Improving a regional chemotherapy service by learning from deaths occurring within 30 days of treatment with systemic anti-cancer therapy.

Background: Outwith clinical trials, patient outcomes specifically related to SACT (systemic anti-cancer therapy) are not well reported despite a significant proportion of patients receiving active treatment at the end of life. The NCEPOD reviewing deaths within 30 days of SACT found SACT caused or hastened death in 27% of cases.

Method: Across the Northern Ireland cancer network, 95 patients who died within 30 days of SACT for solid tumours were discussed at the Morbidity and Mortality monthly meeting during 2013. Using a structured template, each case was independently reviewed, with particular focus on whether SACT caused or hastened death.

Results: Lung, GI and breast cancers were the most common sites. Performance status was recorded in 92% at time of final SACT cycle (ECOG PS 0-2 89%).

In 57% the cause of death was progressive disease. Other causes included thromboembolism (13%) and infection (5% neutropenic sepsis, 6% non-neutropenic sepsis). In 26% with death from progressive disease, the patient was first cycle of first line treatment for metastatic disease. In the majority discussion regarding treatment aims and risks was documented. Only one patient was receiving SACT with curative intent, who died from appropriately managed neutropenic sepsis.

A definitive decision regarding SACT's role in death was made in 60%: in 49% SACT was deemed non-contributory and in 11% SACT was deemed the cause of death. In 40% SACT did not play a major role, but a definitive negative association could not be made.

Conclusion: Development of a robust review process of 30-day mortality after SACT established a benchmark for SACT delivery for future comparisons and identified areas for SACT service organisation improvement. Moreover it encourages individual practice reflection and highlights the importance of balancing patients' needs and concerns with realistic outcomes and risks, particularly in heavily pre-treated patients or those of poor performance status.

Promoting self-regulated learning in technology enhanced learning environments : keeping a digital track of the learning process

Tese de doutoramento (co-tutela), Psicologia (Psicologia da Educação), Faculdade de Psicologia da Universidade de Lisboa, Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, Technial University of Darmstadt, 2014

Interpersonal Relationships in the Primary Classroom: an Analysis of Social and Affective Outcomes

Recent research regarding the quality of relationships in primary classrooms has focused largely on the enhancement and development of cognitive skills. The study reported here focused on a range of social and affective outcomes with the intention of broadening our understanding of the classroom as an interactive system, from the child's perspective. This paper provides empirical evidence on children's perceptions at Key Stage 2 (pupil age 7-11 years) of their relationships with teachers, other adults and children. Data were collected via an attitudinal questionnaire survey in nine primary schools in England. Results indicate that, in addition to the development of social skills, children also valued academic confidence, learning and the involvement of their parents in homework, and that these were associated with the interactions and routines established within the primary classroom settings. Some variations in terms of pupil age, teacher career phase, and the socio-economic context of the school were identified; however, the importance of the relationship between pupil and teacher remained consistent across schools.

From engagement to outcomes: measuring the impact of researcher training using the rugby team impact framework

This study addresses our approach to the difficult task of measuring the impact of an eLearning service, the Graduate Virtual Research Environment (GVRE), provided to doctoral students at a UK University since October 2009. The GVRE provides research students with access to a training needs analysis tool which is linked to a repository of video learning resources created by academics and experienced research students. This paper explores the use of the Rugby Team Impact Framework as a guide to measuring impact and our use of a number of techniques to gather evidence about the changes resulting from use of the GVRE. The framework gives four levels of evidence, starting with simple measures of provision, through attendance, interest and to outcomes. As with other research, we found the former easy to assess but the outcomes harder to define. We conclude with a critical evaluation of our research process and outcomes.

