Utilising fiction to promote english language acquisition

Towards the end of the university stage, students residing in the United Arab Emirates and specialising in subjects other than English are expected- amongst other university requirements- to have acquired adequate communicative competence as well as a repertoire of critical thinking skills. Despite the efforts made within the field of teaching English to EFL university students in the country, the output gained in terms of acquired skills and competencies is still below expectations. The main concerns of the current thesis are, therefore, a) to investigate the factors which inhibit EFL university students’ progress in the areas of acquiring adequate communicative competence as well as critical thinking skills, and b) to propose a course book and pedagogic methods to improve students’ progress in the areas of acquiring adequate communicative competence as well as critical thinking skills. Believing in the essential role literature plays in enhancing critical thinking and promoting communicative competence on the part of EFL learners, the current study introduces a course, designed and implemented by the researcher: LEARN AND GAIN. The proposed course is fiction-based language teaching, adopting the view that literature is a resource rather than an object, thus advocating the use of literature as one of the main resources in foreign/second language acquisition. Investigating whether or not the proposed course was effective in promoting EFL university students’ communicative competence as well as enhancing their critical thinking skills, a study sample taken from the study population was selected. Adopting an experimental design, the research project involved two groups: experimental and control. The experimental group students were exposed to the proposed course whilst the control group students were exposed to a general English language course. To examine treatment effectiveness, the researcher set and administered a pre-post test. Divided into two main parts, communicative critical reading competence and communicative critical writing competence, the pre-post test measured subjects’ communicative critical reading competence and subjects’ communicative critical writing competence. In addition, a pre-post questionnaire was administered and a semi-structured interview was conducted involving the experimental group students, to gain an awareness of students’ attitudes towards learning literary texts in general, and the proposed course in particular. To examine issues of interest and relevance, gender differences: male vs. female, and university major: science vs. non-science, were also examined for enrichment purposes. For the purpose of gathering sufficient data about subjects’ achievements on the pre-post, the following statistical tests were conducted: Mann-Whitney test, and paired data t-test. Based on the statistical findings, the experimental group students’ performance on the communicative critical reading competence pre-post test and the communicative critical writing competence pre-post test was significantly better than their counterparts of the control group students. Speaking of gender differences in relation to language performance on the communicative critical reading competence pre-post test and the communicative critical writing competence pre-post test, no significant differences were cited. Neither did the researcher cite any significant performance differences between science/non-science students on the communicative critical reading competence pre-post test and the communicative critical writing competence pre-post test. As far as the questionnaire’s findings are concerned, the experimental group students’ responses to the post-questionnaire’s items were more positive than those of their responses to the pre-questionnaire’s, thus indicating some positive attitudes towards literature, which students possibly gained throughout the course of implementation. Relating the discussion to the interview’s results, students conveyed their satisfaction with the proposed course, emphasising that promoting English language skills through the use of literary texts was rewarding. In the light of findings and conclusions, a number of recommendations as well as implications have been proposed. The current study aimed to arrive at some appropriate suggestions to a number of enquiries, yet concluding with some areas of enquiry to be explored for further research.

A randomised controlled trial of the clinical effectiveness and cost-effectiveness of the levonorgestrel-releasing intrauterine system in primary care against standard treatment for menorrhagia:the ECLIPSE trial

