A Critical Review of Contemporary Practice in Internationalisation in the Hospitality, Leisure, Sport and Tourism (HLST) Subject Communities

This report identifies and critically reviews contemporary practice in the field of internationalisation within the HLST subject communities in order to inform curriculum development and pedagogy geared towards the development of international perspectives and global awareness. Drawing on current pedagogical literatures as well as staff and student consultations, it identifies a number of key points which reflect good practice in UK HLST curricula in the UK. Due to the broad disciplinary scope of the subject area in focus and the diversity of curricular activities across the UK, this critical review is selective rather than exhaustive and seeks to stimulate further discussion and research into this area

A Critical Review of Contemporary Practice and Educational Research in Internationalisation within the business education subject communities

This report critically reviews contemporary educational research and practice in the field of internationalisation within the business education subject communities in order to inform curriculum development and pedagogy geared towards the development of international perspectives and intercultural learning. Drawing on current pedagogical literatures as well as staff and student consultations, it identifies a number of key points which reflect good practice in business education curricula. Due to the broad disciplinary scope of the subject area in focus and the diversity of curricular activities across the UK, this critical review is selective rather than exhaustive and seeks to stimulate further discussion and research in the field. The report is structured as a reference text around key themes and issues emerging from the review, providing the reader who has a particular interest or issue in their practice with an outline of key texts which can be followed up as appropriate

Internationalisation and Equality and Diversity in Higher Education: Merging Identities

Summary This project arises out of Eade and Peacock’s (2009) scoping report, commissioned by Equality Challenge Unit (ECU) entitled Internationalising equality and equalising internationalisation: The intersection between internationalisation and Equality and Diversity in higher education. The principal aim of the current study is to identify the advantages of building on the intersection of Internationalisation and E and D agendas, through an exploration of the effective mechanisms for linking E and D and internationalisation policies, structures and activities within a small sample of heterogenous HE institutions located in Australia, England and Wales. Reflecting a multi-level and mixed-method approach this report provides an in-depth account of awareness, commitment, understanding and involvement of domestic and international staff and students, and other key players, in Internationalisation and Equality and Diversity. This account is supported by examples of good practice and synergy and consideration of areas of potential improvement in the two fields. The mixed-method approach involves desk research to consider the influence of geographical location, profile and size on rationales for internationalisation and commitment to Equality and Diversity, complemented by interviews of key personnel to provide insights regarding performance, accessibility etc. Data regarding staff and student awareness, perceptions and dispositions is captured via online survey and focus groups. Finally a review of the literature supports data interpretation by suggesting emergent key themes. Institutional challenges are identified within the context of what may be learned from other organisational forms. A central focus is the student learning experience, with discussions embracing key issues such as competing perspectives on learner support models, the association between inclusive curricula and multicultural education and attendant barriers and tensions. Extensive and systematic analysis of institutional policy in Internationalisation and Equality and Diversity within specific local contexts provides substantial evidence of how current and future direction is shaped by the socio-economic and cultural make-up of surrounding communities, tempered by institutional aspirations in the global arena. The insights of senior managers provide the personal accounts and deep insights into the ongoing strategic initiatives and perceived challenges which determine the practice which emerges from the rhetoric of policy statements. The in-depth exploration of awareness, perceptions and dispositions of staff and students serves to highlight a striking continuity of perspective across the range of stakeholders, within different institutions which approach Internationalisation and Equality and Diversity from widely contrasting positions vis-à-vis locality, status, market position and relative size. Seemingly, any shortcomings of policy to practice transfer are not the outcome of a lack of will on the part of those who have engaged in this research, but rather reflect the complexity of finding the most appropriate way, whether senior manager, teacher, support and development professional, student or other stakeholder. The challenges of internationalisation and Equality and Diversity simply manifest themselves in different ways at different levels within different institutional contexts and key messages from this research include for example: • The need to manage structural diversity within the framework of a broadly-based business-case approach in order to maintain internal cohesion and external credibility. Such an approach should acknowledge diversity of mission which derives from the nature of the global-local interface, profile, status etc. • Broad awareness of the potential synergies between Internationalisation and E and D within a framework of inclusive practice • Broad consensus surrounding the merits of inclusion embodying both local and global dimensions. At this level, diversity of mission, location, status etc. becomes irrelevant. Universities with different cultures can learn much from each other since inclusion should be the response of all institutions recruiting international and/or students from a diversity of cultural, ethnic, religious, socio-economic etc. backgrounds • Awareness of tensions at policy and practice levels, which might be eased by appropriate organisational structures and processes designed specifically to embed synergy across institutions • Acknowledgement of the need to embed the concept of synergy at three levels of diversity: structural (demographic mix); classroom (curriculum and pedagogies) and interactional (informal and social settings) • The significance of readily accessible research-informed and evidence-based practice to raise awareness, build confidence, promote engagement and inform future direction within cross-disciplinary and cross-institutional context

