A core outcomes set for clinical trials of interventions for young adults with type 1 diabetes: an international, multi-perspective Delphi consensus study

BACKGROUND: Achieving consensus from a range of relevant stakeholders about an agreed set of core outcomes to be measured and reported as a minimum in clinical trials has the potential to enhance evidence synthesis and make findings more relevant and applicable. Intervention research to improve outcomes for young adults with type 1 diabetes (T1DM) is hampered by inconsistent use of outcome measures. This population frequently struggles to manage their condition and reports suboptimal clinical outcomes. Our aim was to conduct an international, e-Delphi consensus study to identify a core outcome set (COS) that key stakeholders (young adults with T1DM, diabetes health professionals, diabetes researchers and diabetes policy makers) consider as essential outcomes for future intervention research. METHODS: Using a list of 87 outcomes generated from a published systematic review, we administered two online surveys to a sample of international key stakeholders. Participants in the first survey (survey 1; n = 132) and the second survey (survey 2; n = 81) rated the importance of the outcomes. Survey 2 participants received information on total mean rating for each outcome and a reminder of their personal outcome ratings from Survey 1. Survey 2 results were discussed at a consensus meeting and participants (n = 12: three young adults with T1DM, four diabetes health professionals, four diabetes researchers and one diabetes policy maker) voted on outcomes. Final core outcomes were included provided that 70% of consensus group participants voted for their inclusion. RESULTS: Eight core outcomes were agreed for inclusion in the final COS: measures of diabetes-related stress; diabetes-related quality of life; number of severe hypoglycaemic events; self-management behaviour; number of instances of diabetic ketoacidosis (DKA); objectively measured glycated haemoglobin (HbA1C); level of clinic engagement; and perceived level of control over diabetes. CONCLUSIONS: This study is the first to identify a COS for inclusion in future intervention trials to improve outcomes for young adults with T1DM. Use of this COS will improve the quality of future research and increase opportunities for evidence synthesis. Future research is necessary to identify the most robust outcome measure instruments

Yang-Mills instantons on the taub-NUT space and supersymmetric N=2 gauge theories with impurities

THESIS 9465We write a formula for arbitrary charge calorons, instantons on R3 x S1, in terms of the Green\u27s function of the Laplacian defined for the Nahm Transform, thus generalising the formula for the charge one caloron derived by Kraan and van Baal in [1]. The Laplacian is constructed from Nahm data. The usual approach to the Nahm Transform involves an integration over the interval on which the Nahm data are defined. By using Green\u27s functions we avoid this integration and our formula is straightforward to use

The Effects of High Literacy Demands in Mathematics on International Students

Project Maths is an ambitious reform of Irish post-primary education. It involves changes to what students learn in mathematics, how they learn it and how they will be assessed. There is a much greater emphasis placed on student understanding of mathematical concepts, with increased use of contexts and applications that will enable students to relate mathematics to their everyday experiences. The assessment reflects the different emphasis on problem solving and applications in the teaching and learning of mathematics and there is a much greater emphasis on reading and understanding the problems. Hence there is a greater emphasis on student’s English language proficiency. This study aims to investigate the effect of Project Maths on international students studying in Ireland who do not speak English as their first language. As part of the study participants completed two sample examinations, one which comprised of mathematical word problems and the other which was technically the same examination but was mathematical procedure and skill based only. The results show a statistically significant difference between the mean scores of students in both examinations, with students performing better when the majority of language and context in questions was removed. This highlights the impact that literacy skills can play in the mathematics classroom

The Effects of High Literacy Demands in Mathematics on International Students

Project Maths is an ambitious reform of Irish post-primary education. It involves changes to what students learn in mathematics, how they learn it and how they will be assessed. There is a much greater emphasis placed on student understanding of mathematical concepts, with increased use of contexts and applications that will enable students to relate mathematics to their everyday experiences. The assessment reflects the different emphasis on problem solving and applications in the teaching and learning of mathematics and there is a much greater emphasis on reading and understanding the problems. Hence there is a greater emphasis on student’s English language proficiency. This study aims to investigate the effect of Project Maths on international students studying in Ireland who do not speak English as their first language. As part of the study participants completed two sample examinations, one which comprised of mathematical word problems and the other which was technically the same examination but was mathematical procedure and skill based only. The results show a statistically significant difference between the mean scores of students in both examinations, with students performing better when the majority of language and context in questions was removed. This highlights the impact that literacy skills can play in the mathematics classroom