BACKGROUND: Heavy menstrual bleeding (HMB) is a common problem, yet evidence to inform decisions about initial medical treatment is limited. OBJECTIVES: To assess the clinical effectiveness and cost-effectiveness of the levonorgestrel-releasing intrauterine system (LNG-IUS) (Mirena(®), Bayer) compared with usual medical treatment, with exploration of women's perspectives on treatment. DESIGN: A pragmatic, multicentre randomised trial with an economic evaluation and a longitudinal qualitative study. SETTING: Women who presented in primary care. PARTICIPANTS: A total of 571 women with HMB. A purposeful sample of 27 women who were randomised or ineligible owing to treatment preference participated in semistructured face-to-face interviews around 2 and 12 months after commencing treatment. INTERVENTIONS: LNG-IUS or usual medical treatment (tranexamic acid, mefenamic acid, combined oestrogen-progestogen or progesterone alone). Women could subsequently swap or cease their allocated treatment. OUTCOME MEASURES: The primary outcome was the patient-reported score on the Menorrhagia Multi-Attribute Scale (MMAS) assessed over a 2-year period and then again at 5 years. Secondary outcomes included general quality of life (QoL), sexual activity, surgical intervention and safety. Data were analysed using iterative constant comparison. A state transition model-based cost-utility analysis was undertaken alongside the randomised trial. Quality-adjusted life-years (QALYs) were derived from the European Quality of Life-5 Dimensions (EQ-5D) and the Short Form questionnaire-6 Dimensions (SF-6D). The intention-to-treat analyses were reported as cost per QALY gained. Uncertainty was explored by conducting both deterministic and probabilistic sensitivity analyses. RESULTS: The MMAS total scores improved significantly in both groups at all time points, but were significantly greater for the LNG-IUS than for usual treatment [mean difference over 2 years was 13.4 points, 95% confidence interval (CI) 9.9 to 16.9 points; p < 0.001]. However, this difference between groups was reduced and no longer significant by 5 years (mean difference in scores 3.9 points, 95% CI -0.6 to 8.3 points; p = 0.09). By 5 years, only 47% of women had a LNG-IUS in place and 15% were still taking usual medical treatment. Five-year surgery rates were low, at 20%, and were similar, irrespective of initial treatments. There were no significant differences in serious adverse events between groups. Using the EQ-5D, at 2 years, the relative cost-effectiveness of the LNG-IUS compared with usual medical treatment was £1600 per QALY, which by 5 years was reduced to £114 per QALY. Using the SF-6D, usual medical treatment dominates the LNG-IUS. The qualitative findings show that women's experiences and expectations of medical treatments for HMB vary considerably and change over time. Women had high expectations of a prompt effect from medical treatments. CONCLUSIONS: The LNG-IUS, compared with usual medical therapies, resulted in greater improvement over 2 years in women's assessments of the effect of HMB on their daily routine, including work, social and family life, and psychological and physical well-being. At 5 years, the differences were no longer significant. A similar low proportion of women required surgical intervention in both groups. The LNG-IUS is cost-effective in both the short and medium term, using the method generally recommended by the National Institute for Health and Care Excellence. Using the alternative measures to value QoL will have a considerable impact on cost-effectiveness decisions. It will be important to explore the clinical and health-care trajectories of the ECLIPSE (clinical effectiveness and cost-effectiveness of levonorgestrel-releasing intrauterine system in primary care against standard treatment for menorrhagia) trial participants to 10 years, by which time half of the cohort will have reached menopause. TRIAL REGISTRATION: Current Controlled Trials ISRCTN86566246. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 88. See the NIHR Journals Library website for further project information.

Assessing the effectiveness of business support services in England:evidence from a theory based evaluation

In England, publicly supported advice to small firms is organized primarily through the Business Link (BL) network. Using the programme theory underlying this business support, we develop four propositions and test these empirically using data from a new survey of over 3000 English SMEs. We find strong support for the value to BL operators of a high profile to boost take-up. We find support for the BL’s market segmentation that targets intensive assistance to younger firms and those with limited liability. Allowing for sample selection, we find no significant effects on growth from ‘other’ assistance but find a significant employment boost from intensive assistance. This partially supports the programme theory assertion that BL improves business growth and strongly supports the proposition that there are differential outcomes from intensive and other assistance. This suggests an improvement in the BL network, compared with earlier studies, notably Roper et al. (2001), Roper and Hart (2005).

