Use of standardized body composition measurements and malnutrition screening tools to detect malnutrition risk and predict clinical outcomes in children with chronic conditions

Background: Better tools are needed to diagnose and identify children at risk of clinical malnutrition. / Objectives: We aimed to compare body composition (BC) and malnutrition screening tools (MSTs) for detecting malnutrition on admission; and examine their ability to predict adverse clinical outcomes [increased length of stay (LOS) and complications] in complex pediatric patients. / Methods: This was a prospective study in children 5–18 y old admitted to a tertiary pediatric hospital (n = 152). MSTs [Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids)] were completed on admission. Weight, height, and BC [fat mass (FM) and lean mass (LM) by DXA] were measured (n = 118). Anthropometry/BC and MSTs were compared with each other and with clinical outcomes. / Results: Subjects were significantly shorter with low LM compared to reference data. Depending on the diagnostic criteria used, 3%–17% were classified as malnourished. Agreement between BC/anthropometric parameters and MSTs was poor. STAMP and STRONGkids identified children with low weight, LM, and height. PYMS, and to a lesser degree STRONGkids, identified children with increased LOS, as did LM compared with weight or height. Patients with complications had lower mean ± SD LM SD scores (−1.38 ± 1.03 compared with −0.74 ± 1.40, P < 0.05). In multivariable models, PYMS high risk and low LM were independent predictors of increased LOS (OR: 3.76; 95% CI: 1.36, 10.35 and OR: 3.69; 95% CI: 1.24, 10.98, respectively). BMI did not predict increased LOS or complications. / Conclusions: LM appears better than weight and height for predicting adverse clinical outcomes in this population. BMI was a poor diagnostic parameter. MSTs performed differently in associations to BC/anthropometry and clinical outcomes. PYMS and LM provided complementary information regarding LOS. Studies on specific patient populations may further clarify the use of these tools and measurements

To grade or not to grade: balancing formative and summative assessment in post-16 teacher trainee observations

The issue of whether trainee teachers in the post-16 sector should have their classroom practice graded has been debated for a number of years. The case for training courses retaining an emphasis on written and verbal ‘developmental’ feedback at the expense of ‘judgements’ appears to be lost. This article is set within the context of an ever-growing culture of performativity in English further education colleges, where grading is regarded as an essential requirement to ensure high quality teaching. Tensions are explored between stakeholders who call for graded observations of trainees’ classroom performance (e.g. Ofsted and FEC quality assurance managers), and classroom-based trainers and researchers who argue that grading is too judgemental and compromises the formative and developmental progress of trainees. The rationale for trainee teachers to have their classroom practice graded is contrasted with evidence that highlights the negative results of grading. This article reports findings from the evaluation of an innovative, alternative strategy that addresses Ofsted’s central requirement for trainees to know ‘where they are’ in their development by offering a middle way between grading and not grading trainees’ classroom performance

"Aye, but it were wasted on thee": Cricket, British Asians, ethnic identities, and the 'magical recovery of community'

People in sport tend to possess rather jaded perceptions of its colour-blindness and thus, they are reluctant to confront the fact that, quite often racism is endemic. Yorkshire cricket in particular, has faced frequent accusations from minority ethnic communities of inveterate and institutionalised racism and territorial defensiveness. Drawing upon semi-structured interviews conducted with amateur white and British Asian cricketers, this paper examines the construction of regional identities in Yorkshire at a time when traditional myths and invented traditions of Yorkshire and 'Yorkshireness' are being deconstructed. This is conceptualised through a reading of John Clarke's 'magical recovery of community'. Although cricket has been multiracial for decades, I argue that some people's position as insiders is more straightforward than others. I present evidence to suggest that, regardless of being committed to Yorkshire and their 'Yorkshireness', white Yorkshire people may never fully accept British Asians as 'one of us'. Ideologically and practically, white Yorkshire people are engaged in constructing British Asians as anathema to Yorkshire culture. The paper concludes by advocating that, for sports cultures to be truly egalitarian, the ideology of sport itself has to change. True equality will only ever be achieved within a deracialised discourse that not only accepts difference, but embraces it

