Health-related quality of life in patients with pain related to depression (Results from UK subsample of the European Finder study)

Objectives: To estimate the health-related quality of life (HRQOL) and impact of concurrent pain on HRQOL in patients seeking treatment for depression in a 6 month observational study in the United Kingdom (subsample results from pan-European study).Methodology: HRQOL was measured using two generic quality of life instruments: the Short Form 36 Health Status Survey (SF-36) and the EuroQol (EQ-5D). Pain was assessed using a visual analogue scale (range 0-100, no/mild pain [NMP] 0-29, clinically significant pain ?30).Results: 608 eligible patients were enrolled, mean age 42.8 years (SD 14.7) and 61.2% were female. 49.4% of patients reported NMP; 10.8% had significant pain from a co-morbid medical condition known to cause pain (PMC) and 39.8% had significant pain associated with a medical disorder not known to cause pain or without further co-morbidity (PD). SF-36 physical component scores were lowest in the PMC group, 36.7 (SD 9.7); with improving scores in the PD group, 44.4 (SD 10.0) and the NMP group, 54.5 (SD 8.3). There was no marked variation in mental component summary scores between the groups; 23.0 (SD 8.5), 20.4 (SD 9.1) and 21.7 (SD 10.8) respectively. A similar trend in HRQOL loss was observed for the EQ-5D health state index, where scores of 0.30 (SD 0.32), 0.41 (SD 0.30) and 0.60 (SD 0.25) were observed respectively.Conclusions: A high proportion of patients presented with pain presumably related to depression. The presence of concurrent pain appears to be associated with reductions in SF-36 physical component scores and overall HRQOL (EQ-5D)

Computing Teachers' Perspectives on Threshold Concepts: Functions and Procedural Abstraction

With the introduction of the new computing curriculum in England, teachers are facing many challenges, among them the teaching of computer programming. Literature suggests that the conceptual understanding of this subject contributes to its difficulty and that threshold concepts, as a source of troublesome knowledge, have a significant role in this. This paper explores computing teachers' perspectives on the Threshold Concept framework and suggests potential threshold concepts in the area of Functions and, more generally, in Procedural Abstraction. A study was conducted, using the Delphi method, including both computing teachers with experience teaching at upper secondary/high school and computing teachers with experience practicing programming in a professional environment for more than 7 years. The results indicate that the majority of the participants support that the Threshold Concept framework can explain students' difficulties in programming and agreed on 11 potential threshold concepts in the area of Functions and Procedural Abstraction. The participants focused more on the troublesome characteristic of threshold concepts and less on the transformative and integrative. Most of the participants also specified that they would change the way they teach a concept if they knew that this is a threshold one. Finally, the paper discusses the findings and how these will shape our future research

Bioavailability and Preliminary Clinical Efficacy of Intrarectal Artesunate in Ghanaian Children with Moderate Malaria

We report the first detailed pharmacokinetic assessment of intrarectal (i.r.) artesunate (ARS) in African children. Artesunate was given intravenously (i.v.; 2.4 mg/kg of body weight) and i.r. (10 or 20 mg/kg formulated as 50- or 200-mg suppositories [Rectocaps]) in a crossover study design to 34 Ghanaian children with moderate falciparum malaria. The median relative bioavailability of dihydroartemisinin (DHA), the active antimalarial metabolite of ARS, was higher in the low-dose i.r. group (10 mg/kg) than in the high-dose i.r. group (20 mg/kg) (58 versus 23%; P = 0.018). There was wide interpatient variation in the area under the concentration-time curve after i.r. ARS administration (up to 9-fold in the high-dose group and 20-fold in the low-dose group). i.r. administered ARS was more rapidly absorbed in the low-dose group than the high-dose group (median [range] absorption half-lives, 0.7 h [0.3 to 1.24 h] versus 1.1 h [0.6 to 2.7 h] [P = 0.023]. i.r. administered ARS was eliminated with a median (range) half-life of 0.8 h (0.4 to 2.7 h) (low-dose group and 0.9 h (0.1 to 2.5 h) (high-dose group) (P = 1). The fractional clearances of DHA were 3.9, 2.6, and 1.5 liters/kg/h for the 20-mg/kg, 10-mg/kg and i.v. groups, respectively (P = 0.001 and P = 0.06 for the high-and low-dose i.r. groups compared with the i.v. groups, respectively). The median volumes of distribution for DHA were 1.5 liters kg (20 mg/kg, i.r. group), 1.8 liters/kg (10 mg/kg, i.r. group), and 0.6 liters/kg (i.v. group) (P < 0.05 for both i.r. groups compared with the i.v. group). Parasite clearance kinetics were comparable in all treatment groups. i.r. administered ARS may be a useful alternative to parenterally administered ARS in the management of moderate childhood malaria and should be studied further

Threshold concepts and certainty: a critical analysis of ‘troublesomeness’

The threshold concept framework is a key contemporary theory in pedagogy. The core idea is that ‘threshold concepts’ are distinctively ‘troublesome’ for students and act as gatekeepers to their disciplines. No doubt the theory is compelling because there is surely something right about this. Student difficulty with conceptual material is familiar to all teaching practitioners. Furthermore, to avoid rote levels of understanding, mastery of discipline-specific conceptual material is key. However, TCF has struggled to articulate key dimensions of its theory: it is without a methodology for identifying threshold concepts. It has also faltered in explaining how student difficulty is a function of difficulties endemic to the concepts, rather than as a contingent phenomenon about individual students. I offer a novel way to think about identifying threshold concepts, and for theorising student difficulties which may arise from those concepts. I argue that there is an ‘existential’ kind of certainty which acts as a framework within which epistemic activities take place. Disciplines which theorise concepts in ways that clash with students’ existential certainties are candidates for threshold concepts and may generate ‘objective’ difficulties for students. As much as I think theorising existential certainty helps TCF overcome theoretical challenges, it would require revisions to the way that it is currently being theorised and applied. I also believe that even without attachments to TCF, ‘existential certainty’ is a real phenomenon, shaping the very possibilities of student experience, and which any pedagogical theory should be aware of