Audit of Antenatal Testing of Sexually Transmissible Infections and Blood Borne Viruses at Western Australian Hospitals

In August 2007, the Western Australian Department of Health (DOH) released updated recommendations for testing of sexually transmissible infections (STI) and blood-borne viruses (BBV) in antenates. Prior to this, the Royal Australian & New Zealand College of Obstetricians & Gynaecologists (RANZCOG) antenatal testing recommendations had been accepted practice in most antenatal settings. The RANZCOG recommends that testing for HIV, syphilis, hepatitis B and C be offered at the first antenatal visit. The DOH recommends that in addition, chlamydia testing be offered. We conducted a baseline audit of antenatal STI/BBV testing in women who delivered at selected public hospitals before the DOH recommendations. We examined the medical records of 200 women who had delivered before 1st July 2007 from each of the sevenWAhospitals included in the audit. STI and BBV testing information and demographic data were collected. Of the 1,409 women included, 1,205 (86%) were non-Aboriginal and 200 (14%) were Aboriginal. High proportions of women had been tested for HIV (76%), syphilis (86%), hepatitis C (87%) and hepatitis B (88%). Overall, 72% of women had undergone STI/BBV testing in accordance with RANZCOG recommendations. However, chlamydia testing was evident in only 18% of records. STI/BBV prevalence ranged from 3.9% (CI 1.5– 6.3%) for chlamydia, to 1.7% (CI 1–2.4%) for hepatitis C, 0.7% (CI 0.3–1.2) for hepatitis B and 0.6% (CI 0.2–1) for syphilis. Prior to the DOH recommendations, nearly three-quarters of antenates had undergone STI/BBV testing in accordance with RANZCOG recommendations, but less than one fifth had been tested for chlamydia. The DOH recommendations will be further promoted with the assistance of hospitals and other stakeholders. A future audit will be conducted to determine the proportion of women tested according to the DOH recommendations. The hand book from this conference is available for download Published in 2008 by the Australasian Society for HIV Medicine Inc © Australasian Society for HIV Medicine Inc 2008 ISBN: 978-1-920773-59-

Future benefits and applications of intelligent on-board processing to VSAT services

The trends and roles of VSAT services in the year 2010 time frame are examined based on an overall network and service model for that period. An estimate of the VSAT traffic is then made and the service and general network requirements are identified. In order to accommodate these traffic needs, four satellite VSAT architectures based on the use of fixed or scanning multibeam antennas in conjunction with IF switching or onboard regeneration and baseband processing are suggested. The performance of each of these architectures is assessed and the key enabling technologies are identified

The Radon Monitoring System in Daya Bay Reactor Neutrino Experiment

We developed a highly sensitive, reliable and portable automatic system (H$^{3}$) to monitor the radon concentration of the underground experimental halls of the Daya Bay Reactor Neutrino Experiment. H$^{3}$ is able to measure radon concentration with a statistical error less than 10\% in a 1-hour measurement of dehumidified air (R.H. 5\% at 25$^{\circ}$C) with radon concentration as low as 50 Bq/m$^{3}$. This is achieved by using a large radon progeny collection chamber, semiconductor $\alpha$-particle detector with high energy resolution, improved electronics and software. The integrated radon monitoring system is highly customizable to operate in different run modes at scheduled times and can be controlled remotely to sample radon in ambient air or in water from the water pools where the antineutrino detectors are being housed. The radon monitoring system has been running in the three experimental halls of the Daya Bay Reactor Neutrino Experiment since November 2013

UC: a language for the connection machine

n designing parallel languages, the concern for defining a simple virtual machine must be balanced against the need to efficiently map a program on a specific architecture. UC addresses this problem by separating the programming task from efficiency considerations. UC programs are designed using a small set of constructs that include reduction, parallel assignment, and fixed-point computation. The language also provides a map section that may optionally be used by a programmer to specify data mappings for the program. The authors describe the UC constructs and their implementation on the Connection Machine. They also present measurements of the compiler for simple benchmarks

Applications of satellite technology to broadband ISDN networks

Two satellite architectures for delivering broadband integrated services digital network (B-ISDN) service are evaluated. The first is assumed integral to an existing terrestrial network, and provides complementary services such as interconnects to remote nodes as well as high-rate multicast and broadcast service. The interconnects are at a 155 Mbs rate and are shown as being met with a nonregenerative multibeam satellite having 10-1.5 degree spots. The second satellite architecture focuses on providing private B-ISDN networks as well as acting as a gateway to the public network. This is conceived as being provided by a regenerative multibeam satellite with on-board ATM (asynchronous transfer mode) processing payload. With up to 800 Mbs offered, higher satellite EIRP is required. This is accomplished with 12-0.4 degree hopping beams, covering a total of 110 dwell positions. It is estimated the space segment capital cost for architecture one would be about $190M whereas the second architecture would be about$250M. The net user cost is given for a variety of scenarios, but the cost for 155 Mbs services is shown to be about $15-22/minute for 25 percent system utilization

