The impact of co-located NHS walk-in centres on emergency departments

Objectives: To determine the impact of establishing walk-in centres alongside emergency departments on attendance rates, visit duration, process, costs and outcome of care. Methods: Eight hospitals with co-located emergency departments and walk-in centres were compared with eight matched emergency departments without walk-in centres. Site visits were conducted. Routine data about attendance numbers and use of resources were analysed. A random sample of records of patients attending before and after walk-in centres opened were also assessed. Patients who had not been admitted to hospital were sent a postal questionnaire. Results: In most sites, the walk-in centres did not have a distinct identity and there were few differences in the way services were provided compared with control sites. Overall, there was no evidence of an increase in attendance at sites with walk-in centres, but considerable variability across sites. The proportion of patients managed within the four-hour NHS target improved at sites both with and without walk-in centres. There was no evidence of any difference in re-consultation rates, costs of care or patient outcomes at sites with or without walk-in centres. Conclusions: Most hospitals in this study implemented the walk-in centre concept to a very limited extent. Consequently there was no evidence of any impact on attendance rates, process, costs or outcome of care

Developing reading comprehension for children with Autism Spectrum Disorder through concrete representations : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Educational Psychology at Massey University, Albany, New Zealand

The ability to comprehend written text is an essential skill for all students, leading to their increased engagement at school, and the development of communication and cognitive skills. Recent research has found that a significant number of students with autism spectrum disorder (ASD) may have fluent word reading skills, but often experience difficulties with reading comprehension. Research is limited on this topic, and there are few studies that have identified strategies that enhance comprehension for learners with ASD. In the present study, the researcher investigated whether it was possible for students with ASD to improve their reading comprehension through a multimodal, researcher developed intervention, “Show Me’. Concrete figures and objects representing text features were manipulated by the students in accordance with the text they read, as a scaffold to assist their understanding. A single subject multiple baseline design was utilised to assess the effect of the intervention on the reading comprehension ability of three participants (aged 7-10 years old) with ASD. The results established a functional relationship between the independent variable, the ‘Show Me’ intervention, and participants’ ability to respond to comprehension questions during and after a reading session. A smaller relationship was established between the intervention and the verbal output of the students. Staff responses to the intervention were positive and indicated high social validity. The findings suggest that the manipulation of concrete representations may support students with ASD develop their reading comprehension abilities

Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Our main objective is to assess the effectiveness of follow-up services for ICU survivors that aim to identify and address unmet health needs related to the ICU period. We aim to assess the effectiveness in relation to health-related quality of life, mortality, depression and anxiety, post-traumatic stress disorder, physical function, cognitive function, ability to return to work or education and adverse events. Our secondary objectives are, in general, to examine both the various ways that follow-up services are provided and any major influencing factors. Specifically, we aim to explore: the effectiveness of service organisation (physician versus nurse led, face to face versus remote, timing of follow-up service); possible differences in services related to country (developed versus developing country); and whether participants had delirium within the ICU setting

First language in the classroom: the forbidden fruit?

Tesis (Profesor de Inglés para la Enseñanza Básica y Media y al grado académico de Licenciado en Educación)Over the past years, the use of students’ first language (L1) in the classroom has been a highly discussed topic in the EFL classroom as well as in the field of second language (L2) teaching/learning research. There is a tendency that advocates communicative language teaching which suggests that L1 use should forbidden in the classroom. However, research has yet to discover whether L1 use has a positive or negative impact on L2 learning. Hence, the present study aimed to examine L1 functions and the impact of L1 use on L2 development. The present study was conducted in a private school in Santiago, Chile. The participants of this study (N = 34) were engaged in two collaborative writing tasks about the book they were reading in their English literature classes, and their discussions were audio-recorded and later analyzed. A quasi-experimental method was utilized in order to observe the influence that group work had on their L2 vocabulary development. The results demonstrated that the students’ L1 played a major role in their interaction while together working on the collaborative tasks, and it served for the development of L2 vocabulary. Specifically, the results suggest that the way in which individual learners contributed to interaction affected their learning outcomes.En los últimos años, el uso de la primera lengua de los estudiantes ha sido un tema altamente discutido en las salas de clases y en la investigación de la enseñanza de inglés como Lengua Extranjera. Existe una tendencia general de prohibir el uso de la primera lengua, sin embargo, aún existen vacíos sobre la influencia positiva o negativa que esta podría tener en el aprendizaje de vocabulario. El presente estudio se realizó en una escuela privada en Santiago, Chile. El propósito del mismo fue observar las funciones que cumplía la lengua nativa en la interacción de los estudiantes y cómo esto afectaba al desarrollo de la segunda lengua en alumnos de octavo básico con alto nivel de inglés. Los participantes de este estudio fueron involucrados en dos actividades de escritura colaborativa sobre el libro que estaban leyendo en las clases de literatura inglesa, donde sus discusiones fueron grabadas en audio y luego analizadas. Se utilizó un método cuasi experimental para observar la influencia que tuvieron sus discusiones grupales –utilizando su primera lengua—en el desarrollo del vocabulario en la segunda lengua. Se aplicaron evaluaciones pre y post con el fin de tener un registro del desarrollo del vocabulario de los estudiantes y las funciones que la lengua materna cumplió fueron codificadas como sugirieron DiCamilla y Antón (2012). Los resultados demostraron que la lengua materna de los estudiantes jugó un rol mayor en su interacción mientras desarrollaban en conjunto actividades colaboración, y sirvió para el desarrollo del vocabulario de la segunda lengua. Más aun, los resultados sugieren que la forma en la que alumnos contribuyeron individualmente en las discusiones afectó los resultados en sus aprendizajes