The Advancing MOOCs for Development Initiative: An examination of MOOC usage for professional workforce development outcomes in Colombia, the Philippines, & South Africa

The potential of online learning has long afforded the hope of providing quality education to anyone, anywhere in the world. The recent development of Massive Open Online Courses (MOOCs) heralded an exciting new breakthrough by providing free academic instruction and professional skills development from the world’s leading universities to anyone with the sufficient resources to access the internet. The research in Advancing MOOCs for Development Initiative study was designed to analyze the MOOC landscape in developing countries and to better understand the motivations of MOOC users and afford insights on the advantages and limitations of MOOCs for workforce development outcomes. The key findings of this study challenge commonly held beliefs about MOOC usage in developing countries, defying typical characterizations of how people in resource constrained settings use technology for learning and employment. In fact, some of the findings are so contrary to what has been reported in the U.S. and other developed environments that they raise new questions for further investigation.

Leading as designing: how educational developers in leadership and management studies can use architectural design to facilitate student learning about delivering innovation

This paper describes a qualitative observational study of how a work based learning masters leadership development programme for middle managers in health and social care in the UK introduced students to key aspects of delivering innovation, through a formative assignment on contemporary architectural design. Action learning and activity theoretical approaches were used to enable students to explore common principles of leading the delivery of innovation. Between 2001 and 2013 a total of 89 students in 7 cohorts completed the assignment. Evaluation lent support for the view that the assignment provided a powerful learning experience for many. Several students found the creativity, determination and dedication of architects, designers and structural engineers inspirational in their ability to translate a creative idea into a completed artefact, deploy resources and negotiate complex demands of stakeholders. Others expressed varying levels of self-empowerment as regards their capacity for fostering an equivalent creativity in self and others. Theoretical approaches in addition to activity theory, including Engeström’s concepts of stabilisation knowledge and possibility knowledge, are discussed to explain these differing outcomes and to clarify the challenges and opportunities for educational developers seeking to utilise cross-disciplinary, creative approaches in curriculum design.

Adaptive learning in agents behaviour: a framework for electricity markets simulation

Electricity markets are complex environments with very particular characteristics. A critical issue regarding these specific characteristics concerns the constant changes they are subject to. This is a result of the electricity markets’ restructuring, which was performed so that the competitiveness could be increased, but it also had exponential implications in the increase of the complexity and unpredictability in those markets scope. The constant growth in markets unpredictability resulted in an amplified need for market intervenient entities in foreseeing market behaviour. The need for understanding the market mechanisms and how the involved players’ interaction affects the outcomes of the markets, contributed to the growth of usage of simulation tools. Multi-agent based software is particularly well fitted to analyze dynamic and adaptive systems with complex interactions among its constituents, such as electricity markets. This dissertation presents ALBidS – Adaptive Learning strategic Bidding System, a multiagent system created to provide decision support to market negotiating players. This system is integrated with the MASCEM electricity market simulator, so that its advantage in supporting a market player can be tested using cases based on real markets’ data. ALBidS considers several different methodologies based on very distinct approaches, to provide alternative suggestions of which are the best actions for the supported player to perform. The approach chosen as the players’ actual action is selected by the employment of reinforcement learning algorithms, which for each different situation, simulation circumstances and context, decides which proposed action is the one with higher possibility of achieving the most success. Some of the considered approaches are supported by a mechanism that creates profiles of competitor players. These profiles are built accordingly to their observed past actions and reactions when faced with specific situations, such as success and failure. The system’s context awareness and simulation circumstances analysis, both in terms of results performance and execution time adaptation, are complementary mechanisms, which endow ALBidS with further adaptation and learning capabilities.

Learning new tricks: Corticostriatal dynamics during novel skill learning

Learning novel actions and skills is a prevalent ability across multiple species and a critical feature for survival and competence in a constantly changing world. Novel actions are generated and learned through a process of trial and error, where an animal explores the environment around itself, generates multiple patterns of behavior and selects the ones that increase the likelihood of positive outcomes. Proper adaptation and execution of the selected behavior requires the coordination of several biomechanical features by the animal. Cortico-basal ganglia circuits and loops are critically involved in the acquisition, learning and consolidation of motor skills.(...)

