SCRIPTED AND STRATEGIC POWER RELATIONS WITHIN STUDENT TEACHING TRIADS: Experience, Understandings, Accommodation/Resistance and Transformative Possibilities in Curriculum, Classroom Management and Evaluation Decisions

This qualitative descriptive study uses an intersubjective approach to examine relational aspects of the student teaching triad. Triad members include the student teacher, the cooperating teacher and the university supervisor. Beginning with a close reading of teaching socialization literature that focuses on the student teaching experience, various roles or scripted power relations, are carefully laid out. Working from the premise that conceptions of power may determine the quality of relationships, this interpretive study examines the power dynamics of eight specific student teaching triads from all three perspectives. The primary researcher was also the university supervisor in each of the triads studied. As an adjunct faculty member and former public school teacher, the researcher as supervisor brought a non-traditional 'eye' to the role of supervisor. Student teaching triad members were encouraged to consider and articulate the influence and control each triad member had in relation to decision-making concerning curriculum, classroom management and evaluation in an elementary classroom. Results reinforced much conventional wisdom about the student teaching experience and attempted to establish that in the institutional context studied an ideology of reputation and dependability held sway. Strong personal connections were found to be paramount for optimal functioning of the triads studied. Power struggles were noted as triad members strategically maneuvered in efforts to hide various aspects of their scripted roles. Conclusions from this study included the difficulty of moving the student teaching experience beyond ritual, how a cooperating teacher's own student teaching experience may strongly influence their supervisory styles and the difficulty of establishing spaces for critical dialogue within the student teaching triad as constituted. Suggestions include the establishment and maintenance of sustained robust communication between triad members. Critical dialogue that includes the articulation and consideration of various scripted power relations or roles in relation to potential strategic power relations would be encouraged. This recognition and 'naming' of power in language more in line with the elementary public school context, as perceived by the elementary teacher, could perhaps precipitate modifications to the traditional student teaching triad that would benefit all triad members

The Role of Rx in Embryonic Retinogenesis: Determining Genetic Influences on Optic Vesicle Formation and Photoreceptor Cell Fate

Eye development is a dynamic and complex process that is controlled by the interactions of transcription factors, signaling pathways, and growth factors. Disruption of the developmental process can result in ocular malformations or retinal diseases, which can cause blindness. Developing tools to study embryonic retinogenesis and understanding the molecular mechanisms involved are important for increasing our understanding of neural development, understanding ocular malformations such as anophthalmia, and may improve or lead to new treatments for eye diseases including blindness. This work aims to develop new tools for studying early eye development and explore genes associated with optic vesicle development and photoreceptor cell fate. In Study 1, we sought to identify and characterize markers of embryonic cone photoreceptors. We identified that two genes involved in phototransduction, phosducin and cone transducin gamma, are expressed in developing cones. We characterized the temporal and spatial profile of both genes and their associated proteins over the developmental timeline of retinogenesis. Further, we determined their colocalization with known cone and photoreceptor markers and thus established them as useful markers for further studies of early cone histogenesis. In Study 2, we assessed the role of the homeobox gene, Rx, in progenitor proliferation and cell fate determination in the mouse retina using a conditional knockout. Deletion of Rx in retinal progenitors led to a loss of retinal lamination, depletion of the retinal progenitors and in the mature retina showed changes in retinal cell types. Late-born cells (rods, bipolar cells, and Muller glia) were absent, likely due to the depleted progenitor pool. Cones (an early-born retinal cell type) were also absent; examination of cone histogenesis showed Rx is necessary for cone photoreceptor generation. Finally, in Study 3 we identified an effective gene knockdown method for 3D optic vesicle organoid culture that is useful for studying gene expression and early retinal development. Using this method, we assessed the roles of three candidate genes in optic vesicle development and identified one gene that warrants further investigation in vivo. Collectively these studies provide new tools for studying early embryogenesis and further our knowledge of the genetics underlying optic vesicle development and cone photoreceptor formation

Use of a 3-item short-form version of the Barthel Index for use in stroke: systematic review and external validation

Background and Purpose—There may be a potential to reduce the number of items assessed in the Barthel Index (BI), and shortened versions of the BI have been described. We sought to collate all existing short-form BI (SF-BI) and perform a comparative validation using clinical trial data. Methods—We performed a systematic review across multidisciplinary electronic databases to find all published SF-BI. Our validation used the VISTA (Virtual International Stroke Trials Archive) resource. We describe concurrent validity (agreement of each SF-BI with BI), convergent and divergent validity (agreement of each SF-BI with other outcome measures available in the data set), predictive validity (association of prognostic factors with SF-BI outcomes), and content validity (item correlation and exploratory factor analyses). Results—From 3546 titles, we found 8 articles describing 6 differing SF-BI. Using acute trial data (n=8852), internal reliability suggested redundancy in BI (Cronbach α, 0.96). Each SF-BI demonstrated a strong correlation with BI, modified Rankin Scale, National Institutes of Health Stroke Scale (all ρ≥0.83; P<0.001). Using rehabilitation trial data (n=332), SF-BI demonstrated modest correlation with quality of life measures Stroke Impact Scale and 5 domain EuroQOL (ρ≥0.50, P<0.001). Prespecified prognostic factors were associated with SF-BI outcomes (all P<0.001). Our factor analysis described a 3 factor structure, and item reduction suggested an optimal 3-item SF-BI comprising bladder control, transfer, and mobility items in keeping with 1 of the 3-item SF-BI previously described in the literature. Conclusions—There is redundancy in the original BI; we have demonstrated internal and external validity of a 3-item SF-BI that should be simple to use

