Kolmiportaisen tuen toteutuminen TUKEMO-oppimisympäristössä

Tiivistelmä. Tutkimuksen tavoite oli tutkia, miten eri tukimuotojen oppilaat hyötyisivät TUKEMO-oppimisympäristöstä. Tutkimuksen tavoite oli myös kartoittaa opettajien ennakko-oletuksia TUKEMO:sta. Tutkimuksessa oli mukana erään yläkoulun kaksi 7. luokkaa ja kaksi 9. luokkaa. Luokat valikoituivat mukaan tutkimukseen, koska ne olivat käyttäneet paljon TUKEMO-tiloja. Tutkimus toteutettiin kyselylomakkeilla. Tutkimus on fenomenografinen. Tutkimuksessa kerättiin sekä määrällistä että laadullista aineistoa. Määrällisen aineiston tarkoitus oli selvittää, hyötyvätkö oppilaat TUKEMO-tilasta sekä sitä, onko TUKEMO-hankkeella vaikutusta oppilaan oppimiseen. Laadullinen aineisto pyrki selvittämään oppilaiden ja opettajien mielipiteitä ja kokemuksia TUKEMO-tiloista. TUKEMO-tiloissa on tarkoitus ottaa paremmin huomioon erilaiset oppilaat sekä toteuttaa kolmiportaista tukea konkreettisemmin. Suurin osa tehostettua ja erityistä tukea saavista oli sitä mieltä, että he oppivat paremmin TUKEMO:ssa kuin perinteisessä luokassa. TUKEMO oli normaalia luokkaa viihtyisämpi, esimerkiksi tuolien ansiosta. Tilat olivat myös muunneltavissa. Opettajien mielestä viihtyisä oppimisympäristö voi lisätä oppilaiden motivaatiota ja kouluviihtyvyyttä. TUKEMOoppimisympäristö on suunniteltu siten, että opettajien on helpompi ottaa huomioon tukea tarvitsevat oppilaat. Pelkät tilat eivät kuitenkaan auta oppilaita oppimaan, vaan opettajien täytyy myös hyödyntää tilojen suomia mahdollisuuksia. TUKEMO-tilojen myötä eriyttämisestä tulee arkipäivää. Täytyy muistaa, että tulokset eivät ole yleistettävissä kaikkiin oppimisympäristöihin, mutta niitä voi hyödyntää uusia oppimisympäristöjä suunniteltaessa.Abstract. The goal of this thesis was to research, how students of different aid benefited TUKEMO- learning environment and to investigate teacher’s views about TUKEMO. In research was two 7. classes and two 9. classes in one comprehensive school. Those classes took part to this research because they had used a lot of TUKEMO- learning environment. The research implemented with questionnaires. The research is a phenomenography research. In the research collected both quantitative and qualitative material. The goal of quantitative material was to research, did students benefit about TUKEMO and did TUKEMO- project have influence on student’s learning. The goal of qualitative material was to investigate opinions and experiences of teachers and students about TUKEMO- learning environment. The aim of TUKEMO- learning environment is to take note different students better than now and to implement three-step intervention more concrete. The most of students, who get intensified or special support opined that they learn better in TUKEMO than in a normal class. Students of a general support learn equally well in a normal class and in TUKEMO- learning environment. TUKEMO is more pleasant than a normal classroom, for example for chairs. The room is also configurable. Teachers think that a pleasant learning environment can add students a motivation and pleasant of school. TUKEMO- learning environment is planed so that teachers is easier to take note different students, for example to diversify the teaching. A bare environment do not help students to learn but teachers have to utilize opportunities about these environments. TUKEMO- learning environment helps teacher to differentiating their teaching. You have to remember that these results are not to generalize to all learning environments bur results can utilize for planning new learning environment

Noninvasive Neuromonitoring of Hypothermic Circulatory Arrest in Aortic Surgery

Background and Aims: Circulatory arrest carries a high risk of neurological damage, but modern monitoring methods lack reliability, and is susceptible to the generalized effects of both anesthesia and hypothermia. The objective of this prospective, explorative study was to research promising, reliable, and noninvasive methods of neuromonitoring, capable of predicting neurological outcome after hypothermic circulatory arrest. Materials and Methods: Thirty patients undergoing hypothermic circulatory arrest during surgery of the thoracic aorta were recruited in a single center and over the course of 4 years. Neuromonitoring was performed with a four-channel electroencephalogram montage and a near-infrared spectroscopy monitor. All data were tested off-line against primary neurological outcome, which was poor if the patient suffered a significant neurological complication (stroke, operative death). Results: A poor primary neurological outcome seen in 10 (33%) patients. A majority (63%) of the cases were emergency surgery, and thus, no neurological baseline evaluation was possible. The frontal hemispheric asymmetry of electroencephalogram, as measured by the brain symmetry index, predicted primary neurological outcome with a sensitivity of 79 (interquartile range; 62%-88%) and specificity of 71 (interquartile range; 61%-84%) during the first 6 h after end of circulatory arrest. Conclusion: The hemispheric asymmetry of frontal electroencephalogram is inherently resistant to generalized dampening effects and is predictive of primary neurological outcome. The brain symmetry index provides an easy-to-use, noninvasive neuromonitoring method for surgery of the thoracic aorta and postoperative intensive care.Peer reviewe

Responsiveness Index versus the RASS-Based Method for Adjusting Sedation in Critically Ill Patients

Publisher Copyright: © 2021 Johanna E. Wennervirta et al.Background. Sedation of intensive care patients is needed for patient safety, but deep sedation is associated with adverse outcomes. Frontal electromyogram-based Responsiveness Index (RI) aims to quantify the level of sedation and is scaled 0-100 (low index indicates deep sedation). We compared RI-based sedation to Richmond Agitation-Sedation Scale- (RASS-) based sedation. Our hypothesis was that RI-controlled sedation would be associated with increased total time alive without mechanical ventilation at 30 days without an increased number of adverse events. Methods. 32 critically ill adult patients with mechanical ventilation and administration of sedation were randomized to either RI- or RASS-guided sedation. Patients received propofol and oxycodone, if possible. The following standardized sedation protocol was utilized in both groups to achieve the predetermined target sedation level: either RI 40-80 (RI group) or RASS -3 to 0 (RASS group). RI measurement was blinded in the RASS group, and the RI group was blinded to RASS assessments. State Entropy (SE) values were registered in both groups. Results. RI and RASS groups did not differ in total time alive in 30 days without mechanical ventilation (p=0.72). The incidence of at least one sedation-related adverse event did not differ between the groups. Hypertension was more common in the RI group (p=0.01). RI group patients were in the target RI level 22% of the time and RASS group patients had 57% of scores within the target RASS level. The RI group spent significantly more time in their target sedation level than the RASS group spent in the corresponding RI level (p=0.03). No difference was observed between the groups (p=0.13) in the corresponding analysis for RASS. Propofol and oxycodone were administered at higher RI and SE values and lower RASS values in the RI group than in the RASS group. Conclusion. Further studies with a larger sample size are warranted to scrutinize the optimal RI level during different phases of critical illness.Peer reviewe