An exploratory study of nurses' perceptions of their action learning experience /

Each year, the College of Nurses of Ontario (CNO) requires all registered nurses and registered practical nurses in Ontario to complete a Reflective Practice learning activity. In doing so, nurses are expected to perform a self- assessment, identify a practice problem or issue, create and implement a personal learning plan, and evaluate the learning and outcomes accomplished. The process and components of CNO's Reflective Practice program are very similar to an Action Learning activity. The purpose of this qualitative research was to explore the perceptions of 1 1 nurses who completed at least 1 Action Learning activity. Data analysis of their comments provided insight into their perceptions of the Action Learning experience, perceptions of the negative and positive characteristics of various activities within the Action Learning process, and perceptions of barriers or challenges within this experience. The author concluded that participants perceived their Action Learning activities to be a positive experience because the process focused on practice problems and issues, enhanced thinking about practice problems, and achieved practice-relevant outcomes. However, the results indicated that self-directed learning and journal writing were difficult activities for some participants, and some experienced negative emotional responses during reflection. The research concluded that barriers to implementation of Action Learning include a lack of understanding of the process and a perceived lack of support from employers.

Therapeutic riding : learning and recovery for people with disabilities

The purpose ofthis study was to explore the process oftherapeutic riding as an experiential and holistic approach to learning and recovery for people with disabilities as perceived by the providers oftherapeutic riding. To enhance the connection between theory and practice and to suggest future research, the researcher endeavoured to develop a theory that contributed to the knowledge base oftherapeutic riding, animal-assisted therapy and education, experiential education, and experiential therapy in addition to contributing to connections among them. This topic was investigated because ofthe lack ofresearch about the process of therapeutic riding, particularly from learning and a recovery perspective. Few studies have addressed how therapeutic riding outcomes are achieved or how the therapeutic riding process actually works. This study was identified as grounded theory using qualitative data through interviews and narrative reflections with therapeutic riding providers, a researcher's journal, field notes, and written documents. Grounded theory analysis was used to analyze the qualitative data. This consisted ofdoing open, axial, and selective coding. This study provided detailed descriptions ofthe research approach, researcher's involvement, participant and site selection, data collection and analysis, methodological assumptions and limitations, credibility established, and ethical considerations. The findings ofthe data analysis revealed the theme ofrelationships as central to the learning and recovery process oftherapeutic riding for people with disabilities. The significance ofthe team relationships, the horse and rider relationship, and the providers and rider relationship was found. The essential components ofthe learning and recovery process were presented in a diagram in the selective coding phase. Goals oftherapeutic riding included psycho-education; behavioural and social; physical; and equestrian. Parts ofthe process ofhow outcomes were achieved included motivation; "opens new doors;" risk; task analysis; control; communication; and environmental factors. Outcomes of therapeutic riding included independence and mobility; confidence; and transfer abilities or skills. The implications ofthese findings for theory, practice, and further research were also. explored.

Examining the influence of family support on diabetes education behavioural outcomes

The purpose of this study was to examine the influence of family support on diabetes education behavioural outcomes, specifically in relation to diet, exercise, and blood glucose monitoring in adult individuals with Type 2 diabetes. Fifty-three individuals attending diabetes education for the first time were followed approximately 1 month. The findings for the influence of family support were mixed. Family attending diabetes class with participants had a positive influence with respect to diet. This is consistent with Carl Rogers (1969) who espouses setting a positive climate for learning and that learning new attitudes or information comes when external barriers are at a minimum. However family attending class with participants had no influence with respect to exercise or blood glucose monitoring. The family support action of encouraging with respect to diet overall did not influence healthy eating behaviours except for decreased skipped meals and scheduled snacks. In fact, in the areas of family willing to make healthy choices along with participant, the less the family was involved in encouraging, the better the participant did. Exercise on the other hand was influenced positively by family encouragement. This is consistent with Bandura's theory that enhancement of self-confidence and self-efficacy can lead to desired behaviour changes. Family encouragement however did not appear to influence blood glucose monitoring behaviours. This study has implications for practice in that diabetes education programs can encourage family to attend classes or get involved in encouraging the person with diabetes, so that it may help to increase healthy eating behaviours and exercise. As time is necessary to implement changes in behaviour, future research can look at the influence of family support over a 6-month, I-year, or greater period.

