Knowles, Kolb, & Google: Prior Learning Assessment as a Model for 21st-Century Learning

For adult students who have committed anew to completing a four-year bachelor’s degree, prior learning assessment (PLA) can be a surprising bonus that affirms their previous life experiences, shortens the degree completion pathway, and ultimately lowers tuition dollars. What students typically do not realize as they enter the process, however, is that PLA can be much more than simply a road to a diploma: When designed with an intentional framework of andragogical principles and experiential emphases, PLA can provide adult students with a lifelong model for self-assessment and higher-level learning in a 21st-century Google era

Formulation of the Two Part Analysis for State Action Exemption - Hoover v. Ronwin

This note begins by discussing the Hoover case in light of the actual holding by the Court. It then tracks the history of the Parker doctrine and examines the Court\u27s progression in attempting to formulate a practical analysis for the state exemption. Finally, the note shows that Justice Powell\u27s opinion in Hoover articulated a clear and workable analytical process based on, and consistent with, previous Court decisions

Characterization of the Deleted in Autism 1 Protein Family: Implications for Studying Cognitive Disorders

Autism spectrum disorders (ASDs) are a group of commonly occurring, highly-heritable developmental disabilities. Human genes c3orf58 or Deleted In Autism-1 (DIA1) and cXorf36 or Deleted in Autism-1 Related (DIA1R) are implicated in ASD and mental retardation. Both gene products encode signal peptides for targeting to the secretory pathway. As evolutionary medicine has emerged as a key tool for understanding increasing numbers of human diseases, we have used an evolutionary approach to study DIA1 and DIA1R. We found DIA1 conserved from cnidarians to humans, indicating DIA1 evolution coincided with the development of the first primitive synapses. Nematodes lack a DIA1 homologue, indicating Caenorhabditis elegans is not suitable for studying all aspects of ASD etiology, while zebrafish encode two DIA1 paralogues. By contrast to DIA1, DIA1R was found exclusively in vertebrates, with an origin coinciding with the whole-genome duplication events occurring early in the vertebrate lineage, and the evolution of the more complex vertebrate nervous system. Strikingly, DIA1R was present in schooling fish but absent in fish that have adopted a more solitary lifestyle. An additional DIA1-related gene we named DIA1-Like (DIA1L), lacks a signal peptide and is restricted to the genomes of the echinoderm Strongylocentrotus purpuratus and cephalochordate Branchiostoma floridae. Evidence for remarkable DIA1L gene expansion was found in B. floridae. Amino acid alignments of DIA1 family gene products revealed a potential Golgi-retention motif and a number of conserved motifs with unknown function. Furthermore, a glycine and three cysteine residues were absolutely conserved in all DIA1-family proteins, indicating a critical role in protein structure and/or function. We have therefore identified a new metazoan protein family, the DIA1-family, and understanding the biological roles of DIA1-family members will have implications for our understanding of autism and mental retardation

UBVRI photopolarimetry of the long period eclipsing AM Herculis binary V1309

We report simultaneous UBVRI photo-polarimetric observations of the long period (7.98 h) AM Her binary V1309 Ori. The length and shape of the eclipse ingress and egress varies from night to night. We suggest this is due to the variation in the brightness of the accretion stream. By comparing the phases of circular polarization zero-crossovers with previous observations, we confirm that V1309 Ori is well synchronized, and find an upper limit of 0.002 percent for the difference between the spin and orbital periods. We model the polarimetry data using a model consisting of two cyclotron emission regions at almost diametrically opposite locations, and centered at colatitude 35 (deg) and 145 (deg) on the surface of the white dwarf. We also present archive X-ray observations which show that the negatively polarised accretion region is X-ray bright.Comment: 11 pages, 12 figures (2 colour), Fig1 and Fig 4 are in lower resolution than in original paper, accepted for publication in Monthly Notices of the Royal Astronomical Societ

As Low As Reasonably Practicable (ALARP), a moral model for clinical risk management in the setting of technology dependence

Children dependent upon life-prolonging medical technology are often subject to a constant background risk of sudden death or catastrophic complications. Such children can be cared for in hospital, in an intensive care environment with highly trained nurses and doctors able to deliver specialised, life-saving care immediately. However, remaining in hospital, when life expectancy is limited can considered to be a harm in of itself. Discharge home offers the possibility for an improved quality of life for the child and her family but comes with significant medical risks. When making decisions for children, two ethical models predominate, the promotion of the child's best interests or the avoidance of harm. However, in some circumstances, particularly for children with life-limiting and / or life-threatening illness, all options may be associated with risk. There are no good options, only potentially harmful choices. In this paper we explore decisions made by one family in such circumstances. We describe a model adopted from risk management programmes beyond medicine, that offers a potential framework for identifying risks to the child that are morally permissible. Some risks and harms to a child, not ordinarily permitted, may be acceptable when undertaken in the pursuit of a specified desired good, so long as they are As Low as Reasonably Practicable

Building analytic skills to drive improvements in patient care and organisational decision making: an information analysts’ development programme

