Practices and views on fetal heart monitoring:A structured observation and interview study

Objective: To assess and explain deviations from recommended practice in National Institute for Clinical Excellence (NICE) guidelines in relation to fetal heart monitoring. Design: Qualitative study. Setting: Large teaching hospital in the UK. Sample: Sixty-six hours of observation of 25 labours and interviews with 20 midwives of varying grades. Methods: Structured observations of labour and semistructured interviews with midwives. Interviews were undertaken using a prompt guide, audiotaped, and transcribed verbatim. Analysis was based on the constant comparative method, assisted by QSR N5 software. Main outcome measures: Deviations from recommended practice in relation to fetal monitoring and insights into why these occur. Results: All babies involved in the study were safely delivered, but 243 deviations from recommended practice in relation to NICE guidelines on fetal monitoring were identified, with the majority (80%) of these occurring in relation to documentation. Other deviations from recommended practice included indications for use of electronic fetal heart monitoring and conduct of fetal heart monitoring. There is evidence of difficulties with availability and maintenance of equipment, and some deficits in staff knowledge and skill. Differing orientations towards fetal monitoring were reported by midwives, which were likely to have impacts on practice. The initiation, management, and interpretation of fetal heart monitoring is complex and distributed across time, space, and professional boundaries, and practices in relation to fetal heart monitoring need to be understood within an organisational and social context. Conclusion: Some deviations from best practice guidelines may be rectified through straightforward interventions including improved systems for managing equipment and training. Other deviations from recommended practice need to be understood as the outcomes of complex processes that are likely to defy easy resolution. © RCOG 2006.

The nature of cognitive style and its relationship to educational performance

A survey is made of the literature relating to a number of dimensions of cognitive style, from which it is concluded that cognitive style has a strong theoretical potential as a predictor of academic performance. It is also noted that there have been few attempts to relate co gnitive style to academic performance, and that these have met with limited success. On the assumption that theories of individual differences should be congruent with theories of general functioning, an examination is made of the model of cognition presupposed by ,dimen sions of cognitive style. A central feature of this model is the distinction between cognitive content and cognitive structure. The origins of this distinction are traced back to the normative and experimental or quasi-experimental characteristics of research in psychology. The validity of the distinction is examined with reference to modern research findings, and the conclusion is drawn that the norma~ive experimental method is an increasingly inappropriate tool of research when applied to higher levels of cognitive functioning, as it cannot handle subject idiosyncracy or patterns of interaction. An examination of the presuppositions of educational research leads to the complementary conclusion that the research methods imply an oversimplified model of the educational situation. Two empirical studies are reported: (1) An experiment using conventional cognitive style dimensions as predictors of performance under two teaching methods (2) An attempt to predict individual differences in overall academic performance by means of a research technique which uses a questionnaire, intra-individual scoring, and an analysis of patterns of responses, and which attempts to take some account of subject idiosyncracy. The implifications of these studies for fUrther research are noted.

A speech analysis system for use in educational research

This thesis describes work undertaken in order to fulfil a need experienced in the Department of Educational Enquiry at the University of Aston in Birmingham for speech analysis facilities suitable for use in teaching and research work within the Department. The hardware and software developed during the research project provides displays of speech fundamental frequency and intensity in real time. The system is suitable for the provision of visual feedback of these parameters of a subject's speech in a learning situation, and overcomes the inadequacies of equipment currently used for this task in that it provides a clear indication of fundamental frequency contours as the subject is speaking. The thesis considers the use of such equipment in several related fields, and the approaches that have been reported to one of the major problems of speech analysis, namely pitch-period estimation. A number of different systems are described, and their suitability for the present purposes is discussed. Finally, a novel method of pitch-period estimation is developed, and a speech analysis system incorporating this method is described. Comparison is made between the results produced by this system and those produced by a conventional speech spectrograph.

