A survey of eight successful enrichment programs.

Thesis (Ed.M.)--Boston Universit

Power without representation? The House of Lords and social policy

In the past the House of Lords has generally, and arguably for good reasons, been ignored in discussions of the making and scrutiny of welfare. However, it has always played some role in this field, particularly in the scrutiny and passage of legislation, and since the removal of hereditary Peers in 1999, some writers have argued that the House has become more assertive. This article examines the attitudes of Peers, including a comparison with the views of Members of Parliament, and draws a number of conclusions about the role of the upper House in relation to social policy

Infected deep vein thrombophlebitis in people who inject drugs: missed opportunities and potential for alternative antimicrobial approaches.

Infected deep vein thrombophlebitis (i-DVT) in people who inject drugs (PWID) is a clinically challenging but poorly characterised disease. We undertook a retrospective observational study of 70 PWID presenting acutely with i-DVT to improve the clinical and microbiological characterisation of this disease. i-DVT was frequently associated with bacteraemia (59.1% patients with blood cultures obtained), groin abscesses (in 34.3%; of which 54.2% required surgical drainage), and septic pulmonary emboli (38.6%) requiring anticoagulation. Network analysis identified a cluster of patients presenting with respiratory symptoms but lacking typical DVT symptoms, more likely to have septic pulmonary emboli. A microbiologic diagnosis was frequently achieved (70%). Causative pathogens were predominantly gram-positive (S. aureus and streptococci, especially anginosus group), whereas gram-negative pathogens were identified very infrequently (in 6.1% of microbiological diagnoses). This suggests routine empiric therapy against gram-negative bacteria, though commonly administered, is not required. High rates of clinical cure (88.6%) were observed despite the complex nature of infections and independently of the highly variable intravenous and total antimicrobial durations received. There exists a rationale to devise pragmatic approaches to implement novel individualised treatment plans utilising oral antimicrobial therapy for i-DVT. Despite frequent healthcare interactions, opportunities to address HCV treatment and opioid substitution therapy were frequently missed during these acute admissions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s15010-021-01725-3

Early angiogenic change in dental pulp stromal cells cultured on biomimetic matrices

Revascularisation of the devitalised root canal is the Holy Grail of Endodontics and is being hotly pursued by many teams of clinicians but has yet to be achieved. The overall aim of this work was to attempt to induce early angiogenesis in human dental pulp stromal cells (DPSCS) in vitro and in vivo using a biomimetic approach based on combining scaffolds comprised of ECM components with DPSCs as a first step towards a tissue engineering strategy for dental pulp regeneration. After isolating DPSCs using collagenase digest, they were cultured on 1% hyaluronic acid (HyA) or Types I and III collagen matrices used either singly or in combination to determine the ability of these scaffolds to support/induce early angiogenic change in DPSCs both in vitro and in vivo. Angiogenic change was determined using a combined approach of DNA quantification, histology, immunohistochemistry to detect the angiogenic markers CD31 and CD34 and quantitative RT-PCR. DPSCs were shown to attach and proliferate on Type I and III collagen membranes in vitro but early angiogenic change in vitro was evidenced only when 1% HyA gel was used, including in the absence of the morphogen rhVEGF165 as shown immunohistochemically. PCR at two and five days post-seeding showed an up-regulation of CD31 and CD34 genes dependant on culture conditions, with CD31 being upregulated early and CD34 later in the culture period. A modified tooth slice model containing a combination of HyA/collagen scaffold/DPSC constructs within its lumen also showed positive early angiogenic change in vitro. SEM examination further confirmed that DPSCs could attach, colonise and proliferate to/on the combined scaffold. The same combined scaffold-tooth slice model ± DPSCs used in vivo in nude mice showed cellular ingress into the lumen with a soft tissue closely resembling dental pulp-like tissues in its appearance with new tubule-like material grown on from the dentinal tubules of the tooth slice. There was a defined demarcation line between this latter material and the dentinal tubules of the tooth slice and the new material closely resembled predentine or dentine-like matrix in appearance and stained strongly for CD31 and CD34 markers. It also had a layer of cells adjacent to and in intimate contact with its deposition front, whose cell processes transited the new tubule-like material and continued into the dentine tubules of the tooth slice for some distance. Interestingly, this neo-tissue was independent of the addition of DPSCs to the construct. The results suggest that biomimetic scaffolds based upon components of the pulp extracellular matrix may provide a useful platform for future engineering of a vascularised replacement dental pulp

