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The labor of teaching assistants (TAs), as full-time students and part-time teachers, faces a "time bind." Although research and teaching together compose graduate school for TAs, through this ethnography of TAing I argue these domains tend toward arrhythmia. Research and teaching engage distinct work rhythms that persistently interrupt one another, rendering individualized, improvisational coordination an organizing principle of TAing. Coordination is complicated by the commitment to research and teaching as meaningful projects. The autonomy to develop a projection of good teaching "responsibilizes" TAs, channeling surplus effort to teaching. I highlight preparatory work like lesson planning as a crucial site through which to understand the competing coordinative and projective pressures of TAing. I close by outlining some implications of arrhythmia for contemporary US higher education and for the sociology of labor. [ABSTRACT FROM AUTHOR]

The twin pressures of dwindling state funding and widening student access has created a crisis of higher education that reverberates into the hidden abode of teaching and learning. In this special issue we reconnect pedagogy to its context of determination (and nondetermination) by bringing theories of the labor process to bear on the dilemmas and challenges faced by teaching assistants (TAs). Our project of auto-ethnography was suspended between two crises—COVID-19 and an unprecedented university-wide strike by graduate students. Elizabeth Torres Carpio advances the idea of the university's "selective recognition" that expands the work of street-level educators -TAs facing increasing numbers of students from economically poor and culturally diverse backgrounds. Natalie Pasquinelli considers the way faculty manage TAs as apprentices through hegemonic "status control." Justin Germain focuses on the autonomy that allows TAs to turn teaching into "innovation games," offering the players a sense of accomplishment. Thomas Gepts examines the "arrhythmic" time bind in which graduate students are caught between commitments to future-oriented research and present-oriented teaching. Margaret Eby shows how the "power of silence" allows TAs to conceal their anxiety and defend their autonomy. The university extracts the labor of TAs by giving them "constrained autonomy" to absorb, divert, and conceal the pressures descending from a top-heavy administrative structure. We extend the idea of "constrained autonomy" to other occupations. [ABSTRACT FROM AUTHOR]

BACKGROUND Despite the large body of literature evaluating interventions to improve hypertension management, few studies have addressed seasonal variation in blood pressure (BP) control. This underreported phenomenon has implications for interpreting study findings and informing clinical care. We share a methodology that accounts for BP seasonality, presented through a case study—HealthyHearts NYC, an intervention aimed at increasing adherence to the Million Hearts BP control evidence-based guidelines in primary care practices. METHODS We used a randomized stepped-wedge design (n = 257 practices). Each intervention included 13 visits from practice facilitators trained in improving practice-level BP control over 12 months. Two models were used to assess the intervention effect—one that did not account for seasonality (model 1) and one that did (model 2). Model 2 was a re-specification of model 1 to include our proposed two fixed-effects terms to address BP seasonality. RESULTS Model 1 showed a significant negative association between the intervention and BP control (IRR = 0.98, 95% CI = 0.96–0.99, P ≤ 0.05). In contrast, Model 2, which did address seasonality, showed no intervention effect on BP control (IRR = 0.99, 95% CI = 0.97–1.01, P = 0.19). CONCLUSIONS These findings reveal that analyses that do not account for BP seasonality may not present an accurate picture of intervention effects. In our case study, accounting for BP seasonality turned a negative association into a null association. We recommend that when evaluating BP control, studies compare outcome measures across similar seasons and that the measurement period last long enough to account for seasonal effects. CLINICAL TRIALS REGISTRATION Trial registration number: NCT02646488. [ABSTRACT FROM AUTHOR]

Introduction: HealthyHearts NYC (HHNYC), a cooperative in the Agency for Healthcare Research and Quality EvidenceNOW initiative, tested the effect of practice facilitation (PF) on practice-level blood pressure (BP) control in 255 small independent practices (SIPs). Few studies of interventions to improve BP control have considered the implications of seasonal variation when analyzing BP outcomes Methods: HHNYC used a cluster randomized stepped-wedge design to test the effect of PF (12 month intervention) on the proportion of patients meeting the Million Hearts BP target (≥70% BP controlled) among SIPs in NYC. BP data were extracted from SIPs' electronic health records. We used Poisson generalized linear mixed-effects models, with repeated measures nested within one of 255 SIPs and randomly varying intercepts across SIPs to assess the intervention effect. We did a second analysis that adapted the Poisson model to include (1) an observation-level random effect to address overdispersion (more variance in the counts than expected for a Poisson distribution) and (2) two terms in the fixed-effects portion of the model to separately contrast quarter one and then quarter three with quarters two and four, to address BP seasonality. Results: The first model found a significant negative association between PF and BP control (i.e., BP control declined) (IRR=0.98, 95% CI=0.96-0.99, p=<.001). In the full model (i.e., addressing seasonal changes) PF had no effect on BP control (IRR = 0.99, 95% CI=0.97-1.0, p=.19). The rate of BP control was significantly lower in quarter one (IRR = 0.97; 95% CI: 0.96-0.98, p<.01) and higher in quarter three (IRR=1.02; 95% CI: 1.01-1.03, p<.01) when compared with quarters two and four. Discussion: Many SIPs already met or exceeded national estimates of BP control and the Million Hearts BP performance target before the intervention, perhaps challenging further improvement without additional patient level intervention components that were not part of HHNYC. BP seasonality has strong study design implications. For stepped-wedge trials, sufficient waves are required to ensure the expected timing of intervention impact is spread evenly over quarters so the seasonality and any intervention impact can be more easily disentangled. [ABSTRACT FROM AUTHOR]