The impact of deep versus standard neuromuscular block on intraoperative safety during laparoscopic surgery: an international multicenter randomized controlled double-blind strategy trial - EURO-RELAX TRIAL

Background: Muscle relaxants are routinely used during anesthesia to facilitate endotracheal intubation and to optimize surgical conditions. However, controversy remains about the required depth of neuromuscular block (NMB) needed for optimal surgical working conditions and how this relates to other outcomes. For instance, a deep neuromuscular block yields superior surgical working conditions compared to a standard NMB in laparoscopic surgery, however, a robust association to other (safety) outcomes has not yet been established.Methods: Trial design: an international multicenter randomized controlled double-blind strategy trial. Trial population: 922 patients planned for elective, laparoscopic or robotic, abdominal surgery. Intervention: Patients will be randomized to a deep NMB (post-tetanic count 1-2 twitches) or standard care (single-dose muscle relaxant administration at induction and repeated only if warranted by surgical team). Main trial endpoints: Primary endpoint is the difference in incidence of intraoperative adverse events during laparoscopic surgery graded according to ClassIntra (R) classification (i.e., ClassIntra (R) grade >= 2) between both groups. Secondary endpoints include the surgical working conditions, 30-day postoperative complications, and patients' quality of recovery.Discussion: This trial was designed to analyze the effect of deep neuromuscular block compared to standard neuromuscular block on intra- and postoperative adverse events in patients undergoing laparoscopic surgery.Perioperative Medicine: Efficacy, Safety and Outcome (Anesthesiology/Intensive Care

The role of picture books in young children’s mathematics learning

In this chapter we address the role of picture books in kindergartners’ learning of mathematics. The chapter is based on various studies we carried out on this topic from different perspectives. All studies sought to provide insight into the power of picture books to contribute to the development of mathematical understanding by young children. We start the chapter with some background information about picture books as a didactical tool in mathematics education. Then, we discuss a framework of picture book characteristics that support young children’s learning of mathematics. In the next section, we give a short impression of children’s spontaneous mathematics-related utterances that occur during the reading of a picture book. This section is followed by a deeper look at the influence of the pictures in a picture book. Hereafter, the reading itself is the focus. Three book reading techniques are discussed and illustrated by classroom vignettes. Finally, based on an intervention program in which kindergartners were read a series of picture books, we report what we learned about the effectiveness of picture book reading on kindergartners’ performance in mathematics

Mapping kindergartners’ number competence

In this study the number competence of kindergartners was investigated. Based on a series of items involving counting, subitizing, additive reasoning and multiplicative reasoning we collected data from a sample of kindergartners in the Netherlands (N = 334) and Cyprus (N = 304). A confirmatory factor analysis showed that the four-factor structure fit to the empirical data from the Netherlands, and that the competence of the kindergartners in Cyprus reflected a two-factor structure including extended counting and additive reasoning. With respect to this latter, common number component, the Netherlands children outperformed those from Cyprus. In both countries the children who were in the second year of kindergarten did better than those who were in the first year. In the Netherlands, out of the four components, multiplicative reasoning was the most difficult, whereas in Cyprus additive reasoning was more difficult than extended counting

Mapping kindergartners’ number competence

In this study the number competence of kindergartners was investigated. Based on a series of items involving counting, subitizing, additive reasoning and multiplicative reasoning we collected data from a sample of kindergartners in the Netherlands (N = 334) and Cyprus (N = 304). A confirmatory factor analysis showed that the four-factor structure fit to the empirical data from the Netherlands, and that the competence of the kindergartners in Cyprus reflected a two-factor structure including extended counting and additive reasoning. With respect to this latter, common number component, the Netherlands children outperformed those from Cyprus. In both countries the children who were in the second year of kindergarten did better than those who were in the first year. In the Netherlands, out of the four components, multiplicative reasoning was the most difficult, whereas in Cyprus additive reasoning was more difficult than extended counting

Developing a framework for the evaluation of picturebooks that support kindergartners’ learning of mathematics

The purpose of this study was to investigate what experts in the use of picturebooks in mathematics education consider powerful characteristics of such books in the support of young children’s learning of mathematics. The study started by investigating experts’ views of such characteristics, as reflected in academic and professional publications on the use of picturebooks in mathematics education. This resulted in a first version of a framework of learning-supportive characteristics of picturebooks. In the second part of the study the framework was refined, and its tenability was tested through a four-round Delphi method, in which seven experts were asked to comment on, and work with, the framework when evaluating three picturebooks. The experts’ evaluations of these books showed that a larger number of learning-supportive characteristics were identified when using the framework than when not using it