proven effective across many natural language processing tasks, but a rigorous evaluation of the relative merits of these methods for scoring complex constructed response formative assessments has not previously been carried out. We present a detailed empirical investigation of feature-based, recurrent neural network, and pre-trained transformer models on scoring content in real-world formative assessment data. We demonstrate that recent neural methods can rival or exceed the performance of feature-based methods. We also provide evidence that different classes of neural models take advantage of different learning cues, and pre-trained transformer models may be more robust to spurious, dataset-specific learning cues, better reflecting scoring rubrics.
        • Article
        • Peer Reviewed
        UC Irvine Previously Published Works (2017)

        Context

        Augmented uterine artery (UA) production of vasodilators, including nitric oxide (NO) and hydrogen sulfide (H2S), has been implicated in pregnancy-associated and agonist-stimulated rise in uterine blood flow that is rate-limiting to pregnancy health.

        Objective

        Developing a human UA endothelial cell (hUAEC) culture model from main UAs of nonpregnant (NP) and pregnant (P) women for testing a hypothesis that pregnancy augments endothelial NO and H2S production and endothelial reactivity to vascular endothelial growth factor (VEGF).

        Design

        Main UAs from NP and P women were used for developing hUAEC culture models. Comparisons were made between NP- and P-hUAECs in in vitro angiogenesis, activation of cell signaling, expression of endothelial NO synthase (eNOS) and H2S-producing enzymes cystathionine β-synthase (CBS) and cystathionine γ-lyase, and NO/H2S production upon VEGF stimulation.

        Results

        NP- and P-hUAECs displayed a typical cobblestone-like shape in culture and acetylated low-density lipoprotein uptake, stained positively for endothelial and negatively for smooth muscle markers, maintained key signaling proteins during passage, and had statistically significant greater eNOS and CBS proteins in P- vs NP-hUAECs. Treatment with VEGF stimulated in vitro angiogenesis and eNOS protein and NO production only in P-hUEACs and more robust cell signaling in P- vs NP-hUAECs. VEGF stimulated CBS protein expression, accounting for VEGF-stimulated H2S production in hUAECs.

        Conclusion

        Comparisons between NP- and P-hUAECs reveal that pregnancy augments VEGF-stimulated in vitro angiogenesis and NO/H2S production in hUAECs, showing that the newly established hUAEC model provides a critical in vitro tool for understanding human uterine hemodynamics.
          Cover page: Pregnancy Augments VEGF-Stimulated In Vitro Angiogenesis and Vasodilator (NO and H2S) Production in Human Uterine Artery Endothelial Cells.
          • Article
          • Peer Reviewed
          UC Davis Previously Published Works (2024)
          Current models of early human subsistence economies suggest a focus on large mammal hunting. To evaluate this hypothesis, we examine human bone stable isotope chemistry of 24 individuals from the early Holocene sites of Wilamaya Patjxa (9.0-8.7 cal. ka) and Soro Mikaya Patjxa (8.0-6.5 cal. ka) located at 3800 meters above sea level on the Andean Altiplano, Peru. Contrary to expectation, Bayesian mixing models based on the isotope chemistry reveal that plants dominated the diet, comprising 70-95% of the average diet. Paleoethnobotanical data further show that tubers may have been the most prominent subsistence resource. These findings update our understanding of earliest forager economies and the pathway to agricultural economies in the Andean highlands. The findings furthermore suggest that the initial subsistence economies of early human populations adapting to new landscapes may have been more plant oriented than current models suggest.
            Cover page: Stable isotope chemistry reveals plant-dominant diet among early foragers on the Andean Altiplano, 9.0-6.5 cal. ka.
            • Article
            • Peer Reviewed
            UCLA Previously Published Works (2017)
            OBJECTIVES: Homeless adults have low primary care engagement and high emergency department (ED) utilization. Homeless-tailored, patient-centered medical homes (PCMH) decrease this populations acute care use. We studied the feasibility (focused on patient recruitment) and acceptability (conceptualized as clinicians attitudes/beliefs) of a pilot initiative to colocate a homeless-tailored PCMH with an ED. After ED triage, low-acuity patients appropriate for outpatient care were screened for homelessness; homeless patients chose between a colocated PCMH or ED visit. METHODS: To study feasibility, we captured (from May to September 2012) the number of patients screened for homelessness, positive screens, unique patients seen, and primary care visits. We focused on acceptability to ED clinicians (physicians, nurses, social workers); we sent a 32-item survey to ED clinicians (n = 57) who worked during clinic hours. Questions derived from an instrument measuring clinician attitudes toward homeless persons; acceptability of homelessness screening and the clinic itself were also explored. RESULTS: Over the 5 months of interest, 281 patients were screened; 172 (61.2%) screened positive for homelessness; 112 (65.1%) of these positive screens were seen over 215 visits. Acceptability data were obtained from 56% (n = 32) of surveyed clinicians. Attitudes toward homeless patients were similar to prior studies of primary care physicians. Most (54.6%) clinicians agreed with the homelessness screening procedures. Nearly all (90.3%) clinicians supported expansion of the homeless-tailored clinic; a minority (42.0%) agreed that ED colocation worked well. CONCLUSION: Our data suggest the feasibility of recruiting patients to a homeless-tailored primary care clinic colocated with the ED; however, the clinics acceptability was mixed. Future quality improvement work should focus on tailoring the clinic to increase its acceptability among ED clinicians, while assessing its impact on health, housing, and costs.
              Cover page: Feasibility and Acceptability of a Colocated Homeless-Tailored Primary Care Clinic and Emergency Department.
              • Article
              • Peer Reviewed
              UC San Francisco Previously Published Works (2022)

