Technological aids for the rehabilitation of memory and executive functioning in children and adolescents with acquired brain injury (Review).

Background The use of technology in healthcare settings is on the increase and may represent a cost-effective means of delivering rehabilitation. Reductions in treatment time, and delivery in the home, are also thought to be benefits of this approach. Children and adolescents with brain injury often experience deficits in memory and executive functioning that can negatively affect their school work, social lives, and future occupations. Effective interventions that can be delivered at home, without the need for high-cost clinical involvement, could provide a means to address a current lack of provision. We have systematically reviewed studies examining the effects of technology-based interventions for the rehabilitation of deficits in memory and executive functioning in children and adolescents with acquired brain injury. Objectives To assess the effects of technology-based interventions compared to placebo intervention, no treatment, or other types of intervention, on the executive functioning and memory of children and adolescents with acquired brain injury. Search methods We ran the search on the 30 September 2015. We searched the Cochrane Injuries Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), EMBASE Classic + EMBASE (OvidSP), ISI Web of Science (SCI-EXPANDED, SSCI, CPCI-S, and CPSI-SSH), CINAHL Plus (EBSCO), two other databases, and clinical trials registers. We also searched the internet, screened reference lists, and contacted authors of included studies. Selection criteria Randomised controlled trials comparing the use of a technological aid for the rehabilitation of children and adolescents with memory or executive-functioning deficits with placebo, no treatment, or another intervention. Data collection and analysis Two review authors independently reviewed titles and abstracts identified by the search strategy. Following retrieval of full-text manuscripts, two review authors independently performed data extraction and assessed the risk of bias. Main results Four studies (involving 206 participants) met the inclusion criteria for this review. Three studies, involving 194 participants, assessed the effects of online interventions to target executive functioning (that is monitoring and changing behaviour, problem solving, planning, etc.). These studies, which were all conducted by the same research team, compared online interventions against a 'placebo' (participants were given internet resources on brain injury). The interventions were delivered in the family home with additional support or training, or both, from a psychologist or doctoral student. The fourth study investigated the use of a computer program to target memory in addition to components of executive functioning (that is attention, organisation, and problem solving). No information on the study setting was provided, however a speech-language pathologist, teacher, or occupational therapist accompanied participants. Two studies assessed adolescents and young adults with mild to severe traumatic brain injury (TBI), while the remaining two studies assessed children and adolescents with moderate to severe TBI. Risk of bias We assessed the risk of selection bias as low for three studies and unclear for one study. Allocation bias was high in two studies, unclear in one study, and low in one study. Only one study (n = 120) was able to conceal allocation from participants, therefore overall selection bias was assessed as high. One study took steps to conceal assessors from allocation (low risk of detection bias), while the other three did not do so (high risk of detection bias). Primary outcome 1: Executive functioning: Technology-based intervention versus placebo Results from meta-analysis of three studies (n = 194) comparing online interventions with a placebo for children and adolescents with TBI, favoured the intervention immediately post-treatment (standardised mean difference (SMD) -0.37, 95% confidence interval (CI) -0.66 to -0.09; P = 0.62; I2 = 0%). (As there is no 'gold standard' measure in the field, we have not translated the SMD back to any particular scale.) This result is thought to represent only a small to medium effect size (using Cohen’s rule of thumb, where 0.2 is a small effect, 0.5 a medium one, and 0.8 or above is a large effect); this is unlikely to have a clinically important effect on the participant. The fourth study (n = 12) reported differences between the intervention and control groups on problem solving (an important component of executive functioning). No means or standard deviations were presented for this outcome, therefore an effect size could not be calculated. The quality of evidence for this outcome according to GRADE was very low. This means future research is highly likely to change the estimate of effect. Primary outcome 2: Memory One small study (n = 12) reported a statistically significant difference in improvement in sentence recall between the intervention and control group following an eight-week remediation programme. No means or standard deviations were presented for this outcome, therefore an effect size could not be calculated. Secondary outcomes Two studies (n = 158) reported on anxiety/depression as measured by the Child Behavior Checklist (CBCL) and were included in a meta-analysis. We found no evidence of an effect with the intervention (mean difference -5.59, 95% CI -11.46 to 0.28; I2 = 53%). The GRADE quality of evidence for this outcome was very low, meaning future research is likely to change the estimate of effect. A single study sought to record adverse events and reported none. Two studies reported on use of the intervention (range 0 to 13 and 1 to 24 sessions). One study reported on social functioning/social competence and found no effect. The included studies reported no data for other secondary outcomes (that is quality of life and academic achievement). Authors' conclusions This review provides low-quality evidence for the use of technology-based interventions in the rehabilitation of executive functions and memory for children and adolescents with TBI. As all of the included studies contained relatively small numbers of participants (12 to 120), our findings should be interpreted with caution. The involvement of a clinician or therapist, rather than use of the technology, may have led to the success of these interventions. Future research should seek to replicate these findings with larger samples, in other regions, using ecologically valid outcome measures, and reduced clinician involvement.

