Promoting student success in science: Pulling together relevant frameworks to create inclusive learning environments

As educators, we can agree that a passion for science is developed during the formative years (Hanson, 2009; Murphy & Beggs, 2005) and it is important for elementary teachers to facilitate rich learning experiences that encourage all students to pursue science beyond high school. In this paper I examine the language of science and identify limiting factors (such as the notion of scientific inquiry) that may discourage some inner-city students from actively pursuing science beyond elementary school. I draw upon personal best practices to demonstrate how inclusive and equitable approaches to teaching can bridge the communication gap. I then show culturally relevant and responsive teaching and learning strategies that can be used to reflect upon personal practice and mobilize the inclusiveness and equity that is implicit in science. This results in an effective approach to reflexive teaching, which is suitable for all science educators, as evidenced by practical learning activities that will be demonstrated. Further, university and college professors can use the inclusive approaches shared while working in their community alongside elementary, middle, and high school teachers to more effectively promote science to a wider audience of learners

Maternal Mortality Reimagined: Saving Lives Through Data Transparency, Disaggregation, and Context

Graduate Theoretical Proposa

Ethnographic and functional perspectives of tilapia names among the Ewe of Ghana

Modern methods of rearing tilapia in recent years and the importation of same may have contributed to the increase in the consumption of tilapia in Ghana as a whole, particularly among the Eʋe. Most organisms, including animals and fish, are named but they may not respond to their names as humans do. Observation also shows that consumers of tilapia are mostly conversant with the generic name of the fish and less interested in particularising the different species with their names. This paper seeks to investigate the essence of animal names with particular reference to tilapia among the Eʋe of Ghana. The research questions that are germane to the study are the following: Does the composition of names of tilapia derive from their physical characteristics? What knowledge do the Eʋe have about the names of tilapia and how does their knowledge influence the production, marketing and consumption of tilapia. The paper adopts a descriptive design approach in data collection and analysis. It establishes that the idiosyncrasies and general physical features of tilapia reflect in their naming system. Analysis also reveals that the names are both free and bound morphemes. The data further shows that geographical location, vocation, sex and age dynamics affect knowledge on the names of tilapia. These, to some extent, influence the production, marketing and consumption of the fish. The paper, therefore, concludes that even though organisms may not respond to their names, the names of those organisms such as tilapia are relevant to the people who ascribe these names to them

Sub-optimal cholesterol response to initiation of statins and future risk of cardiovascular disease

Objective:To assess low-density lipoprotein cholesterol (LDL-C) response in patients after initiation of statins, and future risk of CVD.Method:Prospective cohort study of 165,411 primary care patients, from the UK Clinical Practice Research Datalink, who were free from CVD prior to statin initiation, and had at least one pre-treatment LDL-C within 12 months prior to, and one post-treatment LDL-C within 24 months after, statin initiation. Based on current national guidelines, a less than 40% reduction in baseline LDL-cholesterol level within 24 months was classified as sub-optimal statin response. Cox proportional regression and competing-risks survival regression models were used to determine adjusted hazard ratios and sub-hazard ratios for incident CVD outcomes for LDL-C response to statins.Results: 84,609 (51.2%) patients had sub-optimal LDL-cholesterol response to initiated statin therapy within 24 months. During 1,077,299 person-years of follow-up (median follow-up 6.2 years), there were 22,798 CVD events (12,142 in sub-optimal responders and 10,656 in optimal responders). In sub-optimal responders, compared to optimal responders, the hazard ratio (95% CI) for incident CVD was 1.17 (1.13–1.20) and 1.22 (1.19–1.25) after adjusting for age and baseline untreated LDL-cholesterol level. Considering competing risks resulted in lower but similar sub-hazards ratios for both unadjusted 1.13 (1.10–1.16) and adjusted cumulative incidence function, 1.19 (1.16–1.23) of CVD.Conclusions:Optimal lowering of LDL-cholesterol is not achieved within two years in over half of patients in the general population initiated on statin therapy, and these patients will experience significantly increased risk of future cardiovascular disease

Nasal fentanyl alone plus buccal midazolam: an open-label, randomised, controlled feasibility study in the dying