The effectiveness of lamotrigine in the treatment of photosensitive epilepsy

Photosensitive epilepsy and associated pattern sensitivity are more prevalent in females and are usually treated with sodium valproate. Sodium valproate has an adverse effect profile, which particularly affects females, including teratogenicity, association with the polycystic ovary syndrome and weight gain. It would be useful therefore if an alternative treatment for photosensitive epilepsy could be found. The principle aim of this study was to investigate the effectiveness of lamotrigine in the treatment of photosensitive epilepsy in adults and children. Patients were either drug-naive, commencing lamotrigine therapy or were transferring from other antiepileptic drugs to lamotrigine (primarily sodium valproate) due to lack of response, adverse effects or desired pregnancy. The photoparoxsymal response in the electroencephalograph was used as the primary measure of photo and pattern sensitivity. In addition the effects of lamotrigine on occipital spikes and normal responses in the EEG to visual stimuli were investigated. Secondary measures also included the resting EEG, seizures, body mass index, menstrual function, mood and cognitive function. The results suggest that in adult patients lamotrigine is efficacious in the treatment of photosensitive epilepsy, although it appears inferior to sodium valproate. Lamotrigine does however have a more favourable adverse effect profile than valproate. The results indicate that lamotrigine therapy is suitable for photosensitive epilepsy in women of childbearing age or in patients experiencing unacceptable adverse effects with valproate therapy. Patients are more likely to respond to lamotrigine treatment if they present with sensitivity to a limited number of frequencies. Lamotrigine does not seem to be as efficacious in the treatment of children, although against it may be considered a second line drug if the child does not respond to or will not tolerate sodium valproate.

An evaluation of the effectiveness of intervention strategies for the promotion of health and safety performance in small firms

Recognition of the contribution of small firms to the UK economy has grown considerably since 1995 when this research first began. The poor record of small firms in managing health and safety effectively has caused concern, and efforts made to improve knowledge and awareness of the target group through various initiatives have had some success. This research thesis attempts to identify the range of intervention routes and methods available to reach the target group, and to consider ways of evaluating the outcome of such efforts. Various interventions were tested with small firms, including a Workshop; use of Questionnaires; short postal Reply Slip survey; leading to a closer evaluation of a specific industry- the Licensed Trade. Attitudes and beliefs of the sample were identified, and observations carried out to consider actions taken by workers and others in the workplace. These empirical research findings were used to develop the theme of Primary and Secondary interventions intended to change behaviours, and to confirm assumptions about what small firms currently do to manage health and safety risks. Guidance for small firms was developed as a Secondary intervention tool to support Primary interventions, such as inspection or insurance provision.

Controlled study into the effectiveness of individual client-centred counselling for young offenders in residential care

This study is toe first documented account in the British Isles of an evaluation of the effectiveness of client-centred counselling with young offenders in secure residential care. It is a test of Rogers' (1957) position on the 'necessary and sufficient' conditions of therapeutic personality change within a counselling relationship. Forty teenage male offenders, the subjects of Training School Orders, were randomly allocated in equal numbers to either an experimental or control group. Boys in the experimental group received weekly individual sessions of client-centred counselling over a seven month period. Boys in the control group received no formal counselling but were shown to have similar intellectual, personality, socio-economic and criminal backgrounds to those in the experimental group. It was hypothesised that counselled subjects would show more positive outcomes than control subjects over a range of measures relating to criminal behaviour and self-conception. The results indicated that the counselled subjects had a significantly lower rate of offending and a srnaller range of offences over a mean follow-up period of 2.5 years. They were also licensed from the institution significantly earlier and spent less time in custody during a one year follow-up after counselling was completed. Self-conception measures gave less clear-cut results. The direction of change towards better adjustment favoured the counselled subjects but the magnitude was often small. Those counselled subjects with most positive behaviour change tended to have significantly improved self-evaluation, less self/ideal self discrepancy and more variation on 'actual' self concept compared to pre-counselling. The results are discussed in the context of client-centred theory, methodological adequacy of the experimental design, and their application to the future treatment of young offenders in secure residential care.

