A Comparison of Methodologies from Two Longitudinal Community-Based Randomized Controlled Trials of Similar Interventions in Palliative Care: What Worked and What Did Not

Background: Methodological challenges such as recruitment problems and participant burden make clinical trials in palliative care difficult. In 2001-2004, two community-based randomized controlled trials (RCTs) of case conferences in palliative care settings were independently conducted in Australia-the Queensland Case Conferences trial (QCC) and the Palliative Care Trial (PCT). Design: A structured comparative study of the QCC and PCT was conducted, organized by known practical and organizational barriers to clinical trials in palliative care. Results: Differences in funding dictated study designs and recruitment success; PCT had 6 times the budget of QCC. Sample size attainment. Only PCT achieved the sample size goal. QCC focused on reducing attrition through gatekeeping while PCT maximized participation through detailed recruitment strategies and planned for significant attrition. Testing sustainable interventions. QCC achieved a higher percentage of planned case conferences; the QCC strategy required minimal extra work for clinicians while PCT superimposed conferences on normal work schedules. Minimizing participant burden. Differing strategies of data collection were implemented to reduce participant burden. QCC had short survey instruments. PCT incorporated all data collection into normal clinical nursing encounters. Other. Both studies had acceptable withdrawal rates. Intention-to-treat analyses are planned. Both studies included substudies to validate new outcome measures. Conclusions: Health service interventions in palliative care can be studied using RCTs. Detailed comparative information of strategies, successes and challenges can inform the design of future trials. Key lessons include adequate funding, recruitment focus, sustainable interventions, and mechanisms to minimize participant burden.

Dietary and nutritional aspects of tooth wear

There is a general perception that the problem of tooth wear is increasing due to elements of the modern diet and due to increased retention of dentition into older age. Tooth wear encompasses erosion, abrasion and attrition of dental tissues – these often co-exist – yet in general, erosion is of more significance to the young and attrition is of more significance to the older population. Diet plays a significant role in the aetiology of tooth wear and likewise advanced tooth wear in older age may impose dietary restrictions with consequences for dietary intake and nutritional status. There is a need to increase the awareness of the disease of tooth wear and the associated nutritional problems. At present, the aetiology of tooth wear is poorly understood – especially with respect to the role of diet. Clearer information on how best to measure and monitor the incidence and prevalence is needed in order to obtain longitudinal data on trends in tooth wear and to monitor the factors that contribute to this condition. These issues will be addressed in the following presentations: 1) What is tooth wear? Aetiology, measurement and monitoring, 2) The role of diet in the aetiology of dental erosion, 3) Groups at increased risk of tooth wear: Eating disorders, ‘dieters' sportsmen and those with impairments, 4) Tooth wear in older adults: nutritional implications. In summary this symposium seeks to: 1) increase awareness of the disease of tooth wear, and its associated nutritional problems 2) increase understanding of the aetiology of tooth wear, especially the dietary role, 3) provide information on how to measure and monitor tooth wear, 4) highlight future research requirements in the area of tooth wear and diet.

Bilingualism and educational achievement:a study of young bilinguals in Birmingham schools and colleges

This study aimed firstly to investigate current patterns of language use amongst young bilinguals in Birmingham and secondly to examine the relationship between this language use and educational achievement. The research then focussed on various practices, customs and attitudes which would favour the attrition or survival of minority languages in the British situation. The data necessary to address this question was provided by a sample of three hundred and seventy-four 16-19 year olds, studying in Birmingham schools and colleges during the period 1987-1990 and drawn from the main linguistic minority communities in Birmingham. The research methods chosen were both quantitative and qualitative. The study found evidence of ethnolinguistic vitality amongst many of the linguistic minority communities in Birmingham: a number of practices and a range of attitudes indicate that linguistic diversity may continue and that a stable diglossic situation may develop in some instances, particularly where demographical and religious factors lead to closeness of association. Where language attrition is occurring it is often because of the move from a less prestigious minority language or dialect to a more prestigious minority language in addition to pressures from English. The educational experience of the sample indicates that literacy and formal language study are of key importance if personal bilingualism is to be experienced as an asset; high levels of oral proficiency in the L1 and L2 do not, on their own, necessarily correlate with positive educational benefit. The intervening variable associated with educational achievement appears to be the formal language learning process and literacy. A number of attitudes and practices, including the very close associations maintained with some of the countries of origin of the families, were seen to aid or hinder first language maintenance and second language acquisition.