Introduction: Many patients want to stay at home to die. They invariably become unable to take oral medication during their terminal phase. Symptoms are usually controlled by subcutaneous medications. There have been no studies on nasal fentanyl (NF) or buccal midazolam (BM) to control symptoms in the dying.Objective: To establish how best to conduct a definitive, randomised controlled trial (RCT) to determine whether NF and BM administered by families, for patients dying at home, lead to faster and better symptom control and fewer community nursing visits than standard breakthrough medication by healthcare professionals.Methods: This open-label mixed-method feasibility RCT compared the efficacy of NF and BM by family members to standard breakthrough medication by nurses for the terminally ill in a specialist palliative care unit. Partway through the study, a third observational arm was introduced where BM alone was used. The primary outcomes were whether recruitment and randomisation were possible, assessment of withdrawal and drop-out, and whether the methods were acceptable and appropriate.Results: Administration of NF and BM was acceptable to patients and families. Both were well tolerated. We were unable to obtain quality of life data consistently but did get time period data for dose-controlled symptoms.Conclusions: Study participation in a hospice population of the dying was acceptable. The results will help guide future community study planning

Performance and clinical utility of supervised machine-learning approaches in detecting familial hypercholesterolaemia in primary care

Familial hypercholesterolaemia (FH) is a common inherited disorder, causing lifelong elevated low-density lipoprotein cholesterol (LDL-C). Most individuals with FH remain undiagnosed, precluding opportunities to prevent premature heart disease and death. Some machine-learning approaches improve detection of FH in electronic health records, though clinical impact is under-explored. We assessed performance of an array of machine-learning approaches for enhancing detection of FH, and their clinical utility, within a large primary care population. A retrospective cohort study was done using routine primary care clinical records of 4,027,775 individuals from the United Kingdom with total cholesterol measured from 1 January 1999 to 25 June 2019. Predictive accuracy of five common machine-learning algorithms (logistic regression, random forest, gradient boosting machines, neural networks and ensemble learning) were assessed for detecting FH. Predictive accuracy was assessed by area under the receiver operating curves (AUC) and expected vs observed calibration slope; with clinical utility assessed by expected case-review workload and likelihood ratios. There were 7928 incident diagnoses of FH. In addition to known clinical features of FH (raised total cholesterol or LDL-C and family history of premature coronary heart disease), machine-learning (ML) algorithms identified features such as raised triglycerides which reduced the likelihood of FH. Apart from logistic regression (AUC, 0.81), all four other ML approaches had similarly high predictive accuracy (AUC > 0.89). Calibration slope ranged from 0.997 for gradient boosting machines to 1.857 for logistic regression. Among those screened, high probability cases requiring clinical review varied from 0.73% using ensemble learning to 10.16% using deep learning, but with positive predictive values of 15.5% and 2.8% respectively. Ensemble learning exhibited a dominant positive likelihood ratio (45.5) compared to all other ML models (7.0–14.4). Machine-learning models show similar high accuracy in detecting FH, offering opportunities to increase diagnosis. However, the clinical case-finding workload required for yield of cases will differ substantially between models

Does acupressure help reduce nausea and vomiting in palliative care patients? A double blind randomised controlled trial

Introduction: Nausea and vomiting are common symptoms for patients with advanced cancer. While there is evidence for acupuncture point stimulation for treatment of these symptoms for patients having anticancer treatment, there is little for when they are not related to such treatment.Objective: To determine whether acupressure at the pericardium 6 site can help in the treatment of nausea and vomiting suffered by palliative care patients with advanced cancer.Materials and methods: Double blind randomised controlled trial—active versus placebo acupressure wristbands. In-patients with advanced cancer in two specialist palliative care units who fitted either or both of the following criteria were approached: Nausea that was at least moderate; Vomiting daily on average for the prior 3 days.Results: 57 patients were randomised to have either active or placebo acupressure wristbands. There was no difference in any of the outcome measures between the two groups: change from baseline number of vomits; Visual Analogue Scale for ‘did acupressure wristbands help you to feel better?’; total number of as needed doses of antiemetic medication; need for escalation of antiemetics.Conclusions: In contrast to a previously published feasibility study, active acupressure wristbands were no better than placebo for specialist palliative care in-patients with advanced cancer and nausea and vomiting

The Influence of Senior High School Mathematics Teachers’ Demographic Variables on their Self-Efficacy in Teaching

