施設に入所中の認知症高齢者の自律神経活動の特徴

This study clarified the characteristic autonomic nervous activity of institutionalized elders diagnosed with dementia using Hasegawa’s Dementia Scale-Revised. Twenty-six healthy adult persons (HPs) in their 20 s - 40 s met the inclusion criteria, and 16 persons (27.6 ± 8.2 years old) completed the research procedure. Of 70 persons with dementia (PDs) residing at the one geriatric health services facilities, only 24 persons met the inclusion criteria, and only nine (N = 9, 83.44 ± 9.45 years old) completed the procedure. Actigraph and ambulatory electrocardiographic instruments measuring autonomic nervous activity were attached to the subjects for 24 hours. Activities and behaviors of PDs and HPs were observed by clinically experienced staff nurses and care workers. High frequency (HF) power indicating parasympathetic activity and LF/HF ratio indicating sympathetic activity were calculated. When awake, PDs’ LF/HF ratio was significantly lower than HP’s (Z = −2.60, p < 0.01), showing significant differences in the LF/HF ratios between waking and sleeping, more than those of the PDs (p < 0.001). Similarly, when awake, significant positive correlations were observed in the LF/HF ratio and actigraph activity count (AC) in 11 HPs and 3 PDs (range r = 0.17 to 0.49, p < 0.05); however, significant negative correlation was found in HF and AC of 12 HPs and 3 PDs (range r = −0.55 to −0.18, p < 0.05). While sleeping, significant positive correlations were observed in LF/HF and AC of 3 HPs and 1 PD (range r = 0.35 to 0.42, p < 0.05) and significant negative correlation was found in the HF and AC of 1 HP (r= −0.32, p < 0.001) and 1 PD (r = −0.32, p < 0.05). The mean value of LF/HF in a wakeful state was significantly lower for PDs than HPs. Combined results of behavioral observation, actigrapy and heart rate variability (HRV) analyses suggested that PDs showed positive correlations between LF/HF and AC in a wakeful state. Compared to those who showed no positive correlation, they did not require much nursing care

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Geography fieldwork : making a difference by using a ‘backward design process’ to enhance learning

The effectiveness of learning through fieldwork for three classes of Year 9 students on two extended fieldwork camps across two years is examined. The importance of the alignment of curriculum, pedagogy and assessment is discussed in relation to the ‘backward design process’. In this process the desired results and acceptable standards are determined first before other learning experiences are planned. In this study, the desired outcomes from the extended fieldworks (up to 4 weeks) were firstly, reconnecting the students with nature; secondly, achieving specified curriculum outcomes derived from syllabuses; and thirdly achieving specific Action Statements of the Education Queensland’s Middle phase of learning state school action plan (2004). The findings supported the use of the ‘backward design process’ as a highly effective way to design learning, and particularly with fieldwork

Education for sustainability innovative learning experiences for middle year students on a tropical island /

"A once in a lifetime experience!' exclaimed students, parents and teachers involved in the first extended residential program for eighteen Year 6 and 7 students at North Keppel Island Environmental Education Centre in Queensland, Australia held in 2005. Surrounded by the waters of the world heritage Great Barrier Reef, and located on a national park island some ten kilometres from the coast, the setting provided and comprehensively planned program provided a unique learning environment. NKIEEC completes its first ten years of operation in 2006 and provides a very rich environment for education for sustainability. For example, the Centre is Australia's second largest stand-alone alternative energy site, it must maximise water conservation with its relatively low rainfall regime, and being on a National Park needs to effectively manage waste. Learning is the program focussed on reconnecting participants with nature and addressing thirteen Action statements of the Queensland Department of Education's Middle Phase of Learning State School Action Plan (2004). This paper examines the program and how it has impacted on student and community learning that includes action plans developed by the participating students. Real learning gains in authentic settings where pedagogy, curriculum and assessment aligned were evidenced in the program that provides a case study to further inform learning and teaching practices

Geography teachings standards and the development of teacher expertise

This paper explores the connection between professional standards developed by the peak Australian professional body in the area, and the implications for teachers and their professional development

Making connections and creating sustainable futures through a residential learning program in the middle years of schooling

