Contrastive Video Examples in Teacher Education : A Matter of Sequence and Prompts

Everyday teaching requires teachers to deal with a variety of pedagogical issues, such as classroom disruptions. Against the background of on-going calls for an evidence-informed practice, teachers should ground their pedagogical decisions not only on subjective theories or experience-based knowledge but also on educational theories and empirical findings. However, research suggests that pre- and in-service teachers rather refer to experiential knowledge than to educational knowledge when addressing practical, pedagogical issues. One reason for the infrequent use of educational knowledge is that acquired knowledge has remained inert and cannot be applied to complex situations in practice. Therefore, implementing learning with contrastive (i.e., functional and dysfunctional) video examples in teacher education seems promising to promote pre-service teachers’ acquisition of educational knowledge. The 2×2-intervention study (N = 220) investigated the effects of the video sequence (dysfunctional-functional/functional-dysfunctional) and of video analysis prompts (with/without) on learning outcomes (concept knowledge, application knowledge) and on learning processes (written video analyses). Results revealed that the sequence dysfunctional-functional led to higher application knowledge in the post-test. There was no sequencing effect on concept knowledge. Prompted groups showed higher concept knowledge and application knowledge in the post-test. Furthermore, both experimental factors affected learning processes, which resulted in higher learning outcomes. In conclusion, learning with contrastive video examples in teacher education seems to be more effective if the video examples are presented in the sequence dysfunctional-functional and if instructional prompts guide the video analysis. The results substantiate the relevance of instructional guidance in learning with video examples and broaden the scope of validity of the concept of learning from errors

Problems of an evidence-oriented educational practice - Suggestions and solution approaches

In diesem Beitrag soll anhand eines fiktiven Anwendungsbeispiels aus der schulischen Unterrichtspraxis exemplarisch dargestellt werden, mit welchen Barrieren sich Lehrkräfte konfrontiert sehen, wenn sie individuelle unterrichtsbezogene Entscheidungen evidenzbasiert zu treffen versuchen. Es werden Stärken und Schwächen des Konzeptes der Evidenzbasierung sowie unterschiedlicher Arten von Evidenz und Forschungsdesigns (zum Beispiel Meta-Metaanalysen, Metaanalysen, Fallstudien) reflektiert und diskutiert. Unter anderem wird ein Vorgehen vorgeschlagen, welches sich weniger an der gängigen Evidenzhierarchie orientiert, an deren Spitze sich als „Gold-Standard“ systematische Reviews, Metaanalysen und randomisierte kontrollierte Studien finden, sondern vielmehr an übergeordneten Wissensbeständen (d. h. insbesondere an wissenschaftlichen Theorien und Konzepten, aber auch an einschlägigen wissenschaftlichen Ansätzen, Prinzipien und Modellen), welche aus der bildungswissenschaftlichen Forschung hervorgegangen sind. Zudem werden exemplarisch Planungsprozesse skizziert, welche die Qualität der Unterrichtspraxis mit einfachen Mitteln unterstützen können, indem wissenschaftliches Wissen, Erfahrungswissen und Kontextwissen sowie praktisches Handlungswissen integriert werden. Abschließend werden als eine mögliche Förderkomponente evidenzorientierter Unterrichtspraxis verschiedene Möglichkeiten zum weiteren Ausbau von Clearing Houses vorgeschlagen. Zudem wird auf Forschungsdesiderate hinsichtlich der Integration verschiedener, möglicherweise inkohärenter Wissensbestände hingewiesen. Dieser Beitrag hat nicht zum Ziel, die aktuellen Entwicklungen hin zu einer evidenzbasierten Schul- und Unterrichtspraxis in Frage zu stellen. Vielmehr wird eine evidenzorientierte Praxis im Sinne einer Orientierung an übergeordneten Wissensbeständen ausdrücklich befürwortet.In this paper, a fictitious example from teaching practice at school will be used to illustrate the barriers a teacher faces when trying to make individual teaching-related decisions based on scientific evidence. The strengths and weak nesses of the concept of evidence-based educational practice as well as of different types of evidence and research designs (e.g., meta-meta-analyses, meta-analyses, case studies) will be considered and discussed. Among other things, a procedure will be proposed that is oriented less towards the common hierarchy of evidence, at the top of which systematic reviews, meta-analyses and randomised controlled trials are found as the “gold standard”. Instead, a procedure will be proposed that is oriented towards more general bodies of knowledge (i.e., especially scientific theo ries and concepts, but also relevant scientific approaches, principles, and models), which education research has put forth. Moreover, exemplary planning processes will be outlined that can support the quality of teaching practice in simple ways by integrating scientific knowledge, experiential knowledge, context knowledge and practical action knowledge. Finally, various possibilities for the further development of Clearing Houses are suggested as a component of fostering evidence-oriented teaching practice. Research desiderata concerning the integration of different, pos sibly incoherent bodies of knowledge will be pointed out. The paper does not aim to question current developments in evidence-based teaching practice. Rather, an evidence-oriented practice in the sense of an orientation to higher-level bodies of knowledge is explicitly advocated

Pre-service teachers' evidence-informed reasoning: do attitudes, subjective norms, and self-efficacy facilitate the use of scientific theories to analyze teaching problems?