Gold mineralisation in the Caledonides of the British Isles with special reference to the Dolgellau Gold-belt, North Wales and the Southern Uplands, Scotland. Available in 2 volumes.

Two aspects of gold mineralisation in the Caledonides of the British Isles have been investigated: gold-telluride mineralisation at Clogau Mine, North Wales; and placer gold mineralisation in the Southern Uplands, Scotland. The primary ore assemblage at Clogau Mine is pyrite, arsenopyrite, cobaltite, pyrrhotine, chalcopyrite, galena, tellurbismuth, tetradymite, altaite, hessite, native gold, wehrlite, hedleyite, native bismuth, bismuthunite and various sulphosalts. The generalised paragenesis is early Fe, Co, Cu, As and S species, and later minerals of Pb, Bi, Ag, Au, Te, Sb. Electron probe micro-analysis (EPMA) of complex telluride-sulphide intergrowths suggests that these intergrowths formed by co-crystallisation/replacement processes and not exsolution. Minor element chemical variation, in the sulphides and tellurides, indicates that antimony and cadmium are preferentially partitioned into telluride minerals. Mineral stability diagrams suggest that during gold deposition log bf aTe2 was between -7.9 and -9.7 and log bf aS2 between -12.4 and -13.8. Co-existing mineral assemblages indicate that the final stages of telluride mineralisation were between c. 250 - 275oC. It is suggested that the high-grade telluride ore shoot was the result of remobilisation of Au, Bi, Ag and Te from low grade mineralisation elsewhere within the vein system, and that gold deposition was brought about by destabilisation of gold chloride complexes by interaction with graphite, sulphides and tellurbismuth. Scanning electron microscopy of planer gold grains from the Southern Uplands, Scotland, indicates that detailed studies on the morphology of placer gold can be used to elucidate the history of gold in the placer environment. In total 18 different morphological characteristics were identified. These were divided on an empirical basis, using the relative degree of mechanical attrition, into proximal and distal characteristics. One morphological characteristic (a porous/spongy surface at high magnification) is considered to be chemical in origin and represent the growth of `new' gold in the placer environment. The geographical distribution of morphological characteristics has been examined and suggests that proximal placer gold is spatially associated with the Loch Doon, Cairsphairn and Fleet granitoids. Quantitative EPMA of the placer gold reveals two compositional populations of placer gold. Examination of the geographical distribution of fineness suggests a loose spatial association between granitoids and low fineness placer gold. Also identified was chemically heterogeneous placer gold. EPMA studies of these heterogeneities allowed estimation of annealing history limits, which suggest that the heterogeneities formed between 150 and 235oC. It is concluded, on the basis of relationships between morphology and composition, that there are two types of placer gold in the Southern Uplands: (i) placer gold which is directly inherited from a hypogene source probably spatially associated with granitoids; and (ii) placer gold that has formed during supergene processes.