Research indicates that learning in the natural environment is a powerful way to engage students in sustainability issues (see, for example, Gralton, Sinclair & Purnell, 2004; Ballantyne, Fien & Packer, 2001; Ballantyne, Packer & Everett, 2005). It is this premise that underpins an environmental education centre at North Keppel Island, Queensland, Australia. This Environmental Education Centre (North Keppel Island Environmental Education Centre [NKIEEC]) regularly host residential school student based programs of three to five days' duration. In late 2005 the Centre held the first extended Queensland state school residential program for two weeks' duration with eighteen Year 6 and 7 students from five nearby mainland schools.Planning for the program took two years and involved principals and staff from the local Capricorn Coast (CapCoast) Cluster of Schools as well as staff from NKIEEC. The key policy underpinning the planning was the Queensland Department of Education and the Art's Middle Phase of Learning State School Action Plan (2004) with it’s the thirteen action statements (Appendix 1). Planning also focussed on the nine values of nature identified in the professional development kit, Nature eXposed (Mumbray & Hossack, 2002). Each day of the residential had a focus on one value such as "Utilitarian' with some foci being repeated. The nine values are outlined in Appendix 2.There is a strong focus in the planning, delivery and evaluation of the program to make connections between people through partnerships, people and the natural environment and creating preferred futures through sustainable practices. Learning gains in terms of knowledge and attitudes are very important in the program. However, many other environmental programs tend to concentrate on knowledge and values only (see Ballantyne, Packer & Everett, 2005; Gralton, Sinclair & Purnell, 2004). In this program there is also an emphasis on behavioural change that results in more sustainable practices. There is a clear link between theory and practice to create more sustainable futures.This paper examines the extent to which the program achieved the stated outcomes and its impacts on learning.The aims of the program were to:To support the needs of selected CapCoast Cluster Middle Years of Learning (MYOL) students through an extended residential program;Be a powerful celebration of connection to place, people and self;Immerse learners in the values of nature; andEffect inspirational curriculum development with a focus on empowering people towards a more sustainable future.(Source: Hossack, 2005).The aims of the program are consistent with NKIEEC's Development Plan 2005-2007 (NKIEEC, 2006) where the Centre's key value is 'to empower learners through inspirational connections of people and place to affect a more sustainable future'.It is argued that the thoroughly planned extended residential experience has had a powerful and lasting impact on the participants, and that action plans developed, implemented and monitored by the participating students in their schools and the broader community are integral in contributing to sustainability practices and student learning. This is consistent with findings by Tilbury and Cooke (2005) where change is sought beyond the individual to the community

Student learning journey supporting student success through the student readiness questionnaire /

Students enrolling at university expect to succeed. The Student Learning Journey is a Central Queensland University (CQU) initiative to support students in achieving this goal. This paper explicitly examines an important “first step” in the process where on enrolment it is intended that students complete the Student Readiness Questionnaire (SRQ). This questionnaire was developed following over a thousand hours of interviews with students identified as being “at academic risk ”, and as part of a working group of the Student Learning Journey. The development and use of this questionnaire as part of CQU’s initiative to help all students be successful in their studies are discussed in this paper. The questionnaire will build a student profile in areas including mode of study, age, educational preparedness, lifestyle and cognitive and emotional readiness. These factors tell a powerful story about essential elements of a student’s expectations, motivation to succeed and persistence to seek help. From this, personalised learning programs can be designed. By knowing the profile of our student community and what that means in relation to the academic journey, it is possible to identify what particular structural and systemic solutions are required to support further student retention

World-class assessment practices in Grades 11 and 12

Purnell, KN ORCiD: 0000-0001-7445-9824Is there an alternative to external exams at the end of Grade 12? In such high-stakes as entrance to university, external exams are considered by some as ‘the gold standard’. Contrasting external exams is a system of externally-moderated, school-based assessment where teachers are at the heart of high stakes assessment decisions (Stobart, 2015). Such a system has existed in Queensland, Australia since 1972 where there is a long history with a range of quality assurance processes. One such example of those processes is the scaling instrument of the Queensland Core Skills Test that consists of four papers across two days - seven hours of testing - that has two 50 item multiple choice tests, Short Response Items and a Writing Task based on the Common Curriculum Elements in Grade 11 and 12 subjects and is used to measure school group results and to calculate Overall Positions for use in tertiary entrance selection. Another example is the panel system of expert teachers in a subject at two levels - local district subject panels to give advice on school submissions of sample student assessment responses in each subject, and State subject panels dealing with any unresolved cases between a school and a local panel as well as checking for State-wide comparability of standards. The inter-marker comparability is typically in the order of 0.9 – about what is achieved on hand scored multiple choice tests. It is very high and it is across not just a five-point scale, but 50. So, if it isn’t broke, why fix it

Climate change : how real is it? the issues and implications

For many people confusion still exists about climate change, how real is it, what does it mean, what are the impacts and can we ameliorate them, how do we adapt? For more than a decade, scientists and governments throughout the world have been investing resources in a collaborative effort to examine and address emerging issues in the stability of the world's climate. This collaborative effort has largely been driven by concern over the changing climate and the impact that major climatic events have on the global economy. One of the major products to emerge from this effort was the formation of the International Panel on Climate Change (IPCC, 2001a). The IPCC's three major working groups that include internationally-recognised scientists examined the science behind understanding climate change and the cause, the impacts of the change in climate and possible adapatation strategies, and the mitigation of the impacts (IPCC, 2001a)

Inquiry in geography and science : can it work?

The compulsory learning areas of geography and science in the Australian Curriculum have inquiry as a major pedagogical approach in learning and teaching. In this paper we argue that teacher-informed professionalism is critical in an inquiry to develop student knowledge and skills in geography and science. This includes the effective and efficient use of the steps in an inquiry and the ‘Backward design process’. Assessment, teaching strategies and learning experiences are designed to achieve the goals of the inquiry from the outset. We conclude that professional teaching using guided inquiry maximises the learning gains of students, as it is highly brain compatible for students and their teachers