Educational intervention improves anticoagulation control in atrial fibrillation patients:the TREAT randomised trial

Background: Stroke prevention in atrial fibrillation (AF), most commonly with warfarin, requires maintenance of a narrow therapeutic target (INR 2.0 to 3.0) and is often poorly controlled in practice. Poor patient-understanding surrounding AF and its’ treatment may contribute to patient’s willingness to adhere to recommendations. Method: A theory-driven intervention, developed using patient interviews and focus groups, consisting of a one-off group session (1-6 patients) utilising an ‘expert-patient’ focussed DVD, educational booklet, self-monitoring diary and worksheet, was compared in a randomised controlled trial (ISRCTN93952605) against usual care, with patient postal follow-ups at 1, 2, 6, and 12-months. Ninety-seven warfarin-naïve AF patients were randomised to intervention (n=46, mean age (SD) 72.0 (8.2), 67.4% men), or usual care (n=51, mean age (SD) 73.7 (8.1), 62.7% men), stratified by age, sex, and recruitment centre. Primary endpoint was time within therapeutic range (TTR); secondary endpoints included knowledge, quality of life, anxiety/depression, beliefs about medication, and illness perceptions. Main findings: Intervention patients had significantly higher TTR than usual care at 6-months (76.2% vs. 71.3%; p=0.035); at 12-months these differences were not significant (76.0% vs. 70.0%; p=0.44). Knowledge increased significantly across time (F (3, 47) = 6.4; p<0.01), but there were no differences between groups (F (1, 47) = 3.3; p = 0.07). At 6-months, knowledge scores predicted TTR (r=0.245; p=0.04). Patients’ scores on subscales representing their perception of the general harm and overuse of medication, as well as the perceived necessity of their AF specific medications predicted TTR at 6- and 12-months. Conclusions: A theory-driven educational intervention significantly improves TTR in AF patients initiating warfarin during the first 6-months. Adverse clinical outcomes may potentially be reduced by improving patients’ understanding of the necessity of warfarin and reducing their perception of treatment harm. Improving education provision for AF patients is essential to ensure efficacious and safe treatment.

Focus group method and methodology:current practice and recent debate

This paper considers the contemporary use of focus groups as a method of data collection within qualitative research settings. The authors draw upon their own experiences of using focus groups in educational and 'community' user-group environments in order to provide an overview of recent issues and debates surrounding the deployment of focus group methods and to pick out specific areas of contention in relation to both their epistemological and practical implications. Accordingly, the paper reflects on some of the realities of 'doing' focus groups whilst, at the same time, highlighting common problems and dilemmas which beginning researchers might encounter in their application. In turn, the paper raises a number of related issues around which there appears to have been a lack of academic discussion to date.

Innovating engineering education: the RVS approach:an empirically grounded method to improved practice and enhanced student experience

This paper builds on previous work (Clark, 2009; Clark & Andrews 2011, 2014) to continue the debate around a seemingly universal question…“How can educational theory be applied to engineering education in such a way so as to make the subject more accessible and attractive to students? It argues that there are three key elements to student success; Relationships, Variety & Synergy (RVS). By further examining the purposefully developed bespoke learning and teaching approach constructed around these three elements (RVS) the discourse in this paper links educational theory to engineering education and in doing so further develops arguments for the introduction of a purposefully designed pedagogic approach for use in engineering education.

Method of Linear Programming as an Idea for High School Curriculum

2010 Mathematics Subject Classification: 97D40, 97M10, 97M40, 97N60, 97N80, 97R80

Cultural Institutions and Citizen Science: Some Educational Aspects

Report published in the Proceedings of the National Conference on "Education and Research in the Information Society", Plovdiv, May, 2015

The Ghana National Service Scheme: Perceptions of former educational personnel, students and guardians

The purpose of this inquiry was to investigate the perceptions of former service personnel, students and their parents about the organizational effectiveness of the Ghana National Service Scheme (GNSS). The inquiry addressed the following questions: How do the participants perceive the effectiveness of the national service program on the Ghanaian society? What are the perceptions of school administrators who worked with service personnel, parents and students vis-à-vis the over all impact of the GNSS on the educational system? What are the perceptions of former service personnel, students and their parents in regard to the impact of the GNSS on them? ^ The GNSS is a part within the ministry of education, which is also part in the Ghanaian social structure. Hence, a systems theory approach which asks, “How and why a system as a whole functions as it does” (Patton, 1990), was utilized in the study. Methodologies included purposive sampling; interviews; participant observation, and follow-up interviews. The study was conducted over a six-moth period. ^ A cross-sectional survey design was used to generate data. The survey was followed up with an ethnographic study where in-depth, face-to-face interviews were conducted together with observations. The results were described and interpreted. ^ The summary of findings concludes that perceptional determinants of the effectiveness of the GNSS were biased by the age and zone of origin but not gender. This partially agrees with Marenin's (1990) except for gender. A significant difference was detected between the responses of those who were officials of the National service Secretariat and of former service personnel. The administrators defended the status quo and demonstrated their deeper knowledge about the scheme. The former personnel and parents freely criticized the program when necessary and did not seem to know much about the GNSS. Respondents mostly stressed the need for the secretariat to focus on the following areas: (1) involvement in the agricultural sector of the economy, (2) involvement in rural mass, civic and health education, (3) adequacy of remuneration and personnel welfare, and (4) ensuring posting of personnel to areas of their expertise. Recommendation for further research concluded the study. ^