Using the theory of planned behavior, we investigated whether attitudes, subjective norms, and self-efficacy facilitate pre-service teachers’ engagement in evidence-informed reasoning about classroom problems. N=157 pre-service teachers were asked about these motivationally relevant antecedents to engaging in evidence-informed reasoning about classroom-related challenges and analyzed case scenarios of problematic teaching situations. Results revealed that self-reported evidence-informed reasoning was directly predicted by intention to engage in evidence-informed reasoning, self-efficacy, and attitude toward evidence-informed reasoning. However, the objectively coded quality of teachers’ evidence-informed reasoning was seemingly negatively predicted by perceived costs and self-efficacy. Thus, the theory of planned behavior partly explained selfreported evidence-informed reasoning, but not objectively observed reasoning. Pre-service teachers might not be skilled enough to assess their own competency accurately and might be unaware of external conditions facilitating or hindering evidence-informed reasoning. Thus, interventions aiming to foster pre-service teachers’ motivation to engage in evidence-informed reasoning might not be effective until such teachers gain the necessary skills

Inhibition of FGF receptor blocks adaptive resistance to RET inhibition in CCDC6-RET-rearranged thyroid cancer.

Genetic alterations in RET lead to activation of ERK and AKT signaling and are associated with hereditary and sporadic thyroid cancer and lung cancer. Highly selective RET inhibitors have recently entered clinical use after demonstrating efficacy in treating patients with diverse tumor types harboring RET gene rearrangements or activating mutations. In order to understand resistance mechanisms arising after treatment with RET inhibitors, we performed a comprehensive molecular and genomic analysis of a patient with RET-rearranged thyroid cancer. Using a combination of drug screening and proteomic and biochemical profiling, we identified an adaptive resistance to RET inhibitors that reactivates ERK signaling within hours of drug exposure. We found that activation of FGFR signaling is a mechanism of adaptive resistance to RET inhibitors that activates ERK signaling. Combined inhibition of FGFR and RET prevented the development of adaptive resistance to RET inhibitors, reduced cell viability, and decreased tumor growth in cellular and animal models of CCDC6-RET-rearranged thyroid cancer

Dolutegravir twice-daily dosing in children with HIV-associated tuberculosis: a pharmacokinetic and safety study within the open-label, multicentre, randomised, non-inferiority ODYSSEY trial

Background: Children with HIV-associated tuberculosis (TB) have few antiretroviral therapy (ART) options. We aimed to evaluate the safety and pharmacokinetics of dolutegravir twice-daily dosing in children receiving rifampicin for HIV-associated TB. Methods: We nested a two-period, fixed-order pharmacokinetic substudy within the open-label, multicentre, randomised, controlled, non-inferiority ODYSSEY trial at research centres in South Africa, Uganda, and Zimbabwe. Children (aged 4 weeks to <18 years) with HIV-associated TB who were receiving rifampicin and twice-daily dolutegravir were eligible for inclusion. We did a 12-h pharmacokinetic profile on rifampicin and twice-daily dolutegravir and a 24-h profile on once-daily dolutegravir. Geometric mean ratios for trough plasma concentration (Ctrough), area under the plasma concentration time curve from 0 h to 24 h after dosing (AUC0–24 h), and maximum plasma concentration (Cmax) were used to compare dolutegravir concentrations between substudy days. We assessed rifampicin Cmax on the first substudy day. All children within ODYSSEY with HIV-associated TB who received rifampicin and twice-daily dolutegravir were included in the safety analysis. We described adverse events reported from starting twice-daily dolutegravir to 30 days after returning to once-daily dolutegravir. This trial is registered with ClinicalTrials.gov (NCT02259127), EudraCT (2014–002632-14), and the ISRCTN registry (ISRCTN91737921). Findings: Between Sept 20, 2016, and June 28, 2021, 37 children with HIV-associated TB (median age 11·9 years [range 0·4–17·6], 19 [51%] were female and 18 [49%] were male, 36 [97%] in Africa and one [3%] in Thailand) received rifampicin with twice-daily dolutegravir and were included in the safety analysis. 20 (54%) of 37 children enrolled in the pharmacokinetic substudy, 14 of whom contributed at least one evaluable pharmacokinetic curve for dolutegravir, including 12 who had within-participant comparisons. Geometric mean ratios for rifampicin and twice-daily dolutegravir versus once-daily dolutegravir were 1·51 (90% CI 1·08–2·11) for Ctrough, 1·23 (0·99–1·53) for AUC0–24 h, and 0·94 (0·76–1·16) for Cmax. Individual dolutegravir Ctrough concentrations were higher than the 90% effective concentration (ie, 0·32 mg/L) in all children receiving rifampicin and twice-daily dolutegravir. Of 18 children with evaluable rifampicin concentrations, 15 (83%) had a Cmax of less than the optimal target concentration of 8 mg/L. Rifampicin geometric mean Cmax was 5·1 mg/L (coefficient of variation 71%). During a median follow-up of 31 weeks (IQR 30–40), 15 grade 3 or higher adverse events occurred among 11 (30%) of 37 children, ten serious adverse events occurred among eight (22%) children, including two deaths (one tuberculosis-related death, one death due to traumatic injury); no adverse events, including deaths, were considered related to dolutegravir. Interpretation: Twice-daily dolutegravir was shown to be safe and sufficient to overcome the rifampicin enzyme-inducing effect in children, and could provide a practical ART option for children with HIV-associated TB

