Movilidad internacional de los futuros-maestros: una herramienta para desarrollar una actitud profesional

In contemporary Europe international student mobility has become relatively common and the idea that spending time studying abroad is advantageous is now widely accepted. Through analysis of student-teacher responses to a questionnaire completed at the end of an Erasmus Intensive Programme, this paper examines the extent to which participation in a period of student mobility could help student-teachers to develop four key actions of teacher professional posture: critical self-reflection, participation in professional networks, turning to theory and distancing. The conclusions suggest that the period of student mobility made a positive contribution to the development of teacher professional posture amongst the participants. However, this study does not reveal the extent to which similar transformative processes could be triggered simply by engaging in collaborative group work with student-teachers working within other education systems without leaving the country of origin.En la Europa actual, la movilidad estudiantil internacional se ha vuelto relativamente común y la idea de que pasar tiempo estudiando en el extranjero es una ventaja está ahora ampliamente aceptada. A través del análisis de las respuestas de los estudiantes y maestros a un cuestionario completado al final de un Erasmus Intensive Programme, este trabajo examina la medida en que la participación en un período de movilidad de los estudiantes podría ayudar a los futuros maestros a desarrollar cuatro medidas clave del maestro en su desarrollo profesional: la auto-reflexión crítica, la participación en redes profesionales, la vuelta a la teoría y el distanciamiento. Las conclusiones sugieren que el período de movilidad de los estudiantes contribuye de forma positiva al desarrollo de la postura profesional entre los participantes. Sin embargo, este estudio no revela el grado en que los procesos de transformación similares podrían activarse simplemente mediante la participación en grupo de trabajo colaborativo con los estudiantes-maestros que trabajan en otros sistemas educativos sin salir del país de origen

Modelling the impacts of projected future climate change on water resources in north-west England

International audienceOver the last two decades, the frequency of water resource drought in the UK, coupled with the more recent pan-European drought of 2003, has increased concern over changes in climate. Using the UKCIP02 Medium-High (SRES A2) scenario for 2070?2100, this study investigates the impact of climate change on the operation of the Integrated Resource Zone (IRZ), a complex conjunctive-use water supply system in north-western England. The results indicate that the contribution of individual sources to yield may change substantially but that overall yield is reduced by only 18%. Notwithstanding this significant effect on water supply, the flexibility of the system enables it to meet modelled demand for much of the time under the future climate scenario, even without a change in system management, but at significant expense for pumping additional abstraction from lake and borehole sources. This research provides a basis for the future planning and management of the complex water resource system in the north-west of England

Help im worried about music! perceptions of generalist primary teachers in the context of the national curriculum for music in England

Since the introduction of a National Curriculum in England in 1988 generalist teachers in\ud primary schools have been expected to be able to teach music to their classes. Teachers\ud have frequently experienced major and sometimes disabling problems in this aspect of\ud their teaching, which neither initial teacher education nor continuing professional\ud development have been able to overcome. A model of the teacher in the music\ud classroom was used to structure an exploration of teachers' perceptions of their working\ud context in relation to music. The model proposes that the teacher's context is socially\ud constructed and of a complex nature. Within the classroom the teacher operates in a\ud variety of roles, each of which interacts with aspects of the contextual structure.\ud Case studies of four teachers uncovered high emotional engagement with the\ud professional environment and its musical dimensions and suggested that teachers\ud perceive three particular areas of difficulty when teaching music. The content of the\ud National Curriculum for Music is problematic; self-perceived non-musicians found both\ud the language and the content to be daunting, and those with some musical knowledge\ud encountered difficulties in relating the National Curriculum to their own musical\ud experience. The teachers all regarded themselves as confident and successful generalist\ud primary teachers, but experienced varying degrees of discomfort and distress caused by\ud the disjunction between this image of success and perceived failures in the field of music.\ud Thirdly, the teachers felt themselves to have limited relationships with groups or\ud communities of practice which they believed could enable them in their music teaching.\ud In the light of these findings the original model was refined to indicate the perceived\ud problematic links between the teachers and their practice in curricular music. The thesis\ud argues that if generalist teachers are to be enabled in music all three disjunctions must be\ud acknowledged and overcome

Prolapsed bilateral ureteroceles leading to intermittent outflow obstruction

A ureterocele refers to a cystic dilatation of the distal ureter. It may be unilateral or bilateral and may be associated with a duplex system in some cases. We present an unusual case where a young patient was found to have large bilateral ureteroceles which prolapsed into the urethra, causing intermittent incontinence and obstruction. We discuss the case and review the literature concerning this rare anomaly

