Teachers' classroom feedback: still trying to get it right

This article examines feedback traditionally given by teachers in schools. Such feedback tends to focus on children's acquisition and retrieval of externally prescribed knowledge which is then assessed against mandated tests. It suggests that, from a sociocultural learning perspective, feedback directed towards such objectives may limit children's social development. In this article, I draw on observation and interview data gathered from a group of 27 9- to 10-year olds in a UK primary school. These data illustrate the children's perceived need to conform to, rather than negotiate, the teacher's feedback comments. They highlight the children's sense that the teacher's feedback relates to school learning but not to their own interests. The article also includes alternative examples of feedback which draw on children's own inquiries and which relate to the social contexts within which, and for whom, they act. It concludes by suggesting that instead of looking for the right answer to the question of what makes teachers' feedback effective in our current classrooms, a more productive question might be how a negotiation can be opened up among teachers and learners themselves, about how teachers' feedback could support children's learning most appropriately

Incidence, prevalence and care of type 1 diabetes in children and adolescents in Germany: Time trends and regional socioeconomic situation

Background: Trends over time and possible socio-spatial inequalities in the incidence and care of type 1 diabetes mellitus (T1D) in children and adolescents are important parameters for the planning of target-specific treatment structures. Methodology: The incidence and prevalence of type 1 diabetes, diabetic ketoacidosis and severe hypoglycaemia as well as the HbA1c value are presented for under 18-year-olds based on data from the nationwide Diabetes Prospective Follow-up Registry (DPV) and the diabetes registry of North Rhine-Westphalia. Indicators were mapped by sex over time between 2014 and 2020, and stratified by sex, age and regional socioeconomic deprivation for 2020. Results: In 2020, the incidence was 29.2 per 100,000 person-years and the prevalence was 235.5 per 100,000 persons, with the figures being higher in boys than in girls in either case. The median HbA1c value was 7.5%. Ketoacidosis manifested in 3.4% of treated children and adolescents, significantly more often in regions with very high (4.5%) deprivation than in regions with very low deprivation (2.4%). The proportion of severe hypoglycaemia cases was 3.0%. Between 2014 and 2020, the incidence, prevalence and HbA1c levels changed little, while the proportions of ketoacidosis and severe hypoglycaemia decreased. Conclusions: The decrease in acute complications indicates that type 1 diabetes care has improved. Similar to previous studies, the results suggest an inequality in care by regional socioeconomic situation

Incidence, prevalence and care of type 1 diabetes in children and adolescents in Germany: Time trends and regional socioeconomic situation

Background: Trends over time and possible socio-spatial inequalities in the incidence and care of type 1 diabetes mellitus (T1D) in children and adolescents are important parameters for the planning of target-specific treatment structures. Methodology: The incidence and prevalence of type 1 diabetes, diabetic ketoacidosis and severe hypoglycaemia as well as the HbA1c value are presented for under 18-year-olds based on data from the nationwide Diabetes Prospective Follow-up Registry (DPV) and the diabetes registry of North Rhine-Westphalia. Indicators were mapped by sex over time between 2014 and 2020, and stratified by sex, age and regional socioeconomic deprivation for 2020. Results: In 2020, the incidence was 29.2 per 100,000 person-years and the prevalence was 235.5 per 100,000 persons, with the figures being higher in boys than in girls in either case. The median HbA1c value was 7.5%. Ketoacidosis manifested in 3.4% of treated children and adolescents, significantly more often in regions with very high (4.5%) deprivation than in regions with very low deprivation (2.4%). The proportion of severe hypoglycaemia cases was 3.0%. Between 2014 and 2020, the incidence, prevalence and HbA1c levels changed little, while the proportions of ketoacidosis and severe hypoglycaemia decreased. Conclusions: The decrease in acute complications indicates that type 1 diabetes care has improved. Similar to previous studies, the results suggest an inequality in care by regional socioeconomic situation

Area deprivation and demographic factors associated with diabetes technology use in adults with type 1 diabetes in Germany

