Evidence Briefing: Hospital Associated Deconditioning

Acute illness in older adults that results in hospitalisation can trigger deconditioning and functional decline. Several risk factors, in addition to prolonged bed-rest, account for hospital-associated deconditioning (HAD). Evidence indicates that an integrated, multi-component approach to addressing co-existing risk factors may reduce HAD syndromes as well as hospital length of stay. This approach would include reducing sedentary behaviour, educating and supporting patients to be more mobile, and modifying the hospital environment to facilitate activities based around socialising. Our attached poster summarises the four areas to be addressed in future work: Physical activity. Eating drinking and continence. Promoting recovery. Predictors and measures

Introduction to the Issue: Preparing the Next Generation of Middle School Leaders

The articles in this issue of Current Issues in Middle Level Education are based on a Symposium that did not take place as planned. In May 2020, middle level educators and researchers from across the Southeast and beyond would have gathered in Asheville, NC, for a Symposium sponsored by the Southeast Professors of Middle Level Education (SEPOMLE). Due to COVID-19, however, the in-person Symposium was canceled, and accepted authors were invited to submit manuscripts based on their work for this issue. These articles represent ideas on the Symposium theme of “Preparing the Next Generation of Middle School Leaders.” Across the articles, a theme of connection emerges. This idea of connection is linked to middle level concepts about curriculum and teaching, and it is also linked to a professional goal of meetings like the Symposium to connect with one another, share ideas, and build a community of learners. The idea of connection also relates to our national context and the importance of building bridges and looking forward together: to include diverse voices and perspectives, to connect across distances, to strengthen education. In the words of the late John Lewis, “You must be a headlight, not a taillight.” We thank the authors of these articles for shining light on ways for middle level educators and researchers to connect and to prepare new leaders. SEPOMLE is planning a Symposium in 2021. Please check the website for the National Association of Professors of Middle Level Education (www.napomle.com) for information in the months ahead

Finding qualitative research: an evaluation of search strategies

BACKGROUND: Qualitative research makes an important contribution to our understanding of health and healthcare. However, qualitative evidence can be difficult to search for and identify, and the effectiveness of different types of search strategies is unknown. METHODS: Three search strategies for qualitative research in the example area of support for breast-feeding were evaluated using six electronic bibliographic databases. The strategies were based on using thesaurus terms, free-text terms and broad-based terms. These strategies were combined with recognised search terms for support for breast-feeding previously used in a Cochrane review. For each strategy, we evaluated the recall (potentially relevant records found) and precision (actually relevant records found). RESULTS: A total yield of 7420 potentially relevant records was retrieved by the three strategies combined. Of these, 262 were judged relevant. Using one strategy alone would miss relevant records. The broad-based strategy had the highest recall and the thesaurus strategy the highest precision. Precision was generally poor: 96% of records initially identified as potentially relevant were deemed irrelevant. Searching for qualitative research involves trade-offs between recall and precision. CONCLUSIONS: These findings confirm that strategies that attempt to maximise the number of potentially relevant records found are likely to result in a large number of false positives. The findings also suggest that a range of search terms is required to optimise searching for qualitative evidence. This underlines the problems of current methods for indexing qualitative research in bibliographic databases and indicates where improvements need to be made

The CONSENSUS study: protocol for a mixed methods study to establish which outcomes should be included in a core outcome set for oropharyngeal cancer

BACKGROUND: The incidence of oropharyngeal cancer is increasing in the developed world. This has led to a large rise in research activity and clinical trials in this area, yet there is no consensus on which outcomes should be measured. As a result, the outcomes measured often differ between trials of comparable interventions, making the combination or comparison of results between trials impossible. Outcomes may also be ‘cherry-picked’, such that favourable results are reported, and less favourable results withheld. The development of a minimum outcome reporting standard, known as a core outcome set, goes some way to addressing these problems. Core outcome sets are ideally developed using a patient-centred approach so that the outcomes measured are relevant to patients and clinical practice. Core outcome sets drive up the quality and relevance of research by ensuring that the right outcomes are consistently measured and reported in trials in specific areas of health or healthcare. METHODS/DESIGN: This is a mixed methods study involving three phases to develop a core outcome set for oropharyngeal cancer clinical trials. Firstly, a systematic review will establish which outcomes are measured in published oropharyngeal cancer randomised controlled trials (RCTs). Secondly, qualitative interviews with patients and carers in the UK and the USA will aim to establish which outcomes are important to these stakeholders. Data from these first two stages will be used to develop a comprehensive list of outcomes to be considered for inclusion in the core outcome set. In the third stage, patients and clinicians will participate in an iterative consensus exercise known as a Delphi study to refine the contents of the core outcome set. This protocol lays out the methodology to be implemented in the CONSENSUS study. DISCUSSION: A core outcome set defines a minimum outcome reporting standard for clinical trials in a particular area of health or healthcare. Its consistent implementation in oropharyngeal cancer clinical trials will improve the quality and relevance of research. TRIALS AND REGISTRATION: This study is registered at the National Institute for Health Research (NIHR) Clinical Research Network (CRN) portfolio, ID 13823 (17 January 2013)