The academic orientation of first and second generation Nicaraguan immigrant adolescents

The rise in diversity and numbers of U.S. immigrants since 1965 has spawned a number of studies about the education of these immigrants and their children. Most of this research finds that school-age immigrants arriving in the last 20 years have the highest drop-out rates, lowest test scores, and are less likely than their native born peers to go to college. This dissertation examines the experiences of Nicaraguan immigrant youth living in Miami and the factors that make some of these adolescents feel positive about education, while others have negative attitudes about education. The method for this study combined structured and unstructured interviews, participant observation, focus groups, and data collected from a larger data set to understand the academic orientation of 25 Nicaraguan youths over a 4-year period. One of the independent variables is length of time in the United States. During the time of my initial contact with the subjects, 6 had been living in the United States for less than 3 years, 14 had been living in the United States between 6 and 12 years, and 6 had been living in the in the United States most or all of their lives (either they were born in the United States or had resided here for over 12 years). ^ Results are based on the students' particular experiences, which influence the dependent variable, academic orientation. Besides length of time, the independent variables also include ethnic self-identity, perceived discrimination, social capital in Miami, and peer influence. The study finds that those who are very recent arrivals have a “dual frame of reference,” that is, they directly compare their educational opportunities here in the United States, with their prior, often less favorable, situation in their homeland. Many of those who were born in Nicaragua, but have been residing in Miami most of their lives, have a less favorable view of education based on a higher degree of perceived discrimination. However, those who are second generation Nicaraguans deliberately take advantage of the strength inherent in their co-ethnic community unique to Miami. Recognition of this ethnic community prompts them to perceive education as worthwhile. ^

A study of the relationship between educational placement and the achievement of urban low socioeconomic Hispanic middle school students with and without specific learning disabilities

Public schools traditionally have been held accountable for educating the majority of the nation’s school children, and through the years, these schools have been evaluated in a variety of ways. Currently, evaluation measures for accountability purposes consist solely of standardized test scores. In the past, only test scores of general education students were analyzed. Laws governing the education of students with disabilities, however, have extended accountability measures not only to include those students, but to report their scores in a disaggregated form (No Child Left Behind Act, 2001). The recent emphasis on accountability and compliance has resulted in the need for schools to carefully examine how programs, services, and policies impact student achievement (Bowers & Figgers, 2003). ^ Standard-based school reform and accountability systems have raised expectations about student learning outcomes for all students, including those with disabilities and minority students. Yet, overall, racial/ethnic minority students are performing well below their White non-Hispanic peers in most academic areas. Additionally, with respect to special education, there exists an enduring problem of disproportionate representation of racial/ethnic minority students (National Research Council, 2000). ^ This study examined classroom placement (inclusive versus non-inclusive) relative to academic performance of urban, low socioeconomic Hispanic students with and without disabilities in secondary content area classrooms. A mixed method research design was used to investigate this important issue using data from a local school district and results from field observations. The study compared performance levels of four middle school Hispanic student subgroups (students with disabilities in inclusive settings, students without disabilities in inclusive settings, students with disabilities in resource settings, and student without disabilities in general education settings) each in their respective placements for two consecutive years, exploring existing practices within authentic settings. ^ Significant differences were found in the relationship of educational placement and achievement between grade level and disability in the areas of math and reading. Additionally, clear and important differences were observed in student-teacher interactions. Recommendations for further researchers and stakeholders include soliciting responses from teams at the schools composed of general education and special education teachers, administrative personnel, and students as well as broadening the study across grade levels and exceptionalities. ^

A comparison of academic achievement of Montessori and non -Montessori students in a public school setting