Causes of brain dysfunction in acute coma: a cohort study of 1027 patients in the emergency department

BACKGROUND: Coma of unknown etiology (CUE) is a major challenge in emergency medicine. CUE is caused by a wide variety of pathologies that require immediate and targeted treatment. However, there is little empirical data guiding rational and efficient management of CUE. We present a detailed investigation on the causes of CUE in patients presenting to the ED of a university hospital. METHODS: One thousand twenty-seven consecutive ED patients with CUE were enrolled. Applying a retrospective observational study design, we analyzed all clinical, laboratory and imaging findings resulting from a standardized emergency work-up of each patient. Following a predefined protocol, we identified main and accessory coma-explaining pathologies and related these with (i.a.) GCS and in-hospital mortality. RESULTS: On admission, 854 of the 1027 patients presented with persistent CUE. Their main diagnoses were classified into acute primary brain lesions (39%), primary brain pathologies without acute lesions (25%) and pathologies that affected the brain secondarily (36%). In-hospital mortality associated with persistent CUE amounted to 25%. 33% of patients with persistent CUE presented with more than one coma-explaining pathology. In 173 of the 1027 patients, CUE had already resolved on admission. However, these patients showed a spectrum of main diagnoses similar to persistent CUE and a significant in-hospital mortality of 5%. CONCLUSION: The data from our cohort show that the spectrum of conditions underlying CUE is broad and may include a surprisingly high number of coincidences of multiple coma-explaining pathologies. This finding has not been reported so far. Thus, significant pathologies may be masked by initial findings and only appear at the end of the diagnostic work-up. Furthermore, even transient CUE showed a significant mortality, thus rendering GCS cutoffs for selection of high- and low-risk patients questionable. Taken together, our data advocate for a standardized diagnostic work-up that should be triggered by the emergency symptom CUE and not by any suspected diagnosis. This standardized routine should always be completed - even when initial coma-explaining diagnoses may seem evident

The diagnostic value of the neurological examination in coma of unknown etiology

Background: Identifying the cause of non-traumatic coma in the emergency department is challenging. The clinical neurological examination is the most readily available tool to detect focal neurological deficits as indicators for cerebral causes of coma. Previously proposed clinical pathways have granted the interpretation of clinical findings a pivotal role in the diagnostic work-up. We aimed to identify the actual diagnostic reliability of the neurological examination with regard to identifying acute brain damage. Methods: Eight hundred and fifty-three patients with coma of unknown etiology (CUE) were examined neurologically in the emergency department following a predefined routine. Coma-explaining pathologies were identified retrospectively and grouped into primary brain pathology with proof of acute brain damage and other causes without proof of acute structural pathology. Sensitivity, specificity and percentage of correct predictions of different examination protocols were calculated using contingency tables and binary logistic regression models. Results: The full neurological examination was 74% sensitive and 60% specific to detect acute structural brain damage underlying CUE. Sensitivity and specificity were higher in non-sedated patients (87/61%) compared to sedated patients (64%/59%). A shortened four-item examination protocol focusing on pupils, gaze and pyramidal tract signs was only slightly less sensitive (67%) and more specific (65%). Conclusions: Due to limited diagnostic reliability of the physical examination, the absence of focal neurological signs in acutely comatose patients should not defer from a complete work-up including brain imaging. In an emergency, a concise neurological examination should thus serve as one part of a multimodal diagnostic approach to CUE

Modified p-modes in penumbral filaments?

Aims: The primary objective of this study is to search for and identify wave modes within a sunspot penumbra. Methods: Infrared spectropolarimetric time series data are inverted using a model comprising two atmospheric components in each spatial pixel. Fourier phase difference analysis is performed on the line-of-sight velocities retrieved from both components to determine time delays between the velocity signals. In addition, the vertical separation between the signals in the two components is calculated from the Stokes velocity response functions. Results: The inversion yields two atmospheric components, one permeated by a nearly horizontal magnetic field, the other with a less-inclined magnetic field. Time delays between the oscillations in the two components in the frequency range 2.5-4.5 mHz are combined with speeds of atmospheric wave modes to determine wave travel distances. These are compared to expected path lengths obtained from response functions of the observed spectral lines in the different atmospheric components. Fast-mode (i.e., modified p-mode) waves exhibit the best agreement with the observations when propagating toward the sunspot at an angle ~50 degrees to the vertical.Comment: 8 pages, 12 figures, accepted for publication in Astronomy & Astrophysic