Identification and predictability of soil quality indicators from conventional soil and vegetation classifications

The physical, chemical and biological attributes of a soil combined with abiotic factors (e.g. climate and topography) drive pedogenesis and some of these attributes have been used as proxies to soil quality. Thus, we investigated: (1) whether appropriate soil quality indicators (SQIs) could be identified in soils of Great Britain, (2) whether conventional soil classification or aggregate vegetation classes (AVCs) could predict SQIs and (3) to what extent do soil types and/ or AVCs act as major regulators of SQIs. Factor analysis was used to group 20 soil attributes into six SQI which were named as; soil organic matter (SOM), dissolved organic matter (DOM), soluble N, reduced N, microbial biomass, DOM humification (DOMH). SOM was identified as the most important SQI in the discrimination of both soil types and AVCs. Soil attributes constituting highly to the SOM factor were, microbial quotient and bulk density. The SOM indicator discriminated three soil type groupings and four aggregate vegetation class groupings. Among the soil types, only the peat soils were discriminated from other groups while among the AVCs only the heath and bog classes were isolated from others. However, the peat soil and heath and bog AVC were the only groups that were distinctly discriminated from other groups. All other groups heavily overlapped with one another, making it practically impossible to define reference values for each soil type or AVC. The two-way ANOVA showed that the AVCs were a better regulator of the SQIs than the soil types. We conclude that conventionally classified soil types cannot predict the SQIs defined from large areas with differing climatic and edaphic factors. Localised areas with similar climatic and topoedaphic factors may hold promise for the definition of SQI that may predict the soil types or AVCs

Fragmentation and thresholds in hydrological flow‐based ecosystem services

Loss and fragmentation of natural land cover due to expansion of agricultural areas is a global issue. These changes alter the configuration and composition of the landscape, particularly affecting those ecosystem services (benefits people receive from ecosystems) that depend on interactions between landscape components. Hydrological mitigation describes the bundle of ecosystem services provided by landscape features such as woodland that interrupt the flow of runoff to rivers. These services include sediment retention, nutrient retention and mitigation of overland water flow. The position of woodland in the landscape and the landscape topography are both important for hydrological mitigation. Therefore, it is crucial to consider landscape configuration and flow pathways in a spatially explicit manner when examining the impacts of fragmentation. Here we test the effects of landscape configuration using a large number (>7,000) of virtual landscape configurations. We created virtual landscapes of woodland patches within grassland, superimposed onto real topography and stream networks. Woodland patches were generated with user‐defined combinations of patch number and total woodland area, placed randomly in the landscape. The Ecosystem Service model used hydrological routing to map the “mitigated area” upslope of each woodland patch. We found that more fragmented woodland mitigated a greater proportion of the catchment. Larger woodland area also increased mitigation, however, this increase was nonlinear, with a threshold at 50% coverage, above which there was a decline in service provision. This nonlinearity suggests that the benefit of any additional woodland depends on two factors: the level of fragmentation and the existing area of woodland. Edge density (total edge of patches divided by area of catchment) was the best single metric in predicting mitigated area. Distance from woodland to stream was not a significant predictor of mitigation, suggesting that agri‐environment schemes planting riparian woodland should consider additional controls such as the amount of fragmentation in the landscape. These findings highlight the potential benefits of fragmentation to hydrological mitigation services. However, benefits for hydrological services must be balanced against any negative effects of fragmentation or habitat loss on biodiversity and other services

Drug therapy for delirium in terminally ill adult patients.