Mixed-phenotype grouping: the interaction between oddity and crypsis

Aggregations of different-looking animals are frequently seen in nature, despite well-documented selection pressures on individuals to maintain phenotypically homogenous groups. Two well-known theories, the ‘confusion effect’ (reduced ability of a predator to accurately target an individual in a group) and the ‘oddity effect’ (preferential targeting of phenotypically distinct, ‘odd’, individuals) act together to predict the evolution of behaviours in prey that lead to groups of animals that are homogeneous in appearance. In contrast, a recently proposed mechanism suggests that mixed groups could be maintained if one species in a mixed group is more conspicuous against the habitat than the other, as confusion effects generated by the conspicuous species impede predator targeting of the cryptic species; thus, cryptic species benefit from association with conspicuous ones. We test these contrasting predictions from the perspective of both predators and prey, and show that cryptic individual Daphnia are at reduced risk of predation from three-spine sticklebacks Gasterosteus aculeatus when in mixed-phenotype groups, a risk that is reduced further as the number of conspicuous individuals increases, supporting the hypothesis for the evolution of mixed groups. In contrast, while the preference for associating with colour-matched conspecifics by mollies (Poecilia sphenops) was reduced when they were cryptic, we found no evidence for active association with conspicuous conspecifics. We conclude that prey animals must balance the relative risks of oddity and conspicuousness in their social decisions, and that this could potentially lead to the evolution of mixed-phenotype grouping as a response to predation risk alone

The positive predictive value of stroke identification by ambulance clinicians in North East England: a retrospective cohort study

Introduction/background Accurate prehospital identification of patients who had an acute stroke enables rapid conveyance to specialist units for time-dependent treatments such as thrombolysis and thrombectomy. Misidentification leads to patients who had a ‘stroke mimic’ (SM) being inappropriately triaged to specialist units. We evaluated the positive predictive value (PPV) of prehospital stroke identification by ambulance clinicians in the North East of England. Methods This service evaluation linked routinely collected records from a UK regional ambulance service identifying adults with any clinical impression of suspected stroke to diagnostic data from four National Health Service hospital trusts between 1 June 2013 and 31 May 2016. The reference standard for a confirmed stroke diagnosis was inclusion in Sentinel Stroke National Audit Programme data or a hospital diagnosis of stroke or transient ischaemic attack in Hospital Episode Statistics. PPV was calculated as a measure of diagnostic accuracy. Results Ambulance clinicians in North East England identified 5645 patients who had a suspected stroke (mean age 73.2 years, 48% male). At least one Face Arm Speech Test (FAST) symptom was documented for 93% of patients who had a suspected stroke but a positive FAST was only documented for 51%. Stroke, or transient ischaemic attack, was the final diagnosis for 3483 (62%) patients. SM (false positives) accounted for 38% of suspected strokes identified by ambulance clinicians and included a wide range of non-stroke diagnoses including infections, seizures and migraine. Discussion In this large multisite data set, identification of patients who had a stroke by ambulance clinicians had a PPV rate of 62% (95% CI 61 to 63). Most patients who had a suspected stroke had at least one FAST symptom, but failure to document a complete test was common. Training for stroke identification and SM rates need to be considered when planning service provision and capacity. http://dx.doi.org/10.1136/emermed-2019-208902. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

A survey of UK paramedics’ views about their stroke training, current practice and the identification of stroke mimics

