Does iPad use support learning in students aged 9-14 years? A systematic review

This systematic literature review sought to examine whether iPad or other mobile technology use by school students aged 9 to 14 years enhanced academic outcomes. Conducted in March 2019 using the PRISMA statement, the review identified 43 studies published between 2010 and 2019 which specifically addressed the research question. Findings revealed that iPad use for specific school learning areas such as mathematics, English, science, and the like has not consistently enhanced academic outcomes. Some reviewed papers also indicated that teachers were not always employing the technology most effectively. To defend the current extensive classroom use of mobile technology such as iPads, further research employing within-subject designs must be conducted. Such research must assess the efficacy of iPad use for attaining specific content area outcomes against pedagogies which utilise paper reading, handwriting and/or other manipulations of teaching materials. Moreover, teacher professional learning needs to be provided so that when teachers use iPads in classrooms they are able to deploy them in the most appropriate way

Sexual assault and the ethics of non-representation in contemporary fiction

This thesis consists of a critical component and a creative component in an examination of how non-explicit representations of sexual assault against women can function in an ethical manner in contemporary fiction. In particular, the thesis argues that representations which veil or otherwise deny the reader direct access to the sexual assault scene can create productive, ethical spaces which invite the reader to reflect on cultural assumptions. The thesis analyses J.M. Coetzee’s Disgrace (1999) and Toni Morrison’s A Mercy (2008) and explores current debates concerning the representation of suffering. The thesis raises the question of what is at stake in the representation of sexual assault. In Disgrace, Coetzee’s use of an unreliable narrator and a limited point of view, among other strategies, confronts the reader with the unknowable and directs the reader’s attention to issues of sexism, racism and violence in post-Apartheid South Africa. A Mercy represents sexual assault obliquely and uses euphemism to refocus readers away from the immediate ‘body in pain’, representing sexual assault as a systemic (and historic) culture with social implications for the understanding the present. In the creative writing component, my novella titled Taking Care of Amy explores the issues raised in the thesis. The story, set in present-day Western Australia, centres on a single mother who is raising her three daughters — two teenagers (one of whom is disabled) and a toddler — under difficult circumstances

Mental health in primary care: Integration through in-service training in a South African rural clinic

Background: Integrating mental health into primary care is a global priority. It is proposed to ‘task-share’ the screening, diagnosis and treatment of common mental disorders fromspecialists to primary care workers. Key to facilitating this is training primary care workers to deliver mental health care. Mental health training in Africa shows a predominance of short-term, externally driven training programmes. Locally, a more sustainable delivery system was needed. Aim: The aim of the study was to develop and evaluate a locally delivered, long-term, inservice training programme to facilitate mental health care in primary care. Methods: This was a quasi-experimental study using mixed methods. The in-service training programme was delivered in weekly 1-h sessions by local psychiatry staff to 20 primary care nurses at the clinic over 5 months. The training was evaluated using quantitative data from participant questionnaires and analysis of the referrals from primary to specialist care. Qualitative data were collected via semi-structured interviews and 14 observed training sessions. Results: The training was feasible and well received. Referrals to the mental health nurse increased in quality and participants’ self-rated competence improved. Additional benefits included the development of supervision skills of mental health nurses and providing a forum for staff to discuss service improvement. The programme acted as a vehicle to pilot integration in one clinic and identify unanticipated barriers prior to rollout. Conclusions: Long-term, in-service training, using existing local staff had benefits to the integration of mental health into primary care. This approach could be relevant to similar contexts elsewhere

A central role for hepatic conventional dendritic cells in supporting Th2 responses during helminth infection