The impact of Feedback on student attainment: a systematic review

Abstract Meta-syntheses have reported positive impacts of feedback for student achievement at different stages of education and have been influential in establishing feedback as an effective strategy to support student learning. However, these syntheses combine studies of a variety of different feedback approaches, combine studies where feedback is one of a number of intervention components and have several methodological limitations. For example the lack of quality appraisal of the included studies. There is also still more research needed to investigate the impact of different types of feedback on different students in different settings. Objective This systematic review was conducted at the request of the Education Endowment Foundation to provide more precise estimates of the impact of different types of feedback in different contexts for different learners aged between 5 and 18. The review analysis sought to explore potential variations in the impact of feedback through subgroup analysis of the characteristics of the feedback, the educational setting, the learners and the subject. This review provides evidence that can be used to support the development of guidance for teachers and schools about feedback practices. Methods design A systematic review was undertaken in two stages. First, a systematic map identified and characterised a subset of studies that investigated the attainment impacts of feedback. Second, an in-depth review comprising of a meta-analysis was performed to answer the review questions about the impact of interventions that comprised of feedback only and to explore the variety of characteristics that may influence the impact of feedback. Methods search We used the Microsoft Academic Graph (MAG) dataset hosted in EPPI-Reviewer to conduct a semantic network analysis to identify records related to a set of pre-identified study references. The MAG search identified 23,725 potential studies for screening. Methods study selection Studies were selected using a set of pre-specified selection criterion. Semi-automated priority screening was used to screen the title and abstract of studies using bespoke systematic review software EPPI-Reviewer. The title and abstract screening was stopped after 3,028 studies and 745 were identified for full-text screening. Reviewers carried out a moderation exercise, all screening a selection of the same titles to develop consistency of screening. Thereafter, single reviewer screening was used with referral for a second reviewer opinion in cases of uncertainty. Methods data collection Studies were coded using a bespoke data extraction tool developed by the EEF Database Project. Study quality was assessed using a bespoke risk of bias assessment adapted from the ROBINS-I tool. The review team undertook a moderation exercise coding the same set of studies to develop consistency. Thereafter, single reviewer coding was used, based on the full text with referral for a second opinion in cases of uncertainty. Methods synthesis Data from the studies was used to calculate standardised effect sizes (Standardised Mean Difference- Hedge’s g). Effect sizes from each study were combined to produce a pooled estimate of effect using Random Effects Meta-analysis. Statistical Heterogeneity tests were carried out for each synthesis. Sensitivity analysis was carried out for assessed study quality. Subgroup analysis was completed using meta-analysis to explore outcomes according to the different characteristics of feedback, context and subjects. Main results The full text screening identified 304 studies to include in the initial systematic map, of which 171 studies investigated feedback only. After applying final selection criteria, 43 papers with 51 studies published in and after the year 2000 were included. The 51 studies had approximately 14,400 students. Forty studies were experiments with random allocation to groups and 11 were prospective quantitative experimental design studies. The overall ecological validity was assessed as moderate to high in 40 studies and the overall risk of bias assessed as low to moderate in 44 studies. The interventions took place in curriculum subjects including literacy, mathematics, science, social studies, and languages, and tested other cognitive outcomes. The source of feedback included teacher, researcher, digital, or automated means. Feedback to individual students is reported in 48 studies and feedback to group or class is reported in four studies. Feedback took the form of spoken verbal, non-verbal, written verbal, and written non-verbal. Different studies investigated feedback that took place immediately after the task, during the task and up to one week after the task (delayed feedback). Most of the feedback interventions gave the learner feedback about the outcome and the process/strategy. Some provided feedback on outcome only and two provided feedback about task/strategy only. On the main research question, the pooled estimate of effect of synthesis of all studies with a low or moderate risk of bias indicated that students who received feedback had better performance than students who did not receive feedback or experienced usual practice (g = 0.17, 95% C.I. 0.09 to 0.25). However, there is statistically significant heterogeneity between these studies (I2 = 44%, Test for Heterogeneity: Q(df = 37) = 65.92, p = 0.002), which suggests that this may not be a useful indicator of the general impact of feedback on attainment when compared to no feedback or usual practice. The heterogeneity analysis suggested considerable heterogeneity between studies in the main synthesis and all the subgroup synthesis, and in the majority of the cases the heterogeneity is statistically significant. This means caution is required when considering the results of the synthesis. The results of the subgroup synthesis suggest that a variety of student and context factors may have an effect on the impact of feedback. Conclusions The results of the review may be considered broadly consistent with claims made on the basis of previous synthesis and meta-synthesis, suggesting that feedback interventions, on average, have a positive impact on attainment when compared to no feedback or usual practice. The limitations in the study reports and the comparatively small number of studies within each subgroup synthesis meant that the review was not able to provide very much more certainty about the factors that affect variation in the impact of single component feedback interventions within different contexts and with different students. More research is needed in this area to consider what may moderate the impact of feedback. However, the findings further support the conclusion made by previous studies that feedback, on average, has a positive impact on attainment; moreover, this is based on a more precise and robust analysis than previous syntheses. This suggests that feedback may have a role to play in raising attainment alongside other effective interventions. Findings were further interpreted by a panel of expert practitioners and academics to produce the EEF’s Teacher feedback to improve pupil learning guidance report. 