Frailty is independently associated with increased hospitalisation days in patients on the liver transplant waitlist

AIM: To investigate the impact of physical frailty on risk of hospitalisation in cirrhotic patients on the liver transplant waitlist. METHODS: Cirrhotics listed for liver transplantation at a single centre underwent frailty assessments using the Fried Frailty Index, consisting of grip strength, gait speed, exhaustion, weight loss, and physical activity. Clinical and biochemical data including MELD score as collected at the time of assessment. The primary outcome was number of hospitalised days per year; secondary outcomes included incidence of infection. Univariable and multivariable analysis was performed using negative binomial regression to associate baseline parameters including frailty with clinical outcomes and estimated incidence rate ratios (IRR). RESULTS: Of 587 cirrhotics, 64% were male, median age (interquartile range) was 60 (53-64) years and MELD score was 15 (12-18). Median Fried Frailty Index was 2 (1-3); 31.6% were classified as frail (fried frailty ≥ 3). During 12 mo of follow-up, 43% required at least 1 hospitalisation; 38% of which involved major infection. 107/184 (58%) frail and 142/399 (36%) non-frail patients were hospitalised at least once (P < 0.001). In univariable analysis, Fried Frailty Index was associated with total hospitalisation days per year (IRR = 1.51, 95%CI: 1.28-1.77; P ≤ 0.001), which remained significant on multivariable analysis after adjustment for MELD, albumin, and gender (IRR for frailty of 1.21, 95%CI: 1.02-1.44; P = 0.03). Incidence of infection was not influenced by frailty. CONCLUSION: In cirrhotics on the liver transplant waitlist, physical frailty is a significant predictor of hospitalisation and total hospitalised days per year, independent of liver disease severity

Examining Teacher Experiences: A Qualitative Study on Inclusion in the Elementary Classroom

This qualitative study utilized a semi-structured interview approach to better understand the experiences of general education teachers (n = 8) with the inclusion of special education students in the general education classroom. By gaining information about the experiences that general education teachers have with supports and services for, as well as communication about, inclusion, the study results provide additional information about experiences in order to inform the supports teachers receive to better educate students with and without disabilities. Each semi-structured interview was transcribed and coded for themes. Seven key themes emerged from findings: Acceptance, Time in General Education Classroom, Supports and Strategies, Special Education Teacher Role, Collaboration and Communication, Dangerous, Destructive, Disruptive Behaviors, and Other Barriers. Literature names the frequent barrier to inclusion being negative attitudes of general education teachers, special education teachers, and parents; that was not the case in the findings of this research, which found the large barrier described by all participants to be experiences with dangerous, destructive, disruptive behavior. Along with the large barrier described as a result of student behavior, teachers detailed experiences with a lack of human supports because of student behavioral support needs. Research findings include that despite teachers having supports and services in place for the education and inclusion of special education students in the general education classroom, such things didn’t appear to be enough to combat the significant barrier that arose from dangerous, destructive, disruptive behavior. Behavior affected the presence, participation, and achievement of special education students. Additionally, participants detailed the rippling effects that dangerous, destructive, disruptive behavior had on inclusion, as well as the learning of other students in the classroom and often across the school. Of importance is for leaders and districts to be cognizant and focused on providing supports to school staff when programming and providing supports for students with significant behavioral needs. Adequate staffing is a must. Candid, supportive Individualized Education Program (IEP) conversations around least restrictive environment are critical

Small and Large Scale Limits of Multifractal Stochastic Processes with Applications

Various classes of multifractal processes, that is processes that display different properties at different scales, are studied. Most of the processes examined in this work exhibit stable trends at small scales and Gaussian trends at large scales, although the opposite can also occur. Many natural phenomena exhibit a fractal structure depending on some scaling factor, such as space or time. Thus, these types of processes have many useful modeling applications, including Biology and Economics. First, generalized tempered stable processes are defined and studied, following the original work on tempered stable processes by Jan Rosinski [16]. Generalized tempered stable processes encompass the modern variations on tempered stable distributions that have been introduced in the field, including Modified tempered stable distributions [10], Layered stable distributions [8], and Lamperti stable processes [2]. This work shows generalized tempered stable processes exhibit multifractal properties at different scales in the space of cadlag functions equipped with the Skorokhod topology and investigates other properties, such as series representations and absolute continuity. Next, processes driven by generalized tempered stable processes involving a certain Volterra kernel are defined and short and long term behavior is established, following the work of Houdré and Kawai [7]. Finally, inspired by the work of Pipiras and Taqqu [13], the multifractal behavior of more general infinitely divisible processes is established, based on the Lévy-Itô representation of infinitely divisible processes. Numerous examples are given throughout the entire text to exemplify the strong presence of processes of this type in current literature

Assessment on the Go: Surveying Students With an iPad

Ongoing assessment in academic libraries, particularly the measurement of student perceptions, preferences, and satisfaction, can be a challenge to schedule and execute. This paper describes a pilot project at Georgia State University Library that combined assessment with the portability of the tablet computer. A tablet computer--in this case, Apple’s iPad--loaded with survey software became a digital clipboard with the added benefit of automatic data compilation. Subjects were surveyed quickly in the library buildings, maximizing convenience for both subjects and researchers alike. The result was a model that other libraries, as well as campus student services divisions and classroom instructors, can easily adopt. Methodology, benefits, lessons learned, and ideas for future projects are discussed