Assessment done write : using collaboration to reculture teacher learning

This study examined the impact that collaborative learning had on the assessment and evaluation of writing practices of a group of teachers as they engaged in a community of learners. The study explored the development of teacher knowledge and perceptions as well as the implementation of effective assessment strategies in writing for students in grades 4 to 8 that could be achieved through collaboration. Teachers' perceptions of the value of collaboration were also embedded within the study. Multiple methods of data collection were used to gather rich and descriptive data. Those methods included interviews, observation, and documentation of meetings and of participants' perceptions of their assessment and evaluation practices. Five preexisting themes describing desired outcomes of change were used to analyze the data. These themes included: knowledge, attitude, skill, aspiration, and behaviour. While it was difficult to identify definitively the degree oflearning achieved by the participants, conclusions can be drawn that the participants experienced learning and some change in the areas of knowledge and skill, attitude, aspiration, and behaviour. What was notable was the continued belief on the part of the participants of the value of collaboration as a means of learning.

Efficiency and Equity in Learning Communities and schools

Traditionally, school efficiency has been measured as a function of educational production. In the last two decades, however, studies in the economics of education have indicated that more is required to improve school efficiency: researchers must explore how significant changes in school organization affect the performance of at-risk students. In this paper we introduce Henry Levin’s adoption of the X-efficiency approach to education and we describe the efficient and cost-effective characteristics of one Learning Communities Project School that significantly improved its student outcomes and enrollment numbers and reduced its absenteeism rate to zero. The organizational change that facilitated these improvements defined specific issues to address. Students’ school success became the focus of the school project, which also offered specific incentives, selected teachers, involved parents and community members in decisions, and used the most efficient technologies and methods. This case analysis reveals new two elements—family training and community involvement—that were not explicit parts of Levin’s adaptation. The case of the Antonio Machado Public School should attract the attention of both social scientists and policy makers

La Autogestión del aprendizaje y la autonomía e iniciativa personal = The self-regulation of learning and autonomy and personal Initiative

En esta investigación se trata de vincular la autogestión del aprendizaje con el desarrollo de la autonomía personal, la cual favorece el aprendizaje a lo largo de la vida. Partimos, en este proyecto de investigación, de la hipótesis de que la autogestión del aprendizaje es un elemento multidimensional cuya mejora revierte de forma positiva en el desarrollo de la autonomía e iniciativa personal. En esta comunicación se presentan los resultados obtenidos en la aplicación de la fase piloto de un proyecto más amplio, en el que se ha recogido información a través de autoinforme sobre las distintas estrategias y aspectos de la autogestión del aprendizaje y sobre la autonomía e iniciativa personal. Los resultados indican que, en general, hay una relación significativa positiva moderada entre las estrategias de aprendizaje y la autonomía, lo que confirma la importancia de ambos aspectos para favorecer el desarrollo integral de los estudiantes. El fomento de las estrategias de aprendizaje hace que los estudiantes desarrollen la autonomía. A su vez, exponer a los estudiantes a situaciones de aprendizaje que fomenten su autonomía mejora su competencia para aprender

The effectiveness of assessment learning objects produced using pair programming

Pair Programming is a technique from the software development method eXtreme Programming (XP) whereby two programmers work closely together to develop a piece of software. A similar approach has been used to develop a set of Assessment Learning Objects (ALO). Three members of academic staff have developed a set of ALOs for a total of three different modules (two with overlapping content). In each case a pair programming approach was taken to the development of the ALO. In addition to demonstrating the efficiency of this approach in terms of staff time spent developing the ALOs, a statistical analysis of the outcomes for students who made use of the ALOs is used to demonstrate the effectiveness of the ALOs produced via this method.