              Background

              Tobacco use is common among persons experiencing homelessness (PEH), and interventions are needed. We conducted a community-based, single-arm uncontrolled trial of a pharmacy-linked intervention for smoking cessation for PEH.

              Methods

              The intervention took place between September 2019 and June 2021 in homeless shelters in San Francisco, CA. We trained shelter staff on how to provide brief cessation counseling, then tested a program among PEH in two shelters that included one-time pharmacist-delivered cessation counseling and nicotine replacement therapy (NRT) for 3 months. We examined factors associated with cigarette consumption and quit attempts.

              Results

              We trained 69 staff from 8 shelters and selected 2 of those shelters as pilot sites for the program. Of the 52 participants, 71% were male and 49% were Black. The majority of participants reported making a quit attempt (70%) and using NRT (84%). Having an encounter with staff in the past week was associated with a 40% reduction in weekly consumption (Incidence rate ratio (IRR) 0.61, 95% CI 0.57-0.67) and using medications in the past week was associated with a 23% reduction in weekly consumption (IRR 0.78, 95% CI 0.75-0.81). Using medications in the past week increased the odds of a quit attempt 2.89 times compared to not using medications (Adjusted odds ratio (AOR), 2.89, 95% CI 1.45-5.77).

              Conclusions

              Our findings highlight a role for leveraging community-based pharmacists to expand smoking cessation services in homeless shelters to reduce tobacco use among PEH.
                Cover page: A community-based tobacco cessation program for individuals experiencing homelessness
                • Article
                • Peer Reviewed
                UC Irvine Previously Published Works (2012)
                Port wine stains (PWS) are the most common vascular malformation of the skin, occurring in 0.3% to 0.5% of the population. Noninvasive laser irradiation with flashlamp-pumped pulsed dye lasers (selective photothermolysis) currently comprises the gold standard treatment of PWS; however, the majority of PWS fail to clear completely after selective photothermolysis. In this review, the clinically used PWS treatment modalities (pulsed dye lasers, alexandrite lasers, neodymium:yttrium-aluminum-garnet lasers, and intense pulsed light) and techniques (combination approaches, multiple passes, and epidermal cooling) are discussed. Retrospective analysis of clinical studies published between 1990 and 2011 was performed to determine therapeutic efficacies for each clinically used modality/technique. In addition, factors that have resulted in the high degree of therapeutic recalcitrance are identified, and emerging experimental treatment strategies are addressed, including the use of photodynamic therapy, immunomodulators, angiogenesis inhibitors, hypobaric pressure, and site-specific pharmaco-laser therapy.
                  Cover page: An overview of clinical and experimental treatment modalities for port wine stainsCreative Commons 'BY' version 4.0 license
                  • Article
                  • Peer Reviewed
                  UCLA Previously Published Works (2023)

