Flecainide overdose – support using an intra-aortic balloon pump

BACKGROUND: Flecainide is an antiarrhythmic agent which is being used increasingly for the management of super-ventricular arrhythmias. Overdose with flecainide is frequently fatal with mortality reported as high as 22% due to arrhythmias, myocardial depression and conduction defects leading to electro-mechanical dissociation and asytole. Supportive measures are often required during the case and previously have included inotropes, extracorporeal membrane oxygenation and cardiopulmonary bypass. CASE PRESENTATION: A 47 year old lady presented to the emergency department with a four hour history of severe central chest pain. Her ECG showed atrial fibrillation and broad QRS complexes with a sine wave appearance. She had a past history of paroxysmal atrial fibrillation and significant psychiatric history. Following thrombolysis for a presumed myocardial infarction she developed cardiogenic shock with severely impaired left ventricular function. An intra-aortic balloon pump was inserted and coronary angiography demonstrated normal coronary arteries. With inotropic support she improved over 48 hours, with both her QRS duration and left ventricular function returning to normal. Biochemical testing following her discharge demonstrated significantly elevated levels of flecainide. CONCLUSION: The use of an intra-aortic balloon pump is a useful supportive measure during the acute phase of flecainide overdose associated with severe myocardial depression

Exploring the role of curriculum materials in teacher professional development

Curriculum materials (schemes of work, lesson plans, etc.) play a complex and pivotal role in school and teacher practices. The adaptation and development of curriculum materials often constitute part of teacher professional development (PD) activities. However, compared with research examining the relationship between PD and teacher professional change, the role of curriculum materials in professional learning remains under-researched and under-theorised. We address this gap by applying a multi-perspectival approach to data from a PD programme in which teachers were supported to develop curriculum materials. We use an interconnected model to analyse the role of curriculum materials in catalysing change in individual teachers’ practice. Our use of Boundary Theory proposes that curriculum material adoption is mediated by the solidity of boundaries between school practice and research findings, and Actor-Network Theory perspectives examine the assemblage of networked relations within and beyond schools that are entangled in curriculum materials. We highlight how combining linear and non-linear perspectives may contribute to improved understanding of the complexity of supporting teachers’ learning and use our analyses to outline implications of using curriculum materials in teacher professional development

The relationship between the perception of distributed leadership in secondary schools and teachers' and teacher leaders' job satisfaction and organizational commitment

This study investigates the relation between distributed leadership, the cohesion of the leadership team, participative decision-making, context variables, and the organizational commitment and job satisfaction of teachers and teacher leaders. A questionnaire was administered to teachers and teacher leaders (n=1770) from 46 large secondary schools. Multiple regression analyses and path analyses revealed that the study variables explained significant variance in organizational commitment. The degree of explained variance for job satisfaction was considerably lower compared to organizational commitment. Most striking was that the cohesion of the leadership team and the amount of leadership support was strongly related to organizational commitment, and indirectly to job satisfaction. Decentralization of leadership functions was weakly related to organizational commitment and job satisfaction

Using evidence-informed logic models to bridge methods in educational evaluation

Designs combining different types of data are increasingly used in educational evaluation, to provide both evidence of impact and an explanation of the processes by which impacts are created. Logic models are visual representations of how an intervention leads via a set of steps from resources and inputs to outputs and then sets of outcomes. Their use has become widespread to underpin evaluations; and they have become of more interest in education as they have been promoted by policy makers and funders including the Education Endowment Foundation (EEF) in England. This paper addresses the question: how can logic models be used to frame and implement educational evaluations using combinations of methods? To do so, the paper draws on theory-based evaluation literature to identify a set of issues to be considered: the role of implementation logic; causal mechanisms; the context of interventions; and the importance of considering and addressing issues around complexity. Using detailed examples from two study designs for EEF evaluations, the paper presents an evidence-informed logic model approach to deal with these issues. The paper concludes by reflecting on the practical and theoretical implications of this approach, laying out a set of key issues to address in future evaluations for which a design framed by an evidence-informed logic model may be appropriate

Students’ Perceptions of Learning Processes as Co-Authors of Digital Tabletop Activities

We conducted a small-scale study in order to explore students’ perceptions of the learning processes when engaged as co-authors of content for collaborative higher order thinking skills learning tasks. We specifically designed the process to allow for self-critique – where authors can observe their creations being solved and therefore understand where they may improve their design. We collected data over a three-day period from a sample of twelve thirteen year olds, working in teams, authoring content for Digital Mysteries (a higher order thinking skills collaborative learning application based on the digital tabletop). The study was structured to follow Bloom’s taxonomy, a continuum of cognitive skills that develop during a learning process. We found that 1) rather than follow this continuum, skills developed in a non-linear manner due to the abstract nature of the authoring activity, and 2) the students’ demonstrated good metacognitive insights into the authoring task, technology and collaborative learning as a whole

Teacher quality in the twenty first century: new lives, old truths

This chapter is based upon a keynote address to the first global teacher education summit, organised by Beijing Normal University in 2011, in which research across the world about influences which affect teachers' sense of professional identity, capacity for compassion, commitment, resilience and effectiveness long after they have graduated from their pre-service education and training programmes in universities and colleges were shared. The findings suggest that teaching pre-service students about how the conditions in which they work may enhance or diminish their capacity to teach to their best and how they might act to mediate these is a key part of the work of all teacher educators and an important focus for the work of educational researchers

Place-based governance and leadership in decentralised school systems: evidence from England

Relatively few studies have explored the ways in which 'middle tier' institutional arrangements in education, such as school districts and local authorities, are responding to New Public Management reforms characterized by centralization, decentralization, marketization and disintermediation (Lubienski, 2014). This paper analyses these issues, drawing on governance (Tenbensel, 2017) and path dependency theories (Streeck and Thelen, 2005), together with evidence from five locality case studies in England (Greany and Higham, 2018; Greany, 2018). It finds that the process and impact of 'middle tier' disintermediation is uneven and often fraught, with significant implications for place-based coherence, equity and legitimacy. It shows how national hierarchical mechanisms work in concert to require and/or incentivise change across local school systems, most obviously by reducing the remit and capacity of traditional Local Authorities. This process can open up new opportunities for emerging and existing actors to work together through network and community forms of governance to counteract the negative impact of fragmentation, a process that Munby and Fullan (2016) dub 'middle out' change. However, responses and outcomes vary widely across the five localities and productive 'middle out' change is by no means a given, so the article analyses the processes at work and their impact across different contexts. It concludes by assessing implications for research, policy and practice in contemporary education systems

Professional learning for distributed leadership:Primary headteachers’ perspectives

This article draws from a small-scale study of headteachers motivated to positively impact on the quality of pupil experience by involving all staff in a distributed perspective on leadership. Each headteacher perceived leadership as involving learned processes requiring support and experience, expending considerable effort in providing a fertile environment for learning about its practice. This perspective developed from their personal experience of challenging established leadership orthodoxies prior to and since appointment to headship. The article explores the impact of formal work-based postgraduate leadership preparation and experiential professional learning on each headteacher’s understandings of distributed leadership and its practice. It then explores the ways in which they supported the professional learning of staff. The article concludes by suggesting that headteachers and staff encounter a range of challenges in developing school practices inherent in distributed leadership and can benefit from ongoing support with informed reflection on practice beyond initial preparation for headship