Two Optimal Strategies for Active Learning of Causal Models from Interventional Data

From observational data alone, a causal DAG is only identifiable up to Markov equivalence. Interventional data generally improves identifiability; however, the gain of an intervention strongly depends on the intervention target, that is, the intervened variables. We present active learning (that is, optimal experimental design) strategies calculating optimal interventions for two different learning goals. The first one is a greedy approach using single-vertex interventions that maximizes the number of edges that can be oriented after each intervention. The second one yields in polynomial time a minimum set of targets of arbitrary size that guarantees full identifiability. This second approach proves a conjecture of Eberhardt (2008) indicating the number of unbounded intervention targets which is sufficient and in the worst case necessary for full identifiability. In a simulation study, we compare our two active learning approaches to random interventions and an existing approach, and analyze the influence of estimation errors on the overall performance of active learning

Socioscientific decision making in the science classroom: the effect of embedded metacognitive instructions on students' learning outcomes

The purpose of the present study was to examine the effects of cooperative training strategies to enhance students' socioscientific decision making as well as their metacognitive skills in the science classroom. Socioscientific decision making refers to both “describing socioscientific issues” as well as “developing and evaluating solutions” to socioscientific issues. We investigated two cooperative training strategies which differed with respect to embedded metacognitive instructions that were developed on the basis of the IMPROVE method. Participants were 360 senior high school students who studied either in a cooperative learning setting (COOP), a cooperative learning setting with embedded metacognitive questions (COOP+META), or a nontreatment control group. Results indicate that students in the two training conditions outperformed students in the control group on both processes of socioscientific decision making. However, students in the COOP+META condition did not outperform students in the COOP condition. With respect to students' learning outcomes on the regulation facet of metacognition, results indicate that all conditions improved over time. Students in the COOP+META condition exhibited highest mean scores at posttest measures, but again, results were not significant. Implications for integrating metacognitive instructions into science classrooms are discussed

Selenium-Binding Protein 1 Indicates Myocardial Stress and Risk for Adverse Outcome in Cardiac Surgery

Selenium-binding protein 1 (SELENBP1) is an intracellular protein that has been detected in the circulation in response to myocardial infarction. Hypoxia and cardiac surgery affect selenoprotein expression and selenium (Se) status. For this reason, we decided to analyze circulating SELENBP1 concentrations in patients (n = 75) necessitating cardioplegia and a cardiopulmonary bypass (CPB) during the course of the cardiac surgery. Serum samples were collected at seven time-points spanning the full surgical process. SELENBP1 was quantified by a highly sensitive newly developed immunological assay. Serum concentrations of SELENBP1 increased markedly during the intervention and showed a positive association with the duration of ischemia (ρ = 0.6, p < 0.0001). Elevated serum SELENBP1 concentrations at 1 h after arrival at the intensive care unit (post-surgery) were predictive to identify patients at risk of adverse outcome (death, bradycardia or cerebral ischemia, "endpoint 1"; OR 29.9, CI 3.3-268.8, p = 0.00027). Circulating SELENBP1 during intervention (2 min after reperfusion or 15 min after weaning from the CPB) correlated positively with an established marker of myocardial infarction (CK-MB) measured after the intervention (each with ρ = 0.5, p < 0.0001). We concluded that serum concentrations of SELENBP1 were strongly associated with cardiac arrest and the duration of myocardial ischemia already early during surgery, thereby constituting a novel and promising quantitative marker for myocardial hypoxia, with a high potential to improve diagnostics and prediction in combination with the established clinical parameters