OCT evaluation of visible and subthreshold retinal photocoagulation using 532nm laser

Presentation Purpose:We conducted a study to determine if the spectral domain optical coherence tomography (SD-OCT) could be used as a tool to assess effective delivery of threshold and subthreshold laser burns created using 532nm green wavelength laser. Methods:10 patients planned for panretinal photocoagulation (PRP) for proliferative diabetic retinopathy were included in this study. Before initiating the full PRP, a row of moderately white laser burns as used for conventional PRP was created using 532 nm laser set at threshold power for 0.1 second with 300 microns spot size. Further rows of laser burns were created by altering the duration and power settings on the laser device. The area of the retina irradiated with laser was imaged using the Topcon SD-OCT within a few minutes of laser treatment. Results:Laser burns created using threshold power were seen on the OCT scan in all cases as a homogenous diffuse increase in reflectivity extending across the full thickness of retina (Fig 1). Retinal burns created by lowering the duration of laser pulse to 0.01s were barely visible ophthalmoscopically but were clearly detectable on the OCT scan as a localised, well-defined area of increased tissue reflectivity (Fig 2). Conclusions:OCT is a useful to tool to assess the delivery of laser burns created using the 532 nm green laser. Burns of a subthreshold intensity that may not be visible ophthalmoscopically result in retinal changes that are clearly detectable on OCT imaging. Further studies would be needed to assess the clinical effectiveness of subthreshold laser treatment for retinal vascular diseases using the 532 nm green laser.

Rapid testing for group B streptococcus during labour: a test accuracy study with evaluation of acceptability and cost-effectiveness

OBJECTIVE: To determine the accuracy, acceptability and cost-effectiveness of polymerase chain reaction (PCR) and optical immunoassay (OIA) rapid tests for maternal group B streptococcal (GBS) colonisation at labour. DESIGN: A test accuracy study was used to determine the accuracy of rapid tests for GBS colonisation of women in labour. Acceptability of testing to participants was evaluated through a questionnaire administered after delivery, and acceptability to staff through focus groups. A decision-analytic model was constructed to assess the cost-effectiveness of various screening strategies. SETTING: Two large obstetric units in the UK. PARTICIPANTS: Women booked for delivery at the participating units other than those electing for a Caesarean delivery. INTERVENTIONS: Vaginal and rectal swabs were obtained at the onset of labour and the results of vaginal and rectal PCR and OIA (index) tests were compared with the reference standard of enriched culture of combined vaginal and rectal swabs. MAIN OUTCOME MEASURES: The accuracy of the index tests, the relative accuracies of tests on vaginal and rectal swabs and whether test accuracy varied according to the presence or absence of maternal risk factors. RESULTS: PCR was significantly more accurate than OIA for the detection of maternal GBS colonisation. Combined vaginal or rectal swab index tests were more sensitive than either test considered individually [combined swab sensitivity for PCR 84% (95% CI 79-88%); vaginal swab 58% (52-64%); rectal swab 71% (66-76%)]. The highest sensitivity for PCR came at the cost of lower specificity [combined specificity 87% (95% CI 85-89%); vaginal swab 92% (90-94%); rectal swab 92% (90-93%)]. The sensitivity and specificity of rapid tests varied according to the presence or absence of maternal risk factors, but not consistently. PCR results were determinants of neonatal GBS colonisation, but maternal risk factors were not. Overall levels of acceptability for rapid testing amongst participants were high. Vaginal swabs were more acceptable than rectal swabs. South Asian women were least likely to have participated in the study and were less happy with the sampling procedure and with the prospect of rapid testing as part of routine care. Midwives were generally positive towards rapid testing but had concerns that it might lead to overtreatment and unnecessary interference in births. Modelling analysis revealed that the most cost-effective strategy was to provide routine intravenous antibiotic prophylaxis (IAP) to all women without screening. Removing this strategy, which is unlikely to be acceptable to most women and midwives, resulted in screening, based on a culture test at 35-37 weeks' gestation, with the provision of antibiotics to all women who screened positive being most cost-effective, assuming that all women in premature labour would receive IAP. The results were sensitive to very small increases in costs and changes in other assumptions. Screening using a rapid test was not cost-effective based on its current sensitivity, specificity and cost. CONCLUSIONS: Neither rapid test was sufficiently accurate to recommend it for routine use in clinical practice. IAP directed by screening with enriched culture at 35-37 weeks' gestation is likely to be the most acceptable cost-effective strategy, although it is premature to suggest the implementation of this strategy at present.

