Treatment of Unexplained Chronic Cough: CHEST Guideline and Expert Panel Report

Background: Unexplained chronic cough (UCC) causes significant quality of life impairment. There is a need to identify effective assessment and treatment approaches for UCC.

Methods: This systematic review of randomized controlled clinical trials asked: What is the efficacy of treatment compared to usual care on cough severity, cough frequency, and cough-related quality of life in patients with unexplained chronic cough (UCC)? Studies of adults and adolescents >12 years with a chronic cough of >8 weeks duration that was unexplained after systematic investigation and treatment were included and assessed for relevance and quality. Based upon the systematic review, guideline suggestions were developed and voted upon using CHEST organization methodology.

Results: 11 RCTs and 5 systematic reviews were included. The 11 RCTs reported data on 570 participants with chronic cough who received a variety of interventions. Study quality was high in 10 RCTs. The studies used a variety of descriptors and assessments to identify unexplained chronic cough. While gabapentin and morphine showed positive effects on cough-related quality of life, only gabapentin was supported as a treatment recommendation. Studies of inhaled corticosteroids (ICS) suffered from intervention fidelity bias, and when this was addressed, ICS were not found to be effective for UCC. Esomeprazole was not effective for UCC without features of gastroesophageal acid reflux. Studies addressing non-acid gastroesophageal reflux were not identified. A multimodality speech pathology intervention improved cough severity.

Conclusions: The evidence supporting the diagnosis and management of UCC is limited. UCC requires further study to establish agreed terminology and the optimal methods of investigation using established criteria for intervention fidelity. Speech pathology based cough suppression is suggested as a treatment option for UCC. This guideline presents suggestions for diagnosis and treatment based on the best available evidence and identifies gaps in our knowledge and areas for future research.

Assessment of Intervention Fidelity and Recommendations for Researchers Conducting Studies on the Diagnosis and Treatment of Chronic Cough in the Adult: CHEST Guideline and Expert Panel Report

BACKGROUND: Successful management of chronic cough has varied in the primary research studies in the reported literature. One of the potential reasons relates to a lack of intervention fidelity to the core elements of the diagnostic and/or therapeutic interventions that were meant to be used by the investigators.

METHODS: We conducted a systematic review to summarize the evidence supporting intervention fidelity as an important methodologic consideration in assessing the effectiveness of clinical practice guidelines used for the diagnosis and management of chronic cough. We developed and used a tool to assess for five areas of intervention fidelity. Medline (PubMed), Scopus, and the Cochrane Database of Systematic Reviews were searched from January 1998 to May 2014. Guideline recommendations and suggestions for those conducting research using guidelines or protocols to diagnose and manage chronic cough in the adult were developed and voted upon using CHEST Organization methodology.

RESULTS: A total of 23 studies (17 uncontrolled prospective observational, two randomized controlled, and four retrospective observational) met our inclusion criteria. These articles included 3,636 patients. Data could not be pooled for meta-analysis because of heterogeneity. Findings related to the five areas of intervention fidelity included three areas primarily related to the provider and two primarily related to the patients. In the area of study design, 11 of 23 studies appeared to be underpinned by a single guideline/protocol; for training of providers, two of 23 studies reported training, and zero of 23 reported the use of an intervention manual; and for the area of delivery of treatment, when assessing the treatment of gastroesophageal reflux disease, three of 23 studies appeared consistent with the most recent guideline/protocol referenced by the authors. For receipt of treatment, zero of 23 studies mentioned measuring concordance of patient-interventionist understanding of the treatment recommended, and zero of 23 mentioned measuring enactment of treatment, with three of 23 measuring side effects and two of 23 measuring adherence. The overall average intervention fidelity score for all 23 studies was poor (20.74 out of 48).

CONCLUSIONS: Only low-quality evidence supports that intervention fidelity strategies were used when conducting primary research in diagnosing and managing chronic cough in adults. This supports the contention that some of the variability in the reporting of patients with unexplained or unresolved chronic cough may be due to lack of intervention fidelity. By following the recommendations and suggestions in this article, researchers will likely be better able to incorporate strategies to address intervention fidelity, thereby strengthening the validity and generalizability of their results that provide the basis for the development of trustworthy guidelines.

