Searching for common ground: developing mathematical reasoning through dialogue

In the majority of the schools in the Eastern Cape, South Africa, teaching and learning takes place in the second language, English, of both teachers and learners. The purpose of this research was to elicit the perceptions of teachers in multilingual mathematics classes about language issues that they encounter and to ascertain whether they could experientially learn the theory of dialogic teaching through an intervention in order to introduce dialogue in practice in their classes. The effect of the intervention on teacher practices was qualitatively observed and the effect of the teacher practices on learner reasoning competence, numeracy competence and English language competence was quantitatively tested by using validated pre- and post-tests. The study follows a mixed method concurrent triangulation design with both quantitative and qualitative results. Two cohorts of students/teachers studying for qualifications at Nelson Mandela Metropolitan University centres throughout the Eastern Cape expressed their opinions about language challenges and solutions through questionnaires, reflective writing and poetry. A cohort of BEd Honours (Mathematics and Science) students experienced a semester long intervention on the theory and practice of dialogic teaching, particularly exploratory talk, and were tasked to introduce the practice into their multilingual mathematics classes in the form of reported action research. The next phase of the study focussed on the practices of three teachers and their grade seven multilingual mathematics learners who were observed and tested over a period of nine months. The following year the observations and testing were repeated with one teacher and his grade seven learners to ascertain whether the intervention would result in similar findings. iv The results enhance the validity of the Vygotskian claim concerning the relationship between language use, social interaction and reasoning development. In classes where there was evidence of dialogic practices the learners collaborated in groups using code-switching and their main language. Their reasoning, numeracy and English skills test scores improved statistically significantly. Teachers were able to give voice to their deep-felt emotions through poetry. They felt that the devaluing of isiXhosa had resulted in the loss of learners’ main language literacy competencies and consequent loss of cultural capital; however they considered it necessary to develop English competence in the learners, even if it was at the expense of developing mathematical competence. The introduction of exploratory talk in their home languages served the dual purpose of promoting the value of isiXhosa in an academic environment as well as enhancing mathematical reasoning. It appears that when teachers focus on developing language as a tool for reasoning, significant improvements in learners’ problem solving competences occur. When the language used is the main language of both teachers and learners both mathematical understanding and cultural identity are enhanced. The study concludes with a suggestion for a model for future interventions to train teachers to introduce dialogic practices in multilingual mathematics classes

CERVICAL SPINAL CORD INJURY AND UPPER LIMB ROBOTIC THERAPY

Abstract. A major debilitating factor of sustaining a cervical level spinal cord injury is the loss of independence in completing activities of daily living as a result of impaired upper limb function. Early intervention has been hypothesised to preserve upper limb function in this population and enhance capacity to perform functional tasks. The use of robotics as an upper limb therapy modality is increasing in the neurorehabilitation field, however there is limited evidence to support their use in the cervical spinal cord injury population. Despite this, occupational therapists are using them as part of a therapy program. Aim: This study aimed to explore the upper limb outcomes of using a computer assisted robotic device in acute therapy for people who have sustained a cervical spinal cord injury. Methods: A single case pre-post study design was performed with one middle aged male who had who was an inpatient at a public metropolitan hospital in Australia. They undertook a three week therapy program using the Diego by Tyromotion in conjunction with standard occupational therapy interventions. Range of motion, muscular strength, pain, fatigue the Spinal Cord Independence Measure, and the Canadian Occupational Performance Measure were used as outcome measures. Results: Increases were seen in range of motion and muscular strength and functional status; objective and subjectively. Conclusion: Preliminary findings suggest that the Diego may be a useful tool for improving upper limb outcomes when combined with occupational therapy in this population, however greater research and participants are required for definitive data

Reel Life Methodology: Developing intercultural competence through film fragments and dialogue in South Africa.