Pulse oximetry as a screening test for congenital heart defects in newborn infants: a test accuracy study with evaluation of acceptability and cost-effectiveness

Background: Screening for congenital heart defects (CHDs) relies on antenatal ultrasound and postnatal clinical examination; however, life-threatening defects often go undetected. Objective: To determine the accuracy, acceptability and cost-effectiveness of pulse oximetry as a screening test for CHDs in newborn infants. Design: A test accuracy study determined the accuracy of pulse oximetry. Acceptability of testing to parents was evaluated through a questionnaire, and to staff through focus groups. A decision-analytic model was constructed to assess cost-effectiveness. Setting: Six UK maternity units. Participants: These were 20,055 asymptomatic newborns at = 35 weeks’ gestation, their mothers and health-care staff. Interventions: Pulse oximetry was performed prior to discharge from hospital and the results of this index test were compared with a composite reference standard (echocardiography, clinical follow-up and follow-up through interrogation of clinical databases). Main outcome measures: Detection of major CHDs – defined as causing death or requiring invasive intervention up to 12 months of age (subdivided into critical CHDs causing death or intervention before 28 days, and serious CHDs causing death or intervention between 1 and 12 months of age); acceptability of testing to parents and staff; and the cost-effectiveness in terms of cost per timely diagnosis. Results: Fifty-three of the 20,055 babies screened had a major CHD (24 critical and 29 serious), a prevalence of 2.6 per 1000 live births. Pulse oximetry had a sensitivity of 75.0% [95% confidence interval (CI) 53.3% to 90.2%] for critical cases and 49.1% (95% CI 35.1% to 63.2%) for all major CHDs. When 23 cases were excluded, in which a CHD was already suspected following antenatal ultrasound, pulse oximetry had a sensitivity of 58.3% (95% CI 27.7% to 84.8%) for critical cases (12 babies) and 28.6% (95% CI 14.6% to 46.3%) for all major CHDs (35 babies). False-positive (FP) results occurred in 1 in 119 babies (0.84%) without major CHDs (specificity 99.2%, 95% CI 99.0% to 99.3%). However, of the 169 FPs, there were six cases of significant but not major CHDs and 40 cases of respiratory or infective illness requiring medical intervention. The prevalence of major CHDs in babies with normal pulse oximetry was 1.4 (95% CI 0.9 to 2.0) per 1000 live births, as 27 babies with major CHDs (6 critical and 21 serious) were missed. Parent and staff participants were predominantly satisfied with screening, perceiving it as an important test to detect ill babies. There was no evidence that mothers given FP results were more anxious after participating than those given true-negative results, although they were less satisfied with the test. White British/Irish mothers were more likely to participate in the study, and were less anxious and more satisfied than those of other ethnicities. The incremental cost-effectiveness ratio of pulse oximetry plus clinical examination compared with examination alone is approximately £24,900 per timely diagnosis in a population in which antenatal screening for CHDs already exists. Conclusions: Pulse oximetry is a simple, safe, feasible test that is acceptable to parents and staff and adds value to existing screening. It is likely to identify cases of critical CHDs that would otherwise go undetected. It is also likely to be cost-effective given current acceptable thresholds. The detection of other pathologies, such as significant CHDs and respiratory and infective illnesses, is an additional advantage. Other pulse oximetry techniques, such as perfusion index, may enhance detection of aortic obstructive lesions.

Patient education in the treatment of asthma:a controlled evaluation of providing information for "new" asthmatics

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The effectiveness of leflunomide etanercept and infliximab in the treatment of rheumatoid arthritis:a systematic review

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