Think, code, succeed: The Programming Studio as a games-based collaboration:Paper published in the Proceedings of the Association for Teacher Education in Europe conference: Teacher Education through Partnerships and Collaborative Learning Communities, Glasgow, UK. ATEE, 2015

This paper investigates the profile of teachers in the island of Ireland who declared themselves willing to undertake professional development activities in programming, in particular to master programming by taking on-line courses involving the design of computer games. Using the Technology Acceptance Model (TAM), it compares scores for teachers “willing” to undertake the courses with scores for those who declined, and examines other differences between the groups of respondents. Findings reflect the perceived difficulties of programming and the current low status accorded to the subject in Ireland. The paper also reviews the use of games-based learning as a “hook” to engage learners in programming and discusses the role of gamification as a tool for motivating learners in an on-line course. The on-line course focusing on games design was met with enthusiasm, and there was general consensus that gamification was appropriate for motivating learners in structured courses such as those provided.

'This is a beautiful school.' 'This school is useless!' Explaining disengagement in a Greek vocational school through the examination of teacher ideologies

This multimethod case study of a Greek vocational school explored teachers’ culture (including beliefs about education, teachers’ role, and students’ nature) using the concept of Pupil Control Ideology to explain problems of disengagement and low morale among staff and students, as well as tensions in relationships. A prominent custodial culture was identified in the school using a functional/apolitical pedagogy to transmit ‘legitimate’ knowledge to students whose working-class background did not produce desired outcomes. This generated deficit views of students, teachers’ sympathy, and a seemingly caring school ethos which was, nevertheless, oppressive. Students’ failings were naturalised and vocational education misinterpreted as merely a streaming device in a system honouring academic achievement and middle-class ways. Teachers were blind to these cultural subtleties, believing they acted ‘rationally’ and altruistically. A humanistic subculture emphasising student empowerment and social transformation consisted of a minority of teachers and was rather marginalised. This disallowed meaningful dialogue and the identification of an alternative rationale for the sector, generating strong feelings of futility. Positive change in this school necessitated the deconstruction and (subsequent) reconstruction of custodial teachers’ worldview as embedded in their practice.

