Tools for Assessing Outcomes in Studies of Chronic Cough: CHEST Guideline and Expert Panel Report

BACKGROUND: Since the publication of the 2006 American College of Chest Physicians (CHEST) cough guidelines, a variety of tools has been developed or further refined for assessing cough. The purpose of the present committee was to evaluate instruments used by investigators performing clinical research on chronic cough. The specific aims were to (1) assess the performance of tools designed to measure cough frequency, severity, and impact in adults, adolescents, and children with chronic cough and (2) make recommendations or suggestions related to these findings.

METHODS: By following the CHEST methodologic guidelines, the CHEST Expert Cough Panel based its recommendations and suggestions on a recently published comparative effectiveness review commissioned by the US Agency for Healthcare Research and Quality, a corresponding summary published in CHEST, and an updated systematic review through November 2013. Recommendations or suggestions based on these data were discussed, graded, and voted on during a meeting of the Expert Cough Panel.

RESULTS: We recommend for adults, adolescents (≥ 14 years of age), and children complaining of chronic cough that validated and reliable health-related quality-of-life (QoL) questionnaires be used as the measurement of choice to assess the impact of cough, such as the Leicester Cough Questionnaire and the Cough-Specific Quality-of-Life Questionnaire in adult and adolescent patients and the Parent Cough-Specific Quality of Life Questionnaire in children. We recommend acoustic cough counting to assess cough frequency but not cough severity. Limited data exist regarding the performance of visual analog scales, numeric rating scales, and tussigenic challenges.

CONCLUSIONS: Validated and reliable cough-specific health-related QoL questionnaires are recommended as the measurement of choice to assess the impact of cough on patients. How they compare is yet to be determined. When used, the reporting of cough severity by visual analog or numeric rating scales should be standardized. Previously validated QoL questionnaires or other cough assessments should not be modified unless the new version has been shown to be reliable and valid. Finally, in research settings, tussigenic challenges play a role in understanding mechanisms of cough.

Sonification as Concurrent Augmented Feedback for Motor Skill Learning and the Importance of Mapping Design

In recent years, sonification of movement has emerged as a viable method for the provision of feedback in motor learning. Despite some experimental validation of its utility, controlled trials to test the usefulness of sonification in a motor learning context are still rare. As such, there are no accepted conventions for dealing with its implementation. This article addresses the question of how continuous movement information should be best presented as sound to be fed back to the learner. It is proposed that to establish effective approaches to using sonification in this context, consideration must be given to the processes that underlie motor learning, in particular the nature of the perceptual information available to the learner for performing the task at hand. Although sonification has much potential in movement performance enhancement, this potential is largely unrealised as of yet, in part due to the lack of a clear framework for sonification mapping: the relationship between movement and sound. By grounding mapping decisions in a firmer understanding of how perceptual information guides learning, and an embodied cognition stance in general, it is hoped that greater advances in use of sonification to enhance motor learning can be achieved.

Ocular comorbidities among cataract-operated patients in rural China: the caring is hip Study of Cataract Outcomes and Uptake of Services (SCOUTS), report No. 3.

PURPOSE: To determine the prevalence and impact on vision and visual function of ocular comorbidities in a rural Chinese cataract surgical program, and to devise strategies to reduce their associated burden. DESIGN: Cross-sectional cohort study. PARTICIPANTS: Persons undergoing cataract surgery by one of two recently trained local surgeons at a government-run village-level hospital in rural Guangdong between August 8 and December 31, 2005. INTERVENTIONS: Eligible subjects were invited to return for a comprehensive ocular examination and visual function interview 10 to 14 months after surgery. Prevalent ocular comorbid conditions were identified. MAIN OUTCOME MEASURES: Presenting and best-corrected vision, visual function, and treatability of the comorbidity. RESULTS: Of 313 persons operated within the study window, 242 (77%) could be contacted by telephone; study examinations and interviews were performed on 176 (74%). Examined subjects had a mean age of 69.4+/-10.5 years, 116 (66%) were female, and 149 (85%) had been blind (presenting vision < or = 6/60) in the operative eye before surgery. Among unoperated eyes, 89 of 109 (81.7%) had > or =1 ocular comorbidities, whereas for operated eyes the corresponding proportion was 72 of 211 (34.1%). The leading comorbidity among operated eyes was refractive error (43/72 [59.7%]), followed by glaucoma/glaucoma suspect (14/72 [19.4%]), whereas for unoperated eyes, it was cataract (80/92 [87.0%]), followed by refractive error (12/92 [13.0%]). Among operated eyes with comorbidities, 90.3% (65/72) had > or =1 comorbidities that were treatable. In separate models adjusting for age and gender, persons with > or =1 comorbidities in the operated eye had significantly worse presenting vision (P<0.001) than those without such findings, but visual function (P = 0.197) and satisfaction with surgery (P = 0.796) were unassociated with comorbidities. CONCLUSIONS: Ocular comorbidities are highly prevalent among persons undergoing cataract surgery in this rural Asian setting, and their presence is significantly associated with poorer visual outcomes. The fact that the great majority of comorbidities encountered in this program are treatable suggests that strategies to reduce their impact can be successful.

