Improving the economic value of photographic screening for optical coherence tomography-detectable macular oedema:a prospective, multicentre, UK study

Objectives: To determine the best photographic surrogate markers for detecting sight-threatening macular oedema (MO) in people with diabetes attending UK national screening programmes. Design: A multicentre, prospective, observational cohort study of 3170 patients with photographic signs of diabetic retinopathy visible within the macular region [exudates within two disc diameters, microaneurysms/dot haemorrhages (M/DHs) and blot haemorrhages (BHs)] who were recruited from seven study centres. Setting: All patients were recruited and imaged at one of seven study centres in Aberdeen, Birmingham, Dundee, Dunfermline, Edinburgh, Liverpool and Oxford. Participants: Subjects with features of diabetic retinopathy visible within the macular region attending one of seven diabetic retinal screening programmes. Interventions: Alternative referral criteria for suspected MO based on photographic surrogate markers; an optical coherence tomographic examination in addition to the standard digital retinal photograph. Main outcome measures: (1) To determine the best method to detect sight-threatening MO in people with diabetes using photographic surrogate markers. (2) Sensitivity and specificity estimates to assess the costs and consequences of using alternative strategies. (3) Modelled long-term costs and quality-adjusted life-years (QALYs). Results: Prevalence of MO was strongly related to the presence of lesions and was roughly five times higher in subjects with exudates or BHs or more than two M/DHs within one disc diameter. Having worse visual acuity was associated with about a fivefold higher prevalence of MO. Current manual screening grading schemes that ignore visual acuity or the presence of M/DHs could be improved by taking these into account. Health service costs increase substantially with more sensitive/less specific strategies. A fully automated strategy, using the automated detection of patterns of photographic surrogate markers, is superior to all current manual grading schemes for detecting MO in people with diabetes. The addition of optical coherence tomography (OCT) to each strategy, prior to referral, results in a reduction in costs to the health service with no decrement in the number of MO cases detected. Conclusions: Compared with all current manual grading schemes, for the same sensitivity, a fully automated strategy, using the automated detection of patterns of photographic surrogate markers, achieves a higher specificity for detecting MO in people with diabetes, especially if visual acuity is included in the automated strategy. Overall, costs to the health service are likely to increase if more sensitive referral strategies are adopted over more specific screening strategies for MO, for only very small gains in QALYs. The addition of OCT to each screening strategy, prior to referral, results in a reduction in costs to the health service with no decrement in the number of MO cases detected. © Queen's Printer and Controller of HMSO 2013.

Sustainable energy systems for seawater reverse osmosis desalination

Desalination of seawater driven by solar and other sustainable energy sources could in principle fulfil the growing needs of the world's most water-stressed countries. Reverse osmosis (RO) has become the most efficient process for desalination, making it the technology of choice for use with solar energy, and photovoltaics (PV) has become the most successful technology for solar energy conversion. But despite recent gains in the efficiency of PV-RO, substantial improvements are still possible because of the numerous energy losses occurring between input of sunlight and output of freshwater. This chapter gives an overview of some of the research activities and recent advances that could ultimately result in solar-powered RO systems becoming more than 10 times efficient than today. It also describes advances in waste heat recovery for RO desalination that are yielding greatly improved performance over desalination processes based on distillation.

A comparison of content-based and context-based teaching on ninth-grade mathematics achievement

The purpose of this study was to determine if an experimental context-based delivery format for mathematics would be more effective than a traditional model for increasing the performance in mathematics of at-risk students in a public high school of choice, as evidenced by significant gains in achievement on the standards-based Mathematics subtest of the FCAT and final academic grades in Algebra I. The guiding rationale for this approach is captured in the Secretary's Commission on Achieving Necessary Skills (SCANS) report of 1992 that resulted in school-to-work initiatives (United States Department of Labor). Also, the charge for educational reform has been codified at the state level as Educational Accountability Act of 1971 (Florida Statutes, 1995) and at the national level as embodied in the No Child Left Behind Act of 2001. A particular focus of educational reform is low performing, at-risk students. ^ This dissertation explored the effects of a context-based curricular reform designed to enhance the content of Algebra I content utilizing a research design consisting of two delivery models: a traditional content-based course; and, a thematically structured, content-based course. In this case, the thematic element was business education as there are many advocates in career education who assert that this format engages students who are often otherwise disinterested in mathematics in a relevant, SCANS skills setting. The subjects in each supplementary course were ninth grade students who were both low performers in eighth grade mathematics and who had not passed the eighth grade administration of the standards-based FCAT Mathematics subtest. The sample size was limited to two groups of 25 students and two teachers. The site for this study was a public charter school. Student-generated performance data were analyzed using descriptive statistics. ^ Results indicated that contrary to the beliefs held by many, contextual presentation of content did not cause significant gains in either academic performance or test performance for those in the experimental treatment group. Further, results indicated that there was no meaningful difference in performance between the two groups. ^