A review of the imaging and intervention of liver transplant complications

Liver transplantation has become a successful surgical solution to a variety of medical and oncological parenchymal liver diseases. As a result, these patients are being encountered more frequently within diagnostic imaging departments which may be remote from the transplant centre. Radiologists must therefore be proficient in identifying normal post-transplant anatomy which involves the anastomosis of four structures between the donor and recipient, namely the hepatic artery, the main portal vein, the retro-hepatic inferior vena cava and the extra-hepatic bile ducts. A number of potential complications can arise involving any or all of these structures, which can be potentially devastating and lead to graft failure. Radiologists must familiarise themselves with the normal post-operative appearances of liver transplantation and become competent in diagnosing post-transplant complications. Where possible, complications should be treated using interventional radiological techniques, thus avoiding the need for repeat surgical intervention or retransplantation

Labour migration, communities and perceptions of social cohesion in England

Abstract The unexpected scale of labour migration from eastern Europe to the UK following EU enlargement in 2004 was thought to pose a threat to the cohesiveness of those local communities hosting larger influxes of migrants. Nevertheless, areas rich in community capacity may have been able to incorporate migrant workers in ways that sustained social cohesion. This paper explores the effects of labour migration on residents’ perceptions of social cohesion in urban areas in England using multivariate statistical techniques. The statistical results suggest that post-enlargement migration weakened social cohesion, but that the prospects of social incorporation were better in areas with stronger community capacity. Theoretical and practical implications of the findings are discussed

Quality-of-life outcomes in older patients with early-stage rectal cancer receiving organ-preserving treatment with hypofractionated short-course radiotherapy followed by transanal endoscopic microsurgery (TREC): non-randomised registry of patients unsuitable for total mesorectal excision

Background Older patients with early-stage rectal cancer are under-represented in clinical trials and, therefore, little high-quality data are available to guide treatment in this patient population. The TREC trial was a randomised, open-label feasibility study conducted at 21 centres across the UK that compared organ preservation through short-course radiotherapy (SCRT; 25 Gy in five fractions) plus transanal endoscopic microsurgery (TEM) with standard total mesorectal excision in adults with stage T1–2 rectal adenocarcinoma (maximum diameter ≤30 mm) and no lymph node involvement or metastasis. TREC incorporated a non-randomised registry offering organ preservation to patients who were considered unsuitable for total mesorectal excision by the local colorectal cancer multidisciplinary team. Organ preservation was achieved in 56 (92%) of 61 non-randomised registry patients with local recurrence-free survival of 91% (95% CI 84–99) at 3 years. Here, we report acute and long-term patient-reported outcomes from this non-randomised registry group. Methods Patients considered by the local colorectal cancer multidisciplinary team to be at high risk of complications from total mesorectal excision on the basis of frailty, comorbidities, and older age were included in a non-randomised registry to receive organ-preserving treatment. These patients were invited to complete questionnaires on patient-reported outcomes (the European Organisation for Research and Treatment of Cancer Quality of Life [EORTC-QLQ] questionnaire core module [QLQ-C30] and colorectal cancer module [QLQ-CR29], the Colorectal Functional Outcome [COREFO] questionnaire, and EuroQol-5 Dimensions-3 Level [EQ-5D-3L]) at baseline and at months 3, 6, 12, 24, and 36 postoperatively. To aid interpretation, data from patients in the non-randomised registry were compared with data from those patients in the TREC trial who had been randomly assigned to organ-preserving therapy, and an additional reference cohort of aged-matched controls from the UK general population. This study is registered with the ISRCTN registry, ISRCTN14422743, and is closed. Findings Between July 21, 2011, and July 15, 2015, 88 patients were enrolled onto the TREC study to undergo organ preservation, of whom 27 (31%) were randomly allocated to organ-preserving therapy and 61 (69%) were added to the non-randomised registry for organ-preserving therapy. Non-randomised patients were older than randomised patients (median age 74 years [IQR 67–80] vs 65 years [61–71]). Organ-preserving treatment was well tolerated among patients in the non-randomised registry, with mild worsening of fatigue; quality of life; physical, social, and role functioning; and bowel function 3 months postoperatively compared with baseline values. By 6–12 months, most scores had returned to baseline values, and were indistinguishable from data from the reference cohort. Only mild symptoms of faecal incontinence and urgency, equivalent to less than one episode per week, persisted at 36 months among patients in both groups. Interpretation The SCRT and TEM organ-preservation approach was well tolerated in older and frailer patients, showed good rates of organ preservation, and was associated with low rates of acute and long-term toxicity, with minimal effects on quality of life and functional status. Our findings support the adoption of this approach for patients considered to be at high risk from radical surgery. Funding Cancer Research UK