implementation of an in-house management routine

Background Coma of unknown origin is an emergency caused by a variety of possibly life-threatening pathologies. Although lethality is high, there are currently no generally accepted management guidelines. Methods We implemented a new interdisciplinary standard operating procedure (SOP) for patients presenting with non-traumatic coma of unknown origin. It includes a new in- house triage process, a new alert call, a new composition of the clinical response team and a new management algorithm (altogether termed “coma alarm”). It is triggered by two simple criteria to be checked with out-of-hospital emergency response teams before the patient arrives. A neurologist in collaboration with an internal specialist leads the in-hospital team. Collaboration with anaesthesiology, trauma surgery and neurosurgery is organised along structured pathways that include standardised laboratory tests and imaging. Patients were prospectively enrolled. We calculated response times as well as sensitivity and false positive rates, thus proportions of over- and undertriaged patients, as quality measures for the implementation in the SOP. Results During 24 months after implementation, we identified 325 eligible patients. Sensitivity was 60 % initially (months 1–4), then fluctuated between 84 and 94 % (months 5–24). Overtriage never exceeded 15 % and undertriage could be kept low at a maximum of 11 % after a learning period. We achieved a median door-to-CT time of 20 minutes. 85 % of patients needed subsequent ICU treatment, 40 % of which required specialised neuro- ICUs. Discussion Our results indicate that our new simple in-house triage criteria may be sufficient to identify eligible patients before arrival. We aimed at ensuring the fastest possible proceedings given high portions of underlying time-sensitive neurological and medical pathologies while using all available resources as purposefully as possible. Conclusions Our SOP may provide an appropriate tool for efficient management of patients with non- traumatic coma. Our results justify the assignment of the initial diagnostic workup to neurologists and internal specialists in collaboration with anaesthesiologists

Serial measurement of neuron specific enolase improves prognostication in cardiac arrest patients treated with hypothermia: A prospective study

<p>Abstract</p> <p>Background</p> <p>Neuron specific enolase (NSE) has repeatedly been evaluated for neurological prognostication in patients after cardiac arrest. However, it is unclear whether current guidelines for NSE cutoff levels also apply to cardiac arrest patients treated with hypothermia. Thus, we investigated the prognostic significance of absolute NSE levels and NSE kinetics in cardiac arrest patients treated with hypothermia.</p> <p>Methods</p> <p>In a prospective study of 35 patients resuscitated from cardiac arrest, NSE was measured daily for four days following admission. Outcome was assessed at ICU discharge using the CPC score. All patients received hypothermia treatment for 24 hours at 33°C with a surface cooling device according to current guidelines.</p> <p>Results</p> <p>The cutoff for absolute NSE levels in patients with unfavourable outcome (CPC 3-5) 72 hours after cardiac arrest was 57 μg/l with an area under the curve (AUC) of 0.82 (sensitivity 47%, specificity 100%). The cutoff level for NSE kinetics in patients with unfavourable outcome (CPC 3-5) was an absolute increase of 7.9 μg/l (AUC 0.78, sensitivity 63%, specificity 100%) and a relative increase of 33.1% (AUC 0.803, sensitivity 67%, specificity 100%) at 48 hours compared to admission.</p> <p>Conclusion</p> <p>In cardiac arrest patients treated with hypothermia, prognostication of unfavourable outcome by NSE kinetics between admission and 48 hours after resuscitation may be superior to prognostication by absolute NSE levels.</p

Assessment of breast cancer risk factors reveals subtype heterogeneity

Subtype heterogeneity for breast cancer risk factors has been suspected, potentially reflecting etiological differences and implicating risk prediction. Reports are conflicting regarding presence of heterogeneity for many exposures. To examine subtype heterogeneity across known breast cancer risk factors, we conducted a case-control analysis of 2,632 breast cancers and 15,945 controls in Sweden. Molecular subtype was predicted from pathology-record derived immunohistochemistry markers by a classifier trained on PAM50 subtyping. Multinomial logistic regression estimated separate odds ratios for each subtype by the exposures parity, age at first birth, breastfeeding, menarche, HRT use, somatotype at age 18, benign breast disease, mammographic density, polygenic risk score, family history of breast cancer and BRCA mutations. We found clear subtype heterogeneity for genetic factors and breastfeeding. The polygenic risk score was associated with risk of all subtypes except for the basal-like (p heterogeneity < 0.0001). Parous women who never breastfed were at higher risk of basal-like subtype (OR 4.17; 95% CI 1.89 to 9.21) compared to both nulliparous (reference) and breastfeeding women. Breastfeeding was not associated with risk of HER2-overexpressing type, but protective for all other subtypes. The observed heterogeneity in risk of distinct breast cancer subtypes for germline variants supports heterogeneity in etiology and has implications for their use in risk prediction. The increased risk of basal-like subtype among women who never breastfed merits more research into potential causal mechanisms and confounders.Swedish Research CouncilSwedish Cancer SocietyAccepte