A computer based approach to improve the dietary and physical activity patterns of a diverse group of adolescents

Diet and physical activity patterns have been implicated as major factors in the increasing prevalence of childhood and adolescent obesity. It is estimated that between 16 and 33 percent of children and adolescents in the United States are overweight (CDC, 2000). Moreover, the CDC estimates that less than 50% of adolescents are physically active on a regular basis (CDC, 2003). Interventions must be focused to modify these behaviors. Facilitating the understanding of proper nutrition and need for physical activity among adolescents is the first step in preventing overweight and obesity and delaying the development of chronic diseases later in life (Dwyer, 2000). The purpose of this study was to compare the outcomes of students receiving one of two forms of education (both emphasizing diet and physical activity), to determine whether a computer based intervention (CBI) program using an interactive, animated CD-ROM would elicit a greater behavior change in comparison to a traditional didactic intervention (TDI) program. A convenience sample of 254 high school students aged 14-19 participated in the 6-month program. A pre-test post-test design was used, with follow-up measures taken at three months post-intervention. ^ No change was noted in total fat, saturated fat, fruit/vegetables, or fiber intake for any of the groups. There was also no change in perceived self-efficacy or perceived social support. Results did, however, indicate an increase in nutrition knowledge for both intervention groups (p<0.001). In addition, the CBI group demonstrated more positive and sustained behavior changes throughout the course of the study. These changes included a decrease in BMI (ppre/post<0.001, ppost/follow-up<0.001), number of meals skipped (ppre/post<0.001), and soda consumption (ppre/post=0.003, ppost/follow-up=0.03) and an increase in nutrition knowledge (ppre/post<0.001, ppre/follow-up <0.001), physical activity (ppre/post<0.05, p pre/follow-up<0.01), frequency of label reading (ppre/follow-up <0.0l) and in dairy consumption (ppre/post=0.03). The TDI group did show positive gains in some areas post intervention, however a return to baseline behavior was shown at follow-up. Findings of this study suggest that compared to traditional didactic teaching, computer-based nutrition and health education has greater potential to elicit change in knowledge and behavior as well as promote maintenance of the behavior change over time. ^

The effect of a clinical practicum on elementary education preservice teachers' development of reading expertise

The purpose of the study was to measure gains in the development of elementary education teachers’ reading expertise, to determine if there was a differential gain in reading expertise, and last, to examine their perceptions of acquiring reading expertise. This research is needed in the field of teacher education, specifically in the field of reading. A quasi-experimental design with a comparison group using pretest-posttest mixed-method, repeated measures was utilized. Quantitative data analysis measured the development of reading expertise of elementary preservice teachers compared to early childhood preservice teachers; and, was used to examine the differential gains in reading expertise. A multivariate analysis of variance (MANOVA) was conducted on pre- and posttest responses on a Protocol of Questions. Further analysis was conducted on five variables (miscue analysis, fluency analysis, data analysis, inquiry orientation and intelligent action) using a univariate analysis of variance (ANOVA). A one-way ANOVA was carried out on gain scores of the low and middle groups of elementary education preservice teachers. Qualitative data analysis suggested by Merriam (1989) and Miles and Huberman (1994) was used to determine if the elementary education preservice teachers perceived they had acquired the expertise to teach reading. Elementary education preservice teachers who participated in a supervised clinical practicum made significant gains in their development of reading expertise as compared to early childhood preservice teachers who did not make significant gains. Elementary education preservice teachers who were in the low and middle third levels of expertise at pretest demonstrated significant gains in reading expertise. Last, elementary education preservice teachers perceived they had acquired the expertise to teach reading. The study concluded that reading expertise can be developed in elementary education preservice teachers through participation in a supervised clinical practicum. The findings support the idea that preservice teachers who will be teaching reading to elementary students would benefit from a supervised clinical practicum.

Detention Home Teens as Tutors: A Cooperative Cross-Age Tutoring Pilot Project

Concerned professionals in the juvenile justice field frequently express concern for effective programs that help youth offenders successfully rejoin society. This mixed-method pilot study, involved detention home teens functioning as tutors for special education students in a public school. Tutors experienced gains in self-esteem and overall school/social attitude.