Purpose This paper briefly outlines a development programme designed to improve the skills of NHS Information Analysts and assesses the extent these skills have been developed. There are significant opportunities for the NHS to utilise information more effectively, and Analysts have a key role. However, training opportunities prior to the development of this programme have been limited for this professional group. The purpose of this paper is to explore the potential benefits to the organisations, patients and the NHS as a whole,that improvements in the quality of analysis can deliver. Design/methodology/approach The authors compared pre-course and post-course self-assessment of skill levels of Analysts who attended the programme. The authors also considered general feedback and comments from participants. Findings All of the 40 skills areas assessed demonstrated an increase in mean competency score. In cohorts 1 and 2, 38 of these were statistically significant (p < 0.001-0.041, mean increase in score 1.0). For cohorts 3-5, 37 were statistically significant (p < 0.001-0.012; mean increase 1.2). These findings were supported by the positive feedback from participants. Practical implication The programme develops skills for NHS Information Analysts which can improve the quality of analysis in the NHS, offering significant potential to improve the effectiveness and efficiency of healthcare. Originality/value The Information Analysts’ Development Programme provides the only training programme available for NHS Information Analysts, contributing to the development of data driven service improvement within the NHS. This may harness the power contained within data to drive improvement and ensure patients receive the highest quality of care

Orodispersible and transmucosal alternative medications for symptom control in adults

BACKGROUND: Paediatric palliative care makes frequent use of orodispersible and transmucosal drug delivery routes. The limited published experience of this practice suggests that it enables the delivery of needle-free symptom relief, with the potential to train family carers to administer anticipatory medications without reliance on trained health professionals. AIMS: To identify orodispersible and potential transmucosal alternatives that may be used in adults in the event of a patient having no oral or intravenous route and no access to subcutaneous injections. METHODS: The author panel identified medications through review of multiple drug formularies, review of the published evidence and their experience. Where possible, licensed alternatives were identified and any 'off label' or unlicensed medications clearly highlighted. RESULTS: A list of 27 medications is provided, which could be used either via the orodispersible or transmucosal alternative route for healthcare professionals delivering end of life care to consider when the licensed alternative routes are unavailable. All users of this guide are encouraged to use their professional judgement whenever selecting a medication for a patient, recognising that this review is neither a guideline nor a systematic review, and taking account of licensing considerations, adverse effects, potential unpredictability of time to effect and contraindications. CONCLUSION: Should it be necessary to use these orodispersible or transmucosal alternatives then any experience gained should be reported in the literature. Combined with further research, this experience offers the possibility of reducing injection frequency and inherent delays in medication administration, particularly in the community setting during the COVID-19 pandemic

Bereavement during the COVID-19 pandemic in the UK: What do we know so far?

The Covid-19 pandemic has been a devastating mass bereavement event, with measures to control the virus leading to unprecedented changes to end-of-life and mourning practices. In this review we consider the research evidence on the experiences of people bereaved during the pandemic. We summarise key findings reported in the first five publications from our UK-based Bereavement during COVID-19 study, drawing comparisons with available evidence from other studies of bereavement during the pandemic. We summarise these findings across three main topics: experiences at the end of life and in early bereavement; coping and informal support during the pandemic; and access to bereavement and mental health services. The synthesis demonstrates the exceptional challenges of pandemic bereavement, including high levels of disruption to end-of-life care, dying and mourning practices as well as to people’s social networks and usual coping mechanisms. We identified considerable needs for emotional, therapeutic and informal support among bereaved people, compounded by significant difficulties in receiving and accessing such support. We provide evidence-based recommendations for improving people’s experiences of bereavement and access to support at all levels

What elements of a systems approach to bereavement are most effective in times of mass bereavement?:A narrative systematic review with lessons for COVID-19

Background: The global COVID-19 pandemic has left health and social care systems facing the challenge of supporting large numbers of bereaved people in difficult and unprecedented social conditions. Previous reviews have not comprehensively synthesised the evidence on the response of health and social care systems to mass bereavement events. Aim: To synthesise the evidence regarding system-level responses to mass bereavement events, including natural and human-made disasters as well as pandemics, to inform service provision and policy during the COVID-19 pandemic and beyond. Design: A rapid systematic review was conducted, with narrative synthesis. The review protocol was registered prospectively (www.crd.york.ac.uk/prospero, CRD 42020180723). Data sources: MEDLINE, Global Health, PsycINFO and Scopus databases were searched for studies published between 2000 and 2020. Reference lists were screened for further relevant publications, and citation tracking was performed. Results: Six studies were included reporting on system responses to mass bereavement following human-made and natural disasters, involving a range of individual and group-based support initiatives. Positive impacts were reported, but study quality was generally low and reliant on data from retrospective evaluation designs. Key features of service delivery were identified: a proactive outreach approach, centrally organised but locally delivered interventions, event-specific professional competencies and an emphasis on psycho-educational content. Conclusion: Despite the limitations in the quantity and quality of the evidence base, consistent messages are identified for bereavement support provision during the pandemic. High quality primary studies are needed to ensure service improvement in the current crisis and to guide future disaster response efforts