Targeted youth support: Rapid Evidence Assessment of effective early interventions for youth at risk of future poor outcomes

This report describes the findings and methods of a systematic rapid evidence assessment (REA) of research relevant to interventions of interest to Targeted Youth Support. It was commissioned by the Department for Children, Schools and Families (DCSF) to inform the development of policy and practice in relation to this initiative

COAL PARTICLE FLOW PATTERNS FOR O2 ENRICHED, LOW NOx BURNERS

Over the past year, the hot flow studies have focused on the validation of a novel 2M near-flame combustion furnace. The 2M furnace was specifically designed to investigate burner aerodynamics and flame stability phenomena. Key accomplishments include completion of coal & oxygen mass balance calculations and derivation of emission conversion equations, upgrade of furnace equipment and flame safety systems, shakedown testing and partial completion of a parametric flame stability study. These activities are described in detail below along with a description of the 2M furnace and support systems

COAL PARTICLE FLOW PATTERNS FOR O2 ENRICHED, LOW NOx BURNERS

The year-end report summarizes the results of the series of experiments conducted to evaluate the effects of oxygen partial pressure on coal combustion. Specifically, the effects of oxygen partial pressure in the transport air stream on flame stability, flame standoff distance and overall NO{sub x} emissions were examined. A series of experiments were conducted to determine the effect of oxygen partial pressure in the transport air on flame stability and resultant NO{sub x} emissions. In summary, the oxygen partial pressure experiments revealed that: (1) Increasing oxygen partial pressure in the transport air stream produced stable attached flames that were otherwise detached, reducing NO{sub x} emissions due to formation of fuel-rich central core which favors reduction of fuel nitrogen to N{sub 2}. Flame attachment also prevents premixing of fuel and air. (2) The degree of oxygen enrichment necessary to produce attached flames decreased with increasing wall temperature. (3) Increasing oxygen partial pressure in the transport air stream had little effect on emissions for always-attached and always-detached flames. The lack of an effect for always-detached flames is attributed to the extensive pre-mixing that occurs prior to ignition and the limited impact oxygen enrichment of the small transport air stream has on the oxygen concentration of the premixed transport and combustion air streams. (4) Reducing the oxygen partial pressure through nitrogen dilution destabilizes flames leading to flame detachment or blowout. These destabilizing effects increase with decreasing furnace temperature. These results are consistent with published literature. (5) The temperature dependence of NO{sub x,i} for detached flames is approximately 3 times greater than for attached flames

IMPROVING THE DELIVERY OF SPECIAL EDUCATION SERVICES: EXAMINING COMMUNICATION AMONG TEACHERS, PARA-EDUCATORS, AND AN EDUCATIONAL COOPERATIVE

Purpose of the study: The purpose of this study is to explore communication between participating school districts and the Cooperative with regard to the allocation of para-educators in general education classrooms. Methodology: The study employed a comparative qualitative design. Since the goal of our research is to understand the communication channels and patterns between the Cooperative, general education teachers, and para-educators, we conducted focus group discussions with para-educators, the K-5 general education teachers who work in general education classrooms and the special education teachers. Main Findings: The cooperative, special education teachers, general education teachers, and para-educators often operated in isolation of one another. Teachers and para-educators work together in the same classrooms but had a clear idea about who was providing the training and information needed to meet the needs of students in special education. Applications of the study: Frequent communication and enhanced opportunities for planning and training would improve the efficiency and effectiveness of general and special education teachers along with para-educators. Novelty: The study addressed ways to improve communication between participating school districts and the Cooperative with regard to the allocation of para-educators in general education classrooms. This would provide information about necessary training future para-educators need and expectations for engagement with students

An intercalated BSc degree is associated with higher marks in subsequent medical school examinations

<p>Abstract</p> <p>Background</p> <p>To compare medical students on a modern MBChB programme who did an optional intercalated degree with their peers who did not intercalate; in particular, to monitor performance in subsequent undergraduate degree exams.</p> <p>Methods</p> <p>This was a retrospective, observational study of anonymised databases of medical student assessment outcomes. Data were accessed for graduates, University of Aberdeen Medical School, Scotland, UK, from the years 2003 to 2007 (n = 861). The main outcome measure was marks for summative degree assessments taken after intercalating.</p> <p>Results</p> <p>Of 861 medical students, 154 (17.9%) students did an intercalated degree. After adjustment for cohort, maturity, gender and baseline (3^rdyear) performance in matching exam type, having done an IC degree was significantly associated with attaining high (18–20) common assessment scale (CAS) marks in three of the six degree assessments occurring after the IC students rejoined the course: the 4^thyear written exam (p < 0.001), 4^thyear OSCE (p = 0.001) and the 5^thyear Elective project (p = 0.010).</p> <p>Conclusion</p> <p>Intercalating was associated with improved performance in Years 4 and 5 of the MBChB. This improved performance will further contribute to higher academic ranking for Foundation Year posts. Long-term follow-up is required to identify if doing an optional intercalated degree as part of a modern medical degree is associated with following a career in academic medicine.</p