ILS and RTP: Support to Researchers Provided by Information and Learning Services as Part of the Research Training Programme at the University of Worcester, Past, Present and Future.

The purpose of this article is to investigate the involvement of Information and Learning Services staff in the delivery of the Research Training Programme at the University of Worcester, UK with a focus on researcher receptivity. I believe that by constantly reflecting on the development of that part of the programme delivered by ILS and by examining feedback from the sessions, it is possible to improve and increase the level of researcher receptivity. It is hoped that such examination and reflection will be of value and relevance to the IL community since by reflecting on success and failure in a local context and by mapping this reflection to existing research enables librarians to improve the support provided to researchers within their institutions. This article outlines the support given to research students at the University of Worcester in the past, examines the changes leading to present programme delivery and reflects on considerations for future support. The article is underpinned by reference to current research undertaken in international (albeit Western-centric) contexts. I note that the rationale behind changes is embedded in current adult learning and teaching theory. In an increasingly competitive research environment where funding is dependent on a statistically monitored research output, the aim of such support is to integrate any IL contribution into the wider research training programme. Thus resource discovery becomes part of the reflexive research cycle. Implicit in this investigative reflection is the desire of the IL community to constantly strive towards the positive reception of IL into research support programmes which are perceived by researchers as highly valuable to the process and progress of their work.

Job-demand for Learning and Job-related Learning: The Moderating Effect of Need For Achievement

Purpose – The purpose of the research is to examine whether need for achievement moderates the relationship between job-demand for learning and job-related learning. Design/methodology/approach – Data were obtained from 153 participants full-time. The scales for job-demand for learning and job-related learning were developed for this research, whilst the scale for need for achievement was obtained from an external source. Hierarchical regression analysis was used in testing the hypothesized moderating effects. Findings – It was found that need for achievement moderates the relationship between job-demand for learning and job-related learning. Specifically, although job-demand for learning is correlated positively to job-related learning for both the high and the low need for achievement groups, this correlation is stronger amongst the high group. Research limitations/implications – The use of a cross-sectional design in this study prohibits inferences being drawn regarding the causal relationships between job-demand for learning, need for achievement and job-related learning. Practical implications – Job-related learning can be facilitated through increasing the need for achievement by allowing employees to establish their own learning and performance goals rather than by imposing such goals on them. The redesign of jobs to create challenges for employees is an equally important practical consideration. Originality/value – This research provides a succinct view of the relationship between an external factor, job-demand for learning, and an internal motivator, need for achievement. It emphasizes the degree to which organizations can facilitate learning through design of challenging jobs, to the extent of the individuals’ motivation.

Supporting the learning and networking experiences of doctoral students

This study explores the impact of a Graduate Virtual Research Environment (GVRE) on the learning and networking experiences of research students. The GVRE was established to support and enhance research skills and employability training across a university. It provides an extensive range of resources including video reflections based on the experiences of students and staff; GVRE members are encouraged to comment and engage in discussions on these resources. Our work is framed using social theories of learning and the role of communities in the support and development of research students. In particular, we are interested in exploring the challenges involved in developing communities and networks for students whose main focus is their individual research. The GVRE was made available to over 600 students and in this research we explore its impact on the experiences of research students. In particular, we investigate four questions: (a) what impact does the students use of the GVRE have on the development of their research skills; (b) what impact does membership of the GVRE have on the networks and communities of research students; (c) how do research students view the relationships between their research skills training programme, their individual research and the GVRE; and (d) how do research students currently use social media. We use an interpretivist approach and our data sources include site statistics, responses to a questionnaire and also feedback from a focus group. Our findings indicate that networking remains an issue and students suggested approaches to facilitating this using the GVRE: (1) A clearer pathway from skills need identification to skills acquisition; (2) Rewards for activities around networking - possibly through credit on the training scheme; (3) Activities that would involve research directly. Feedback on the GVRE indicated that it is valued by research students as it facilitates the development of their research skills. In terms of marketing the GVRE to research students important factors identified were: the ease of access to the site, the overview it gives of the PhD process; and the value of the site to students around the defining moments of their studies when the students felt they needed additional advice and guidance.