Radical surgery versus organ preservation via short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study

Background: Radical surgery via total mesorectal excision might not be the optimal first-line treatment for early-stage rectal cancer. An organ-preserving strategy with selective total mesorectal excision could reduce the adverse effects of treatment without substantially compromising oncological outcomes. We investigated the feasibility of recruiting patients to a randomised trial comparing an organ-preserving strategy with total mesorectal excision. Methods: TREC was a randomised, open-label feasibility study done at 21 tertiary referral centres in the UK. Eligible participants were aged 18 years or older with rectal adenocarcinoma, staged T2 or lower, with a maximum diameter of 30 mm or less; patients with lymph node involvement or metastases were excluded. Patients were randomly allocated (1:1) by use of a computer-based randomisation service to undergo organ preservation with short-course radiotherapy followed by transanal endoscopic microsurgery after 8–10 weeks, or total mesorectal excision. Where the transanal endoscopic microsurgery specimen showed histopathological features associated with an increased risk of local recurrence, patients were considered for planned early conversion to total mesorectal excision. A non-randomised prospective registry captured patients for whom randomisation was considered inappropriate, because of a strong clinical indication for one treatment group. The primary endpoint was cumulative randomisation at 12, 18, and 24 months. Secondary outcomes evaluated safety, efficacy, and health-related quality of life assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and CR29 in the intention-to-treat population. This trial is registered with the ISRCTN Registry, ISRCTN14422743. Findings: Between Feb 22, 2012, and Dec 19, 2014, 55 patients were randomly assigned at 15 sites; 27 to organ preservation and 28 to radical surgery. Cumulatively, 18 patients had been randomly assigned at 12 months, 31 at 18 months, and 39 at 24 months. No patients died within 30 days of initial treatment, but one patient randomly assigned to organ preservation died within 6 months following conversion to total mesorectal excision with anastomotic leakage. Eight (30%) of 27 patients randomly assigned to organ preservation were converted to total mesorectal excision. Serious adverse events were reported in four (15%) of 27 patients randomly assigned to organ preservation versus 11 (39%) of 28 randomly assigned to total mesorectal excision (p=0·04, χ2 test). Serious adverse events associated with organ preservation were most commonly due to rectal bleeding or pain following transanal endoscopic microsurgery (reported in three cases). Radical total mesorectal excision was associated with medical and surgical complications including anastomotic leakage (two patients), kidney injury (two patients), cardiac arrest (one patient), and pneumonia (two patients). Histopathological features that would be considered to be associated with increased risk of tumour recurrence if observed after transanal endoscopic microsurgery alone were present in 16 (59%) of 27 patients randomly assigned to organ preservation, versus 24 (86%) of 28 randomly assigned to total mesorectal excision (p=0·03, χ2 test). Eight (30%) of 27 patients assigned to organ preservation achieved a complete response to radiotherapy. Patients who were randomly assigned to organ preservation showed improvements in patient-reported bowel toxicities and quality of life and function scores in multiple items compared to those who were randomly assigned to total mesorectal excision, which were sustained over 36 months’ follow-up. The non-randomised registry comprised 61 patients who underwent organ preservation and seven who underwent radical surgery. Non-randomised patients who underwent organ preservation were older than randomised patients and more likely to have life-limiting comorbidities. Serious adverse events occurred in ten (16%) of 61 non-randomised patients who underwent organ preservation versus one (14%) of seven who underwent total mesorectal excision. 24 (39%) of 61 non-randomised patients who underwent organ preservation had high-risk histopathological features, while 25 (41%) of 61 achieved a complete response. Overall, organ preservation was achieved in 19 (70%) of 27 randomised patients and 56 (92%) of 61 non-randomised patients. Interpretation: Short-course radiotherapy followed by transanal endoscopic microsurgery achieves high levels of organ preservation, with relatively low morbidity and indications of improved quality of life. These data support the use of organ preservation for patients considered unsuitable for primary total mesorectal excision due to the short-term risks associated with this surgery, and support further evaluation of short-course radiotherapy to achieve organ preservation in patients considered fit for total mesorectal excision. Larger randomised studies, such as the ongoing STAR-TREC study, are needed to more precisely determine oncological outcomes following different organ preservation treatment schedules. Funding: Cancer Research UK