Teaching and learning about controversial science issues

The overarching Nature of Science (NoS) strand in our revised science curriculum presents teachers of science with a number of challenges. One of them is the ‘Participating and Contributing’ achievement aim with its focus on controversial science issues (CSI). This article reports on a new classroom model for exploring controversial science issues with students that was trialled in New Zealand science classrooms, writes Dr. Kathy Saunders, the University of Waikato

The long and short of it: a comprehensive assessment of axial length estimation in myopic eyes from ocular and demographic variables.

Background/ObjectivesAxial length, a key measurement in myopia management, is not accessible in many settings. We aimed to develop and assess machine learning models to estimate the axial length of young myopic eyes.Subjects/MethodsLinear regression, symbolic regression, gradient boosting and multilayer perceptron models were developed using age, sex, cycloplegic spherical equivalent refraction (SER) and corneal curvature. Training data were from 8135 (28% myopic) children and adolescents from Ireland, Northern Ireland and China. Model performance was tested on an additional 300 myopic individuals using traditional metrics alongside the estimated axial length vs age relationship. Linear regression and receiver operator characteristics (ROC) curves were used for statistical analysis. The contribution of the effective crystalline lens power to error in axial length estimation was calculated to define the latter’s physiological limits.ResultsAxial length estimation models were applicable across all testing regions (p≥0.96 for training by testing region interaction). The linear regression model performed best based on agreement metrics (mean absolute error [MAE]=0.31mm, coefficient of repeatability=0.79mm) and a smooth, monotonic estimated axial length vs age relationship. This model was better at identifying high-risk eyes (axial length >98th centile) than SER alone (area under the curve 0.89 vs 0.79, respectively). Without knowing lens power, the calculated limits of axial length estimation were 0.30mm for MAE and 0.75mm for coefficient of repeatability.ConclusionsIn myopic eyes, we demonstrated superior axial length estimation with a linear regression model utilising age, sex and refractive metrics and showed its clinical utility as a risk stratification tool

NHS Health Check Programme rapid evidence synthesis

Background: The NHS Health Check programme is the largest current prevention initiative in England. Since its introduction in 2009 a growing literature has been published evaluating the first eight years of the programme. These have been summarised in reports published by Public Health England but, to date, no synthesis has been performed. There is, therefore, a need for an independent, comprehensive, rapid evidence synthesis to identify what has been learnt about the NHS Health Check programme so far. Aims and Objectives: To provide a rapid synthesis of the published research evidence on NHS Health Checks, specifically addressing the six research questions posed by Public Health England: 1. Who is and who is not having an NHS Health Check? 2. What are the factors that increase take-up among the population and sub-groups? 3. Why do people not take up an offer of an NHS Health Check? 4. How is primary care managing people identified as being at risk of cardiovascular disease or with abnormal risk factor results? 5. What are patients’ experiences of having an NHS Health Check? 6. What is the effect of the NHS Health Check on disease detection, changing behaviours, referrals to local risk management services, reductions in individual risk factor prevalence, reducing cardiovascular disease risk and on statin and antihypertensive prescribing? Design: A systematic review with descriptive synthesis of quantitative data and thematic synthesis of qualitative data. Data sources: Medline, PubMed, Embase, Health Management Information Consortium (HMIC), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Global Health, PsycInfo, Web of Science, the Cochrane Library, NHS Evidence, Google Scholar, Google, OpenGrey, Clinical Trials.gov, the ISRCTN registry, and article reference lists. Study selection: Studies identified by the searches were selected for inclusion in the review by two reviewers in a two-step process. First, studies relevant to the NHS Health Check were identified. These were then screened against predefined inclusion and exclusion criteria for each of the six research questions. Data extraction: At least two researchers assessed eligibility, extracted data, and assessed the quality of the included studies. Key findings: Coverage varies substantially across regions and in different settings. Multiple definitions used interchangeably make comparisons difficult. It is consistently higher in older people, females and more deprived populations but this may reflect targeting. Outreach services in the community can reach particular socio-demographic groups but better descriptions and robust evaluations are needed. There is a lack of national level studies reporting the characteristics of those who take-up the invitation to an NHS Health Check. Regional studies report uptake between 27% and 53%, similar to national reported uptake (48.3%). Older people, women in younger age groups and men in older age groups, and those from least deprived areas are more likely to take up invitations. Promising methods to increase uptake are modifications to the invitation (3-4% increase), and text message invites or reminders (up to 9% increase). There is a lack of quantitative evidence for the effect of community settings on uptake but qualitative evidence highlights their convenience and the value of community ambassadors. People do not take up the offer of an NHS Health Check due to lack of awareness or knowledge, competing priorities, misunderstanding the purpose, an aversion to preventive medicine, difficulty getting an appointment with a GP, and concerns about privacy and confidentiality of pharmacies. Amongst attendees there are high levels of satisfaction (over 80%). Some reported attendance had acted as a wake-up call and precipitant for lifestyle changes. Others were left with feelings of unmet expectations, were confused about or unable to remember their risk scores, and found lifestyle advice too simplistic and un-personalised. There are wide variations in the process, delivery and content of NHS Health Checks across the country, in part due to different local implementation. Regardless of region or setting those delivering NHS Health Checks reported challenges with workload, IT, funding, and training. Amongst general practice professionals there were concerns about inequality of uptake and doubts about the evidence underpinning the programme and the cost-effectiveness. NHS Health Checks are associated with small increases in disease detection. There is very little data on behaviour change or referrals to lifestyle services. NHS Health Checks are associated with a 3-4% increase in prescribing of statins