IntroductionDiabetes technology improves glycemic control and quality of life for many people with type 1 diabetes (T1D). However, inequalities in access to diabetes technology exist in many countries. In Germany, disparities in technology use have been described in pediatric T1D, but no data for adults are available so far. We therefore aimed to analyze whether demographic factors and area deprivation are associated with technology use in a representative population of adults with T1D.Materials and methodsIn adults with T1D from the German prospective diabetes follow-up registry (DPV), we analyzed the use of continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), and sensor augmented pump therapy (SAP, with and without automated insulin delivery) in 2019-2021 by age group, gender, migration background, and area deprivation using multiple adjusted regression models. Area deprivation, defined as a relative lack of area-based resources, was measured by quintiles of the German index of Multiple Deprivation (GIMD 2015, from Q1, least deprived, to Q5, most deprived districts).ResultsAmong 13,351 adults with T1D, the use of technology decreased significantly with older age: CSII use fell from 56.1% in the 18−<25-year age group to 3.1% in the ≥80-year age group, CGM use from 75.3% to 28.2%, and SAP use from 45.1% to 1.5% (all p for trend <0.001). The use of technology was also significantly higher in women than in men (CSII: 39.2% vs. 27.6%; CGM: 61.9% vs. 58.0%; SAP: 28.7% vs. 19.6%, all p <0.001), and in individuals without migration background than in those with migration background (CSII: 38.8% vs. 27.6%; CGM: 71.1% vs. 61.4%; SAP: 30.5% vs. 21.3%, all p <0.001). Associations with area deprivation were not linear: the use of each technology decreased only from Q2 to Q4.DiscussionOur real-world data provide evidence that higher age, male gender, and migration background are currently associated with lower use of diabetes technology in adults with T1D in Germany. Associations with area deprivation are more complex, probably due to correlations with other factors, like the higher proportion of migrants in less deprived areas or the federal structure of the German health care system

Cataract in children and adolescents with type 1 diabetes. Insights from the German/Austrian DPV registry

Objective To study diabetic cataract in type 1 diabetes in a large pediatric cohort. Methods The 92,633 patients aged 0.5-21 years from German/Austrian multicenter diabetes registry (DPV) were analyzed. The 235 patients (0.25%) with diabetic cataract were found, 200 could be categorized: 67 with early cataract (3 months before diabetes onset - 12 months afterwards), 133 with late cataract (>12 months after diabetes onset). Regression models adjusted for age and gender were used to compare clinical parameters at diabetes onset. Regression models for patients with late cataract were implemented for the total documentation period and additionally adjusted for diabetes duration. Results Rate of cataract development shows a peak at diabetes onset and declines with longer diabetes duration. Patients with cataract showed strong female preponderance. Patients developing early cataract were older at diabetes onset (12.8 years [11.8/13.9] vs. 8.9 [8.9/9.0]; p < 0.001) and showed higher HbA1c than patients without cataract (9.0% [8.55/9.38] vs. 7.6% [7.60/7.61]; p < 0.001). They had lower height-SDS, (-0.22 [-0.48/0.04] vs. 0.25 [0.24/0.26]; p < 0.001), lower weight-SDS (-0.31 [-0.55/-0.08] vs. 0.21 [0.20/0.21]; p < 0.001) and lower BMI-SDS (-0.25 [-0.49/-0.02] vs. 0.12 [0.12/0.13); p = 0.002). Patients with late cataract showed higher HbA1c at diabetes onset (8.35% [8.08/8.62] vs. 8.04% [8.03/8.05]; p = 0.023) and higher mean HbA1c during total documentation period (8.00% [7.62/8.34] vs. 7.62% [7.61/7.63]; p = 0.048). Conclusions Our data confirm known demographic and clinical characteristics of patients developing early cataract. Hyperglycemia-induced osmotic damage to lens fibers at diabetes onset might be the main pathomechanism. Long term glycemic control is associated with cataract development

Connectivity-based parcellation of the thalamus explains specific cognitive and behavioural symptoms in patients with bilateral thalamic infarct

