Marker effects and examination reliability: a comparative exploration from the perspectives of generalizability theory, Rasch modelling and multilevel modelling

This study looked at how three different analysis methods could help us to understand rater effects on exam reliability. The techniques we looked at were: generalizability theory (G-theory) item response theory (IRT): in particular the Many-Facets Partial Credit Rasch Model (MFRM) multilevel modelling (MLM) We used data from AS component papers in geography and psychology for 2009, 2010 and 2011 from Edexcel.</p

Factors Influencing Grief Adjustment in the Elderly

The purpose of this paper was to attempt to identify variables which may enhance the ability of older widowed persons to adjust to viii bereavement. Depression and perceptions of physical health were the two aspects of adjustment selected for study. Several variables which current literature suggests may mediate grief adjustment were examined for their potential relationship to bereavement outcome. These were gender, level of grief, anticipatory grief and social network. The possible relationship between depression and perceptions of physical health was also examined for. Subjects were 75 men and women, age 55 and over, who were recently widowed, and 29 non-bereaved men and women who served as controls. All subjects were caucasian, Mormon, and lived in small rural communities. To gather data on the variables in question, these instruments were used: the Beck Depression Inventory, and the Texas Inventory of Grief. Information on anticipatory grief, social network, and self-ratings of physical health was obtained using a structured interview developed at the Andrus Gerontology Center at the University of Southern California. Data was gathered at two times. The initial interview was held within two months of the death of each bereaved subject\u27s spouse, and again six months later. Control subjects were interviewed twice, six to eight months apart. Multiple regression equations with foreward inclusion were computed to identify those variables which accounted for most of the cvariance in depression scores and self-ratings of physical health. Gender and bereavement status (whether a subject was bereaved or control) were not found to be significantly related to depression or self-ratings of physical health. Social network variables were found to facilitate lower depression scores and higher ratings of physical health, although the aspects of social network which were significant varied over time (initially family, then later non-family relationships were most important.) Depression and self-ratings of physical health were closely related. High level of grief was closely associated with high depression scores, but not with self-ratings of physical health. Expectation of the spouse\u27s death was associated with lower self-ratings of physical health

An FGFR1-SPRY2 Signaling Axis Limits Basal Cell Proliferation in the Steady-State Airway Epithelium.

The steady-state airway epithelium has a low rate of stem cell turnover but can nevertheless mount a rapid proliferative response following injury. This suggests a mechanism to restrain proliferation at steady state. One such mechanism has been identified in skeletal muscle in which pro-proliferative FGFR1 signaling is antagonized by SPRY1 to maintain satellite cell quiescence. Surprisingly, we found that deletion of Fgfr1 or Spry2 in basal cells of the adult mouse trachea caused an increase in steady-state proliferation. We show that in airway basal cells, SPRY2 is post-translationally modified in response to FGFR1 signaling. This allows SPRY2 to inhibit intracellular signaling downstream of other receptor tyrosine kinases and restrain basal cell proliferation. An FGFR1-SPRY2 signaling axis has previously been characterized in cell lines in vitro. We now demonstrate an in vivo biological function of this interaction and thus identify an active signaling mechanism that maintains quiescence in the airway epithelium.This study was supported by the Medical Research Council (G0900424 to ER); Wellcome Trust clinical PhD fellowship (JJ). Core grants: Gurdon Institute: Wellcome Trust (092096), Cancer Research UK (C6946/A14492); Stem Cell Initiative: Wellcome Trust/MRC.This is the final version of the article. It first appeared from Elsevier via https://doi.org/10.1016/j.devcel.2016.03.00

Running a paediatric ambulatory sleep service in a pandemic and beyond

OBJECTIVES: In response COVID-19, re-establishing safe elective services was prioritised in the UK. We assess the impact on face-to-face hospital attendance, cost, and efficiency of implementing a virtual sleep clinic (intervention 1) to screen for children requiring level 3 ambulatory sleep studies using newly implemented ENT-UK guidelines for obstructive sleep apnoea (OSA) investigation (intervention 2). OBJECTIVES: (1) compare the proportion of children attending sleep clinic undertaking a sleep study before and after implementation of these interventions; (2) compare clinic cancellations and first-time success rates of sleep studies before and after intervention. DESIGN: Retrospective analysis. SETTING: District general hospital paediatric sleep clinic. PARTICIPANTS: Children aged 3 months to 16 years referred to sleep clinic by ENT for investigation of OSA over the 3-months immediately following interventions (1 June 2020 - 1 September 2020) to the same period in the previous year (1 June 2019 - 1 September 2019). MAIN OUTCOME MEASURES: Number of children attending sleep clinic; date of birth / age of children attending sleep clinic; of number of children undergoing sleep study; diagnostic outcomes; number of appointment cancellations; number of first-time sleep study failures. RESULTS: Post-intervention, there was a significant reduction in the proportion of children undertaking ambulatory sleep studies, and non-significant reductions in appointment cancellations and in first-time sleep study failures. CONCLUSIONS: The introduction of the virtual sleep clinic meant that only those children requiring a sleep study attended a face-to-face appointment, which led to reduced face-to-face attendance. There were also unintended cost-effectiveness and efficiency benefits, with potential longer-term learning implications for the wider sleep community and other diagnostic services