Impact of cholinesterase inhibitors on behavioral and psychological symptoms of Alzheimer's disease:a meta-analysis

Objective: To determine the efficacy of cholinesterase inhibitors (ChEIs) in improving the behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer’s disease (AD). Data sources: We searched MEDLINE, Cochrane Registry, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from 1966 to 2007. We limited our search to English Language, full text, published articles and human studies. Data extraction: We included randomized, double-blind, placebo-controlled trials evaluating the efficacy of donepezil, rivastigmine, or galantamine in managing BPSD displayed by AD patients. Using the United States Preventive Services Task Force (USPSTF) guidelines, we critically appraised all studies and included only those with an attrition rate of less than 40%, concealed measurement of the outcomes, and intention to treat analysis of the collected data. All data were imputed into pre-defined evidence based tables and were pooled using the Review Manager 4.2.1 software for data synthesis. Results: We found 12 studies that met our inclusion criteria but only nine of them provided sufficient data for the meta-analysis. Among patients with mild to severe AD and in comparison to placebo, ChEIs as a class had a beneficial effects on reducing BPSD with a standard mean difference (SMD) of -0.10 (95% confidence interval [CI]; -0.18, -0.01) and a weighted mean difference (WMD) of -1.38 neuropsychiatry inventory point (95% CI; -2.30, -0.46). In studies with mild AD patients, the WMD was -1.92 (95% CI; -3.18, -0.66); and in studies with severe AD patients, the WMD was -0.06 (95% CI; -2.12, +0.57). Conclusion: Cholinesterase inhibitors lead to a statistical significant reduction in BPSD among patients with AD, yet the clinical relevance of this effect remains unclear.

Evaluating and developing project-based learning:an empirical approach to evaluating CDIO

As a global profession, engineering is integral to the maintenance and further development of society. Indeed, contemporary social problems requiring engineering solutions are not only a consequence of natural and ‘manmade’ disasters (such as the Japanese earthquake or the oil leakage in the Gulf of Mexico) but also encapsulate 21st Century dilemmas around sustainability, poverty and pollution [2,6,7]. Given the complexity of such problems and the constant need for innovation, the demand for engineering education to provide a ready supply of suitably qualified engineering graduates, able to make innovative decisions has never been higher [3,5]. Bearing this in mind, and taking account problems of attrition in engineering education [1,6,4] innovation in the way in which the curriculum is developed and delivered is crucial. CDIO [Conceive, Design, Implement, Operate] provides a potentially ground-breaking solution to such dilemmas. Aimed at equipping students with practical engineering skills supported by the necessary theoretical background, CDIO could potentially change the way engineering is perceived and experienced within higher education. Aston University introduced CDIO into its Mechanical Engineering and Design programmes in October 2011. From its induction, engineering education researchers have ‘shadowed’ the staff responsible for developing and teaching the programme. Utilising an Action Research Design, and adopting a mixed methodological research design, the researchers have worked closely with the teaching team to critically reflect on the processes involved in introducing CDIO into the curriculum. Concurrently, research has been conducted to capture students’ perspectives of CDIO. In evaluating the introduction of CDIO at Aston, the researchers have developed a distinctive research strategy with which to evaluate CDIO. It is the emergent findings from this research that form the basis of this paper. Although early-on in its development CDIO is making a significant difference to engineering education at the University. The paper draws attention to pedagogical, practical and professional issues – discussing each one in turn and in doing so critically analysing the value of CDIO from academic, student and industrial perspectives. The paper concludes by noting that whilst CDIO represents a forwardthinking approach to engineering education, the need for constant innovation in learning and teaching should not be forgotten. Indeed, engineering education needs to put itself at the forefront of pedagogic practice. Providing all-rounded engineers, ready to take on the challenges of the 21st Century!

Undergraduate peer mentoring:an investigation into processes, activities and outcomes

Peer mentoring of undergraduates is increasingly being used in higher education to reduce first year attrition by aiding transition to university. The authors propose that peer mentoring may also be a means of transmitting the values and ethics which reflect academic and personal integrity and underpin graduate and professional identity. In a qualitative study, they examined students' expectations and subsequent experience of a psychology undergraduate pilot mentoring scheme, together with the process and content. Mentors and mentees felt that mentors had a unique part to play in aiding transition to university. Mentors' advice reflected implicit academic values rather than strategic short cuts and mentoring cued reflection on their own development. The implications for encouraging student participation in mentoring schemes are discussed.