A novel approach based on diffusion tractography was used here to characterise the cortico-thalamic connectivity in two patients, both presenting with an isolated bilateral infarct in the thalamus, but exhibiting partially different cognitive and behavioural profiles. Both patients (G.P. and R.F.) had a pervasive deficit in episodic memory, but only one of them (R.F.) suffered also from a dysexecutive syndrome. Both patients had an MRI scan at 3T, including a T1-weighted volume. Their lesions were manually segmented. T1-volumes were normalised to standard space, and the same transformations were applied to the lesion masks. Nineteen healthy controls underwent a diffusion-tensor imaging (DTI) scan. Their DTI data were normalised to standard space and averaged. An atlas of Brodmann areas was used to parcellate the prefrontal cortex. Probabilistic tractography was used to assess the probability of connection between each voxel of the thalamus and a set of prefrontal areas. The resulting map of corticothalamic connections was superimposed onto the patients' lesion masks, to assess whether the location of the thalamic lesions in R.F. (but not in G. P.) implied connections with prefrontal areas involved in dysexecutive syndromes. In G.P., the lesion fell within areas of the thalamus poorly connected with prefrontal areas, showing only a modest probability of connection with the anterior cingulate cortex (ACC). Conversely, R.F.'s lesion fell within thalamic areas extensively connected with the ACC bilaterally, with the right dorsolateral prefrontal cortex, and with the left supplementary motor area. Despite a similar, bilateral involvement of the thalamus, the use of connectivity-based segmentation clarified that R.F.'s lesions only were located within nuclei highly connected with the prefrontal cortical areas, thus explaining the patient's frontal syndrome. This study confirms that DTI tractography is a useful tool to examine in vivo the effect of focal lesions on interconnectivity brain patterns

Inzidenz, Prävalenz und Versorgung von Typ-1-Diabetes bei Kindern und Jugendlichen in Deutschland: Zeittrends und sozialräumliche Lage

Hintergrund: Zeitliche Trends und mögliche sozialräumliche Ungleichheiten hinsichtlich der Häufigkeit und Versorgung von Typ-1-Diabetes mellitus (T1D) bei Kindern und Jugendlichen sind für die Planung von zielgerechten Behandlungsstrukturen von Bedeutung. Methode: Mit Daten der bundesweiten Diabetes-Patienten-Verlaufsdokumentation (DPV) und des Diabetesregisters in Nordrhein-Westfalen wurden für unter 18-Jährige Inzidenz und Prävalenz des Typ-1-Diabetes sowie HbA1c-Wert, diabetische Ketoazidosen und schwere Hypoglykämien dargestellt. Die Indikatoren wurden im Verlauf zwischen 2014 und 2020 nach Geschlecht und für 2020 stratifiziert nach Geschlecht, Alter und regionaler sozioökonomischer Deprivation abgebildet. Ergebnisse: 2020 betrug die Inzidenz 29,2 pro 100.000 Personenjahre und die Prävalenz 235,5 pro 100.000 Personen, mit jeweils höheren Werten bei Jungen als bei Mädchen. Der HbA1c-Wert betrug im Median 7,5 %. Bei 3,4 % der Behandelten trat eine Ketoazidose auf, signifikant häufiger in Regionen mit sehr hoher (4,5 %) als in Regionen mit sehr niedriger Deprivation (2,4 %). Der Anteil schwerer Hypoglykämien lag bei 3,0 %. Zwischen 2014 und 2020 änderten sich Inzidenz, Prävalenz und HbA1c-Wert kaum, während die Anteile von Ketoazidosen und schweren Hypoglykämien abnahmen. Schlussfolgerungen: Die Abnahme von Akutkomplikationen weist auf eine verbesserte Versorgung des Typ-1-Diabetes hin. Ähnlich wie in früheren Studien deuten die Ergebnisse eine Ungleichheit in der Versorgung nach sozialräumlicher Lage an

Inzidenz, Prävalenz und Versorgung von Typ-1-Diabetes bei Kindern und Jugendlichen in Deutschland: Zeittrends und sozialräumliche Lage

Hintergrund: Zeitliche Trends und mögliche sozialräumliche Ungleichheiten hinsichtlich der Häufigkeit und Versorgung von Typ-1-Diabetes mellitus (T1D) bei Kindern und Jugendlichen sind für die Planung von zielgerechten Behandlungsstrukturen von Bedeutung. Methode: Mit Daten der bundesweiten Diabetes-Patienten-Verlaufsdokumentation (DPV) und des Diabetesregisters in Nordrhein-Westfalen wurden für unter 18-Jährige Inzidenz und Prävalenz des Typ-1-Diabetes sowie HbA1c-Wert, diabetische Ketoazidosen und schwere Hypoglykämien dargestellt. Die Indikatoren wurden im Verlauf zwischen 2014 und 2020 nach Geschlecht und für 2020 stratifiziert nach Geschlecht, Alter und regionaler sozioökonomischer Deprivation abgebildet. Ergebnisse: 2020 betrug die Inzidenz 29,2 pro 100.000 Personenjahre und die Prävalenz 235,5 pro 100.000 Personen, mit jeweils höheren Werten bei Jungen als bei Mädchen. Der HbA1c-Wert betrug im Median 7,5 %. Bei 3,4 % der Behandelten trat eine Ketoazidose auf, signifikant häufiger in Regionen mit sehr hoher (4,5 %) als in Regionen mit sehr niedriger Deprivation (2,4 %). Der Anteil schwerer Hypoglykämien lag bei 3,0 %. Zwischen 2014 und 2020 änderten sich Inzidenz, Prävalenz und HbA1c-Wert kaum, während die Anteile von Ketoazidosen und schweren Hypoglykämien abnahmen. Schlussfolgerungen: Die Abnahme von Akutkomplikationen weist auf eine verbesserte Versorgung des Typ-1-Diabetes hin. Ähnlich wie in früheren Studien deuten die Ergebnisse eine Ungleichheit in der Versorgung nach sozialräumlicher Lage an