Formação de professores de ciências para o uso de tecnologias

Na atualidade, torna-se premente que os alunos exerçam um papel ativo face a problemáticas de cariz científico e tecnológico na sociedade em que se inserem. Neste contexto, tem sido recomendada a promoção da Educação em Ciências, com orientação Ciência-Tecnologia-Sociedade (CTS) para o desenvolvimento da Literacia científica dos alunos, em particular, do Ensino Básico (EB). As Tecnologias da Informação e Comunicação (TIC) têm-se assumido, cada vez mais, como recursos privilegiados para os alunos aprenderem ciências. Portanto, é fundamental que os professores de Ciências do EB considerem os aspetos pedagógico-didáticos relacionados com a integração das TIC no processo de ensino e aprendizagem (E/A) das Ciências. No entanto, vários estudos têm revelado que a maioria dos professores parece não integrar as TIC no processo de E/A, o que se relaciona, entre outros obstáculos, com a falta de formação a este nível. Por outro lado, em Portugal, são escassos os estudos relacionados com a formação de professores de Ciências do EB para o uso de TIC no processo de E/A, com orientação CTS. O presente estudo tem como finalidade a criação de uma proposta de esquema referencial para o desenvolvimento de programas de formação (PF) de professores de Ciências do EB com orientação CTS (inicial, contínua e pós-graduada), com vista ao desenvolvimento de “competências TIC” destes (futuros) profissionais. Para tal, procurou-se responder a duas questões de investigação: Que componentes curriculares privilegiar em PF de professores do EB, que contribuam para o desenvolvimento de competências de integração das tecnologias no processo de E/A, em geral, e das Ciências, em particular?; e Qual o contributo de um PF na promoção de práticas pedagógico-didáticas com orientação CTS de Professores de Ciências do EB? O estudo organizou-se em duas fases. A Fase I designou-se “Formação de Professores do Ensino Básico em Tecnologia Educativa”, decorreu entre janeiro de 2009 e novembro de 2009, e teve um caráter exploratório com vista a descrever estratégias para a promoção do desenvolvimento pessoal, social e profissional, em particular, na dimensão do Conhecimento Pedagógico Tecnológico de Conteúdo (CPTC), de estudantes/professores do EB (inicial, contínua e pós-graduada). O CPTC representa o conhecimento de professores do EB para integrar as TIC no processo de E/A das Ciências, de acordo com a Perspetiva de Ensino por Pesquisa (EPP). A recolha de dados envolveu: a análise documental de vinte e três unidades curriculares (UC) de Tecnologia Educativa (TE) de Cursos de Educação Básica (1.º Ciclo de Bolonha), de dezassete Instituições de Ensino Superior Público Português; e o inquérito por entrevista a quatro Investigadores Portugueses em TE. A análise de conteúdo do corpus recolhido possibilitou a identificação dos componentes curriculares a privilegiar em PF de professores do EB neste âmbito, tais como: i) a “competência digital” de “pesquisa, seleção e organização de informação”; ii) a “competência pedagógica com TIC” de “planificação e/ou implementação de atividades de E/A”; iii) a “competência pedagógica com TIC de nível avançado” de reflexão crítica; iv) o conteúdo curricular centrado na colaboração online; v) a estratégia/atividade de E/A de trabalho de projeto; vi) o cenário de E/A misto (b-learning); vii) as ferramentas da web 2.0 (ex. Blog); e viii) a avaliação formativa de portefólios digitais desenvolvidos pelos estudantes/professores do EB em formação. A Fase II denominou-se “Formação de Professores de Ciências do Ensino Básico com Orientação CTS”, decorreu entre dezembro de 2009 e maio de 2011, e teve um caráter interventivo, com o intuito de conceber, produzir, implementar e avaliar um PF com esta orientação. O PF foi integrado nas UC de “TIC e Educação em Ciências” (TIC_EC) e de “Didática das Ciências Integradas II” (DCI_II) do Mestrado em Didática, área de especialização das Ciências, da Universidade de Aveiro (no 2.º semestre do ano letivo 2009/2010). O Mestrando dirigiu-se a um público profissionalizado, em particular, Educadores de Infância, Professores do 1.º CEB e Professores de Matemática e Ciências Naturais do 2.º CEB. A avaliação do PF foi contínua durante todo o seu processo de desenvolvimento, o que implicou a recolha das perceções dos principais envolvidos (os dois Docentes de DCI_II e de TIC_EC, os nove Mestrandos, um especialista externo em TE e a Investigadora do estudo). Para tal recorreu-se ao inquérito por questionário e por entrevista, à observação participante da Investigadora e à análise dos portefólios digitais desenvolvidos pelos Mestrandos durante o PF. A avaliação final do PF ocorreu no final do mesmo e dez meses após a formação ter terminado (maio de 2011). A análise de conteúdo do corpus recolhido permitiu demonstrar que o PF foi exequível e eficaz no contexto em que se projetou, o que se comprova na evidência de práticas pedagógico-didáticas de utilização das TIC no processo de E/A das Ciências, com orientação CTS, por parte de Mestrandos envolvidos no PF. O esquema referencial resultante do estudo integra a “estratégia de investigação conduzida pelo professor”, pressupõe a sinergia entre as áreas científicas da Didática das Ciências (DC) e da TE, e implica a integração da dimensão do CPTC ao nível da formação de professores de Ciências do EB (inicial, contínua e pós-graduada). Neste âmbito, sugere-se o desenvolvimento de projetos CTS pelos (futuros) profissionais, com recurso às TIC, e tendo em conta a perspetiva de EPP. Considera-se que estudos desta natureza poderão ser um contributo para impulsionar a Educação em Ciências com orientação CTS recorrendo às potencialidades educativas das tecnologias, em particular no EB. Assim, preconiza-se a necessidade de se investir na transferência, expansão e avaliação do referencial a outros contextos de formação de professores de Ciências.