The effects of the fungicides fenhexamid and myclobutanil on SH-SY5Y and U-251 MG human cell lines

Mixtures of pesticides in foodstuffs and the environment are ubiquitous in the developed world and although agents are usually exhaustively tested individually, the toxicological implications of pesticide mixtures are underreported. In this study, the effects of two fungicides, fenhexamid and myclobutanil were investigated individually and in combination on two human cell lines, SH-SY5Y neuronal cells and U-251 MG glial cells. After 48. h of incubation with increasing concentrations of pesticides ranging from 1 to 1000. μM, gene expression profiles were studied in addition to toxicity end points, including cell viability, mitochondrial depolarisation as well as cellular glutathione maintenance. There were no significant differences between the susceptibility of the two cell lines in terms of cell viability assessment or mitochondrial membrane potential, when agents were administered either individually or in combination. By contrast, in the presence of the fungicides, the SH-SY5Y cells showed significantly greater susceptibility to oxidative stress in terms of total thiol depletion in comparison with the astrocytic cells. Treatment with the two pesticides led to significant changes in the cell lines' expression of several genes which regulate cell cycle control and growth (RB1, TIMP1) as well as responses to DNA attrition (ATM and CDA25A) and control of apoptosis (FAS). There was no evidence in this study that the combination of fenhexamid and myclobutanil was significantly more toxic than individual exposure, although gene expression changes suggested there may be differences in the sub-lethal response of both cell lines to both individual and combined exposure.

Motivating students to learn through good and helpful coursework feedback

The 2008 National Student Survey revealed that: 44% of full-time students in England did not think that the feedback on their work had been prompt nor did they agree that the feedback on their work helped them clarify things that they did not understand (HEFCE, 2008). Computer Science and Engineering & Technology have been amongst the poorest performers in this aspect as they ranked in the lower quartile (Surridge, 2007, p.32). Five years since the first NSS survey, assessment and feedback remains the biggest concern. Dissatisfaction in any aspect of studies demotivates students and can lead to disengagement and attrition. As the student number grows, the situation can only get worse if nothing is done about it. We have conducted a survey to investigate views on assessment and feedback from Engineering, Mathematics and Computing students. The survey aims at investigating the core issues of dissatisfaction in assessment and feedback and ways in which UK Engineering students can learn better through helpful feedback. The study focuses on collecting students' experiences with feedback received in their coursework, assignments and quizzes in Computing Science modules. The survey reveals the role of feedback in their learning. The results of the survey help to identify the forms of feedback that are considered to be helpful in learning and the time frame for timely feedback. We report on the findings of the survey. We also explore ways to improve assessment and feedback in a bid to better engage engineering students in their studies.

Functionalised particles using dry powder coating in pharmaceutical drug delivery:promises and challenges

Introduction: Production of functionalised particles using dry powder coating is a one-step, environmentally friendly process that paves the way for the development of particles with targeted properties and diverse functionalities. Areas covered: Applying the first principles in physical science for powders, fine guest particles can be homogeneously dispersed over the surface of larger host particles to develop functionalised particles. Multiple functionalities can be modified including: flowability, dispersibility, fluidisation, homogeneity, content uniformity and dissolution profile. The current publication seeks to understand the fundamental underpinning principles and science governing dry coating process, evaluate key technologies developed to produce functionalised particles along with outlining their advantages, limitations and applications and discusses in detail the resultant functionalities and their applications. Expert opinion: Dry particle coating is a promising solvent-free manufacturing technology to produce particles with targeted functionalities. Progress within this area requires the development of continuous processing devices that can overcome challenges encountered with current technologies such as heat generation and particle attrition. Growth within this field requires extensive research to further understand the impact of process design and material properties on resultant functionalities.

