Providing students with formative audio feedback

The provision of timely and constructive feedback is increasingly challenging for busy academics. Ensuring effective student engagement with feedback is equally difficult. Increasingly, studies have explored provision of audio recorded feedback to enhance effectiveness and engagement with feedback. Few, if any, of these focus on purely formative audio feedback on draft submissions of written assignments. This study encouraged a cohort of 40 students to submit drafts of written assignments, two weeks before formal submission, in order to receive audio recorded feedback. Nearly half the cohort either did not submit drafts or submitted only brief outlines. The level of draft completeness impacted on the characteristics of the lecturer's feedback. While students receiving audio feedback gained significantly higher marks for finished work, this cannot be directly attributed to receipt/use of feedback as analysis suggests generally more able students are more likely to submit more complete drafts, which leads us to ask the question, are we simply helping better students to perform even better? Audio feedback was reported as clear, engaging and helpful; however, timing of feedback (before formal submission) may be of greater importance in terms of impact on attainment than the audio format. We suggest a model that focuses efforts on formative feedback (in advance of formal submission) and selective provision of summative feedback (targeted feed forward). © 2013 G. Scott, The Higher Education Academy

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Dear British criminology: Where has all the race and racism gone?

In this article we use Emirbayer and Desmond’s institutional reflexivity framework to critically examine the production of racial knowledge in British criminology. Identifying weakness, neglect and marginalization in theorizing race and racism, we focus principally on the disciplinary unconscious element of their three-tier framework, identifying and interrogating aspects of criminology’s ‘obligatory problematics’, ‘habits of thought’ and ‘position-taking’ as well as its institutional structure and social relations that combine to render the discipline ‘institutionally white’. We also consider, briefly, aspects of criminology’s relationship to race, racism and whiteness in the USA. The final part of the article makes the case for British criminology to engage in telling and narrating racisms, urging it to understand the complexities of race in our subject matter, avoid its reduction to class and inequality, and to pay particular attention to reflexivity, history, sociology and language, turning to face race with postcolonial tools and resolve

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

The implications of grassland and heathland management for the conservation of spider communities: a review

Both intensity and type of habitat management in grasslands and heathlands affect spider communities. With high intensity management, spider communities often lack diversity and are dominated by a few r-selected species affiliated with bare ground. Low intensity management produces more complex communities introducing more niches for aerial web spinners and climbing spiders. The preferred management will be site-dependent and may not be appropriate for all spiders in all situations, particularly for some rare or threatened species. Providing natural cover is recommended when using extreme forms of management or intensive grazing (particularly by sheep). In extreme cases, or where trampling is heavy, the litter layer should be conserved. We advocate research and survey before and after major management implementation. Habitat management for spiders should not be considered alone, but integrated into a holistic plan. Management for spiders may conflict with rare plant conservation and small reserves should examine the viability of providing two contrasting regimes

Spider communities as tools in monitoring reclaimed limestone quarry landforms

Spider communities are sensitive to a wide range of environmental factors and are potential ecological indicators which may be effective in the assessment and monitoring of restored ecosystems. One restoration technique of disused limestone quarry faces, landform replication, attempts to create landforms and ecosystems similar to those found on natural dalesides. Vegetation surveys indicate that communities developing on landform replications are more closely allied to natural dalesides than are those of naturally recolonised disused quarries. Assessment of the spider communities of three landform replication sites, a natural limestone daleside and seven naturally recolonised disused limestone quarries, using DECORANA and TWINSPAN, produced differing patterns of sites than those observed through the assessment of the vegetation communities. DECORANA assessment based on vascular plant species composition highlights the similarities between daleside and reclaimed site communities. The sensitivity of spider communities to vegetation structure and extent of bare ground highlights differences between sites and provides evidence of important differences in vegetation community development particularly in relation to cover and structure. Implications for the assessment of reclamation and restoration techniques are discussed

Pseudoscorpions in Field Margins: Effects of Margin Age, Management and Boundary Habitats

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Relationships between student characteristics and self-, peer and tutor evaluations of oral presentations

There are many influences on how assessors grade themselves and others. Oral presentations are useful for exploring such factors in peer, self- and tutor marked assessments, being rapidly completed and assessed, commonly used in HE and very difficult to anonymize. This opportunistic study examined the effects of gender and level of attainment on the triangulation of marks awarded to student presenters. Grades generated by peer assessment were associated more strongly with tutor-awarded marks than those from self- assessment. For self- assessment there was a strong effect of gender (female students undervalued their performance compared with tutor grades). Peer assessment produced higher marks than from tutors, perhaps because of the close-knit community developed during residential courses. For tutor marks, the greatest variability was at the lower end of the scale, whereas peer assessors were most variable when marking students who self- evaluated or peer assessed highly. Students awarded a narrower range of marks to peers compared with tutors, but when self- assessing used a larger range. Presentations by students who admitted to little sleep the night before received lower grades from both peers and tutors, but this was not reflected by self- assessments, suggesting they were unaware of their poorer performances. Sessions with fewer talks (four rather than seven) reduced the 'dip' in marks previously observed in the middle of sessions. Findings are discussed in the context of bias in this mode of assessment.</p