Reading Instruction for Children who use AAC: Considerations in the Pursuit of Generalizable Results

Our purpose was to review evidence-based literacy instruction for children with severe speech impairment (SSI) who communicate with AAC. This review focuses on three issues important to researchers in this area: participant heterogeneity, assessment and instruction, and research design. We found 8 articles that reported attempts to teach phonological awareness and individual-word reading to a total of 26 children with SSI who used AAC. We evaluated these studies based on reporting of participant characteristics, assessment and instruction modifications, and the strength of research designs. We conclude by highlighting the need for standard assessments that can be used across studies, discussing strategies for facilitating metaanalyses, and suggesting the creation of an online database for researchers to share results on literacy instruction for this population

Measuring differences in the ERG in myopia using the RETeval device with Skin Electrodes

IntroductionPrevious research suggests the electroretinogram (ERG) is reduced and delayed in non-pathological myopia. However, the invasive nature of the electrode and cumbersome equipment required has prevented the widescale uptake of ERG measures. This study investigated whether previously reported changes to the ERG response in myopia are also observable when measured using non-invasive skin electrodes and a hand-held ERG device.MethodMonocular flash ERGs were measured using the RETeval® device according to the ‘ISCEV 6 Step Dark First cd’ protocol in 46 participants with non-pathological myopia (spherical equivalent refraction (SER) -0.50D to -11.25D, median -3.75D, median axial length (AL) 25.4mm) and 47 non-myopic controls (SER +2.00D to -0.25D, median +1.00D, median AL 23.6mm). Measures were performed under pupil mydriasis with Sensor Strip skin electrodes. ResultsThe median implicit time for all dark-adapted (DA) components was longer among myopes. Following Holm-Bonferroni correction, this difference reached statistical significance (p<0.05) for the DA 3.0 A-wave, DA 10.0 A-wave and B-waves and DA Oscillatory potentials 1 and 2. There were no significant differences between median light adapted (LA) implicit times nor response amplitudes between refractive groups. For all DA components, there was a significant, positive correlation between AL and implicit time (all p<0.05). ConclusionsThe RETeval®, used with skin electrodes, did not detect the reduction in ERG amplitude reported in myopic eyes using traditional ERG set ups, potentially due to high inter-subject variability and/or anatomical confounders associated with the use of a skin electrode. The RETeval® with skin electrodes, did detect subtle delays to DA implicit times previously reported in myopia, with a positive relationship observed between AL and implicit time for all DA components. In contrast, no significant differences were observed for LA implicit times, which may indicate underlying differences in the dark-adaptation process and/or scotopic visual pathways in myopia