International issues in education

Anxiety, negative attitudes, and attrition are all issues presented in the teaching of statistics to undergraduates in research-based degrees regardless of location. Previous works have looked at these obstacles, but none have consolidated a multilingual, multinational effort using a consistent method. Over 400 Spanish-, English-, and German-speaking undergraduate students enrolled in introductory psychology statistics courses were given the Composite Survey of Statistics Anxiety and Attitudes to determine the precursors and effects of existing problems. Results indicated that student background was heavily linked to attitudes and anxieties. The measure was supported as a viable method for more than one class or university in addressing issues in statistics education, developing interventions to improve students’ experiences, and then determining the success of those changes.

Sustainability and the Multifunctional Landscape: An Assessment of the Cairngorms National Park Authority’s Approach to Planning and Management in Upland Scotland.

Upland Scotland contains some of Britain’s most prized areas of natural heritage value. However, although such areas may appear both ‘wild’ and ‘remote’, these are typically working landscapes which symbolise the interdependence of nature and society. The complexity of this relationship means that management responses will need to address a multitude of potentially conflicting priorities whilst at the same time ensuring that sufficient social and institutional capital exists to allow for the promotion of landscape integrity. The introduction of national parks to Scotland in the form of the National Parks (Scotland) Act 2000 allows for a high-level of protection for designated areas in upland Scotland. Yet, whilst the recent Act outlines the statutory purpose and direction national parks should take, it allows a significant degree of flexibility in theway in which the Actmay be implemented. This level of discretion allows for significant local distinctiveness within the model but also raises questions about the potential effectiveness of chosen responses. In order to assess the potential implications of a model rooted in self-determination,we provide a case study review of the institutional basis of the Cairngorms National Park along with an assessment of the strategic character of the first National Park Plan. It is argued that whilst the Cairngorms National Park Authority has developed a significant level of stakeholder engagement, the authority may struggle to bridge the policy-implementation gap. Although a number of shortcomings are identified, particular concerns relate to the potential mismatch between strategic ambition and local level capacity.

Enteral feeding methods for nutritional management in patients with head and neck cancers being treated with radiotherapy and/or chemotherapy

Background: This is an update of a Cochrane review first published in The Cochrane Library in Issue 3, 2010.
For many patients with head and neck cancer, oral nutrition will not provide adequate nourishment during treatment with radiotherapy or chemoradiotherapy due to the acute toxicity of treatment, obstruction caused by the tumour, or both. The optimal method of enteral feeding for this patient group has yet to be established.

Objectives: To compare the effectiveness of different enteral feeding methods used in the nutritional management of patients with head and neck cancer receiving radiotherapy or chemoradiotherapy using the clinical outcomes, nutritional status, quality of life and rates of complications.

Search methods: Our extensive search included the Cochrane ENT Group Trials Register, CENTRAL, PubMed, EMBASE, CINAHL, AMED and ISI Web of Science. The date of the most recent search was 13 February 2012.

Selection criteria:Randomised controlled trials comparing one method of enteral feeding with another, e.g. nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) feeding, for adult patients with a diagnosis of head and neck cancer receiving radiotherapy and/or chemoradiotherapy.

Data collection and analysis:Two authors independently assessed trial quality and extracted data using standardised forms. We contacted study authors for additional information.

Main results: One randomised controlled trial met the criteria for inclusion in this review. No further studies were identified when we updated the searches in 2012.
Patients diagnosed with head and neck cancer, being treated with chemoradiotherapy, were randomised to PEG or NG feeding. In total only 33 patients were eligible for analysis as the trial was terminated early due to poor accrual. A high degree of bias was identified in the study.
Weight loss was greater for the NG group at six weeks post-treatment than for the PEG group (P = 0.001). At six months post-treatment, however, there was no significant difference in weight loss between the two groups. Anthropometric measurements recorded six weeks post-treatment demonstrated lower triceps skin fold thickness for the NG group compared to the PEG group (P = 0.03). No statistically significant difference was found between the two different enteral feeding techniques in relation to complication rates or patient satisfaction. The duration of PEG feeding was significantly longer than for the NG group (P = 0.0006). In addition, the study calculated the cost of PEG feeding to be 10 times greater than that of NG, though this was not found to be significant. There was no difference in the treatment received by the two groups. However, four PEG fed patients and two NG fed patients required unscheduled treatment breaks of a median of two and six days respectively.
We identified no studies of enteral feeding involving any form of radiologically inserted gastrostomy (RIG) feeding or comparing prophylactic PEG versus PEG for inclusion in the review.

Authors' conclusions: There is not sufficient evidence to determine the optimal method of enteral feeding for patients with head and neck cancer receiving radiotherapy and/or chemoradiotherapy. Further trials of the two methods of enteral feeding, incorporating larger sample sizes, are required.

Emergency Management in Developed Countries: An Investigation of Hazard Risk, Vulnerability and Government Response in the UK and USA

During the summer of 2007 the United Kingdom experienced some of the worst flooding in its history, with the city of Hull amongst the worst affected. Meanwhile, the city of New Orleans, USA was subject to severe flooding in August 2005 as a result of Hurricane Katrina. The study has found that both the UK and US government disaster management programmes were ill prepared for these flood events. Many parallel issues have been discovered and discussed. The conditions of vulnerability that are evident in developing countries are not widely present in the UK or US but this must not be allowed to lead to complacency and lack of preparation and awareness. The cost in terms of mortality is relatively low compared to similar events in developing countries; however, the economic implications are considerable and must be addressed.