                  Objectives

                  To evaluate rapid COVID-19 vaccine clinic implementation from January-April 2021 in the Los Angeles County Department of Health Services (LACDHS), the second-largest US safety net health system. During initial vaccine clinic implementation, LACDHS vaccinated 59,898 outpatients, 69% of whom were Latinx (exceeding the LA County Latinx population of 46%). LACDHS is a unique safety net setting to evaluate rapid vaccine implementation due to system size, geographic breadth, language/racial/ethnic diversity, limited health staffing resources, and socioeconomic complexity of patients.

                  Methods

                  Implementation factors were assessed through semi-structured interviews of staff from all twelve LACDHS vaccine clinics from August-November 2021 using the Consolidated Framework for Implementation Research (CFIR) and themes analyzed using rapid qualitative analysis.

                  Results

                  Of 40 potential participants, 25 health professionals completed an interview (27% clinical providers/medical directors, 23% pharmacist, 15% nursing staff, and 35% other). Qualitative analysis of participant interviews yielded ten narrative themes. Implementation facilitators included bidirectional communication between system leadership and clinics, multidisciplinary leadership and operations teams, expanded use of standing orders, teamwork culture, use of active and passive communication structures, and development of patient-centered engagement strategies. Barriers to implementation included vaccine scarcity, underestimation of resources needed for patient outreach, and numerous process challenges encountered.

                  Conclusion

                  Previous studies focused on robust advance planning as a facilitator and understaffing and high staff turnover as barriers to implementation in safety net health systems. This study found facilitators that can mitigate lack of advance planning and staffing challenges present during public health emergencies such as the COVID-19 pandemic. The ten identified themes may inform future implementations in safety net health systems.
                    Cover page: Evaluation of COVID-19 vaccine implementation in a large safety net health system
                    • Article
                    • Peer Reviewed
                    UC San Francisco Previously Published Works (2024)
                    BACKGROUND: Management of cirrhosis is challenging and has been complicated by the COVID-19 pandemic due to decreased access to care, increased psychological distress, and alcohol misuse. Recently, The National Institute on Alcohol Abuse and Alcoholism has broadened the definition of recovery from alcohol use disorder to include quality of life (QoL) as an indicator of recovery. This study examined the associations of alcohol-associated cirrhosis etiology and problematic drinking with liver disease QoL (LDQoL). METHODS: Patients with cirrhosis (N=329) were recruited from 3 sites (63% from 2 Veterans Affairs Health Care Systems and 37% from 1 safety net hospital) serving populations that are economically or socially marginalized. Cirrhosis etiology was ascertained by chart review of medical records. Problematic drinking was defined by ≥8 on the Alcohol Use Disorders Identification Test. Multivariable general linear modeling adjusting for age, sex, race/ethnicity, site, pandemic-related stress, and history of anxiety/depressive disorder were conducted. Sensitivity analyses further adjusted for indicators of liver disease severity. RESULTS: Participants were on average 64.6 years old, 17% female, 58% non-White, 44% with alcohol-associated cirrhosis, and 17% with problematic drinking. Problematic drinking was significantly associated with worse LDQoL scores in the overall scale and in the memory/concentration and health distress subscales. These associations remained significant after adjusting for indicators of liver disease severity, including Model for End-Stage Liver Disease-Sodium score and decompensated cirrhosis status. CONCLUSIONS: Among patients with cirrhosis, problematic drinking was associated with worse LDQoL, especially in the domains of memory/concentration and health distress. Assessment and awareness of cognitive deficits and negative emotionality within the context of cirrhosis and problematic drinking may help clinicians provide better integrated care for this population.
                      Cover page: Problematic alcohol use and its impact on liver disease quality of life in a multicenter study of patients with cirrhosis.
                      Top