What is being taught in Religious Education classes in Northern Ireland and to what extent should states be concerned about regulation, quality and control of the subject?

This paper reports on a research project designed to discover what schools are teaching in Religious Education in Northern Ireland and what procedures are in place to maintain standards in the delivery of the subject. A search through literature shows that little research has been carried out to determine what is being taught in Religious Education in Northern Ireland. It also indicates that there are very weak systems of control to measure the effectiveness or quality of what is delivered. A survey of the websites of all Post-Primary schools in the region was used to provide some answers to the basic question of what is being taught in RE. Using content and discourse analysis of these alongside supporting documentary sources (textbooks and exam specifications), it is possible to get a clearer picture of how the Northern Ireland Core Syllabus for Religious Education and any additional curricular elements are delivered in schools. The findings show that a significant minority of schools do not publicly articulate what pupils do in religious education. In situations where the content of religious education is made clear, some definite trends are evident. Despite the existence of a statutory core syllabus, there is significant variation in what is taught in schools. The content is most divergent from the syllabus in relation to the teaching of World Religions at Key Stage 3 and at Key Stage 4 whole elements of the syllabus are neglected due to limited conformity between the syllabus and exam specifications. These results raise important questions about the systems of regulation and control of the subject in the region. In law the subject is exempt from formal inspection by the local inspection authority; instead, a form of inspection is allowed for by the Christian churches who design the syllabus, but it is a process that is either entirely neglected or entirely unreported in situations where it does occur. It is argued that these findings raise questions of more general concern for this and other regions in Europe where the teaching of religious education is largely unregulated. For example, to what extent should states take an interest in what is taught in religious education, how it is delivered, what values it promotes and how standards of teaching and learning in the subject are upheld?

Participating in a fruit and vegetable intervention trial improves longer term fruit and vegetable consumption and barriers to fruit and vegetable consumption: a follow-up of the ADIT study

BACKGROUND: Fruit and vegetable (FV) based intervention studies can be effective in increasing short term FV consumption. However, the longer term efficacy of such interventions is still unclear. The aim of the current study was to examine the maintenance of change in FV consumption 18-months after cessation of a FV intervention and to examine the effect of participating in a FV intervention on barriers to FV consumption.

METHODS: A follow-up of a randomised controlled FV trial in 83 older adults (habitually consuming ≤2 portions/day) was conducted. At baseline, participants were assigned to continue consuming ≤2 portions FV/day or consume ≥5 portions FV/day for 16-weeks. We assessed FV intake and barriers to FV consumption at baseline, end of intervention and 18-months post-intervention.

RESULTS: At 18-months, mean FV intakes in both groups were greater than baseline. The 5 portions/day group continued to show greater increases in FV consumption at 18-months than the 2 portions/day group (p < 0.01). At 18-months, both groups reported greater liking (p < 0.01) and ease in consuming FV (p = 0.001) while difficulties with consuming FV decreased (p < 0.001). The 2 portions/day group reported greater awareness of FV recommendations at 18-months (p < 0.001).

CONCLUSIONS: Participating in a FV intervention can lead to longer-term positive changes in FV consumption regardless of original group allocation.

TRIAL REGISTRATION: Clinical Trials.gov NCT00858728 .

