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The Massachusetts Department of Secondary and Elementary Education (DESE) has implemented an Educator Evaluation Framework that requires MCAS scores be used as a significant indicator of teacher effectiveness when available. This decision has implications for thousands of Massachusetts public school teachers. To date, DESE has not provided evidence to support the validity of using MCAS scores to make interpretations about teacher effectiveness. A review of the literature reveals much variation in the degree to which teachers use state-adopted content standards to plan instruction. The findings in the literature warrant investigation into teacher practice among Massachusetts public school teachers. The research questions for this study will be: 1.) Are there variations in the degree to which Massachusetts public school teachers use the Curriculum Frameworks to plan Math instruction?; and 2.) Is MCAS as an instrument sensitive enough to reflect variations in teacher practice in the student’s scores? A survey of Massachusetts public school principals and Math teachers, grades three through eight, investigated the research questions. Survey results revealed that Massachusetts teachers use the Curriculum Frameworks to plan instruction to varying degrees. Survey results also suggest a lack of relationship between teacher practice related to the use of the Curriculum Frameworks and student MCAS scores. These findings suggest MCAS scores may not be an appropriate indicator of teacher effectiveness; however, there are limitations to the study that require further investigation into these questions.

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Technological innovations have lead to the development of Wearable Physiological Monitoring devices, that have enabled researchers and clinicians in real-time monitoring of physiologic function within a field setting. However, it is important to establish the psychometric properties of a device prior to its utilization. A systematic review was conducted to provide a summary and appraise the quality of the literature on psychometric parameters of Zephyr Bioharness and Fitbit devices. Based on this review, we addressed the current gaps in the literature regarding the reliability parameters of Zephyr Bioharness and Fitbit Charge devices, and established the validity and agreement properties of Fitbit Charge device. For our systematic review, we searched the Google Scholar and PubMed databases to identify articles. To establish the reliability, validity and agreement parameters of Zephyr Bioharness and Fitbit Charge devices, a convenience and snowball sampling approaches were used to recruit sixty participants (30 females) from university student, staff, faculty population, and MacSeniors Community Program at McMaster University. The performance of Zephyr and Fitbit devices were assessed throughout three phases; rest, Modified Canadian Aerobic Fitness Test and recovery. In our study, at rest, inter-session average heart rate (beats/min.) ICCs (SEM) for Zephyr and Fitbit ranged from 0.90 – 0.94 (1.73 – 2.37) and 0.88 – 0.94 (1.83 – 2.67) respectively. At mCAFT, the Zephyr ICCs (SEM) ranged from 0.91 – 0.97 (3.12 – 4.64) and 0.85 – 0.98 (3.28 – 4.88) for the Fitbit. Throughout the recovery, the ICCs (SEM) ranged from 0.93 – 0.97 (2.65 – 4.66) and 0.76 – 0.91 (3.17 – 4.67) for Zephyr and Fitbit devices respectively. Pearson’s correlation coefficients and (Mean differences) for heart rate variable were 0.97 – 0.99 (-0.60 – 0.02) at Rest, 0.89 – 0.99 (13.51 – 0.62) at submaximal testing and 0.70 – 0.84 (-0.54 – 2.52) throughout recovery. The average agreement bias of heart rate in pair-wise device comparison indicated mean differences of -0.20, 4.00 and 1.00 at rest, sub-maximal testing and recovery respectively. We identified fair to very good quality evidence from 14 studies. The Zephyr Bioharness and Fitbit Charge devices demonstrated excellent reliability measures, and the Fitbit Charge device heart rate variable demonstrated strong to very strong correlations when concurrently compared with Zephyr, and provided valuable information regarding its interchangeable use in a sample of sixty healthy male and female participants of various age groups during a resting, standardized submaximal fitness and recovery phases. / Thesis / Master of Science (MSc)

PhD Thesis / Background: Overcrowding in emergency departments (EDs) due to avoidable visits places a significant strain on health systems. There is no known valid classification to identify avoidable ED visits in Canadian administrative data. Research Questions: Which physician interventions and patient characteristics are important to classify avoidable ED visits, and does a novel classification (the Emergency Department Avoidability Classification; EDAC), which incorporated these features, demonstrate validity? Methods: Two independent modified Delphi consensus studies determined ED physician interventions and patient characteristics that classified avoidable ED visits. These studies involved emergency and family medicine physicians across Ontario, Canada. Binary logistic regression was used to examine ED physician interventions in the National Ambulatory Care Reporting System (NACRS) database for associations with patient characteristics. These results constructed the EDAC criteria. ED physicians from an academic hospital evaluated randomly selected retrospective ED visits (n=320) which were also evaluated using the EDAC to assess their avoidability. The primary outcome of this thesis was correlation between the classification and ED physician judgements, measured using a Spearman rank correlation and ordinal logistic regression. The secondary outcome was to compare the correlations of previously published classifications with ED physician judgements. The tertiary outcome was to compare prevalence estimates of avoidable ED visits for all classifications. Results: Consensus showed strong evidence on 146 of 150 (97.3%) ED physician interventions, with 103 (68.7%) deemed suitable for non-ED care. Consensus was established on eight of nine patient characteristics, with four characteristics identified as useful in specifying avoidable ED visits: age (18-70 years), triage acuity (non-emergent), specialist consult in the ED (none) and ED visit outcome (discharged). An adjusted retrospective cohort study found the ED interventions had a strong association with patient characteristics determined in the consensus study: not aged over 65 years, having a non-emergent triage acuity and not being admitted to hospital. The classification was highly correlated with ED physician judgements (r=0.64, p<0.01), with a significant association to classify avoidable ED visits (OR=80.0, 95% CI=17.1-374.9) and strong accuracy (82.8%). The EDAC was the most accurate classifier of avoidable ED visits compared to previously published classifications. The EDAC identified a prevalence of 25.1% ED visits as avoidable and common patient conditions associated with such visits as traumatic injuries, symptoms/signs/abnormal findings, diseases of the musculoskeletal system, mental and behavioural disorders, and diseases of the respiratory system. Conclusion: My thesis developed and established the EDAC as an accurate classifier of avoidable ED visits with supporting evidence of validity and superior performance to previously published classifications. The EDAC can be easily integrated with administrative ED data and has strong potential for use in defining avoidable ED visits by health policy stakeholders. / Thesis / Doctor of Philosophy (PhD)

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