Neuropsychiatric manifestations and sleep disturbances with dolutegravir-based antiretroviral therapy versus standard of care in children and adolescents: a secondary analysis of the ODYSSEY trial

BACKGROUND: Cohort studies in adults with HIV showed that dolutegravir was associated with neuropsychiatric adverse events and sleep problems, yet data are scarce in children and adolescents. We aimed to evaluate neuropsychiatric manifestations in children and adolescents treated with dolutegravir-based treatment versus alternative antiretroviral therapy. METHODS: This is a secondary analysis of ODYSSEY, an open-label, multicentre, randomised, non-inferiority trial, in which adolescents and children initiating first-line or second-line antiretroviral therapy were randomly assigned 1:1 to dolutegravir-based treatment or standard-of-care treatment. We assessed neuropsychiatric adverse events (reported by clinicians) and responses to the mood and sleep questionnaires (reported by the participant or their carer) in both groups. We compared the proportions of patients with neuropsychiatric adverse events (neurological, psychiatric, and total), time to first neuropsychiatric adverse event, and participant-reported responses to questionnaires capturing issues with mood, suicidal thoughts, and sleep problems. FINDINGS: Between Sept 20, 2016, and June 22, 2018, 707 participants were enrolled, of whom 345 (49%) were female and 362 (51%) were male, and 623 (88%) were Black-African. Of 707 participants, 350 (50%) were randomly assigned to dolutegravir-based antiretroviral therapy and 357 (50%) to non-dolutegravir-based standard-of-care. 311 (44%) of 707 participants started first-line antiretroviral therapy (ODYSSEY-A; 145 [92%] of 157 participants had efavirenz-based therapy in the standard-of-care group), and 396 (56%) of 707 started second-line therapy (ODYSSEY-B; 195 [98%] of 200 had protease inhibitor-based therapy in the standard-of-care group). During follow-up (median 142 weeks, IQR 124–159), 23 participants had 31 neuropsychiatric adverse events (15 in the dolutegravir group and eight in the standard-of-care group; difference in proportion of participants with ≥1 event p=0·13). 11 participants had one or more neurological events (six and five; p=0·74) and 14 participants had one or more psychiatric events (ten and four; p=0·097). Among 14 participants with psychiatric events, eight participants in the dolutegravir group and four in standard-of-care group had suicidal ideation or behaviour. More participants in the dolutegravir group than the standard-of-care group reported symptoms of self-harm (eight vs one; p=0·025), life not worth living (17 vs five; p=0·0091), or suicidal thoughts (13 vs none; p=0·0006) at one or more follow-up visits. Most reports were transient. There were no differences by treatment group in low mood or feeling sad, problems concentrating, feeling worried or feeling angry or aggressive, sleep problems, or sleep quality. INTERPRETATION: The numbers of neuropsychiatric adverse events and reported neuropsychiatric symptoms were low. However, numerically more participants had psychiatric events and reported suicidality ideation in the dolutegravir group than the standard-of-care group. These differences should be interpreted with caution in an open-label trial. Clinicians and policy makers should consider including suicidality screening of children or adolescents receiving dolutegravir

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Which motivational factors predict pre-service teachers' evidence-informed reasoning when being confronted with teaching problems?

Teachers are typically confronted with various classroom-related challenges every day (e.g., students might have difficulties understanding new concepts). However, they rarely reason about such challenges in an evidence-informed manner. Based on the theory of planned behavior, we examined what motivational prerequisites might facilitate pre-service teachers’ engagement in evidence-informed reasoning about classroom-related challenges. N = 157 pre-service teachers were asked about their motivation to engage in evidence-informed reasoning and analyzed case scenarios of problematic teaching situations in an online learning environment. Structural equation modeling indicated that attainment value, descriptive normative beliefs, and self-efficacy were important prerequisites for the formation of intentions to engage in evidence-informed reasoning and the subjectively perceived behavior in order to solve classroom-related challenges. The findings suggest to help pre-service teachers carefully reflect and discuss what is part of the teacher role and their identification with this role