Bioelectric impedance vector analysis (BIVA) in hospitalised children; predictors and associations with clinical outcomes

BACKGROUND: Clinical use of bioelectric impedance is limited by variability in hydration. Analysis of raw bioelectric impedance vectors (BIVA), resistance (R), reactance (Xc) and phase angle (PA) may be an alternative for monitoring disease progression/treatment. Clinical experience of BIVA in children is limited. We investigated predictors of BIVA and their ability to predict clinical outcomes in children with complex diagnoses. METHODS: R, Xc and PA were measured (BODYSTAT Quadscan 4000) on admission in 108 patients (4.6-16.8 years, mean 10.0). R and Xc were indexed by height (H) and BIVA-SDS for age and sex calculated using data from healthy children. Potential predictors and clinical outcomes (greater-than-expected length-of-stay (LOS), complications) were recorded. RESULTS: Mean R/H-SDS was significantly higher (0.99 (SD 1.32)) and PA-SDS lower (-1.22 (1.68))) than expected, with a wide range for all parameters. In multivariate models, the Strongkids risk category predicted R/H-SDS (adjusted mean for low, medium and high risk = 0.49, 1.28, 2.17, p = 0.009) and PA-SDS (adjusted mean -0.52, -1.53, -2.36, p = 0.01). BIVA-SDS were not significantly different in patients with or without adverse outcomes. CONCLUSIONS: These complex patients had abnormal mean BIVA-SDS suggestive of reduced hydration and poor cellular health according to conventional interpretation. R/H-SDS was higher and PA-SDS lower in those classified as higher malnutrition risk by the StrongKids tool. Further investigation in specific patient groups, including those with acute fluid shifts and using disease-specific outcomes, may better define the clinical role of BIV

Fans, Racism and British Football in the Twenty-First Century: The Existence of a ‘Colour-Blind’ Ideology

This article draws on 2500 responses from association football (soccer) fans to an anonymous online survey examining the extent of racism in British football. The overall findings are that half of all fans are still witnessing or experiencing some form of racism. Despite the creation of anti-racist initiatives, such as Kick It Out, and a reduction in overt chanting, there exists a ‘colour-blind’ ideology amongst the game’s governing bodies and anti-racist organisations, as the extent of the problem is largely being ignored. Fans call for a long-term focus on anti-racism based on engagement and education within a greater range of social settings and, short-term, the implementation of more severe punishments by the game’s governing bodies to eliminate racist behaviour amongst fans, players and clubs. For current and ex-players who continue to receive racial abuse through social media sites like Twitter, fans urge them to report it and place these matters in the hands of the police

Mindfulness, adult learning and therapeutic education: integrating the cognitive and affective domains of learning

Although it has been given qualified approval by a number of philosophers of education, the so-called 'therapeutic turn' in education has been the subject of criticism by several commentators on post-compulsory and adult learning over the last few years. A key feature of this alleged development in recent educational policy is said to be the replacement of the traditional goals of knowledge and understanding with personal and social objectives concerned with enhancing and developing confidence and self-esteem in learners. After offering some critical observations on these developments, I suggest that there are some educationally justifiable goals underpinning what has been described as a therapeutic turn. Whilst accepting that 'self-esteem' and cognate concepts cannot provide a general end or universal aim of education, the therapeutic function-the affective domain of learning-is more valuable and significant than is generally acknowledged. This claim is justified by an examination of the concept of 'mindfulness' which, it is argued, can be an immensely powerful and valuable notion that is integrally connected with the centrally transformative and developmental nature of learning and educational activity at all levels. The incorporation of mindfulness strategies within adult learning programmes may go some way towards re-connecting the cognitive and affective dimensions of education