Aims ‐ Paramedics play a crucial role in identifying patients with suspected stroke and transporting them to appropriate acute care. Between 25% and 50% of suspected stroke patients are later diagnosed with a condition other than stroke known as a ‘stroke mimic’. If stroke mimics could be identified in the pre-hospital setting, unnecessary admissions to stroke units could potentially be avoided. This survey describes UK paramedics’ stroke training and practice, their knowledge about stroke mimic conditions and their thoughts about pre-hospital identification of these patients.Methods ‐ An online survey invitation was circulated to members within the UK College of Paramedics and promoted through social media (8 September 2016 and 23 October 2016). Topics included: stroke training; assessment of patients with suspected stroke; local practice; and knowledge about and identification of stroke mimics.Results ‐ There were 271 responses. Blank responses (39) and non-paramedic (1) responses were removed, leaving 231 responses from paramedics which equates to 2% of College of Paramedics membership and 1% of Health and Care Professions Council registered paramedics. The majority of respondents (78%) thought that they would benefit from more training on pre-hospital stroke care. Narrative comments focused on a desire to improve the assessment of suspected stroke patients and increase respondents’ knowledge about atypical stroke presentations and current stroke research. The Face Arm Speech Test was used by 97% of respondents to assess suspected stroke patients, although other tools such as Recognition of Stroke in the Emergency Room (17%) and Miami Emergency Neurological Deficit (11%) were also used. According to those responding, 50% of stroke patients were taken to emergency departments, 35% went straight to a stroke ward and 8% were taken directly to CT scan. Most respondents (65%) were aware of the term ‘stroke mimic’. Two-thirds of respondents (65%) thought a tool that predicted the likelihood of a suspected stroke being a stroke mimic would be useful in pre-hospital care.Conclusion ‐ This study reports a survey of UK paramedics’ views about the stroke care they provide. Conclusions are limited by the low number of responses. Assessment of suspected stroke patients was recognised as an important skill by paramedics and an area where many would like further training. Respondents’ current practice varied in terms of the stroke assessment tools used and whether suspected stroke patients were taken to the emergency department or direct to a stroke ward. A stroke mimic identification tool would be useful if it allowed stroke mimic patients to be directed to appropriate care, but it would need to have a high level of specificity and not adversely impact on time to treatment for true stroke patients

Development and validation of a pragmatic prehospital tool to identify stroke mimic patients

Aim Stroke mimics (SM) are non-stroke conditions producing stroke-like symptoms. Prehospital stroke identification tools prioritise sensitivity over specificity.1 It is estimated that >25% of prehospital suspected stroke patients are SM.2 Failure to identify SM creates inefficient use of ambulances and specialist stroke services. We developed a pragmatic tool to identify SM amongst suspected prehospital stroke patients. Method The tool was developed using regression analysis of clinical variables documented in ambulance records of suspected stroke patients linked to primary hospital diagnoses (derivation dataset, n=1,650, 40% SM).3 It was refined using feedback from paramedics (n=3) and hospital clinicians (n=9), and analysis of an expanded prehospital derivation dataset (n=3,797, 41% SM (original 1650 patients included)). Results The STEAM tool combines six variables: 1 point for Systolic blood pressure 38.5°C with Abstracts A2 BMJ Open 2018;8(Suppl 1):A1–A34 (NHS). Protected by copyright. on 14 August 2019 at Manchester University NHS Foundation Trust http://bmjopen.bmj.com/ BMJ Open: first published as 10.1136/bmjopen-2018-EMS.6 on 16 April 2018. Downloaded from heart rate >90 bpm; 1 point for seizures or 2 points for seizures with known diagnosis of Epilepsy; 1 point for Age <40 years or 2 points for age <30 years; 1 point for headache with known diagnosis of Migraine; 1 point for FAST-ve. A score of 2 on STEAM predicted SM diagnosis in the derivation dataset with 5.5% sensitivity, 99.6% specificity and positive predictive value (PPV) of 91.4%. External validation (n=1,848, 33% SM) showed 5.5% sensitivity, 99.4% specificity and a PPV of 82.5%. Conclusion STEAM uses common clinical characteristics to identify SM patients with high certainty. The benefits of using STEAM to reduce SM admissions to stroke services need to be weighed up against delayed admissions for stroke patients wrongly identified as SM. https://bmjopen.bmj.com/content/8/Suppl_1/A2.3 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/bmjopen-2018-EMS.

The frequency, characteristics and aetiology of stroke mimic presentations::a narrative review

A significant proportion of patients with acute stroke symptoms have an alternative ‘mimic’ diagnosis. A narrative review was carried out to explore the frequency, characteristics and aetiology of stroke mimics. Prehospital and thrombolysis-treated patients were described separately. Overall, 9972 studies were identified from the initial search and 79 studies were included with a median stroke mimic rate of 19% (range: 1–64%). The prehospital median was 27% (range: 4–43%) and the thrombolysis median 10% (range: 1–25%). Seizures, migraines and psychiatric disorders are the most frequently reported causes of stroke mimics. Several characteristics are consistently associated with stroke mimics; however, they do not fully exclude the possibility of stroke. Nineteen per cent of suspected stroke patients had a mimic condition. Stroke mimics were more common with younger age and female sex. The range of mimic diagnoses, a lack of clear differentiating characteristics and the short treatment window for ischaemic stroke create challenges for early identification

Factors associated with relationship dissolution of Australian families with children

This project investigated the context in which relationship instability occurs by examining the factors (at the individual, and the couple/family levels) that precede relationship dissolution within Australian families with children. The report considers whether mental health problems, impaired physical functioning, hazardous levels of alcohol consumption and smoking are associated with later divorce or separation