1. Background and review rationale Feedback can be defined as information communicated to the learner that is intended to modify the learner’s thinking or behaviour for the purpose of improving learning. Meta-syntheses have reported positive impacts of feedback, with effect sizes ranging from d = 0.70 to d = 0.79 for student achievement at different stages of education and have been influential in establishing feedback as highly effective with regards to student learning. For example, the EEF Teaching and Learning Toolkit meta-synthesis suggests that feedback may have ‘very high’ impact (equivalent to eight months’ additional progress) for relatively low cost. However, caution is necessary when interpreting the findings of these meta-syntheses for a number of reasons. Firstly, the average effect size reported in the EEF Toolkit is based on combining the estimates from existing meta-analyses of individual studies, which may contain limitations of various kinds (see the list below for examples) that may mean that average effect sizes identified are overestimates. Second, some studies included in syntheses (such as Kluger and DeNisi’s meta-analysis ) suggest that some feedback interventions may, in fact, negatively impact pupils. Third, previous meta-syntheses have not explored in detail the impact of potential moderating factors, such as different types of feedback. As Ekecrantz has argued, there is still a need to better understand how and under what circumstances teacher feedback on student performance promotes learning as well as, to question the generalised claim (that feedback improves attainment) itself. For example, a recent meta-analysis that re-analysed studies included in the original synthesis by Hattie and Timperley revised down the average effect size from the estimates of the effects of feedback from their originally published Standardised Mean Difference of d = 0.79 to d = 0.48. In the revised meta-analysis, 17% of the effect sizes from individual studies were negative. The confidence interval ranged from d = 0.48 to d = 0.62, and the authors found a wide range of effect sizes. Different moderators were also investigated to explore the impact of different characteristics of context and feedback. Whilst this meta-analysis offers improvements over previous meta-syntheses, it has a number of limitations, including: • It only included studies drawn from 36 existing meta-analyses, the most recent of which was published in 2015. Eligible studies published after 2015 or not included in these meta-analyses would not have been included. • All comparative study designs were included. Less robust study designs may have overestimated the positive effect of feedback. • There was no reported study quality assessment/moderation or sensitivity analysis, which may have led to an overestimation of the pooled effect sizes. • The meta-analyses included studies with high levels of heterogeneity, I2 = 80% or more (in the main and moderator analysis). This suggests that the synthesis may be combining studies/comparing feedback practices inappropriately. • The meta-analysis did not consider all potentially relevant moderating factors. It may also be the case that the impact of feedback depends on factors other than those analysed, including the ability of the learner, the learning context, and/or the frequency, duration, timing, and type of feedback. This systematic review was conducted at the request of the EEF to try and provide more accurate and precise estimates of the impact of different types of feedback in different schooling contexts. The review examines the impact of single component feedback, in different contexts, and for different learners with a greater degree of granularity and precision than is currently available via the EEF Teaching and Learning Toolkit strand on ‘Feedback’. For EEF, the purpose of the systematic review is to provide evidence that can be used to inform guidance for teachers and schools about effective feedback practices. The systematic review methods and processes were developed and carried out conterminously with the EEF Database project with a view to facilitating the future use of the produced resources and supporting the ongoing work of the Database project. 1.1 Domain being studied: Feedback approaches This review focuses on interventions that provide feedback from teachers to learners in mainstream educational settings. Feedback is defined in accordance with the EEF toolkit definition: ‘Feedback is information given to the learner and/or teacher about the learner’s performance relative to learning goals or outcomes. It should aim to produce (and be capable of) producing improvement in students’ learning. Feedback redirects or refocuses either the teacher’s or the learner’s actions to achieve a goal, by aligning effort and activity with an outcome. It can be about the output of the activity, the process of the activity, the student’s management of their learning or self-regulation, or them as individuals. This feedback can be verbal or written or can be given through tests or via digital technology. It can come from a teacher or someone taking a teaching role, or from ‘peers’.’ This initial broad definition, whilst conceptually coherent, does create challenges both in practice for teachers and in terms of identifying and distinguishing between practices when considering research evidence. For example, what is the difference between small group learning and ‘peer feedback’? It seems perfectly reasonable to assume that small group learning must contain conversations between students about their work and the task they have been asked to complete and thus is ‘feedback’. However, in practice, this may not be what teachers think of as ‘feedback’ and in the research literature, ‘small group learning’ is investigated both as a unique pedagogical strategy and as a component of a number of other pedagogical strategies. As the development of the understanding of the scope of the review evolved, the working definition of feedback for the review became modified practically through the exclusion of certain categories of intervention, even though they may contain an element of feedback practice. The inclusion criteria in the methods section outlines the revised definition that the review team used. 1.2 Conceptual framework/Theory of Change There are several ways in which feedback is conceptualised as improving learner performance—i.e. as a Theory of Change. The ‘Feedback’ strand in the EEF Teaching and Learning Toolkit draws most explicitly on the conceptualisation of Hattie and Timperley’s (2007) model. This model emphasises the importance of systems of feedback where the teacher provides feedback to the specific needs of individual students. The searching processes used in this review are consistent with this model as the studies used in the Feedback strand of the EEF Teaching and Learning Toolkit were used to ‘seed’ the search. However, they did not preclude the inclusion of studies that may draw on other ‘models’ of feedback which, though similar to Hattie and Timperley (2007), may be argued to place more emphasis on, for example: developing learner self-regulation (Nicole and Macfarlane-Dick, 2006); students’ intrinsic motivation (Dweck, 2016); and/or are subject specific—for example, ‘Thinking Mathematically’ (Mason, Burton and Stacey, 2010). The coding tools used in the review were informed by the model (in terms of coding about the source and content of the feedback; see Appendix 3). 1.3 Review design A systematic review approach was used to investigate the research questions. The review was undertaken in two stages. First, a systematic map identified and described the feedback characteristics of a subset of studies that investigated the attainment impacts of feedback. The map was used to make decisions about focusing the analysis in the second in-depth systematic review stage. At the second stage an in-depth review, including meta-analysis, was performed on a subset of the studies identified in the map to answer the review questions and explore the variety of intervention and context characteristics that may influence the impact of feedback. This systematic review was designed to complement the work of the EEF Database project. The EEF Database project is currently undertaking a programme to extract and code the individual studies from the meta-synthesis used in the EEF Teaching and Learning Toolkit. The search strategy used in this review was ‘seeded’ from studies identified as being about ‘feedback’ in the database, and this systematic review used the coding tools developed by the Database team (see Appendix 3). The studies newly identified in this review will be subsequently included in the EEF Database. This systematic review was also designed to provide additional research evidence for use in guidance on feedback developed for schools produced by the EEF, and therefore to fit with a particular time window for the review’s production. The results of the meta-analyses were presented to an advisory panel of academics and teaching practitioners, who used the results , their own expertise, a review of practice undertaken by the University of Oxford, and conceptual models (such as Hattie and Timperley) to draft recommendations for practice