South Africa is a multicultural country; however, the politics of the past have resulted in teachers from diverse cultures being ignorant of the mores of others with whom they interact. Teachers thus risk transferring preconceived knowledge and attitudes into the classroom. The aim of this study was to explore to what extent the methodology of Reel Life can promote the development of intercultural competence among South African teachers. Film fragments were used to stimulate intercultural dialogue, and an environment was created in which teachers from different cultures could share their culture knowledge and begin to develop intercultural competence. Our results show that the teachers were able to shift their frames of reference in a movement between ethnic positions and a shared perspective of them all being South African.publishedVersio

Measuring and decomposing inequity in self-reported morbidity and self-assessed health in Thailand

<p>Abstract</p> <p>Background</p> <p>In recent years, interest in the study of inequalities in health has not stopped at quantifying their magnitude; explaining the sources of inequalities has also become of great importance. This paper measures socioeconomic inequalities in self-reported morbidity and self-assessed health in Thailand, and the contributions of different population subgroups to those inequalities.</p> <p>Methods</p> <p>The Health and Welfare Survey 2003 conducted by the Thai National Statistical Office with 37,202 adult respondents is used for the analysis. The health outcomes of interest derive from three self-reported morbidity and two self-assessed health questions. Socioeconomic status is measured by adult-equivalent monthly income per household member. The concentration index (CI) of ill health is used as a measure of socioeconomic health inequalities, and is subsequently decomposed into contributing factors.</p> <p>Results</p> <p>The CIs reveal inequality gradients disadvantageous to the poor for both self-reported morbidity and self-assessed health in Thailand. The magnitudes of these inequalities were higher for the self-assessed health outcomes than for the self-reported morbidity outcomes. Age and sex played significant roles in accounting for the inequality in reported chronic illness (33.7 percent of the total inequality observed), hospital admission (27.8 percent), and self-assessed deterioration of health compared to a year ago (31.9 percent). The effect of being female and aged 60 years or older was by far the strongest demographic determinant of inequality across all five types of health outcome. Having a low socioeconomic status as measured by income quintile, education and work status were the main contributors disadvantaging the poor in self-rated health compared to a year ago (47.1 percent) and self-assessed health compared to peers (47.4 percent). Residence in the rural Northeast and rural North were the main regional contributors to inequality in self-reported recent and chronic illness, while residence in the rural Northeast was the major contributor to the tendency of the poor to report lower levels of self-assessed health compared to peers.</p> <p>Conclusion</p> <p>The findings confirm that substantial socioeconomic inequalities in health as measured by self-reported morbidity and self-assessed health exist in Thailand. Decomposition analysis shows that inequalities in health status are associated with particular demographic, socioeconomic and geographic population subgroups. Vulnerable subgroups which are prone to both ill health and relative poverty warrant targeted policy attention.</p

Significant benefits of AIP testing and clinical screening in familial isolated and young-onset pituitary tumors

Context Germline mutations in the aryl hydrocarbon receptor-interacting protein (AIP) gene are responsible for a subset of familial isolated pituitary adenoma (FIPA) cases and sporadic pituitary neuroendocrine tumors (PitNETs). Objective To compare prospectively diagnosed AIP mutation-positive (AIPmut) PitNET patients with clinically presenting patients and to compare the clinical characteristics of AIPmut and AIPneg PitNET patients. Design 12-year prospective, observational study. Participants & Setting We studied probands and family members of FIPA kindreds and sporadic patients with disease onset ≤18 years or macroadenomas with onset ≤30 years (n = 1477). This was a collaborative study conducted at referral centers for pituitary diseases. Interventions & Outcome AIP testing and clinical screening for pituitary disease. Comparison of characteristics of prospectively diagnosed (n = 22) vs clinically presenting AIPmut PitNET patients (n = 145), and AIPmut (n = 167) vs AIPneg PitNET patients (n = 1310). Results Prospectively diagnosed AIPmut PitNET patients had smaller lesions with less suprasellar extension or cavernous sinus invasion and required fewer treatments with fewer operations and no radiotherapy compared with clinically presenting cases; there were fewer cases with active disease and hypopituitarism at last follow-up. When comparing AIPmut and AIPneg cases, AIPmut patients were more often males, younger, more often had GH excess, pituitary apoplexy, suprasellar extension, and more patients required multimodal therapy, including radiotherapy. AIPmut patients (n = 136) with GH excess were taller than AIPneg counterparts (n = 650). Conclusions Prospectively diagnosed AIPmut patients show better outcomes than clinically presenting cases, demonstrating the benefits of genetic and clinical screening. AIP-related pituitary disease has a wide spectrum ranging from aggressively growing lesions to stable or indolent disease course

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead