Analysis of science textbook pictures about energy and pupils' readings of them

This article outlines the findings of the part of the "Science Teacher Training in an Information Society" (STTIS) project concerned with describing the possible difficulties the pupils have when "reading" science textbook pictures about "energy". Six documents were selected on the basis that they had some of the textual/graphical features previously identified by the project as potentially presenting difficulties to pupils. The pupils' readings of these were investigated using a questionnaire and a follow-up interview. The analysis of three of the documents and of twelve pupils' readings of them is reported in this paper. The results confirm the hypothesis that the "reading" of science textbook pictures is not at all trivial for pupils and conclude that teachers need to spend time and effort talking through the meaning of the images with them. They also suggest that the list of textual/graphical features used in this research is a good starting point for this kind of critical examination

Expectations and Understanding of Learning in Practice: Student Speech and Language Therapists’ and Practice Educators’ Perspectives of Learning

Research in speech and language therapy education has focussed on investigating models of clinical placements, rather than how learning is optimised in practical settings. A distinction has been made in practice-based learning in medical education between ‘capability’ and ‘competency’, urging educators to prioritise learning that enables problem solving and application of theory. We know little about student speech and language therapists’ (SLTs) and educators’ perception and expectations of clinical learning in placement and how this relates to capability. We investigated student SLTs’ and educators’ beliefs and experiences of successful learning in clinical settings and how they perceived their learner/educator roles using a qualitative study. Data was gathered from 28 students and educators using individual interviews and focus groups. The data was investigated using thematic analysis. Educators see their role as facilitators, developing core skills such as clinical reasoning, understanding professional identity and gaining independence. Some educators see this as a co-learning model, creating opportunities for their own learning. Students’ conceptions change during clinical placements, from focussing on their own development to seeking to understand the client’s perspective as well as identify needs, and respond with well-reasoned options for intervention. Aiming to equip SLT learners to be capable professionals, able to apply skills of clinical reasoning, is considered a core skill for SLT educators. Developing models for clinical placements informed by understanding how students learn to become capable could enhance the readiness of student SLTs to enter professional practice

Climatic effects on the synchrony and stability of temperate headwater invertebrates over four decades

Important clues about the ecological effects of climate change can arise from understanding the influence of other Earth‐system processes on ecosystem dynamics but few studies span the inter‐decadal timescales required. We, therefore, examined how variation in annual weather patterns associated with the North Atlantic Oscillation (NAO) over four decades was linked to synchrony and stability in a metacommunity of stream invertebrates across multiple, contrasting headwaters in central Wales (UK). Prolonged warmer and wetter conditions during positive NAO winters appeared to synchronize variations in population and community composition among and within streams thereby reducing stability across levels of ecological organization. This climatically mediated synchronization occurred in all streams irrespective of acid–base status and land use, but was weaker where invertebrate communities were more functionally diverse. Wavelet linear models indicated that variation in the NAO explained up to 50% of overall synchrony in species abundances at a timescale of 4–6 years. The NAO appeared to affect ecological dynamics through local variations in temperature, precipitation and discharge, but increasing hydrochemical variability within sites during wetter winters might have contributed. Our findings illustrate how large‐scale climatic fluctuations generated over the North Atlantic can affect population persistence and dynamics in inland freshwater ecosystems in ways that transcend local catchment character. Protecting and restoring functional diversity in stream communities might increase their stability against warmer, wetter conditions that are analogues of ongoing climate change. Catchment management could also dampen impacts and provide options for climate change adaptation

Comparison of the two most commonly used treatments for pyoderma gangrenosum: results of the STOP GAP randomised controlled trial

Objective To determine whether ciclosporin is superior to prednisolone for the treatment of pyoderma gangrenosum, a painful, ulcerating skin disease with a poor evidence base for management. Design Multicentre, parallel group, observer blind, randomised controlled trial. Setting 39 UK hospitals, recruiting from June 2009 to November 2012. Participants 121 patients (73 women, mean age 54 years) with clinician diagnosed pyoderma gangrenosum. Clinical diagnosis was revised in nine participants after randomisation, leaving 112 participants in the analysis set (59 ciclosporin; 53 rednisolone). Intervention Oral prednisolone 0.75 mg/kg/day compared with ciclosporin 4 mg/kg/day, to a maximum dose of 75 and 400 mg/day, respectively. Main outcome measures The primary outcome was speed of healing over six weeks, captured using digital images and assessed by blinded investigators. Secondary outcomes were time to healing, global treatment response, resolution of inflammation, self reported pain, quality of life, number of treatment failures, adverse reactions, and time to recurrence. Outcomes were assessed at baseline and six weeks and when the ulcer had healed (to a maximum of six months). Results Of the 112 participants, 108 had complete primary outcome data at baseline and six weeks (57 ciclosporin; 51 rednisolone). Groups were balanced at baseline. The mean (SD) speed of healing at six weeks was −0.21 (1.00) cm2/day in the ciclosporin group compared with −0.14 (0.42) cm2/day in the prednisolone group. The adjusted mean difference showed no between group difference (0.003 cm2/day, 95% confidence interval −0.20 to 0.21; P=0.97). By six months, ulcers had healed in 28/59 (47%) participants in the ciclosporin group compared with 25/53 (47%) in the prednisolone group. In those with healed ulcers, eight (30%) receiving ciclosporin and seven (28%) receiving prednisolone had a recurrence. Adverse reactions were similar for the two groups (68% ciclosporin and 66% prednisolone), but serious adverse reactions, especially infections, were more common in the prednisolone group. Conclusion Prednisolone and ciclosporin did not differ across a range of objective and patient reported outcomes. Treatment decisions for individual patients may be guided by the different side effect profiles of the two drugs and patient preference. Trial registration Current Controlled Trials ISRCTN35898459

TGFb2 induces the soluble isoform of CTLA-4 – implications for CTLA-4 based checkpoint inhibitor antibodies in malignant melanoma

FUNDING This work was funded by the Chief Scientist’s office, Scotland grant no. ETM/280. Acknowledgments Microscopy was performed in the Microscopy and Histology Core Facility at the University of Aberdeen. Flow cytometry was performed in the Iain Fraser Cytometry Centre. We are very grateful to our lab manager Ms. Gill Moir for her assistance with this work and also to the many BSc/MSc project students who worked on this project. We are extremely grateful for all of the volunteer melanoma patient donors and healthy donors that supported this work. FA-F received an Elphinstone PhD scholarship funded by the School of Medicine, Medical Sciences & Nutrition at the University of Aberdeen.Peer reviewedPublisher PD

Is speed of healing a good predictor of eventual healing of pyoderma gangrenosum?

Background: Pyoderma gangrenosum is a rare inflammatory skin condition. The STOPGAP studies compared treatments for pyoderma gangrenosum using a primary outcome of healing speed at 6 weeks. Objective: Using data from both studies we assessed the predictive value of three early predictors for healing at 6 months - speed of healing, Investigator Global Assessment and resolution of inflammation, recorded at 2 and 6 weeks. Methods: Logistic regression models were applied and the effectiveness of the three measures was assessed through estimating the positive (PPV) and negative predictive values (NPV) and the area under the receiver operating characteristic curve (AUC). Results: The PPV and NPV at 6 weeks were 63.5% (95% CI:52.4%, 73.7%) and 74.6% (95% CI:62.5%, 84.5%) respectively for speed of healing; 80% (95% CI:68.7%, 88.6%) and 74.2% (95% CI:64.1%, 2.7%) for IGA; and 72.1% (95% CI:59.9%, 82.3%) and 68.1% (95% CI:57.7%, 77.3%) for resolution of inflammation. Investigator Global Assessment had the best combined PPV, NPV and AUC at 2 and 6 weeks. Limitations: We were limited by data available from the STOP GAP trial and cohort study. Conclusion: Speed of healing, Investigator Global Assessment and resolution of inflammation were all shown to be good predictors of eventual healing

The role of ‘living laboratories’ in accelerating the energy system decarbonization

To decarbonize the energy system by the year 2050, it is crucial that innovations are trialled in a ‘real world’ setting for the purpose of increasing public adoption and support, and for providing insights to decision-makers to ensure their decisions are effective and influential. Together, renewable energy systems, distributed and digitized ‘smart’ energy networks (SEN) provide opportunities to maximize energy efficiency, reduce transmission losses and drive down greenhouse gas emissions. Yet, such integrated Smart Local Energy Systems (SLES) are in the early stages of development and the technologies that underpin them lack testbeds where they can be developed and tested in a real-world environment. Here we demonstrate the potential role of one of Europe’s largest ‘at scale’ multi-vector Smart Energy Network Demonstrator—SEND, developed within a ‘living laboratory’ setting that provides the ‘blueprint’ for the development and testing of low-carbon energy technologies on the UK’s journey to net zero. Based on the SEND platform and data, we have developed and demonstrated several novel AI based smart algorithms for intelligent SLES control and management. We are also working with industry partners to develop a digital twin of the smart energy system on our campus

Risk of major cardiovascular events in patients with psoriasis receiving biologic therapies: a prospective cohort study

Background: The cardiovascular safety profile of biologic therapies used for psoriasis is unclear. Objectives: To compare the risk of major cardiovascular events (CVEs; acute coronary syndrome, unstable angina, myocardial infarction and stroke) in patients with chronic plaque psoriasis treated with adalimumab, etanercept or ustekinumab in a large prospective cohort. Methods: Prospective cohort study examining the comparative risk of major CVEs was conducted using the British Association of Dermatologists Biologics and Immunomodulators Register. The main analysis compared adults with chronic plaque psoriasis receiving ustekinumab with tumour necrosis‐α inhibitors (TNFi: etanercept and adalimumab), whilst the secondary analyses compared ustekinumab, etanercept or methotrexate against adalimumab. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using overlap weights by propensity score to balance baseline covariates among comparison groups. Results: We included 5468 biologic‐naïve patients subsequently exposed (951 ustekinumab; 1313 etanercept; and 3204 adalimumab) in the main analysis. The secondary analyses also included 2189 patients receiving methotrexate. The median (p25–p75) follow‐up times for patients using ustekinumab, TNFi, adalimumab, etanercept and methotrexate were as follows: 2.01 (1.16–3.21), 1.93 (1.05–3.34), 1.94 (1.09–3.32), 1.92 (0.93–3.45) and 1.43 (0.84–2.53) years, respectively. Ustekinumab, TNFi, adalimumab, etanercept and methotrexate groups had 7, 29, 23, 6 and 9 patients experiencing major CVEs, respectively. No differences in the risk of major CVEs were observed between biologic therapies [adjusted HR for ustekinumab vs. TNFi: 0.96 (95% CI 0.41–2.22); ustekinumab vs. adalimumab: 0.81 (0.30–2.17); etanercept vs. adalimumab: 0.81 (0.28–2.30)] and methotrexate against adalimumab [1.05 (0.34–3.28)]. Conclusions: In this large prospective cohort study, we found no significant differences in the risk of major CVEs between three different biologic therapies and methotrexate. Additional studies, with longer term follow‐up, are needed to investigate the potential effects of biologic therapies on incidence of major CVEs

Investigating the effect of independent blinded digital image assessment on the STOP GAP trial

Background Blinding is the process of keeping treatment assignment hidden and is used to minimise the possibility of bias. Trials at high risk of bias have been shown to report larger treatment effects than low risk studies. In dermatology, one popular method of blinding is to have independent outcome assessors who are unaware of treatment allocation assessing the end point using digital photographs. However, this can be complex, expensive and time-consuming. The objective of this study was to compare the effect of blinded and unblinded outcome assessment on the results of the STOP GAP trial. Methods The STOP GAP trial compared prednisolone to ciclosporin in treating pyoderma gangrenosum. Participants’ lesions were measured at baseline and 6 weeks to calculate the primary outcome, speed of healing. Independent blinded assessors obtained measurements from digital photographs using specialist software. In addition, unblinded treating clinicians estimated lesion area by measuring length and width. The primary outcome was determined using blinded measurements where available, otherwise unblinded measurements were used (method referred to as trial measurements). In this study, agreement between the trial and unblinded measurements was determined using the intraclass correlation coefficient (ICC). The STOP GAP primary analysis was repeated using unblinded measurements only. We introduced differential and non-differential error in unblinded measurements and investigated the effect on the STOP GAP primary analysis. Results 86 (80%) of the 108 patients were assessed using digital images. Agreement between trial and unblinded measurements was excellent (ICC=0.92 at baseline; 0.83 at 6 weeks). There was no evidence that the results of the trial primary analysis differed according to how the primary outcome was assessed (p-value for homogeneity = 1.00). Conclusions Blinded digital image assessment in STOP GAP did not meaningfully alter trial conclusions compared with unblinded assessment. However, as the process brought added accuracy and credibility to the trial it was considered worthwhile. These findings question the usefulness of digital image assessment in a trial with an objective outcome and where bias is not expected to be excessive. Further research should investigate if there are alternative, less complex ways of incorporating blinding in clinical trials