The Effects of Repeated Readings on Reading Abilities of English Language Learners with Specific Learning Disabilities

This study evaluates the effects of repeated readings on the reading fluency and comprehension of 4 third through fifth grade English Language Learners (ELLs) with Specific Learning Disabilities (SLD). The results indicate gains in fluency, a decrease in errors, and an increase in correct answers to literal comprehension questions.

Lan American Coups: Have They Vanished or Taken New Shapes?

In the following pages, three well-known Latinoamericanists share their views on the current prospects for coups in Latin America. They are: Rut Diamint of the University Torcuatto de Tella in Buenos Aires, Argentina; Pablo Policzer of the University of Calgary in Canada; and Michael Shifter of the Inter-American Dialogue in Washington, DC. Each looks at the potential for coups from different perspectives but, all three come to similar conclusions. That is, that despite substantial gains in democracy, the threat of coups in Latin America remains latent. The authors agree that democracy is growing in the region. Opinion surveys such as the Americas Barometer consistently show that citizens in Latin America have gradually incorporated democracy as part of their core value system. Yet, the authors argue convincingly that Latin America faces new types of interruptions to its democratic process that should be considered coups, even if not following the traditional style of military coup that predominated in the past. Situations that have taken place in Peru, Ecuador, Nicaragua, Honduras and other countries serve to illustrate the new trends. More specifically, Professor Diamint argues that in Latin America a culture of intolerance, demonization of the opposition, and the utilization of any method to achieve power prevails. In a region with a very high threshold of violence, governments fail to set an example of establishing a culture of debate, consensus, and transparency. This culture is inclined to uncontrollable political expressions, preferring confrontational means to resolve conflict. Within this scenario, “messianic” solutions are promoted and coups cannot be discarded as an option that would never transpire. Professor Policzer looks more closely to the constitutional loopholes that allow for a transformation of limited into absolute power. He argues that coups can be constitutional or unconstitutional, and that a constitutional coup can occur when violations to democracy actually stem from the constitutions themselves. In Honduras, for example specific provisions in the Constitution itself created conditions for a constitutional crisis; similar provisions have also led to constitutional authoritarianism in Venezuela and other countries. Dr. Policzer stresses that when a head of state or the military take absolute power, even temporarily, based on provisions in their constitutions; they are in essence staging a constitutional coup. These blind spots in constitutions, he argues, may be more serious threat to democracy than that of traditional coups. Lastly, Dr. Shifter argues that some kind of coup should be expected in Latin America in coming years, not only because fundamental institutions remain weak in some countries, but because the regional political environment is less prepared to respond effectively to transgressions than it was a few years ago. The good news, however, is that only a handful of countries, show no interest in governing. The bad news is that in those few countries where situations are indeed shaky, they are also in some cases aggravated by rising food and fuel prices, and spreading criminality, which pose serious risks to the rule of law and democratic governance.

A study of the perceived effectiveness of existing recruitment and general institution -wide practices used to enhance women and minority full -time faculty representation at Florida's public universities

As a federal contractor, the State University System of Florida (SUSF) has instituted a wide range of affirmative action practices to hire and promote women and minorities. Should affirmative action be abolished, universities valuing a diverse faculty will have to rely on voluntary practices to attract members of these groups. I explored the present use and perceived effectiveness of recruitment and institution-wide practices used to promote a diverse workforce and identified those practices considered very effective by informed respondents at the nine participating universities. ^ Two questionnaires were used for data collection. Selected recruitment and general institution-wide best practices found in previous studies were used as benchmarks for comparison with existing practices. The questionnaires also included an open-ended question to identify indigenous practices. A follow-up semi-structured interview was conducted to gather information regarding the background of identified practices. ^ Two overall themes emerged from the study. The first was the perception among respondents that women have made substantial gains in faculty representation. This perception is substantiated by actual percentage of women tenure-earning faculty. The second theme was that many of the practices considered very effective are affirmative action-driven, providing women and minorities considerations not afforded White males. These practices, because they single out members of one group over another based on gender and race/ethnicity may become illegal should affirmative action mandates be abolished. ^ Analysis of the data revealed that universities with the highest percentage of practices considered effective and universities located in the most urban areas of the state were the universities with the highest percentage of minority tenure-earning faculty. There appears to be no similar relationship between universities in urban areas and those with the highest percentage of practices considered effective and women tenure-earning faculty representation. The most frequently identified recruitment practice was the development of a receptive institutional image for women and minorities. The most frequently identified practice in promoting a receptive institutional climate was the use of conflict resolution processes and grievance procedures. Five themes also emerged from the 22 barriers in recruiting women and minority full-time faculty identified by the respondents. The most commonly identified barriers were related to a lack of financial resources to support effective practices. ^

