TEACHERS VIEWS OF THE NEW EDUCATIONAL ENVIRONMENT - THE ONE-COMPUTER CLASSROOM

Glavni je cilj provedenih istraživanja, empirijskog neeksperimentalnog u listopadu 2006. g., i kvalitativnog, provedenog metodom Delphi u travnju 2008. g., ispitivanje gledišta učitelja primarnog obrazovanja o uporabi jednog računala u razredu i o novoj obrazovnoj sredini Ñ učionici s jednim računalom. U rezultatima kvantitativnog istraživanja statistički je značajna na razini 1% varijabla posjedovanje računala u razredu, što znači da učitelji koji imaju računalo u razredu imaju pozitivnije gledište o njegovoj uporabi. Rezultati kvalitativnog istraživanja upozoravaju na potrebu prilagodbe obrazovnog sustava promijenjenom načinu življenja. Tradicionalni školski sustav nužno je transformirati u sustav novoga digitalnog doba, obilježenog inovacijama te nizom postupaka pretvorbe i redefinicije nastavnih programa koji su konzistentni s novim tehnologijama i pratećom multimedijom.The main goal of the empirical, non-experimental study conducted in October 2006, and of the qualitative study conducted by using the Delphi method in April 2008, was to examine the views of elementary-school teachers on the use of one computer in the classroom and on the new educational environment - the one-computer classroom. The results of the quantitative study show that the variable of having a computer in the classroom is statistically significant at the level of 1%, which means that teachers who have a computer in the classroom have a more positive view on its use. The results of the qualitative study indicate that there is a need to adjust the education system to a changed way of life. The traditional school system must be transformed into a new digital age system, marked by innovations and a number of processes of transforming and redefining teaching programmes to make them consistent with the new technologies and accompanying multimedia

Protocol for a double-blind randomised controlled trial of low dose intradermal grass pollen immunotherapy versus a histamine control on symptoms and medication use in adults with seasonal allergic rhinitis (PollenLITE)

BACKGROUND: Subcutaneous immunotherapy with high dose grass pollen (typically microgram quantities) was first described over 100 years ago. This treatment suppresses allergen-induced cutaneous late responses, with lesser effects on early responses. We previously reported that repeated 2-weekly intradermal injections of grass pollen - containing approximately 7 ng of major allergen Phl p 5 – led to a progressive suppression of the allergen-induced cutaneous response, and that by the sixth injection, this was inhibited by over 90%. The purpose of this trial is to investigate the clinical efficacy of intradermal desensitisation with low doses (i.e. nanogram quantities) of grass pollen allergen for seasonal allergic rhinitis. METHODS/DESIGN: The Pollen Low dose Intradermal therapy Evaluation (PollenLITE) is a single centre double-blind randomised parallel group controlled trial of the efficacy and safety of intradermal grass pollen injections plus standard treatment, versus histamine injections plus standard treatment, in adults with moderate-severe grass pollen-induced allergic rhinitis (‘summer hay fever’). A minimum of ninety adults with a history of moderate-severe persistent allergic rhinitis during the UK grass pollen season will be randomised into two equal groups to receive 7 or 8 intradermal injections of grass pollen extract (containing approximately 7 ng of major allergen Phl p 5) or histamine, before the grass pollen season. In the summer, participants will score their symptoms, medication requirements, visual analogue scores, and complete EuroQOL (EQ-5D-5 L) and mini Rhinoconjunctivitis Quality of Life Questionnaires. Global assessments will also be recorded at the end of the pollen season. Blood samples will be collected from all participants for mechanistic immune assays. Skin punch biopsies will also be collected in 40 participants selected at random from intradermal injection sites after the grass pollen season for mechanistic assays. Finally, to investigate if the desensitising effect of intradermal immunotherapy on cutaneous responses is long-lasting, all participants will be randomised to receive a follow up intradermal injection after 3, 6 or 12 months with measurement of early and late response sizes. DISCUSSION: Randomisation began in February 2013 and the final participant will complete the trial protocol in August 2014. TRIAL REGISTRATION: ISRCTN 78413121 EudraCT number 2012-002193-31

NF-kappa-B essential modulator (NEMO) gene polymorphism in an adult woman with systemic lupus erythematosus and recurrent non-tuberculous mycobacterial disseminated infections