HPV prevalence and type-distribution in cervical cancer and premalignant lesions of the cervix: A population-based study from Northern Ireland

Assessment of Human papillomavirus (HPV) prevalence and genotype distribution is important for monitoring the impact of prophylactic HPV vaccination. This study aimed to demonstrate the HPV genotypes predominating in pre-malignant and cervical cancers in Northern Ireland (NI) before the vaccination campaign has effect. Formalin fixed paraffin embedded tissue blocks from 2,303 women aged 16-93 years throughout NI were collated between April 2011 and February 2013. HPV DNA was amplified by PCR and HPV genotyping undertaken using the Roche^® linear array detection kit. In total, 1,241 out of 1,830 eligible samples (68.0%) tested positive for HPV, with the majority of these [1,181/1,830 (64.5%)] having high-risk (HR) HPV infection; 37.4% were positive for HPV-16 (n=684) and 5.1% for HPV-18 (n=93). HPV type-specific prevalence was 48.1%, 65.9%, 81.3%, 92.2%, and 64.3% among cervical intraepithelial neoplasias (CIN) Grades I-III, squamous cell carcinomas (SCC) and adenocarcinoma (AC) cases, respectively. Most SCC cases (81.3%) had only one HPV genotype detected and almost a third (32.0%) of all cervical pathologies were HPV negative including 51.9% of CIN I (n=283), 34.1% CIN II (n=145), 18.7% of CIN III (n=146), 7.8% of SCC (n=5), and 35.7% of AC (n=5) cases. This study provides important baseline data for monitoring the effect of HPV vaccination in NI and for comparison with other UK regions. The coverage of other HR-HPV genotypes apart from 16 and 18, including HPV-45, 31, 39, and 52, and the potential for cross protection, should be considered when considering future polyvalent vaccines.

Heritability of peripheral refraction in Chinese children and adolescents: the Guangzhou Twin Eye study.

PURPOSE:

To estimate the heritability of peripheral refraction in Chinese children and adolescents.

METHODS:

The authors examined 72 monozygotic (MZ) twins and 48 dizygotic (DZ) twins aged 8 to 20 years from a population-based twin registry. Temporal and nasal peripheral refraction, each 40° from the visual axis, and axial refraction were measured using an autorefractor. Relative peripheral refractive error (RPRE) was defined as the peripheral refraction minus the axial refraction. Heritability was assessed by structural equation modeling after adjustment for age and sex.

RESULTS:

The mean and SD of temporal refraction (T(40)), nasal refraction (N(40)), RPRE-T(40), RPRE-N(40), and T(40)-N(40) asymmetry were -0.27 ± 2.0 D, 0.36 ± 2.19 D, 1.18 ± 1.39 D, 1.80 ± 1.69 D, and -0.62 ± 1.58 D, respectively. The intraclass correlations for T(40) refraction, N(40) refraction, RPRE-T(40), RPRE-N(40), and T(40)-N(40) asymmetry were 0.87, 0.83, 0.65, 0.74, and 0.58 for MZ pairs and 0.49, 0.42, 0.30, 0.41, and 0.32 for DZ pairs, respectively. A model with additive genetic and unique environmental effects was the most parsimonious, with heritability values estimated as 0.84, 0.76, 0.63, 0.70, and 0.55, respectively, for the peripheral refractive parameters.

CONCLUSIONS:

Additive genetic effects appear to explain most of the variance in peripheral refraction and relative peripheral refraction when adjusting for the effects of axial refraction.

Bullying Experiences of Child and Adolescent Mental Health Service-users: A Pilot Survey

Victims and perpetrators of bullying experience a variety of psychological problems. The aim of the current pilot study was to explore the bullying experiences of Child and Adolescent Mental Health (CAMHS) service-users. The investigation was conducted as a cross-sectional survey at a community-based specialist CAMH service. A modified version of the Revised Olweus Bully/Victim Questionnaire was used to assess bullying experiences. Participants comprised an opportunity sample of 26 adolescent male and female CAMH service-users. Results indicated that 61.5% of participants reported being bullied. Clear links were made between being bullied and the mental health of participants, with 62.5% of bullied participants reporting that being bullied was a ‘‘moderately importantvery important’’ reason for their attendance at the CAMH service. Therapists at the CAMH service made appropriate enquiries about young people being victims of bullying, but more enquiries could be made about young peoples’ experiences as perpetrators. Service-users favoured therapist-led bullying interventions such as assertiveness training, therapy and/or psychological coping strategies, and social skills training. These findings underline the need for ecological approaches to dealing with bullying, and suggest that CAMH services could play an important role in establishing and supporting such interventions.