High-quality and anti-inflammatory diets and a healthy lifestyle are associated with lower sleep apnea risk

Study Objectives: Most studies on diet and sleep apnea focus on calorie restriction. Here we investigate potential associations between dietary quality (Healthy Eating Index [HEI], Dietary Inflammatory Index [DII]) and overall healthy lifestyle with sleep apnea risk. Methods: National Health and Nutrition Examination Survey data (waves 2005-2008 and 2015-2018; n = 14,210) were used to determine HEI, DII, and their quintiles, with the fifth quintile indicating highest adherence to each dietary construct. A healthy lifestyle score was determined using diet, smoking, alcohol intake, and physical activity level. The STOP-BANG questionnaire was used to define sleep apnea risk. Generalized linear regression models with binomial family and logit link were used to investigate potential associations. The models were adjusted for socioeconomic status, lifestyle factors, and chronic conditions. Results: The prevalence of high sleep apnea risk was 25.1%. Higher DII was positively associated with sleep apnea (odds ratioQuintile 5 vs Quintile 1 = 1.55; 95% confidence interval, 1.24-1.94; P for trend < .001), whereas higher HEI was associated with reduced sleep apnea risk (odds ratioQuintile 5 vs Quintile 1 = 0.72; 95% confidence interval, 0.59-0.88; P for trend = .007). Higher healthy lifestyle score was also associated with decreased odds of sleep apnea (P for trend < .001). There was a significant interaction between healthy lifestyle and sex with sleep apnea risk (P for interaction = .049) whereby females with higher healthy lifestyle scores had a lower risk of sleep apnea compared to males. Conclusions: Higher-quality and anti-inflammatory diets and a healthier overall lifestyle are associated with lower sleep apnea risk. These findings underline the importance of strategies to improve overall diet quality and promote healthy behavior, not just calorie restriction, to reduce sleep apnea risk

Communicating Uncertainty During Public Health Emergency Events:A Systematic Review

To answer the question, "What are the best ways to communicate uncertainties to public audiences, at-risk communities, and stakeholders during public health emergency events?" we conducted a systematic review of published studies, grey literature, and media reports in English and other United Nations (UN) languages: Arabic, Chinese, French, Russian, and Spanish. Almost 11,500 titles and abstracts were scanned of which 46 data-based primary studies were selected, which were classified into four methodological streams: Quantitative-comparison groups; Quantitative-descriptive survey; Qualitative; and Mixed-method and case-study. Study characteristics (study method, country, emergency type, emergency phase, at-risk population) and study findings (in narrative form) were extracted from individual studies. The findings were synthesized within methodological streams and evaluated for certainty and confidence. These within-method findings were next synthesized across methodological streams to develop an overarching synthesis of findings. The findings showed that country coverage focused on high and middle-income countries in Asia, Europe, North America, and Oceania, and the event most covered was infectious disease followed by flood and earthquake. The findings also showed that uncertainty during public health emergency events is a multi-faceted concept with multiple components (e.g., event occurrence, personal and family safety, recovery efforts). There is universal agreement, with some exceptions, that communication to the public should include explicit information about event uncertainties, and this information must be consistent and presented in an easy to understand format. Additionally, uncertainty related to events requires a distinction between uncertainty information and uncertainty experience. At-risk populations experience event uncertainty in the context of many other uncertainties they are already experiencing in their lives due to poverty. Experts, policymakers, healthcare workers, and other stakeholders experience event uncertainty and misunderstand some uncertainty information (e.g., event probabilities) similar to the public. Media professionals provide event coverage under conditions of contradictory and inconsistent event information that can heighten uncertainty experience for all