Anxious children who received treatment grow -up: An 8-to-13 year follow-up study

This dissertation examined the long-term efficacy (8-to-13 years, M = 9.54, SD = 1.689) of exposure-based cognitive-behavioral therapy (CBT) for phobic and anxiety disorders in youths. Long-term efficacy was examined in terms of diagnostic recovery, symptom reductions, and clinically significant change. This dissertation also examined predictors of long-term efficacy (e.g., age, gender, and other clinical characteristics) as well as the relative long-term efficacy of CBT for Hispanic/Latino and European American youth. ^ Participants consisted of 67 youth (age range 15–26 years; M = 19.43, SD = 3.02 years at time of follow-up assessment), (47.8% females, 37.3% Hispanic/Latino) who had participated in one of two clinical trials (Silverman et al., 1999a, b). After providing informed consent to participate in the long term follow-up, youths completed a diagnostic interview and a battery of questionnaires. Results indicated that treatment gains were maintained about 9.5 years after treatment was completed. Maintenance of treatment gains was evident in terms of diagnostic recovery, symptom reductions, and clinically significant change. Long-term treatment gains extended to both ethnic groups and the two ethnic groups were functionally equivalent along most indices examined. Analyses of predictors of long-term outcome showed that parent self-reported pre-treatment depression, youth-reported pre-treatment depression, and youths retrospective reports of negative life events were significantly associated with less favorable long-term gains in terms of total symptoms of anxiety at long-term follow-up. In terms of long-term sequelae, youths with less successful post-treatment outcomes reported seeking-out additional treatment as well as using/abused substances and substance dependence significantly more than youths with successful post-treatment outcomes. Results are discussed in terms of the contribution of the present study to knowledge base about the long-term efficacy of exposure-based CBT procedures for phobic and anxiety disorders in youth. Findings also are discussed in terms of the need to modify CBT procedures to target youths with less successful post-treatment outcomes. Limitations and future directions are presented. ^

The relationship between scaffolding metacognitive strategies identified through dialogue journals and second graders' reading comprehension, science achievement, and metacognition using expository text

Poor informational reading and writing skills in early grades and the need to provide students more experience with informational text have been identified by research as areas of concern. Wilkinson and Son (2011) support future research in dialogic approaches to investigate the impact dialogic teaching has on comprehension. This study (N = 39) examined the gains in reading comprehension, science achievement, and metacognitive functioning of individual second grade students interacting with instructors using dialogue journals alongside their textbook. The 38 week study consisted of two instructional phases, and three assessment points. After a period of oral metacognitive strategies, one class formed the treatment group (n=17), consisting of two teachers following the co-teaching method, and two classes formed the comparison group ( n=22). The dialogue journal intervention for the treatment group embraced the transactional theory of instruction through the use of dialogic interaction between teachers and students. Students took notes on the assigned lesson after an oral discussion. Teachers responded to students' entries with scaffolding using reading strategies (prior knowledge, skim, slow down, mental integration, and diagrams) modeled after Schraw's (1998) strategy evaluation matrix, to enhance students' comprehension. The comparison group utilized text-based, teacher-led whole group discussion. Data were collected using different measures: (a) Florida Assessments for Instruction in Reading (FAIR) Broad Diagnostic Inventory; (b) Scott Foresman end of chapter tests; (c) Metacomprehension Strategy Index (Schmitt, 1990); and (d) researcher-made metacognitive scaffolding rubric. Statistical analyses were performed using paired sample t-tests, regression analysis of covariance, and two way analysis of covariance. Findings from the study revealed that experimental participants performed significantly better on the linear combination of reading comprehension, science achievement, and metacognitive function, than their comparison group counterparts while controlling for pretest scores. Overall, results from the study established that teacher scaffolding using metacognitive strategies can potentially develop students' reading comprehension, science achievement, and metacognitive awareness. This suggests that early childhood students gain from the integration of reading and writing when using authentic materials (science textbooks) in science classrooms. A replication of this study with more students across more schools, and different grade levels would improve the generalizability of these results.