Case study investigation of indoor air quality in mechanically ventilated and naturally ventilated UK social housing

There is a significant lack of indoor air quality research in low energy homes. This study compared the indoor air quality of eight
newly built case study homes constructed to similar levels of air-tightness and insulation; with two different ventilation strategies (four homes with Mechanical Ventilation with Heat Recovery (MVHR) systems/Code level 4 and four homes naturally ventilated/Code level 3). Indoor air quality measurements were conducted over a 24 h period in the living room and main bedroom of each home during the summer and winter seasons. Simultaneous outside measurements and an occupant diary were also employed during the measurement period. Occupant interviews were conducted to gain information on perceived indoor air quality, occupant behaviour and building related illnesses. Knowledge of the MVHR system including ventilation related behaviour was also studied. Results suggest indoor air quality problems in both the mechanically ventilated and naturally ventilated homes, with significant issues identified regarding occupant use in the social homes

Portuguese Adaptation of Students Engagement in Schools International Scale (SESIS)

The importance of student’s engagement has been recently pointed out in research. However, there has been a lack of engagement assessment instrument, pertaining psychometric qualities. Objective: This paper presents the Portuguese adaptation of the “Student’s Engagement in School International Scale” (SESIS), drawn up from a12 countries international study (Lam et al., 2012; Lam et al., in press). Method: Psychometric properties of this scale were examined with data from 685 students from different grades (6th, 7th, 9th and 10th), from both sexes, and different regions of the country. Results: Factorial analysis of the results, with varimax rotation, lead to three different factors which explain 50.88% of the variance. The scale integrates the original 33 items, and cognitive, affective and behavioural dimensions. For the external validity study, the relationship between student’s engagement in school results and other school variables — academic performance, self-concept — was considered, and significant relations were observed, as expected. Conclusion: The data presented highlights the qualities of SESIS, as well as its usefulness for research purposes. Suggestion: It is suggested the investigation of the extension of SESIS’s three-dimensionality, in future studiesKeywords: Innovation, technology, research projects, etc. [Arial 10-point, justified alignment].

Portuguese Adaptation of Students Engagement in Schools International Scale (Sesis)

The importance of student’s engagement has been recently pointed out in research. However, there has been a lack of engagement assessment instruments, showing psychometric qualities, such as reliability and validity. Objective: This paper presents the Portuguese adaptation of the “Student’s Engagement in Schools International Scale” (SESIS), drawn up from 12 countries international study (Lam et al., 2012; Lam et al., in press). Method: Psychometric properties of this scale were examined using data from 685 students, of both sexes, and from different grades (6th, 7th, 9th and 10th), and regions of the country. Results: Factorial analysis of the results, with varimax rotation, conducted to three different factors which explain 62,19% of the variance. The scale integrates the original 33 items, and cognitive, affective and behavioural dimensions. For the external validity study, the relationship between student’s engagement in school results and other school variables — academic performance, school conduct — was considered, and significant relations were observed, as expected. Conclusion: The data presented highlights the qualities of SESIS, as well as its usefulness for research purpose. Suggestion: It is suggested the investigation of the extension of SESIS’s three-dimensionality, in future studies

Professional development for professional learners: teachers’ experiences in Norway, Germany and England

Proposals made by the European Commission in 2007 led to the Education Council adopting, for the first time, a European agenda for improving the quality of teaching and teacher education. This article reports on a small-scale longitudinal interview-based study with teachers in England, Norway and Germany demonstrating that while opportunities for professional development are increasing in all three countries, dissatisfaction is expressed by most teachers in relation to its quality and outcomes.

Study of transcripts and reactive oxygen species involved in the defence responses of Quercus suber against Phytophthora cinnamomi