Surgical assessment of the geriatric oncology patient

BACKGROUND: The aging population in the United States will correlate with an increased number of cancer diagnoses as cancer is primarily a disease of the elderly. Providing this ever-growing group of individuals with quality surgical management, while taking into account the unique needs and desires of this cohort, is a great challenge facing both geriatricians and surgeons going forward. The best approach to ensure that oncogeriatric patients receive the best tailored treatment is through the completion of a pre-surgical geriatric assessment. However, only a minority of oncogeriatric patients is undergoing a comprehensive pre-surgical geriatric assessment despite the majority of geriatricians and surgeons acknowledging its importance in order to properly risk stratify their patients. LITERATURE REVIEW FINDINGS: Multiple theories exist as to why geriatric assessments are not being utilized more frequently, but the most probable answer is that these assessments are very time-consuming, making it virtually impossible for incorporation into a healthcare provider’s busy schedule. Comprehensive literature review regarding geriatric assessments amongst the oncogeriatric population found that the most sensitive and specific domains of the geriatric assessments predicting morbidity and mortality include Frailty Index, Social Support Survey, Mini-Nutritional Assessment, and Geriatric Depression Screening. PROPOSED METHODS: A novel educational intervention will be proposed to teach Physician Assistant and Medical Students about the domains of the geriatric assessment most predictive of post-surgical risk during their surgical clerkship. The curriculum will utilize both simulation- and competency-based education training under the guidance of geriatricians and surgeons. Students will first learn the necessary skills in a controlled classroom environment and then proceed to incorporate these skills during their clerkship with patients on their service. CONCLUSIONS: The goal of the proposed method is to instill the confidence and skills necessary to provide an accurate geriatric assessment for oncogeriatric patients in future clinicians. The field of geriatric oncology is going to grow exponentially in the up-coming years and familiarizing future clinicians with the most predictive domains regarding surgical outcome will improve treatment outcomes for oncogeriatric patients in the immediate and foreseeable future

The efects of peer corrective feedback trainning in face to face interaction and synchronousvideo-based computer-mediated comunication

