Randomized controlled trial of urokinase versus placebo for nondraining malignant pleural effusion

Rationale: Patients with malignant pleural effusion experience breathlessness, which is treated by drainage and pleurodesis. Incomplete drainage results in residual dyspnea and pleurodesis failure. Intrapleural fibrinolytics lyse septations within pleural fluid, improving drainage. Objectives: To assess the effects of intrapleural urokinase on dyspnea and pleurodesis success in patients with nondraining malignant effusion. Methods: We conducted a prospective, double-blind, randomized trial. Patients with nondraining effusion were randomly allocated in a 1:1 ratio to intrapleural urokinase (100,000 IU, three doses, 12-hourly) or matched placebo. Measurements and Main Results: Co–primary outcome measures were dyspnea (average daily 100-mm visual analog scale scores over 28 d) and time to pleurodesis failure to 12 months. Secondary outcomes were survival, hospital length of stay, and radiographic change. A total of 71 subjects were randomized (36 received urokinase, 35 placebo) from 12 U.K. centers. The baseline characteristics were similar between the groups. There was no difference in mean dyspnea between groups (mean difference, 3.8 mm; 95% confidence interval [CI], −12 to 4.4 mm; P = 0.36). Pleurodesis failure rates were similar (urokinase, 13 of 35 [37%]; placebo, 11 of 34 [32%]; adjusted hazard ratio, 1.2; P = 0.65). Urokinase was associated with decreased effusion size visualized by chest radiography (adjusted relative improvement, −19%; 95% CI, −28 to −11%; P < 0.001), reduced hospital stay (1.6 d; 95% CI, 1.0 to 2.6; P = 0.049), and improved survival (69 vs. 48 d; P = 0.026). Conclusions: Use of intrapleural urokinase does not reduce dyspnea or improve pleurodesis success compared with placebo and cannot be recommended as an adjunct to pleurodesis. Other palliative treatments should be used. Improvements in hospital stay, radiographic appearance, and survival associated with urokinase require further evaluation. Clinical trial registered with ISRCTN (12852177) and EudraCT (2008-000586-26)

The see-saw of visual arts in early childhood education: Are we up, down or somewhere in-between?

Current context of early childhood visual arts education in Aotearoa / New Zealand. Recognising, promoting and maintaining indigenous visual arts in an early childhood setting

Visual arts education: Provoking learning conversations

Visual arts praxis dilemmas can invoke uncertainty, calling for courage to engage in learning conversations that promote innovative ideas. These may challenge teachers but by engaging in dialogue can invite reflection and possible changes to practice. This workshop explores visual arts education and differing ideas teachers hold about children’s drawing, painting, printmaking and sculpture. Visual arts are a valuable mode for children to make meaning and express emotions so let’s talk and explore possibilitie

Surfing and negotiating the waves of change in visual art education

Practices The Teacher-led approach Production approach Developmental theories A child-centred practice Sociocultural theories Co-construction Guided participation Scaffolding Critical theories Reflective practic

Challenging positional authority : navigating leadership as collaboration

Challenging positional authority Collective nature of leadership Kaupapa Māori model of leadership Building people’s capabilities Sustainable leadership Distributed leadership is transformationa

Toi Tū Te Whenua : a study of Māori visual arts as dialogue with Papatūānuku

This article expands on ideas developed in Ngā Taonga Tuku Iho Māori Visual Arts and Cultural Fusion. Studying Authentic Engagement (Wrightson & Heta-Lensen, 2013). In it we discussed the integrated nature of ngā toi ataata (visual arts) to Māori life and the connectedness to people, places, things and time. In this article we demonstrate how ngā toi ataata dialogues with histories, values and locations across time, place and space. Authentic engagement in ngā toi ataata in the context of early childhood education in Aotearoa New Zealand is critiqued through a socio-cultural and socio-political lens. Through the examples that we present, stories emerge that demonstrate a growing relationship with Ranginui (Sky father) and Papatūānuku (Earth mother) which contribute to developing student teachers’ own working theories, stories, and understandings about the world and their place in it. Employing the visual arts in this way provides opportunities to deepen understandings of indigenous world views and develop a sense of connection to the natural world. It engages student teachers in understandings of artsbased teaching and learning practice from both an educational and a cultural perspective. It provides an opportunity to reflect on multiple perspectives held about the world and how different peoples express their relationship with it. The article also explores how the incorporation of Māori visual arts in an initial teacher education programme supports teachers to meet the requirements of the Aotearoa New Zealand early childhood curriculum, Te Whāriki. He whāriki mātauranga mō ngā mokopuna o Aotearoa. Early childhood curriculum (Ministry of Education, 2017)

Ko tōku whānau tēnei : a whakapapa based approach to building community in mainstream ECE

Within te ao Māori whanaungatanga is seen as a quintessential value, requiring the establishment and maintenance of a pattern of right relationship between people, place, space and time (Williams, 2005). Early childhood education in Aotearoa emphasises children’s sense of belonging in their community. This is evidenced by the strands of the early childhood curriculum, Te Whāriki (Ministry of Education, 1996). The strand Whanau tangata / Family and community calls for this to be an integral part of curriculum. Through the strand of Ngā hōnonga / Relationships, teachers support children’s learning through ensuring responsive and reciprocal relationships with people, places, and things. This presentation (workshop) offers an approach to supporting tamariki to build their sense of community and belonging based on the concept of whanaungatanga. It supports all levels of fluency te reo Māori. It acknowledges whakapapa of the child and whānau and assists in building knowledge of Māori ways of being in the world

Te hononga ki te marae : connecting early learning centres with their local marae

This presentation explores a process to initiate a relationship between early childhood settings (centres) with their local marae. This research is currently in progress. It is intended to guide one or two centres to establish relationships with kuia and kaumātua of the marae and possibilities for developing te reo Māori me ōna tīkanga. As part of Nicole’s Masters of Education thesis, she found that there had been a shift towards utilising te reo Māori in early childhood education, but the level of proficiency varied from centre to centre (Education Review Office, 2012). Further to this the Ministry of Education implemented a bilingual curriculum document Te Whāriki, but there has been no real guidance as to how to implement bilingual practices. Expertise in this area could be drawn from kuia, kaumātua and relationships between centres and their local marae. Also, as a result of community work over 2000 children came through Te Noho Kotahitanga marae at Te Whare Wānanga o Wairaka. We noticed the high demand of centres still wanting a marae experience for their tamariki. This demand on our marae and marae staff has become unrealistic as the marae is on high demand for Unitec itself. Connecting centres with their local marae could be more beneficial as relationships under a kaupapa of whanaungatanga are established between the centres and marae. This could also provide a culturally appropriate and safe space for centres to practice and breathe tīkanga Māori

Inquiry-based project learning in early childhood: Time to develop localised understanding of this pedagogical approach

Ko te tamaiti te pūtake o te ao The child is the centre of the universe Who is the child in the 21st century? Industry 4.0 He kakano i ruia mai i Rangiatea What does the 21st Century child need to know? Inquiry based project work The issues and rationale for the research Aim of the study Data collection Findings: The dominance of the international discourse Evidence of localised curriculum and the influence of National discourse A need for further guidance on processes Discussion, cultural knot