Dendritic cells (DCs) are the key initiators of T-helper (Th) 2 immune responses against the parasitic helminth Schistosoma mansoni. Although the liver is one of the main sites of antigen deposition during infection with this parasite, it is not yet clear how distinct DC subtypes in this tissue respond to S. mansoni antigens in vivo, or how the liver microenvironment might influence DC function during establishment of the Th2 response. In this study, we show that hepatic DC subsets undergo distinct activation processes in vivo following murine infection with S. mansoni. Conventional DCs (cDCs) from schistosome-infected mice upregulated expression of the costimulatory molecule CD40 and were capable of priming naive CD4+ T cells, whereas plasmacytoid DCs (pDCs) upregulated expression of MHC class II, CD86 and CD40 but were unable to support the expansion of either naive or effector/memory CD4+ T cells. Importantly, in vivo depletion of pDCs revealed that this subset was dispensable for either maintenance or regulation of the hepatic Th2 effector response during acute S. mansoni infection. Our data provides strong evidence that S. mansoni infection favors the establishment of an immunogenic, rather than tolerogenic, liver microenvironment that conditions cDCs to initiate and maintain Th2 immunity in the context of ongoing antigen exposure

Lung function from school age to adulthood in primary ciliary dyskinesia

Primary ciliary dyskinesia (PCD) presents with symptoms early in life and the disease course may be progressive, but longitudinal data on lung function are scarce. This multinational cohort study describes lung function trajectories in children, adolescents and young adults with PCD. We analysed data from 486 patients with repeated lung function measurements obtained between the age of 6 and 24 years from the International PCD Cohort and calculated z-scores for forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio using the Global Lung Function Initiative 2012 references. We described baseline lung function and change of lung function over time and described their associations with possible determinants in mixed-effects linear regression models. Overall, FEV1, FVC and FEV1/FVC z-scores declined over time (average crude annual FEV1 decline was -0.07 z-scores), but not at the same rate for all patients. FEV1 z-scores improved over time in 21% of patients, remained stable in 40% and declined in 39%. Low body mass index was associated with poor baseline lung function and with further decline. Results differed by country and ultrastructural defect, but we found no evidence of differences by sex, calendar year of diagnosis, age at diagnosis, diagnostic certainty or laterality defect. Our study shows that on average lung function in PCD declines throughout the entire period of lung growth, from childhood to young adult age, even among patients treated in specialised centres. It is essential to develop strategies to reverse this tendency and improve prognosi

The use of complementary and alternative medicines among patients with locally advanced breast cancer – a descriptive study

BACKGROUND: Complementary and alternative medicine (CAM) use is common among cancer patients. This paper reviews the use of CAM in a series of patients with locally advanced breast cancer (LABC). METHODS: Women with LABC attending a specialist clinic at a single Canadian cancer centre were identified and approached. Participants completed a self-administered survey regarding CAM usage, beliefs associated with CAM usage, views of their risks of developing recurrent cancer and of dying of breast cancer. Responses were scored and compared between CAM users and non-users. RESULTS: Thirty-six patients were approached, 32 completed the questionnaire (response rate 89%). Forty-seven percent of LABC patients were identified as CAM users. CAM users were more likely to be younger, married, in a higher socioeconomic class and of Asian ethnicity than non-users. CAM users were likely to use multiple modalities simultaneously (median 4) with vitamins being the most popular (60%). Motivation for CAM therapy was described as, "assisting their body to heal" (75%), to 'boost the immune system' (56%) and to "give a feeling of control with respect to their treatment" (56%). CAM therapy was used concurrently with conventional treatment in 88% of cases, however, 12% of patients felt that CAM could replace their conventional therapy. Psychological evaluation suggests CAM users perceived their risk of dying of breast cancer was similar to that of the non-Cam group (33% vs. 35%), however the CAM group had less severe anxiety and depression. CONCLUSION: The motivation, objectives and benefits of CAM therapy in a selected population of women with LABC are similar to those reported for women diagnosed with early stage breast cancer. CAM users display less anxiety and depression and are less likely to believe they will die of their breast cancer. However the actual benefit to overall and disease free survival has yet to be demonstrated, as well as the possible interactions with conventional therapy. Consequently more research is needed in this ever-growing field

Exploration Behaviour Is Not Associated with Chick Provisioning in Great Tits

In biparental systems, members of the same pair can vary substantially in the amount of parental care they provide to offspring. The extent of this asymmetry should depend on the relative costs and benefits of care. Individual variation in personality is likely to influence this trade-off, and hence is a promising candidate to explain differences in care. In addition, plasticity in parental care may also be associated with personality differences. Using exploration behaviour (EB) as a measure of personality, we investigated these possibilities using both natural and experimental data from a wild population of great tits (Parus major). Contrary to predictions, we found no association between EB and natural variation in provisioning behaviour. Nor was EB linked to responsiveness to experimentally increased brood demand. These results are initially surprising given substantial data from other studies suggesting personality should influence investment in parental care. However, they are consistent with a recent study showing selection on EB is weak and highly context-specific in the focal population. This emphasises the difficulty faced by personality studies attempting to make predictions based on previous work, given that personalities often vary among populations of the same species