Tesis (Profesor de Inglés para la Enseñanza Básica y Media y al grado académico de Licenciado en Educación)This quasi-experimental study was conducted in a private school, in Santiago, Chile, with four groups formed by 9th graders with the same L1 (Spanish) immersed in an EFL context. The purpose of the study was to examine ways in which the potential of peer interaction on learning is maximized. Specifically, the study examined two instructional techniques, both of which have been gaining increasing attention from second language acquisition researchers: (a) training learners how to correct each other (corrective feedback: CF), and (b) synchronous communicative interaction via video-based computer-mediated communication (SVCMC). Participants were divided into four groups depending on their experimental conditions. Group A (SVCMC+CF training) engaged in communicative peer interaction via SVCMC and received CF training. Group B (SVCMC-CF training) was given the same peer interaction tasks but did not receive any CF training. Groups C (FTF+CF training) and D (FTF-CF training) engaged in the same tasks in face-to-face in the classroom while only Group C received CF training. The intervention period lasted two weeks, consisting of four classes of 45 minutes for each of the four groups. The analysis involved (a) learners’ interactional behaviors, namely, language-related episodes, (b) their developmental outcomes with pre- and posttests focusing on past tense and locative usages, and (c) their perceptions based on exit questionnaire with close- and open-items. The results of this study reflected 3 main findings in peer interaction, corrective feedback, and SVCMC. With regard to interactional patterns (peer interaction), corrective feedback training promotes collaboration and so FTF environments, yet in SVCMC dominant patterns were more likely to arise. Meanwhile, CF training helped enhance learners’ language development as their results in the post-test were higher than in the pre-test and, in turn, SVCMC groups outperformed FTF groups. Concerning students’ perceptions, they overtly expressed positive beliefs regarding Peer Corrective Feedback and SVCMC activities. In short, clear differences were found among groups with different interventions resulting in distinct patterns, L2 development outcomes, and learner perceptions.Este estudio cuasi-experimental fue conducido en un colegio privado en Santiago de Chile, con cuatro grupos formados por estudiantes de primer año medio, cuya lengua nativa es el español. Los estudiantes estuvieron inmersos en un contexto EFL. El propósito del estudio fue examinar medios por las cuales el potencial de la interacción entre pares en el aprendizaje sea maximizado. Específicamente, este estudio examinó dos técnicas instructivas, las cuales han recibido recientemente atención paulatina de los investigadores en el campo de la adquisición de un segundo idioma: (a) capacitar a los estudiantes en como corregir a sus pares (retroalimentación), e (b) interacción comunicativa sincronizada a través de video conferencias (ICSV) mediadas por computadores. Los participantes fueron divididos en cuatro grupos según sus condiciones experimentales. El Grupo A (ICSV+ capacitación en retroalimentación) involucrado en interacción comunicativa— entre pares— a través de ICSV y recibieron instrucción en retroalimentación entre pares. Al Grupo B (ICSV – capacitación en retroalimentación) se le dio las mismas tareas, pero no recibió capacitación en retroalimentación. El Grupo C (cara a cara + capacitación en retroalimentación) y el Grupo D (cara a cara – capacitación en retroalimentación) participaron en las mismas tareas cara a cara en la sala de clases mientras que solo el Grupo C recibió capacitación en retroalimentación. El periodo de intervención fue de 2 semanas, compuesto de 4 clases de 45 min para cada uno de los grupos. Este análisis involucró (a) comportamientos interaccionales de los estudiantes, es decir, episodios relacionados con el lenguaje, (b) los resultados que reflejaron el desarrollo del lenguaje de los estudiantes fueron obtenidos mediante una evaluación previa a la intervención y otra posterior a la intervención; las evaluaciones se enfocaron en el uso del pasado simple y locativos, finalmente (c) las percepciones de los estudiantes obtenidas mediante un cuestionario de preguntas cerradas y abiertas. Los resultados de este estudio reflejaron 3 hallazgos principales en cuanto a interacción entre pares, retroalimentación, e ICSV. En cuanto a los patrones interacciónales (interacción entre pares), la retroalimentación y la comunicación cara a cara resultaron promover la colaboración, a diferencia de ICSV en la cual los patrones dominantes tuvieron más probabilidades de surgir. Mientras tanto, la capacitación en retroalimentación ayudó al mejoramiento del desarrollo del lenguaje de los estudiantes ya que sus resultados a lo largo de las evaluaciones pre y post presentaron un alza y, en consecuencia, los grupos que interactuaron a través de ICSV superaron a los grupos que interactuaron cara a cara. Tomando en cuenta las percepciones de los estudiantes, ellos expresaron abiertamente ideas positivas en cuanto a las actividades la capacitación en retroalimentación e ICSV. En resumen, diferencias claras fueron encontradas entre los grupos con diferentes intervenciones resultando en distintos patrones de interacción, resultados en el desarrollo del lenguaje, y percepciones de los estudiantes

Can screening and brief intervention lead to population-level reductions in alcohol-related harm?

A distinction is made between the clinical and public health justifications for screening and brief intervention (SBI) against hazardous and harmful alcohol consumption. Early claims for a public health benefit of SBI derived from research on general medical practitioners' (GPs') advice on smoking cessation, but these claims have not been realized, mainly because GPs have not incorporated SBI into their routine practice. A recent modeling exercise estimated that, if all GPs in England screened every patient at their next consultation, 96% of the general population would be screened over 10 years, with 70-79% of excessive drinkers receiving brief interventions (BI); assuming a 10% success rate, this would probably amount to a population-level effect of SBI. Thus, a public health benefit for SBI presupposes widespread screening; but recent government policy in England favors targeted versus universal screening, and in Scotland screening is based on new registrations and clinical presentation. A recent proposal for a national screening program was rejected by the UK National Health Service's National Screening Committee because 1) there was no good evidence that SBI led to reductions in mortality or morbidity, and 2) a safe, simple, precise, and validated screening test was not available. Even in countries like Sweden and Finland, where expensive national programs to disseminate SBI have been implemented, only a minority of the population has been asked about drinking during health-care visits, and a minority of excessive drinkers has been advised to cut down. Although there has been research on the relationship between treatment for alcohol problems and population-level effects, there has been no such research for SBI, nor have there been experimental investigations of its relationship with population-level measures of alcohol-related harm. These are strongly recommended. In this article, conditions that would allow a population-level effect of SBI to occur are reviewed, including their political acceptability. It is tentatively concluded that widespread dissemination of SBI, without the implementation of alcohol control measures, might have indirect influences on levels of consumption and harm but would be unlikely on its own to result in public health benefits. However, if and when alcohol control measures were introduced, SBI would still have an important role in the battle against alcohol-related harm