Nationally, the problem of teacher retention compounds the unstable nature of the educational situation, especially in urban, high-needs schools. Much of the instability of urban schools is due to teacher movement, the migration of teachers from school to another school within or between school districts, particularly from high-needs schools. Existing quantitative research about teacher movement cites working conditions generally as an area for improvement; however, the voices of teachers and details about their experiences are missing from the existing body of research. This qualitative study, situated in an approach of Appreciative Inquiry, was conducted in one small high school district that serves a mid-sized city in Southern California. This school district consisted of four high schools with the following variables : two comprehensive schools with higher percentages of students of color and lower socio-economic status; one comprehensive school with lower percentages of students of color and higher socio-economic status; and one continuation school with higher percentages of students of color and lower socio-economic status. Using similar representation from each high school, there are many individual variables concerning the fifteen participants : the variety of race and gender; the wide range in years of experience and the number of previous school sites of employment; and, the representation of many academic departments. Participants identified the working conditions and support most influential to them. The following are the findings based on their input, listed in order of significance : colleague support, professional development, district hiring practices, site administrator support, district office support, autonomy, teaching assignments, workplace culture, personal satisfaction, communication, respect, and teacher induction support. Implications regarding the employment of working conditions by school district personnel and school site administrators to increase teacher retention are discussed in chapter five. These implications include (a) the creation of a respectful workplace culture, (b) the utilization of communication with teachers, the provision of individualized and site-based support for novice teachers, (c) the distribution of an equitable schedule of classes to all teachers, (d) the implementation of information-rich hiring practices, (e) the emphasis of the focus on student learning, and (f) the presentation of constructive feedback about instructional practices to promote professional growth of teachers

Importance

Coenzyme Q10 (CoQ10), an antioxidant that supports mitochondrial function, has been shown in preclinical Parkinson disease (PD) models to reduce the loss of dopamine neurons, and was safe and well tolerated in early-phase human studies. A previous phase II study suggested possible clinical benefit.

Objective

To examine whether CoQ10 could slow disease progression in early PD.

Design, setting, and participants

A phase III randomized, placebo-controlled, double-blind clinical trial at 67 North American sites consisting of participants 30 years of age or older who received a diagnosis of PD within 5 years and who had the following inclusion criteria: the presence of a rest tremor, bradykinesia, and rigidity; a modified Hoehn and Yahr stage of 2.5 or less; and no anticipated need for dopaminergic therapy within 3 months. Exclusion criteria included the use of any PD medication within 60 days, the use of any symptomatic PD medication for more than 90 days, atypical or drug-induced parkinsonism, a Unified Parkinson's Disease Rating Scale (UPDRS) rest tremor score of 3 or greater for any limb, a Mini-Mental State Examination score of 25 or less, a history of stroke, the use of certain supplements, and substantial recent exposure to CoQ10. Of 696 participants screened, 78 were found to be ineligible, and 18 declined participation.

Interventions

The remaining 600 participants were randomly assigned to receive placebo, 1200 mg/d of CoQ10, or 2400 mg/d of CoQ10; all participants received 1200 IU/d of vitamin E.

Main outcomes and measures

Participants were observed for 16 months or until a disability requiring dopaminergic treatment. The prospectively defined primary outcome measure was the change in total UPDRS score (Parts I-III) from baseline to final visit. The study was powered to detect a 3-point difference between an active treatment and placebo.

Results

The baseline characteristics of the participants were well balanced, the mean age was 62.5 years, 66% of participants were male, and the mean baseline total UPDRS score was 22.7. A total of 267 participants required treatment (94 received placebo, 87 received 1200 mg/d of CoQ10, and 86 received 2400 mg/d of CoQ10), and 65 participants (29 who received placebo, 19 who received 1200 mg/d of CoQ10, and 17 who received 2400 mg/d of CoQ10) withdrew prematurely. Treatments were well tolerated with no safety concerns. The study was terminated after a prespecified futility criterion was reached. At study termination, both active treatment groups showed slight adverse trends relative to placebo. Adjusted mean changes (worsening) in total UPDRS scores from baseline to final visit were 6.9 points (placebo), 7.5 points (1200 mg/d of CoQ10; P = .49 relative to placebo), and 8.0 points (2400 mg/d of CoQ10; P = .21 relative to placebo).

Conclusions and relevance

Coenzyme Q10 was safe and well tolerated in this population, but showed no evidence of clinical benefit.

Trial registration

clinicaltrials.gov Identifier: NCT00740714.