The institutionalization of restorative justice in schools : a critical sensemaking account

vi, 130 leaves : ill. (some col.) ; 29 cm.Includes abstract.Includes bibliographical references (leaves 121-129).This thesis examines the implementation of restorative approaches at an Elementary school in Halifax, Nova Scotia. I conducted a case study involving several participants involved in the implementation process. My analysis is framed by a critical criminological approach, specifically informed by critical sensemaking theory. Using critical sensemaking theory I have analyzed how power can shape overall formative contexts and influence the individual sensemaking processes of those involved in a change process. This allowed me to identify key barriers and facilitating factors involved in the implementation of restorative approaches at this school. Factilitating factors included: strong leadership, strong grounding in restorative philosophy, surrendering control to teachers, and a commitment to ongoing sensemaking. Barriers included: strict regulation by the education system, the packaging of restorative approaches as a program, and closed-mindedness on the part of teachers

Errorless Versus Errorful Learning in Memory-Impaired Patients With Schizophrenia: Implications for Cognitive Rehabilitation

Objectives: To provide descriptive data on the types of referral received by clinical psychology within a Community Mental Health Team (CMHT) during a four month period after the service's inception. To identify the perceptions held by other team members (from nursing, psychiatry, occupational therapy, and social work) of the clinical psychologist's role in the CMHT and establish their level of awareness of the skills particular to clinical psychology. To examine the post-intervention effect of an education package to the team, i.e. whether this could effect an attitudinal change in terms of types of referral considered appropriate, satisfaction with, and expectations of clinical psychology. Methods: Case notes were reviewed to identify the types of problem being referred. A questionnaire was designed to assess the above. Following assessment of initial responses an education package was presented at a team meeting. Eight weeks later, the questionnaire was recirculated and assessed for significant change using non-parametric methods. Results: Significant attitudinal change was limited. Members demonstrated sound knowledge of appropriate referrals, placed high value on the psychologist's therapeutic work with individuals, collaborative working, and the provision of information from new research. Satisfaction with the referral process declined. Qualitatively, members emphasised the need for improved interprofessional knowledge of each profession's skill base. Conclusion: Although psychology is clearly valued, group dynamics within teams of different professionals may make such interventions vulnerable to inoculation effects. Attitudinal and behavioural change may best be enhanced by increased awareness of the difficulties which different professions face

Etiology of Ankle Osteoarthritis

The purpose of this study was to evaluate the distribution rate of etiologies leading to ankle arthritis and to quantify and compare the important clinical and radiologic variables among these etiologic groups. We evaluated data from 390 patients (406 ankles) who consulted our center because of painful end-stage ankle osteoarthritis (OA) by using medical history, physical examination, and radiography. Posttraumatic ankle OA was seen in 78% of the cases (n=318), secondary arthritis in 13% (n=52), and primary OA in 9% (n=36). The average American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was 38 points (range, 0-74 points), range of motion was 22° (range, 0°−65°), and visual analog scale for pain was 6.8 (range, 2-10). Patients with posttraumatic end-stage ankle OA were younger than patients with primary OA. The average tibiotalar alignment was 88° (range, 51°-116°) and did not differ between the etiologic groups. Our study showed trauma is the main cause of ankle OA and primary OA is rare. In the majority of patients with ankle OA the average tibiotalar alignment is varus regardless of the underlying etiology. Level of Evidence: Level IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidenc

The safeguarding capability of adults in Catholic Church ministries: A global perspective

Background: In the wake of historical sexual abuse across the Catholic Church globally, the Church continues to develop policies and processes to prevent and respond to child sexual abuse, including supporting the skills, knowledge, and confidence of members of the Church. Objective: We investigated the safeguarding capabilities of a range of people with different roles within Catholic Church ministries in various countries. Participants and setting: Our 184 participants included lay people, religious men and women, school staff, safeguarding officers and tertiary students associated with the Catholic Church. Data were collected across seven different countries. Methods: We measured the awareness, confidence, attitudes, and knowledge of participants and examined differences between participants in different roles within the Church and different countries through General Linear Models. Results: We found varying levels of awareness, confidence, attitudes, and knowledge regarding sexual abuse prevention and safeguarding. We pinpointed the significant differences in three of these domains (confidence, attitudes, and knowledge) both between people with different roles in the church worldwide, but also between the countries from which participants came from. Conclusions: We found that people in various countries and roles within the Church are at different stages of their safeguarding journey. Some are still understanding their roles (attitudes), some are still learning about how it is operationalised (awareness), and others are acquiring skills that will prepare them for enacting safeguarding policies and practices (confidence)