Beyond cognitive deficit: the everyday lived experience of dyslexic students at university

This study explores the lived experiences of three dyslexic university students as they negotiate a number of different learning spaces within their higher education institution. The students completed reflective diaries for a period of three weeks and were subsequently interviewed about the experiences they recorded. The transcribed data from the diaries and interviews were analysed using interpretative phenomenological analysis. The following four themes were constructed following analysis: getting things out of my head; holding back – performance as risk; ever-present inner voices – effort of constant self-monitoring; and not belonging in academic spaces – metaphors of misfit. This study argues that attention to the everyday experiences of students with the dyslexia label is as important as knowledge of cognitive differences in the drive to create a more equitable learning environment in higher education

Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomised, sham-controlled, blinded, phase 3 trial

Background High blood pressure is common in acute stroke and is a predictor of poor outcome; however, large trials of lowering blood pressure have given variable results, and the management of high blood pressure in ultra-acute stroke remains unclear. We investigated whether transdermal glyceryl trinitrate (GTN; also known as nitroglycerin), a nitric oxide donor, might improve outcome when administered very early after stroke onset. Methods We did a multicentre, paramedic-delivered, ambulance-based, prospective, randomised, sham-controlled, blinded-endpoint, phase 3 trial in adults with presumed stroke within 4 h of onset, face-arm-speech-time score of 2 or 3, and systolic blood pressure 120 mm Hg or higher. Participants were randomly assigned (1:1) to receive transdermal GTN (5 mg once daily for 4 days; the GTN group) or a similar sham dressing (the sham group) in UK based ambulances by paramedics, with treatment continued in hospital. Paramedics were unmasked to treatment, whereas participants were masked. The primary outcome was the 7-level modified Rankin Scale (mRS; a measure of functional outcome) at 90 days, assessed by central telephone follow-up with masking to treatment. Analysis was hierarchical, first in participants with a confirmed stroke or transient ischaemic attack (cohort 1), and then in all participants who were randomly assigned (intention to treat, cohort 2) according to the statistical analysis plan. This trial is registered with ISRCTN, number ISRCTN26986053. Findings Between Oct 22, 2015, and May 23, 2018, 516 paramedics from eight UK ambulance services recruited 1149 participants (n=568 in the GTN group, n=581 in the sham group). The median time to randomisation was 71 min (IQR 45–116). 597 (52%) patients had ischaemic stroke, 145 (13%) had intracerebral haemorrhage, 109 (9%) had transient ischaemic attack, and 297 (26%) had a non-stroke mimic at the final diagnosis of the index event. In the GTN group, participants’ systolic blood pressure was lowered by 5·8 mm Hg compared with the sham group (p<0·0001), and diastolic blood pressure was lowered by 2·6 mm Hg (p=0·0026) at hospital admission. We found no difference in mRS between the groups in participants with a final diagnosis of stroke or transient ischaemic stroke (cohort 1): 3 (IQR 2–5; n=420) in the GTN group versus 3 (2–5; n=408) in the sham group, adjusted common odds ratio for poor outcome 1·25 (95% CI 0·97–1·60; p=0·083); we also found no difference in mRS between all patients (cohort 2: 3 [2–5]; n=544, in the GTN group vs 3 [2–5]; n=558, in the sham group; 1·04 [0·84–1·29]; p=0·69). We found no difference in secondary outcomes, death (treatment-related deaths: 36 in the GTN group vs 23 in the sham group [p=0·091]), or serious adverse events (188 in the GTN group vs 170 in the sham group [p=0·16]) between treatment groups. Interpretation Prehospital treatment with transdermal GTN does not seem to improve functional outcome in patients with presumed stroke. It is feasible for UK paramedics to obtain consent and treat patients with stroke in the ultraacute prehospital setting. Funding British Heart Foundation

Where are the World’s Top 100 I.T. Firms and Why?

Various publications tabulate and publish lists of the ?top 100? information-technology (I.T.) firms. The July 1997 issue of PD Magazine, for example, has a list showing that most of the world?s key firms in computing, software, semiconductors, and related fields are American. They are also heavily concentrated in such western states as Texas, Utah, Washington, and of course California. The distribution of firms and entrepreneurs is markedly different from 15 years ago. For example, the December 1997 Upside Magazine list of the top 100 people in I.T. contains only three individuals from supposedly ?high-tech? Massachusetts ? or no more than the number predicted by the state?s share of the US population. The paper will extend my work tracking the westward rebirth of American computing since the early 1980s. It will complement the employment shifts I have already documented with new mappings of firms and entrepreneurs. The hypotheses is that the PC revolution spurs a regional realignment of US computing away from the more hierarchical and bureaucratized firms of the Northeast to flatter, more agile, and more entrepreneurial firms in the younger economic cultures of the West. A look at the specific enterprises and entrepreneurs will illuminate the process by which the US regained its leadership in I.T. within the world economy