Diesel Exhaust Activates & Primes Microglia: Air Pollution, Neuroinflammation, & Regulation of Dopaminergic Neurotoxicity

BACKGROUND: Air pollution is linked to central nervous system disease, but the mechanisms responsible are poorly understood. OBJECTIVES: Here, we sought to address the brain-region-specific effects of diesel exhaust (DE) and key cellular mechanisms underlying DE-induced microglia activation, neuroinflammation, and dopaminergic (DA) neurotoxicity. METHODS: Rats were exposed to DE (2.0, 0.5, and 0 mg/m3) by inhalation over 4 weeks or as a single intratracheal administration of DE particles (DEP; 20 mg/kg). Primary neuron-glia cultures and the HAPI (highly aggressively proliferating immortalized) microglial cell line were used to explore cellular mechanisms. RESULTS: Rats exposed to DE by inhalation demonstrated elevated levels of whole-brain IL-6 (interleukin-6) protein, nitrated proteins, and IBA-1 (ionized calcium-binding adaptor molecule 1) protein (microglial marker), indicating generalized neuroinflammation. Analysis by brain region revealed that DE increased TNFα (tumor necrosis factor-α), IL-1β, IL-6, MIP-1α (macrophage inflammatory protein-1α) RAGE (receptor for advanced glycation end products), fractalkine, and the IBA-1 microglial marker in most regions tested, with the midbrain showing the greatest DE response. Intratracheal administration of DEP increased microglial IBA-1 staining in the substantia nigra and elevated both serum and whole-brain TNFα at 6 hr posttreatment. Although DEP alone failed to cause the production of cytokines and chemokines, DEP (5 μg/mL) pretreatment followed by lipopolysaccharide (2.5 ng/mL) in vitro synergistically amplified nitric oxide production, TNFα release, and DA neurotoxicity. Pretreatment with fractalkine (50 pg/mL) in vitro ameliorated DEP (50 μg/mL)-induced microglial hydrogen peroxide production and DA neurotoxicity. CONCLUSIONS: Together, these findings reveal complex, interacting mechanisms responsible for how air pollution may cause neuroinflammation and DA neurotoxicity

The impact of the COVID-19 pandemic on the lifestyle and behaviours, mental health and education of students studying healthcare-related courses at a British university

Background- The COVID-19 pandemic has affected most industries, including health education. In this study, we surveyed students studying healthcare-related courses at our university on how their lifestyles and behaviours, mental health and education had been affected by the pandemic. Methods- Mixed methods cross-sectional study. Results- Two hundred thirty-three students responded to the questionnaire. Lifestyle and behaviours: 51.5% of the participants changed their diet (n=120); 45.5% (n=106) exercised less; 66.5% (n=155) experienced a change in sleep; 51.1% (n=119) reported a change in appetite. Mental health: 84.2% (n=196) reported worrying too much about different things; 61.9% (n=144) could not stop or control worrying; 71.2% experienced trouble relaxing on several days or more (n=166). At least sometimes, 72.1% (n=168) felt unable to cope with things they had to do; 8.5% (n=20) never, or almost never, felt confident about handling personal problems. Education: 65.7% (n=153) struggled to complete learning outcomes with online delivery; 82% (n=191) worried about practical skills being affected; 60.5% (n=141) worried about the impact of COVID-19 on their future career. Almost half (48.9%, n=114) believed that online teaching should be part of the standard curriculum. Conclusion- In general, there was a negative impact on behaviours, lifestyle and mental health and virtual education was perceived as necessary in making up for the loss of face to face experiences. Students’ mental health and educational needs have been affected by the current pandemic and healthcare educational facilities must respond to these needs to ensure students continue to receive the support they need

Fank1 and Jazf1 promote multiciliated cell differentiation in the mouse airway epithelium