BACKGROUND: Delirium is a syndrome characterised by a disturbance of consciousness (often fluctuating), cognition and perception. In terminally ill patients it is one of the most common causes of admission to clinical care. Delirium may arise from any number of causes and treatment should be directed at addressing these causes rather than the symptom cluster. In cases where this is not possible, or treatment does not prove successful, the use of drug therapy to manage the symptoms may become necessary. This is an update of the review published on 'Drug therapy for delirium in terminally ill adult patients' in The Cochrane Library 2004, Issue 2 ( Jackson 2004). OBJECTIVES: To evaluate the effectiveness of drug therapies to treat delirium in adult patients in the terminal phase of a disease. SEARCH METHODS: We searched the following sources: CENTRAL (The Cochrane Library 2012, Issue 7), MEDLINE (1966 to 2012), EMBASE (1980 to 2012), CINAHL (1982 to 2012) and PSYCINFO (1990 to 2012). SELECTION CRITERIA: Prospective trials with or without randomisation or blinding involving the use of drug therapies for the treatment of delirium in adult patients in the terminal phase of a disease. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality using standardised methods and extracted trial data. We collected outcomes related to efficacy and adverse effects. MAIN RESULTS: One trial met the criteria for inclusion. In the 2012 update search we retrieved 3066 citations but identified no new trials. The included trial evaluated 30 hospitalised AIDS patients receiving one of three agents: chlorpromazine, haloperidol and lorazepam. The trial under-reported key methodological features. It found overall that patients in the chlorpromazine group and those in the haloperidol group had fewer symptoms of delirium at follow-up (to below the diagnostic threshold using the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and that both were equally effective (at two days mean difference (MD) 0.37; 95% confidence interval (CI) -4.58 to 5.32; between two and six days MD -0.21; 95% CI -5.35 to 4.93). Chlorpromazine and haloperidol were found to be no different in improving cognitive status in the short term (at 48 hours) but at subsequent follow-up cognitive status was reduced in those taking chlorpromazine. Improvements from baseline to day two for patients randomised to lorazepam were not apparent. All patients on lorazepam (n = 6) developed adverse effects, including oversedation and increased confusion, leading to trial drug discontinuation. AUTHORS' CONCLUSIONS: There remains insufficient evidence to draw conclusions about the role of drug therapy in the treatment of delirium in terminally ill patients. Thus, practitioners should continue to follow current clinical guidelines. Further research is essential

Minding the Gap: Comparing Student and Instructor Experiences with Critical Reflection

Critical reflection (CR) is regarded as essential for learning in higher education. Many instructors want students to reflect deeply and critically, but lament perceived deficiencies in students’ value and understanding of CR. This qualitative study explored four undergraduate courses across disciplines to appraise how instructors' perceptions of CR compared to the perceptions of their students. We uncovered similarities and differences in how instructors and students define, engage, identify, and value CR. Our findings reveal tensions around how to explain CR to students, and around different methods and meanings across disciplines and contexts with implications for practice. The findings suggest that although facilitating CR remains a challenging and often-nebulous endeavor, both instructors and students value the process and the gap may not be as insurmountable as commonly perceived.&nbsp

Experimental evidence for drought induced alternative stable states of soil moisture

Ecosystems may exhibit alternative stable states (ASS) in response to environmental change. Modelling and observational data broadly support the theory of ASS, however evidence from manipulation experiments supporting this theory is limited. Here, we provide long-term manipulation and observation data supporting the existence of drought induced alternative stable soil moisture states (irreversible soil wetting) in upland Atlantic heath, dominated by Calluna vulgaris (L.) Hull. Manipulated repeated moderate summer drought, and intense natural summer drought both lowered resilience resulting in shifts in soil moisture dynamics. The repeated moderate summer drought decreased winter soil moisture retention by ~10%. However, intense summer drought, superimposed on the experiment, that began in 2003 and peaked in 2005 caused an unexpected erosion of resilience and a shift to an ASS; both for the experimental drought manipulation and control plots, impairing the soil from rewetting in winter. Measurements outside plots, with vegetation removal, showed no evidence of moisture shifts. Further independent evidence supports our findings from historical soil moisture monitoring at a long-term upland hydrological observatory. The results herald the need for a new paradigm regarding our understanding of soil structure, hydraulics and climate interaction

Conjectures about certain parabolic Kazhdan--Lusztig polynomials

Irreducibility results for parabolic induction of representations of the general linear group over a local non-archimedean field can be formulated in terms of Kazhdan--Lusztig polynomials of type $A$. Spurred by these results and some computer calculations, we conjecture that certain alternating sums of Kazhdan--Lusztig polynomials known as parabolic Kazhdan--Lusztig polynomials satisfy properties analogous to those of the ordinary ones.Comment: final versio