Attention-deficit/hyperactivity disorder medication and seizures

OBJECTIVE: Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of seizures, but there is uncertainty about whether ADHD medication treatment increases risk among patients with and without preexisting seizures. METHODS: We followed a sample of 801,838 patients with ADHD who had prescribed drug claims from the Truven Health MarketScan Commercial Claims and Encounters databases to examine whether ADHD medication increases the likelihood of seizures among ADHD patients with and without a history of seizures. First, we assessed overall risk of seizures among patients with ADHD. Second, within-individual concurrent analyses assessed odds of seizure events during months when a patient with ADHD received ADHD medication compared with when the same individual did not, while adjusting for antiepileptic medications. Third, within-individual long-term analyses examined odds of seizure events in relation to the duration of months over the previous 2 years patients received medication. RESULTS: Patients with ADHD were at higher odds for any seizure compared with non-ADHD controls (odds ratio [OR] = 2.33, 95% confidence interval [CI] = 2.24-2.42 males; OR = 2.31, 95% CI = 2.22-2.42 females). In adjusted within-individual comparisons, ADHD medication was associated with lower odds of seizures among patients with (OR = 0.71, 95% CI = 0.60-0.85) and without (OR = 0.71, 95% CI = 0.62-0.82) prior seizures. Long-term within-individual comparisons suggested no evidence of an association between medication use and seizures among individuals with (OR = 0.87, 95% CI = 0.59-1.30) and without (OR = 1.01, 95% CI = 0.80-1.28) a seizure history. CONCLUSIONS: Results reaffirm that patients with ADHD are at higher risk of seizures. However, ADHD medication was associated with lower risk of seizures within individuals while they were dispensed medication, which is not consistent with the hypothesis that ADHD medication increases risk of seizures