A közalkalmazotti béremelés hatása a tanárok pályaelhagyási döntéseire (The effect of a public-sector pay increase on teachers attrition)

A tanárok pályaelhagyási döntését vizsgálva, a tanulmány a következő két kérdésre keresi a választ. Milyen szerepet játszanak e döntésekben a keresetek, alternatív kereseti lehetőségek? Hogyan hatott a tanárok pályaelhagyására a 2002. évi közalkalmazotti béremelés? Az elemzéshez az OEP-ONYF-FH összekapcsolt nagymintás adatbázis felhasználásával kétféle modellt becsült a szerző: 1. két lehetőséget megkülönböztetve (elhagyja a tanári pályát/nem hagyja el) Cox-féle arányos hazárdfüggvényeket, 2. a pályaelhagyás okai között a más állásba kerülést és az egyéb pályaelhagyási okokat megkülönböztetve versengő kockázati modelleket. Az eredmények azt mutatják, hogy a kereseti lehetőségek hatnak a pályaelhagyási döntésekre. A magasabb jövedelem és magasabb relatív kereset csökkenti annak valószínűségét, hogy egy tanár elhagyja a pályát, és más pályán helyezkedjen el, vagy nem foglalkoztatotti státusba kerüljön. A közalkalmazotti béremelés átmenetileg csökkentette a pályaelhagyás valószínűségét a fiatal tanárok körében, de a hatás egy-két év alatt eltűnt. Az 51 évesnél idősebb tanárokat pedig inkább a pályán tartotta a béremelés, csökkentette annak valószínűségét is, hogy más pályán helyezkedjenek el, vagy hogy nem foglalkoztatotti státusba kerüljenek. ______ The paper investigates teachers decisions to leave the profession. It first examines the role in such decisions of pay compared with earnings in alternative occupations, and then discusses how the public-sector pay increase of 2002 af-fected exit decisions by teachers. Duration models were estimated using large merged administrative data sets. First binary-choice Cox proportional hazard models (leaving teaching profession or not), then competing risk models that distinguish exits to another occupation and exits to a non-working state. Results show that earnings matter. Higher wages reduce the probability of exiting teacher profession to go to another occupation or to non-employment. The public-sector pay increase decreased the probability of inexperienced teachers leaving the teacher profession temporarily, but the effect disappeared after one or two years. For experienced teachers over 51 years old, the wage increase was found to reduce attrition.

Development and validation of an instrument to predict online student success using faculty perceptions

Distance learning is growing and transforming educational institutions. The increasing use of distance learning by higher education institutions and particularly community colleges coupled with the higher level of student attrition in online courses than in traditional classrooms suggests that increased attention should be paid to factors that affect online student course completion. The purpose of the study was to develop and validate an instrument to predict community college online student course completion based on faculty perceptions, yielding a prediction model of online course completion rates. Social Presence and Media Richness theories were used to develop a theoretically-driven measure of online course completion. This research study involved surveying 311 community college faculty who taught at least one online course in the past 2 years. Email addresses of participating faculty were provided by two south Florida community colleges. Each participant was contacted through email, and a link to an Internet survey was given. The survey response rate was 63% (192 out of 303 available questionnaires). Data were analyzed through factor analysis, alpha reliability, and multiple regression. The exploratory factor analysis using principal component analysis with varimax rotation yielded a four-factor solution that accounted for 48.8% of the variance. Consistent with Social Presence theory, the factors with their percent of variance in parentheses were: immediacy (21.2%), technological immediacy (11.0%), online communication and interactivity (10.3%), and intimacy (6.3%). Internal consistency of the four factors was calculated using Cronbach's alpha (1951) with reliability coefficients ranging between .680 and .828. Multiple regression analysis yielded a model that significantly predicted 11% of the variance of the dependent variable, the percentage of student who completed the online course. As indicated in the literature (Johnson & Keil, 2002; Newberry, 2002), Media Richness theory appears to be closely related to Social Presence theory. However, elements from this theory did not emerge in the factor analysis.