Group follow-up compared to individual clinic visits after structured education for type 1 diabetes: A cluster randomised controlled trial

Journal articleAim - To compare the effectiveness of group follow-up with individual follow-up after participation in the Dose Adjustment for Normal Eating (DAFNE) structured education programme. Methods - Cluster randomised controlled trial involving 437 adults with type 1 diabetes attending hospital diabetes clinics in Ireland. All participants received DAFNE at baseline. Intervention arm participants received 2 group education sessions post-DAFNE and did not attend clinics. Control arm participants received 2 one-to-one clinic visits post-DAFNE. Results - We observed no significant difference in the primary outcome (change in HbA1c) at 18 months follow-up (mean difference 0.14%; 95% CI ¿0.33 to 0.61; p = 0.47). Secondary outcomes, including rates of severe hypoglycaemia, anxiety, depression, the burden of living with diabetes and quality of life did not differ between groups. Mean level of HbA1c for the entire sample (regardless of treatment arm) did not change between baseline and 18 month follow-up (p = 0.09), but rates of severe hypoglycaemia, diabetes related hospital attendance, levels of anxiety, depression, the burden of living with diabetes, quality of life and treatment satisfaction all significantly improved. Conclusions - Our data suggest that group follow-up as the sole means of follow-up after structured education for individuals with type 1 diabetes is as effective as a return to one-to-one clinic visits.HRB Irelan

Teacher efficacy beliefs at the horizon between primary and secondary school mathematics education

A belief in one’s ability to enact change is central to personal motivation, and thus the way we behave (Bandura, 1993). More particularly, mathematics teaching efficacy beliefs encompass the extent to which a teacher believes that his/her teaching is capable of bringing about change in the mathematical understanding of his/her students, and the extent to which teaching in general supports the learning of mathematics for all students. Bandura (1993) further posits that teachers with a low sense of efficacy are less inclined to support students in responding constructively to challenge and may thus undermine students’ sense of self efficacy in relation to mathematics. This is particularly significant when students’ transition from primary to secondary school, a change that frequently has a negative impact on students’ achievement and enthusiasm for mathematics (Grootenboer & Marshman, 2016). This cross border research study sought to capture the mathematics efficacy beliefs of 6th class and Year 7 teachers in Ireland (Ire) and Northern Ireland (NI), respectively, as well as 1st Year and Year 8 teachers through the use of a questionnaire. Altogether, a representative sample of 428 primary teachers responded, 298 from Ire and 130 from NI and 248 secondary mathematics teachers, 173 from Ire and 75 from NI. The findings show a disparity in relation to teachers’ impressions of mathematics. Primary school teachers (57.8% NI, 57.5% Ire) consider mathematics easier than most subjects to teach with only around 10% of secondary teachers agreeing (8.1% NI, 12.9% Ire) (chi sq p<0.0001). All teachers reported a high sense of self-efficacy in relation to answering students’ questions in class as well as teaching all strands across the mathematics curriculum. Primary teachers were more likely to consider that students were well prepared in all strands of the curriculum upon exiting primary school than secondary teachers. This disagreement is more pronounced when considering Algebra than in any other strand (89% primary, 11% secondary). Particularly significant is that in NI, 72% of secondary teachers as opposed to 51.5% of primary teachers agreed that students have their minds made up about mathematics before they start in secondary school (p=0.006) pointing to a lower outcome expectancy. These findings are particularly pertinent considering that the national Growing Up in Ireland study capturing the transition of students from primary school concluded that the quality of students’ interaction with secondary teachers emerged as having a significant relationship with attitudes to mathematics (ESRI, 2017, 52)

Bridging the primary to secondary school mathematics divide: Teachers\u27 perspectives

The transition from primary to secondary school is regarded as one of the most difficult crossings in students\u27 educational careers. The move, which typically occurs between the ages of twelve and fourteen, can be particularly pronounced for mathematics. This article describes the results of a questionnaire distributed in the Republic of Ireland in which the views of primary and secondary teachers were ascertained with regard to the transition process. A total of 298 primary and 173 secondary teachers completed the questionnaire. Results showed that teachers at both levels identified similar issues such as a lack of continuity between curricula, a lack of knowledge of each other\u27s curriculum and a lack of communication between both levels. Many of the teachers\u27 suggestions on how the transition process could be improved centred on these issues, as well as highlighting a need to provide joint professional development opportunities for teachers