A proposed scoring system for assessing the severity of actinic keratosis on the head: actinic keratosis area and severity index

Background: Actinic keratosis (AK) severity is currently evaluated by subjective assessment of patients. Objectives: To develop and perform an initial pilot validation of a new easy-to-use quantitative tool for assessing AK severity on the head. Methods: The actinic keratosis area and severity index (AKASI) for the head was developed based on a review of other severity scoring systems in dermatology, in particular the psoriasis area and severity index (PASI). Initial validation was performed by 13 physicians assessing AK severity in 18 AK patients and two controls using a physician global assessment (PGA) and AKASI. To determine an AKASI score, the head was divided into four regions (scalp, forehead, left/right cheek ear, chin and nose). In each region, the percentage of the area affected by AKs was estimated, and the severities of three clinical signs of AK were assessed: distribution, erythema and thickness. Results: There was a strong correlation between AKASI and PGA scores (Pearson correlation coefficient: 0.86). AKASI was able to discriminate between different PGA categories: mean (SD) AKASI increased from 2.88 (1.18) for ‘light’ to 5.33 (1.48) for ‘moderate’, 8.28 (1.89) for ‘severe’, and 8.73 (3.03) for ‘very severe’ PGA classification. The coefficient of variation for AKASI scores was low and relatively constant across all PGA categories. Conclusions: Actinic keratosis area and severity index is proposed as a new quantitative tool for assessing AK severity on the head. It may be useful in the future evaluation of new AK treatments in clinical studies and the management of AK in daily practice

Graduate views on access to higher education: is it really a case of pulling up the ladder?

Using as a starting point in the recent work of Mountford-Zimdars et al., the authors analyse attitudes towards expanding higher education (HE) opportunities in the UK. The authors propose that the approach of Mountford-Zimdars et al. is flawed not only in its adoption of a multivariate logistic regression but also in its interpretation of results. The authors make a number of adaptations, chief among them being the use of an ordered probit approach and the addition of a time dimension to test for changes in attitudes between 2000 and 2010. The authors find that attitudes towards HE expansion have intensified during the decade 2000–2010, but the authors uncover no evidence that this is due to graduates wanting to ‘pull up the ladder’, as suggested by Mountford-Zimdars et al. The authors argue that evidence of a widespread desire to reduce access to HE can most likely be explained by social congestion theory, internal institutional disaffection and rising tuition fees

Can Low-Severity Fire Reverse Compositional Change in Montane Forests of the Sierra Nevada, California, USA?

Throughout the Sierra Nevada, nearly a century of fire suppression has altered the tree species composition, forest structure, and fire regimes that were previously characteristic of montane forests. Species composition is fundamentally important because species differ in their tolerances to fire and environmental stressors, and these differences dictate future forest structure and influence fire regime attributes. In some lower montane stands, shade-tolerant, fire-sensitive species have driven a threefold increase in tree density that may intensify the risk of high-severity fire. In upper montane forests, which were historically characterized by longer fire return intervals, the effects of fire exclusion are both less apparent and less studied. Although land managers have been reintroducing fire to lower and upper montane forests for \u3e4 decades, the potentially restorative effects of these actions on species composition remain largely unassessed. We used tree diameter and species data from 51 recently burned and 46 unburned plots located throughout lower and upper montane forests in Yosemite National Park and Sequoia & Kings Canyon National Parks to examine the effects of low-to moderate-severity (hereafter, lower-severity)fire on the demography of seven prevalent tree species. The density of Abies concolor concolor 30–45 cm dbh, A. magnifica Calocedrus decurrens concolor but not for C. decurrens, and (2) variability in tree density among plots that burned at lower severity exceeded the range of tree densities reported in historical data sets. High proportions of shade-tolerant species in some postfire stands may increase the prevalence of shade-tolerant species in the future, a potential concern for managers who seek to minimize ladder fuels and promote forest structure that is less prone to high-severity fire

Challenging nurse student selection policy: using a lifeworld approach to explore the link between care experience and student values

Aim: This study uses a lifeworld perspective to explore beginning students’ values about nursing. Internationally, increasing care demand, a focus on targets and evidence of dehumanized care cultures have resulted in scrutiny of practitioner values. In England, selection policy dictates that prospective nursing students demonstrate person-centred values and care work experience. However, there is limited recent evidence exploring values at programme commencement or the effect of care experience on values. Design: Mixed method study. Methods: A total of 161 undergraduate nursing students were recruited in 2013 from one English university. Thematic content analysis and frequency distribution to reveal descriptive statistics were used. Results: Statistical analysis indicated that most of the values identified in student responses were not significantly affected by paid care experience. Five themes were identified: How I want care to be; Making a difference; The value of learning; Perceived characteristics of a nurse; and Respecting our humanity. Students readily drew on their experience of living to identify person-centred values about nursing

Global Assemblages, Resilience, and Earth Stewardship in the Anthropocene

In this paper, we argue that the Anthropocene is an epoch characterized not only by the anthropogenic dominance of the Earth\u27s ecosystems but also by new forms of environmental governance and institutions. Echoing the literature in political ecology, we call these new forms of environmental governance “global assemblages”. Socioecological changes associated with global assemblages disproportionately impact poorer nations and communities along the development continuum, or the “Global South”, and others who depend on natural resources for subsistence. Although global assemblages are powerful mechanisms of socioecological change, we show how transnational networks of grassroots organizations are able to resist their negative social and environmental impacts, and thus foster socioecological resilience

How to improve medical education website design

<p>Abstract</p> <p>Background</p> <p>The Internet provides a means of disseminating medical education curricula, allowing institutions to share educational resources. Much of what is published online is poorly planned, does not meet learners' needs, or is out of date.</p> <p>Discussion</p> <p>Applying principles of curriculum development, adult learning theory and educational website design may result in improved online educational resources. Key steps in developing and implementing an education website include: 1) Follow established principles of curriculum development; 2) Perform a needs assessment and repeat the needs assessment regularly after curriculum implementation; 3) Include in the needs assessment targeted learners, educators, institutions, and society; 4) Use principles of adult learning and behavioral theory when developing content and website function; 5) Design the website and curriculum to demonstrate educational effectiveness at an individual and programmatic level; 6) Include a mechanism for sustaining website operations and updating content over a long period of time.</p> <p>Summary</p> <p>Interactive, online education programs are effective for medical training, but require planning, implementation, and maintenance that follow established principles of curriculum development, adult learning, and behavioral theory.</p

The Return to Final Paper Examining in English National Curriculum Assessment and School Examinations: Issues of Validity, Accountability and Politics

There are sound educational and examining reasons for the use of coursework assessment and practical assessment of student work by teachers in schools for purposes of reporting examination grades. Coursework and practical work test a range of different curriculum goals to final papers and increase the validity and reliability of the result. However, the use of coursework and practical work in tests and examinations has been a matter of constant political as well as educational debate in England over the last 30 years. The paper reviews these debates and developments and argues that as accountability pressures increase, the evidence base for published results is becoming narrower and less valid as the system moves back to wholly end-of-course testing