Pathways to teacher education for intercultural communicative competence: teachers’ perceptions

Intercultural and plurilingual encounters have become increasingly frequent due to Information and Communication Technologies (ICT) developments, mobility (real/ virtual) and migration. To face the challenges inherent in such encounters, the development of intercultural communicative competence (ICC) is crucial. ICC development may start in the home but should also be a commitment in school curricula, in particular in language classrooms. To facilitate this, language teachers require training in order to integrate the intercultural dimension into their professional practice. In such a context, we implemented a training programme entitled The Intercultural Teacher with an experimental group of language teachers from secondary schools in the Aveiro district (Portugal). In this article, we describe teachers’ social perceptions of ICC and explore the following questions: (a) what does ICC mean for language teachers?; and (b) what are teachers’ views on the development of ICC? The findings of this analysis enabled us, firstly, to design a heuristic model of ICC, based on teachers’ views and perceptions. We were then able to identify some pathways for developing ICC through teacher education, which were validated by teachers themselves.

The militarisation of English schools: Troops to Teaching and the implications for Initial Teacher Education and race equality

This article considers the implications of the Troops to Teaching (TtT) programme, to be introduced in England in autumn 2013, for Initial Teacher Education (ITE) and race equality. TtT will fast-track ex-armed service members to teach in schools, without necessarily the requirement of a university degree. Employing theories of white supremacy, and Althusser’s (1971) concept of Ideological and Repressive State Apparatus, I argue that this initiative both stems from, and contributes to, a system of social privilege and oppression in education. Despite appearing to be aimed at all young people, the planned TtT initiative is actually aimed at poor and racially subordinated youth. This is likely to further entrench polarisation in a system which already provides two tier educational provision: TtT will be a programme for the inner-city disadvantaged, whilst wealthier, whiter schools will mostly continue to get highly qualified teachers. Moreover, TtT contributes to a wider devaluing of current ITE; ITE itself is rendered virtually irrelevant, as it seems TtT teachers will not be subject specialists, rather will be expected to provide military-style discipline, the skills for which they will be expected to bring with them. More sinister, I argue that TtT is part of the wider militarisation of education. This military-industrial-education complex seeks to contain and police young people who are marginalised along lines of race and class, and contributes to a wider move to increase ideological support for foreign wars - both aims ultimately in the service of neoliberal objectives which will feed social inequalities.

Teacher education in the United Kingdom post devolution: convergences and divergences

This paper examines the roles of research in teacher education across the four nations of the United Kingdom. Both devolution and on-going reviews of teacher education are facilitating a greater degree of cross-national divergence. England is becoming a distinct outlier, in which the locus for teacher education is moving increasingly away from Higher Education Institutions and towards an ever-growing number of school-based providers. While the idea of teaching as a research-based profession is increasingly evident in Scotland, Northern Ireland and Wales, it seems that England, at least in respect of the political rhetoric, recent reforms and explicit definitions, is fixed on a contrastingly divergent trajectory towards the idea of teaching as a craft-based occupation, with a concomitant emphasis on a (re)turn to the practical. It is recommended that research is urgently needed to plot these divergences and to examine their consequences for teacher education, educational research and professionalism.

The Role of Teacher Presence during Computer Supported Online Collaborative Sessions in an Adult Education Course.

The convenience sample for this study was taken from an A.E.C. (Attestation of Collegial Studies) Communication course of the Continuing Education Technical Support Program. A key component of this course competency is for students to develop the skill to write business letters for various purposes and to apply the three-step writing process during the crafting of the correspondence. This is achieved with a number of writing assignments which are carried out by students working in teams and completing the writing assignments out-of-class. the out-of-class work was convened using the PrimaryPad program to complete two of the writing assignments, which formed the basis of the research. This research uses a case study design that employed a repeated measures method with two conditions (teacher scaffolding vs. no teacher scaffolding). The possibility of an order effect was controlled for by using a counterbalancing of treatment design. A post-treatment questionnaire was used to gather descriptive statistics.

A consultoria num Agrupamento TEIP II : contributos para a compreensão do seu processo

Tese de mestrado, Educação (Supervisão e Orientação da Prática profissional), Universidade de Lisboa, Instituto de Educação, 2012

Role of Automated Open Source Systems in the Intelligence Analysis of a High-Level Domain Expert

The role of implicit theories in the formation of expert opinion in portuguese criminal law

Tese de doutoramento, Ciências e Tecnologias da Saúde (Medicina Legal e Ciências Forenses), Universidade de Lisboa, Faculdade de Medicina, 2014