The airways are lined by secretory and multiciliated cells which function together to remove particles and debris from the respiratory tract. The transcriptome of multiciliated cells has been extensively studied, but the function of many of the genes identified is unknown. We have established an assay to test the ability of over-expressed transcripts to promote multiciliated cell differentiation in mouse embryonic tracheal explants. Overexpression data indicated that Fank1 (Fibronectin type 3 and ankyrin repeat domains 1) and Jazf1 (JAZF zinc finger 1) promoted multiciliated cell differentiation alone, and cooperatively with the canonical multiciliated cell transcription factor Foxj1. Moreover, knock-down of Fank1 or Jazf1 in adult mouse airway epithelial cultures demonstrated that these factors are both required for ciliated cell differentiation in vitro. This analysis identifies Fank1 and Jazf1 as novel regulators of multiciliated cell differentiation. Moreover, we show that they are likely to function downstream of IL6 signalling and upstream of Foxj1 activity in the process of ciliated cell differentiation. In addition, our in vitro explant assay provides a convenient method for preliminary investigation of over-expression phenotypes in the developing mouse airways.This study was supported by the Medical Research Council (G0900424 and MR/P009581/1 to E.L.R.), the Wellcome Trust (Clinical PhD Fellowship to J.-A.J.; 092087), the Seventh Framework Programme (200720; FP7/2008 to E.L.R.), the Isaac Newton Trust (to E.L.R.) and Gurdon Institute core funding from the Wellcome Trust (092096) and Cancer Research UK (C6946/A14492)

Diesel Exhaust Activates and Primes Microglia: Air Pollution, Neuroinflammation, and Regulation of Dopaminergic Neurotoxicity

Background: Air pollution is linked to central nervous system disease, but the mechanisms responsible are poorly understood

On the supranational spell of PISA in policy

Background: PISA results appear to have a large impact upon government policy. The phenomenon is growing, with more countries taking part in PISA testing and politicians pointing to PISA results as reasons for their reforms. Purpose: The aims of this research were to depict the policy reactions to PISA across a number of jurisdictions, to see whether they exhibited similar patterns and whether the same reforms were evident. Sources of evidence: We investigated policy and media reactions to the 2009 and 2012 PISA results in six cases: Canada, China (Shanghai), England, France, Norway and Switzerland. Cases were selected to contrast high-performing jurisdictions (Canada, China) with average performers (England, France, Norway and Switzerland). Countries that had already been well reported on in the literature were excluded (Finland, Germany). Design and methods: Policy documents, media reports and academic articles in English, French, Mandarin and Norwegian relating to each of the cases were critically evaluated. Results: A policy reaction of ‘scandalisation’ was evident in four of the six cases; a technique used to motivate change. Five of the six cases showed ‘standards-based reforms’ and two had reforms in line with the ‘ideal-governance’ model. However, these are categorisations: the actual reforms had significant differences across countries. There are chronological problems with the notion that PISA results were causal with regard to policy in some instances. Countries with similar PISA results responded with different policies, reflecting their differing cultural and historical education system trajectories. Conclusions: The connection between PISA results and policy is not always obvious. The supranational spell of PISA in policy is in the way that PISA results are used as a magic wand in political rhetoric, as though they conjure particular policy choices. This serves as a distraction from the ideological basis for reforms. The same PISA results could motivate a range of different policy solutions

Reinventing Undergraduate Clinical Placements with a Switch to Delivery by Clinical Teaching Fellows

Purpose: Undergraduate clinical placements have the potential for significant improvement. Previous research has shown the growing value of clinical teaching fellows (CTFs) within medical education. Changing traditional placements to a model whereby CTFs have defined roles and lead the majority of teaching can positively reinvent undergraduate clinical teaching. We wanted to see how a structured teaching programme delivered by CTFs could affect student experience and personal development within a large associate teaching hospital. We consider how such a model could be implemented and explore the opportunities for CTFs to develop in personal and professional capacities. Methods: A mixed methods study was organised to assess student experience of a CTF-led placement. A novel structured teaching programme was delivered by 14 CTFs, who provided or were involved with the majority of teaching for all medical students. Thematic analysis was conducted on focus groups with 48 final year medical students from Queen Mary University of London following completion of their clinical placements. The same students were asked to complete an anonymous survey from which results were analysed using modified 5-point Likert scales. Results: Eight themes were identified from the focus groups. Students appreciated the increased individualisation, relevance and variety of teaching and the ability to record progress. Other perceived effects were higher teacher to student ratios, more learning opportunities and increased familiarity and reliability with CTFs. Of the students surveyed, 96% felt their overall placement experience was very good in comparison to previous placements elsewhere. Survey results supported focus group themes and demonstrated perceived growth in students’ personal development. Conclusion: Placement models where CTFs lead most teaching can improve medical undergraduate experience and training. A move towards CTF-delivered teaching can be of financial benefit to hospital trusts whilst allowing time for junior doctors to explore different clinical specialities and hone their teaching skills