The disease-specific clinical trial network for primary ciliary dyskinesia: PCD-CTN

Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterised by impaired mucociliary clearance leading to irreversible lung damage. In contrast to other rare lung diseases like cystic fibrosis (CF), there are only few clinical trials and limited evidence-based treatments. Management is mainly based on expert opinions and treatment is challenging due to a wide range of clinical manifestations and disease severity. To improve clinical and translational research and facilitate development of new treatments, the clinical trial network for PCD (PCD-CTN) was founded in 2020 under the framework of the European Reference Network (ERN)-LUNG PCD Core. Applications from European PCD sites interested in participating in the PCD-CTN were requested. Inclusion criteria consisted of patient numbers, membership of ERN-LUNG PCD Core, use of associated standards of care, experience in PCD and/or CF clinical research, resources to run clinical trials, good clinical practice (GCP) certifications and institutional support. So far, applications from 22 trial sites in 18 European countries have been approved, including >1400 adult and >1600 paediatric individuals with PCD. The PCD-CTN is headed by a coordinating centre and consists of a steering and executive committee, a data safety monitoring board and committees for protocol review, training and standardisation. A strong association with patient organisations and industrial companies are further cornerstones. All participating trial sites agreed on a code of conduct. As CTNs from other diseases have demonstrated successfully, this newly formed PCD-CTN operates to establish evidence-based treatments for this orphan disease and to bring new personalised treatment approaches to patients

What are the priority research questions for digital agriculture?

There is a need to identify key existing and emerging issues relevant to digitalisation in agricultural production that would benefit from a stronger evidence base and help steer policy formulation. To address this, a prioritisation exercise was undertaken to identify priority research questions concerning digital agriculture in the UK, but with a view to also informing international contexts. The prioritisation exercise uses an established and effective participatory methodology for capturing and ordering a wide range of views. The method involves identifying a large number of participants and eliciting an initial long list of research questions which is reduced and refined in subsequent voting stages to select the top priorities by theme. Participants were selected using purposive sampling and snowballing to represent a number of sectors, organisations, companies and disciplines across the UK. They were each invited to submit up to 10 questions according to certain criteria, and this resulted in 195 questions from a range of 40 participants (largely from England with some representation from Scotland and Wales). Preliminary analysis and clustering of these questions through iterative analysis identified seven themes as follows: data governance; data management; enabling use of data and technologies; understanding benefits and uptake of data and technologies; optimising data and technologies for performance; impacts of digital agriculture; and new collaborative arrangements. Subsequent stages of voting, using an online ranking exercise and a participant workshop for in-depth discussion, refined the questions to a total of 27 priority research questions categorised into 15 gold, 7 silver and 5 bronze, across the 7 themes. The questions significantly enrich and extend previous clustering and agenda setting using literature sources, and provide a range of new perspectives. The analysis highlights the interconnectedness of themes and questions, and proposes two nexus for future research: the different dimensions of value, and the social and institutional arrangements to support digitalisation in agriculture. These emphasise the importance of interdisciplinarity and transdisciplinarity, and the need to tackle the binary nature of current analytical frames. These new insights are equally relevant to contexts outside the UK. This paper highlights the need for research actions to inform policy, not only instrumentally by strengthening the evidence base, but also conceptually, to prompt new thinking. To our knowledge this methodology has not been previously applied to this topic

Management of latent Mycobacterium tuberculosis infection:WHO guidelines for low tuberculosis burden countries

ABSTRACT Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence-based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of <100 per 100000 per year. The guidelines strongly recommend systematic testing and treatment of LTBI in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation, and patients with silicosis. In prisoners, healthcare workers, immigrants from high TB burden countries, homeless persons and illicit drug users, systematic testing an