The use of visualization, onset-and-rime, story read-alouds, and discussion to improve diverse first graders' vocabulary and comprehension

It has long been known that vocabulary is essential in the development of reading. Because vocabulary leading to increased comprehension is important, it necessary to determine strategies for ensuring that the best methods of teaching vocabulary are used to help students make gains in vocabulary leading to reading comprehension. According to the National Reading Panel, multiple strategies that involve active engagement on the part of the student are more effective than the use of just one strategy. The purpose of this study was to determine if students' use of visualization, student-generated pictures of onset-and-rime-patterned vocabulary, and story read-alouds with discussion, would enable diverse first-grade students to increase their vocabulary and comprehension. In addition, this study examined the effect of the multimodal framework of strategies on English learners (ELs). This quasi-experimental study (N=69) was conducted in four first-grade classrooms in a low socio-economic school. Two treatment classes used a multimodal framework of strategies to learn weekly vocabulary words and comprehension. Two comparison classrooms used the traditional method of teaching weekly vocabulary and comprehension. Data sources included Florida Assessments for Instruction in Reading (FAIR), comprehension and vocabulary scores, and weekly MacMillan/McGraw Hill Treasures basal comprehension questions and onset-and-rime vocabulary questions. This research determined that the treatment had an effect in adjusted FAIR comprehension means by group, with the treatment group (adj M = 5.14) significantly higher than the comparison group ( adj M = -8.26) on post scores. However, the treatment means did not increase from pre to post, but the comparison means significantly decreased from pre to post as the materials became more challenging. For the FAIR vocabulary, there was a significant difference by group with the comparison adjusted post mean higher than the treatment's, although both groups significantly increased from pre to post. However, the FAIR vocabulary posttest was not part of the Treasures vocabulary, which was taught using the multimodal framework of strategies. The Treasures vocabulary scores were not significantly different by group on the assessment across the weeks, although the treatment means were higher than those of the comparison group. Continued research is needed in the area of vocabulary and comprehension instructional methods in order to determine strategies to increase diverse, urban students' performance.

French Truffles and Forest Transitions

Truffle production in France has declined by more than 90% over the last 100 years. Commonly cited causes include a massive rural exodus that led to more open canopy forests becoming less intensively managed and reverting to closed canopy forests, the latter which do not favor truffle production. Scholars have labeled such a process as a forest transition, when a location goes from previously losing forest cover to regrowth and net gains in forest cover. Scholars have single out France as a place with a marked forest transition. Commonly these increases in forest cover are assumed to be a beneficial public good. Here, I question if it is accurate to view forest transitions as being universally beneficial, especially considering that this changing ecology has had strongly deleterious impacts on truffle production and those who rely on it for revenue. In this study I will use remote sensed images to examine if a forest transition did in fact occur in the department of Lot, France and what are the impacts forest trends have had on truffle cultivation. I will further estimates potential losses of revenue from truffle production which has resulted from any existing forest transition.

Evoking non-repertory verbal behavior across operant classes : the effects of motor echoic sign language training within the context of a motivating operation

The individual effects that echoic, mand, and sign language training procedures have on the acquisition of verbal behavior have been widely demonstrated, but more efficient strategies are still needed. This study combined all three treatment strategies into one treatment intervention in order to investigate the joint effects they may have on verbal behavior. Six participants took part in the study. Intervention totaled 1 hour/day for 5 days/week until mastery criterion for motor echoic behavior was achieved. Although motor echoic behavior were solely targeted for acquisition, significant increases in spontaneous motor mands were noted in all treatment participants. Additionally, 4 treatment participants also demonstrated significant gains in vocal echoics and spontaneous vocal mands. No significant increases were noted for the control participant. Results suggest that the aforementioned procedure may provide more efficient results as a first-step to teaching a functional repertoire of verbal behavior to developmentally delayed children.

A ação da bancada evangélica na Câmara Municipal de Natal/RN: 2005-2008

The Evangelical Church is an institution that presents itself as a group that aims to be a mediator between society, the state and the country itself. However political practice within the churches have been somewhat taken authoritarian, manipulative, intolerant and realize this reality in the analysis of this work. While understanding that the Church as an institution has formed an opinion about what is right and wrong in their communities as a social institution can be seen in contemporary society growing religious occupation of the public sphere and in all segments of Brazilian society the presence of evangelicals. One of the challenges is the discussion of the practices of Christ when the ownership of the mandate legitimized by the vote happens, what real action is the "Christ policy"? What social contributions to retrieve people, places and cities? What is the competence to work towards promoting the other gains in health, employment, security, education? The purpose of this dissertation is to contribute to the questioning of the current logic and prevailing construction of Christian ideals in politics. Develop an investigation by reference to the absence of a study on the activity of the evangelical councilors Christmas during the period 2004 -2008, order to be able assign a value judgment based on information of projects that every evangelical councilor exercised during the 15th Legislature, occasion that the City Council received the highest representation of evangelical councilors in its history.