Relationships between academic achievement and type of curriculum delivery system, Montessori or traditional, in a diverse group of learners from a public school district were examined in this study. In a repeated measures, within subjects design, students from an elementary Montessori program were paired with agemates from a traditional group on the basis of similar Stanford Achievement Test Scores in reading or math during the baseline year. Two subsequent administrations of the Stanford were observed for each subject to elucidate possible differences which might emerge based on program affiliation over the three year duration of the study. ^ Mathematics scores for both groups were not observed to be significantly different, although following the initial observation, the Montessori group continued to produce higher mean scores than did the traditional students. Marginal significance between the groups suggests that the data analysis should continue in an effort to elucidate a possible trend toward significance at the .05 level. ^ Reading scores for the groups demonstrated marginally significant differences by one analytical method, and significant differences when analyzed with a second method. In the second and third years of the study, Montessori students produced means which consistently outperformed the traditional group. ^ Recommendations included tracking subsequent administrations of the Stanford Achievement Test for all pairs of subjects in order to evaluate emerging trends in both subject areas. ^

School segregation and educational performance in a multicultural society: The case of Miami -Dade County, Florida

One of the most important goals of American educational institutions over the past 47 years has been the desegregation of pubic schools. This goal reflected the Supreme Court's decision in Brown v. Board of Education that segregated schools are inherently unequal and deny segregated minority students equal educational opportunities as mandated by the United States Constitution. This study examined the extent, nature, and causes of segregation in the Miami-Dade County Public Schools and the effects of segregation on the educational performance of minority students. ^ Research questions were analyzed using demographic data from the United States Census Bureau, the Metro-Dade County Planning Department, the United States Commission on Civil Rights, the United States Department of Education, and the Miami Dade County Public Schools. The extent of residential and school segregation in MiamiDade County was measured using the Dissimilarity Index. Historical and sociological literature were analyzed to explain the causes of school segregation, the socioeconomic characteristics of segregated minority students, and the relationship between school segregation and equal educational opportunities. A causal-comparative research method was chosen because it is the most appropriate method to compare the educational performance of minority students in segregated schools with the educational performance of minority students in desegregated schools. ^ The results of this study demonstrates that there is a high degree of residential and school segregation in Miami-Dade County, Florida. Furthermore, the Miami-Dade County Public Schools are characterized by a high degree of socioeconomic segregation. This is significant considering that the socioeconomic status of a student's peers is, after the student's family background, the most influential factor in determining academic performance. Clearly, schools and other social institutions must continue efforts to throughly desegregate the school district and improve minority student academic performance. A racially and economically desegregated school system would constitute an important component in Miami-Dade County's efforts to provide equal educational opportunities to all students. ^

Desenvolvimento profissional de futuros professores: travessias que se entrecruzam em contextos formativos

This study aimed to understand how the educational context contributes to the professional development of future teachers on introduction to teaching practice. To this end, we seek to characterize what the learning and the difficulties experienced in training contexts by future teachers, as well as the intrinsic elements to the training contexts that enable professional development. The investigated contexts were the Institutional Program Initiation Grant to Teaching (Programa Institucional de Bolsa de Iniciação à Docência – PIBID), specifically the sub-projects of Chemistry and Physics of the Federal University of Rio Grande do Norte (Universidade Federal do Rio Grande do Norte – UFRN) and Masters in Teaching of Physics and Chemistry of the University of Lisbon (MEFQ ). In both contexts, the future teachers are in contact with the school in a systematic way. The methodology used in our study is rooted in qualitative research with interpretative guidance and the design in the study of multiple cases with instrumental purpose. Participated in this study as the main subject, 40 future teachers PIBID of Physics, 24 PIBID future teachers of Chemistry and 5 future Master Teachers in Teaching Chemistry and Physics. As supporting subjects, participated in 3 PIBID Area Coordinators, the teacher of Introduction to Professional Practice of MEFQ, and 8 teachers who teach chemistry and / or physics in public schools. Multiple data collection tools were used: naturalistic observation, descriptive questionnaire, individual interviews, focus groups, reading of written records and official documents. In analyzing the data, we used the method of questioning and constant comparison. The results showed that the main learning of future teachers are related to the strategy employed in class, the change in the understanding of the role of teacher and student in the classroom, the construction of the professional profile and the development of collaborative practices. The main difficulties were related to the development of activities, the management of time and group, the dynamics of the classroom and the material conditions of work. The characteristics inherent in training contexts investigated for professional development are: the practice itself of the research, the collaboration, the focused reflection on practice, focus on student learning and the improving public schools. From the results, it is evidenced that the training contexts centered at school have the capability to resize the practice based on the analysis of actions, in a collaborative work as well as create opportunities for awareness of the concepts, the acting and the way to understand the profession. It is needed for effective mediation trainers, so that future teachers undertake their own practice and, therefore, they can build teaching strategies that promote learning which, in addition to increase the quality of education, favor the professional development throughout life.