Infections are among the most serious complications in patients with systemic lupus erythematosus (SLE), with bacterial and viral infections being the most common. Non-tuberculous mycobacterial (NTM) infections are quite rare and are typically seen in older patients with SLE with longstanding disease duration treated with corticosteroids. Here, we describe a 39-year-old woman with SLE and an unusual pattern of recurrent NTM disseminated infections. After excluding the presence of autoantibodies against interferon-γ, whole exome sequencing revealed a homozygous polymorphism in the NF-kappa-B essential modulator (NEMO) gene. Primary immunodeficiencies should be included in the differential diagnosis of patients with recurrent opportunistic infections, even in those with iatrogenic immunosuppression

A randomised placebo-controlled trial investigating efficacy and mechanisms of low-dose intradermal allergen immunotherapy in treatment of seasonal allergic rhinitis

Background: We previously reported that repeated low-dose grass pollen intradermal allergen injection suppresses allergen-induced cutaneous late-phase responses, comparable with conventional high-dose subcutaneous and sublingual immunotherapy. Objective: To evaluate the efficacy and mechanism of grass pollen intradermal immunotherapy for treatment of allergic rhinitis. Design: A Phase II, double-blind, randomised controlled parallel-group trial. Setting: Single-centre UK study. Participants: Adults aged 18–65 years, with grass pollen-induced allergic rhinoconjunctivitis. Interventions: Seven 2-weekly intradermal injections were given into the forearm, containing either Phleum pratense soluble grass pollen extract (7 ng of the major allergen Phl p 5) or histamine control. Main outcome measures: The primary outcome was a combined symptom and medication score (CSMS) during the 2013 grass pollen season. Secondary clinical outcomes were overall symptom scores; individual symptoms scores for nose, mouth, eyes and lungs; overall medication scores; CSMSs during the peak season; visual analogue scale (VAS) scores for nose and eye symptoms; Mini Rhinitis Quality of Life Questionnaire scores; health-related quality-of-life scores (European Quality of Life-5 Dimensions, 5-levels); a global evaluation of symptoms, number of symptom-free and medication-free days; number of days when prednisolone was used; and adverse events. Mechanistic studies included measurement of late-phase skin response sizes, allergen-specific antibody titres, analysis of skin biopsies and basophil activation tests. Results: There was no significant difference in CSMSs between treatment arms [difference in median area under curve (AUC) 14, 95% confidence interval (CI) –172.5 to 215.1; p = 0.80]. Paradoxically, among the secondary outcomes, nasal symptoms measured with daily scores were higher in the active arm (difference in median AUC 35, 95% CI 4.0 to 67.5; p = 0.03), with a trend for higher nasal symptoms measured by VASs (difference in median AUC 53, 95% CI –11.6 to 125.2; p = 0.05). No differences were seen in other clinical outcomes in the main intention-to-treat analysis. In mechanistic studies, active treatment increased P. pratense-, Phl p 1- and Phl p 5-specific immunoglobulin E (all p = 0.001) compared with the control. T cells cultured from skin biopsies of active intradermal immunotherapy subjects showed higher T helper type 2 cell (Th2) marker CRTH2 (chemoattractant receptor-homologous molecule expressed on Th2 cells) expression (p < 0.05) and lower T helper type 1 cell marker CXCR3 [chemokine (C-X-C Motif) receptor 3] expression (p < 0.05), respectively. Interleukin 5 messenger ribonucleic acid, measured by microarray, was more highly expressed by cultured skin T cells in the active arm (p < 0.05). Late-phase skin responses to grass pollen were still inhibited up to 7 months after intradermal immunotherapy (p = 0.03), but not at 10–13 months’ time points. Limitations: Grass pollen doses were not increased during the course, as our proof-of-concept trial showed that repeating the same doses was sufficient to achieve almost complete late-response suppression. Injections were not continued throughout the season, as previous subcutaneous grass pollen immunotherapy trials have demonstrated preseasonal regimen efficacy. Conclusions: Intradermal immunotherapy suppressed late-phase skin responses to allergen, but was not clinically effective. The intervention appeared to have an immunological priming effect and exacerbated certain seasonal symptoms, notably in the nose. Future work: Further studies on low-dose intradermal grass pollen immunotherapy are not recommended because of our demonstrated worsening of allergic rhinitis symptoms and immunological priming. The findings are of great significance for other novel immunotherapies targeting the skin, such as epicutaneous techniques. Trial registration: Current Controlled Trials ISRCTN78413121. Funding: This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research partnership