Does Cost-Effectiveness Analysis Have a Role in US Managed Care Drug Formularies? An Empirical Study of Utilization, Costs, Outcomes, and Elasticity of Demand of a Value-Based Formulary

Thesis (Ph.D.)--University of Washington, 2015

Bachelor of Arts, Honours in String Pulling

In reference to the actions of the Board of Governors of the University.

Experiential learning instruments : an examination of the concept of the instrumental approach in experiential learning

Experiential Learning Instruments (ELls) are employed to modify the leamer's apprehension and / or comprehension in experiential learning situations, thereby improving the efficiency and effectiveness of those modalities in the learning process. They involve the learner in reciprocally interactive and determining transactions with his/her environment. Experiential Learning Instruments are used to keep experiential learning a process rather than an object. Their use is aimed at the continual refinement of the learner's knowledge and skill. Learning happens as the leamer's awareness, directed by the use of Ells, comes to experience, monitor and then use experiential feedback from living situations in a way that facilitates knmvledge/skill acquisition, self-correction and refinement. The thesis examined the literature relevant to the establishing of a theoretical experiential learning framework within which ELls can be understood. This framework included the concept that some learnings have intrinsic value-knowledge of necessary information-while others have instrumental value-knowledge of how to learn. The Kolb Learning Cycle and Kolb's six characteristics of experiential learning were used in analyzing three ELls from different fields of learning-saxophone tone production, body building and interpersonal communications. The ELls were examined to determine their learning objectives and how they work using experiential learning situations. It was noted that ELls do not transmit information but assist the learner in attending to and comprehending aspects of personal experience. Their function is to telescope the experiential learning process.

Health-related learning needs and interests of selected non-institutionalized elderly

The research question in this study was "How do the noninstitutionalized elderly in the Hamilton-Wentworth Region perceive their learning needs and interests related to health?" The theoretical foundations of instruction for adults were reviewed as well as learning needs and interests in adult education, the assessment of learning needs in general, and the assessment of the learning needs of the elderly. The methodology used was a descriptive design. A research-based questionnaire-interview was developed, refined, and pilot tested. From a random sampling procedure, a participant group of 23 was secured. The questionnaireinterview was administered in a home visit situation. Data, which were collected, were coded, analyzed, processed, and printed. The results indicated that each participant had many learning needs and interests of varying intensities. The participants had many preferences in the delivery of health promotion. The learning needs and interests had several significant correlations with other variables. The implications of the result~ were discussed.

Preparing to teach : learning from an exploration of teachers' experiences of teaching in classrooms of difference

This qualitative study explores practicing teachers' experiences of teaching in classrooms of diversity, that is, classrooms where students represent a variety of differences including race, culture, ethnicity, and class. More specifically, this study investigates the types of curricular and pedagogical practices teachers employ in their classrooms. This study attempts to make a contribution to the scholarship of critical pedagogy by drawing upon the works of critical pedagogues to make sense of participants' descriptions oftheir curricular and pedagogical practices. Four participants were involved in this study. Participants were elementary teachers in classrooms of difference in Ontario who contributed the primary sources of data by engaging in 2 individual interviews. Additional sources of data included a focus group meeting that 2 ofthe participants were able to attend, school board curriculum resource documents assisting teachers in teaching critically, as well as a research journal which the researcher kept throughout the study. The scholarship of critical pedagogy (Ellsworth, 1992; Giroux, 1993; McLaren, 1989) informs the analysis of participants' descriptions of their teaching experiences. Many of the participants did not engage in a practice of critical pedagogy. This study explores some of the challenges and possibilities of using critical pedagogy to create spaces in classrooms where teachers can build connections between the curriculum mandated by the government and the multiple identities and experiences that students bring into the classroom. This study concludes with a discussion on what teachers need to know to be able to begin creating equitable and educational experiences in classrooms of difference.