Dosimetric Evaluation of Metal Artefact Reduction using Metal Artefact Reduction (MAR) Algorithm and Dual-energy Computed Tomography (CT) Method

Purpose: Computed Tomography (CT) is one of the standard diagnostic imaging modalities for the evaluation of a patient’s medical condition. In comparison to other imaging modalities such as Magnetic Resonance Imaging (MRI), CT is a fast acquisition imaging device with higher spatial resolution and higher contrast-to-noise ratio (CNR) for bony structures. CT images are presented through a gray scale of independent values in Hounsfield units (HU). High HU-valued materials represent higher density. High density materials, such as metal, tend to erroneously increase the HU values around it due to reconstruction software limitations. This problem of increased HU values due to metal presence is referred to as metal artefacts. Hip prostheses, dental fillings, aneurysm clips, and spinal clips are a few examples of metal objects that are of clinical relevance. These implants create artefacts such as beam hardening and photon starvation that distort CT images and degrade image quality. This is of great significance because the distortions may cause improper evaluation of images and inaccurate dose calculation in the treatment planning system. Different algorithms are being developed to reduce these artefacts for better image quality for both diagnostic and therapeutic purposes. However, very limited information is available about the effect of artefact correction on dose calculation accuracy. This research study evaluates the dosimetric effect of metal artefact reduction algorithms on severe artefacts on CT images. This study uses Gemstone Spectral Imaging (GSI)-based MAR algorithm, projection-based Metal Artefact Reduction (MAR) algorithm, and the Dual-Energy method.

Materials and Methods: The Gemstone Spectral Imaging (GSI)-based and SMART Metal Artefact Reduction (MAR) algorithms are metal artefact reduction protocols embedded in two different CT scanner models by General Electric (GE), and the Dual-Energy Imaging Method was developed at Duke University. All three approaches were applied in this research for dosimetric evaluation on CT images with severe metal artefacts. The first part of the research used a water phantom with four iodine syringes. Two sets of plans, multi-arc plans and single-arc plans, using the Volumetric Modulated Arc therapy (VMAT) technique were designed to avoid or minimize influences from high-density objects. The second part of the research used projection-based MAR Algorithm and the Dual-Energy Method. Calculated Doses (Mean, Minimum, and Maximum Doses) to the planning treatment volume (PTV) were compared and homogeneity index (HI) calculated.

Results: (1) Without the GSI-based MAR application, a percent error between mean dose and the absolute dose ranging from 3.4-5.7% per fraction was observed. In contrast, the error was decreased to a range of 0.09-2.3% per fraction with the GSI-based MAR algorithm. There was a percent difference ranging from 1.7-4.2% per fraction between with and without using the GSI-based MAR algorithm. (2) A range of 0.1-3.2% difference was observed for the maximum dose values, 1.5-10.4% for minimum dose difference, and 1.4-1.7% difference on the mean doses. Homogeneity indexes (HI) ranging from 0.068-0.065 for dual-energy method and 0.063-0.141 with projection-based MAR algorithm were also calculated.

Conclusion: (1) Percent error without using the GSI-based MAR algorithm may deviate as high as 5.7%. This error invalidates the goal of Radiation Therapy to provide a more precise treatment. Thus, GSI-based MAR algorithm was desirable due to its better dose calculation accuracy. (2) Based on direct numerical observation, there was no apparent deviation between the mean doses of different techniques but deviation was evident on the maximum and minimum doses. The HI for the dual-energy method almost achieved the desirable null values. In conclusion, the Dual-Energy method gave better dose calculation accuracy to the planning treatment volume (PTV) for images with metal artefacts than with or without GE MAR Algorithm.