Teachers' self-efficacy is teachers' ideas in their ability to successfully manage the tasks, responsibilities, as well as obstacles associated with their professional activity, plays a crucial role in influencing academic outcomes e.g., students' achievements as well as motivation and wellness in the working environment. The perception students have towards mathematics as a subject is one of the key concerns in educational stakeholder's desire to find a lasting solution to the issue of low grades in the subject and lack of interest in mathematics. Many teachers are reported to dislike, fear, and fail to understand mathematics; this leads to the conclusion that some high school teachers’ negative attitudes toward mathematics negatively affect their mathematics teaching self-efficacy beliefs, which eventually leads to ineffective mathematics instruction. The current study was conducted with the purpose of determining the influence of senior high school mathematics teachers’ demographic variables on their self-efficacy in teaching. The study was anchored on social cognitive theory. After comprehensive review of a number of existing literature, the study found out that majority of the reviewed literature reported that male teachers had significantly stronger self-efficacy views than their female colleagues. Moreover, the outcomes revealed that there was no statistically substantial difference between the means of the 5 teams of teacher mentor experience in regards to teacher efficiency. The research wraps up that teachers' group variables and also perspectives towards mathematics have significant impacts on their self-efficacy in training mathematics. The study hence advises that enhancing mathematics instructor's self-efficacy in instructing the topic is an important necessity that permanent and also potential teachers should be considered for trainees' mathematical success

Comparing the performance of the novel FAMCAT algorithms and established case-finding criteria for familial hypercholesterolaemia in primary care

OBJECTIVE: Familial hypercholesterolaemia (FH) is a common inherited disorder causing premature coronary heart disease (CHD) and death. We have developed the novel Familial Hypercholesterolaemia Case Ascertainment Tool (FAMCAT 1) case-finding algorithm for application in primary care, to improve detection of FH. The performance of this algorithm was further improved by including personal history of premature CHD (FAMCAT 2 algorithm). This study has evaluated their performance, at 95% specificity, to detect genetically confirmed FH in the general population. We also compared these algorithms to established clinical case-finding criteria. METHODS: Prospective validation study, in 14 general practices, recruiting participants from the general adult population with cholesterol documented. For 260 participants with available health records, we determined possible FH cases based on FAMCAT thresholds, Dutch Lipid Clinic Network (DLCN) score, Simon-Broome criteria and recommended cholesterol thresholds (total cholesterol >9.0 mmol/L if ≥30 years or >7.5 mmol/L if <30 years), using clinical data from electronic and manual extraction of patient records and family history questionnaires. The reference standard was genetic testing. We examined detection rate (DR), sensitivity and specificity for each case-finding criteria. RESULTS: At 95% specificity, FAMCAT 1 had a DR of 27.8% (95% CI 12.5% to 50.9%) with sensitivity of 31.2% (95% CI 11.0% to 58.7%); while FAMCAT 2 had a DR of 45.8% (95% CI 27.9% to 64.9%) with sensitivity of 68.8% (95% CI 41.3% to 89.0%). DLCN score ≥6 points yielded a DR of 35.3% (95% CI 17.3% to 58.7%) and sensitivity of 37.5% (95% CI 15.2% to 64.6%). Using recommended cholesterol thresholds resulted in DR of 28.0% (95% CI 14.3% to 47.6%) with sensitivity of 43.8% (95% CI 19.8% to 70.1%). Simon-Broome criteria had lower DR 11.3% (95% CI 6.0% to 20.0%) and specificity 70.9% (95% CI 64.8% to 76.5%) but higher sensitivity of 56.3% (95% CI 29.9% to 80.2%). CONCLUSIONS: In primary care, in patients with cholesterol documented, FAMCAT 2 performs better than other case-finding criteria for detecting genetically confirmed FH, with no prior clinical review required for case finding. TRIAL REGISTRATION NUMBER: NCT03934320

Hip fracture outcomes in patients with COPD

Hip fractures are common in patients with COPD and contemporary outcome data is needed. Patients admitted with a hip fracture to one acute trust (2010-2015) were assessed prospectively (UK National Hip Fracture Database audit) and mortality data collected. Of the 4020 patients, 16.2% had a recorded COPD diagnosis. Mortality was significantly greater in patients with COPD compared to non-COPD: 30-days (12.6% vs 7.8%) and 1-year (35.3% vs 25.3%), both p[less than] 0.001 and remained significant after adjustment (aOR at 1 year 1.44 95% CI1.18 -1.76). There is further excess mortality following a hip fracture in those with COPD