The present work has the merit of exploring an insight into the activation of defence genes of Quercus suber during response to infection by Phytophthora cinnamomi. Thus, cDNA-AFLP methodology was used to identify gene fragments differentially present in the mRNA profiles of host cells of micropropagated Q. suber plantlets roots infected with zoospores of P. cinnamomi at different post challenge time points. Six candidate genes were selected based on their interesting cDNA-AFLP expression patterns and homology to genes known to play a role in defence. These six genes encode a cinnamyl alcohol dehydrogenase 2 (QsCAD2), a protein disulphide isomerase (QsPDI), a CC-NBS-LRR resistance protein (QsRPc), thaumatin-like protein (QsTLP), chitinase (QsCHI) and a 1,3-beta glucanase (QsGLU). The current work has been successful in evaluation of the expression of these genes by qRT-PCR. Data analysis revealed that transcript levels of QsRPc, QsCHI, QsCAD2 and QsPDI increased during the early hours of inoculation, while transcript profiles of thaumatin-like protein showed decreasing. No expression was detected for 1,3-beta-glucanase (QsGLU). Furthermore, the choice of suitable reference genes in any new experimental system is absolutely crucial in qRT-PCR; for this reason in this study and for the first time a set of potential reference genes were analyzed and validated for qRT-PCR normalization in the patho-system Phytophthora-Q. suber. Four candidate reference genes polimerase II (QsRPII), eukaryotic translation initiation factor 5A(QsEIF-5A), b-tubulin (QsTUB) and a medium subunit family protein of Clathrin adaptor complexes (QsCACs) were evaluated to determine the most stable internal references in Q. suber. Analysis of stability of genes was carried out using Genex software. Results indicated all these four potential reference genes assumed stable expression. Data analysis revealed that QsRPII and QsCACs were the two most stable genes, while genes QsTUB and QsEIF-5A were the third and the fourth most stable gene, respectively. In this study, a plasmid-based quantitative PCR method was developed to measure P. cinnamomi colonization during infection process of Q. suber. Plasmid-based detection of P. cinnamomi showed a gradual accumulation of the pathogen DNA in cork oak root tips up to 24 h post infection. The higher increase in P. cinnamomi/plasmid DNA ratio occurred between 18 and 24 h. One of the primary objectives of this research was to study the effect of cinnamomins (elicitins secreted by P. cinnamomin) on inducing defence mechanism against the pathogen, as recent histological and ultra-structural studies showed that P. cinnamomi was restricted to the outer cortex root fragments pre-treated with capsicien and cryptogein, suggesting that elicitins can stimulate plant defence reactions against P. cinnamomi. To complement these studies and to have a clear view of the nature of the interaction, the role of cinnamomins in the production of the oxidative burst [ROS and ROS scavenging enzymes such as superoxide dismutase (SOD), catalase (CAT) and peroxidase (POD)] and in the defence responses was evaluated. Cork oak seedlings were pretreated with alpha-cinnamomin and then inoculated with P. cinnamomi mycelia. Results showed a significant higher production of reactive oxygen species (ROS) (H2O2 and O2•-) in elicitin and non-elicitin treated roots in interaction with P. cinnamomi in comparison to the corresponding control. The plant group inoculated with the pathogen after cinnamomin treatment showed an earlier increase in H2O2 production but this was lower as compared with that group inoculated with P. cinnamomi alone. Also, in elicitin pre-treated group generally, a lower level of O2•− production during infection was observed as compared with inoculated roots with P. cinnamomi alone without elicitin treatment. Furthermore, in this study, we evaluated activities of antioxidant enzymes upon challenge with P. cinnamomi, with and without pretreatment with alpha cinnamomin. Results indicated that the activities of defense enzymes POD, SOD and CAT increased after P. cinnamomi inoculation when compared with those in the control group. Also, in the group treated with alpha-cinnamomin followed by P. cinnamomi inoculation, a higher level of enzymatic activities was detected as compared with elicitin non-treated group, which suggest the protective effect of alpha-cinnamomin against the pathogen due to higher elevated levels of defense enzymes POD, SOD and CAT during the infection period. Furthermore, a sensitive qPCR method was applied to measure the pathogen biomass in elicited and non-elicited Q. suber roots challenged with P. cinnamomi to elucidate the effect of cinnamomins on the colonization of P. cinnamomi. Plasmid-based quantification of P. cinnamomi showed a significant decrease in accumulation of the pathogen DNA in cork oak roots after treatment with alpha and beta-cinnamomins which attest the role of cinnamomins in promoting defense responses in cork oak against P. cinnamomi invasion.

In vitro study of the effect of wound dressings on planktonic and biofilms from diabetic foot isolates

The management of wound bioburden has previously been evaluated using various antimicrobial wound dressings on bacterial pathogens isolated from various wounds. In this present study, the antimicrobial effect of silver-impregnated dressings (Acticoat and Silvercel) and honey-impregnated dressing (Medihoney™ Apinate) on both planktonic bacteria and quasi-biofilms by Staphylococcus aureus and Proteus mirabilis were assessed using a 6-well plate and standard agar technique. In the 6-well plate assay, a bacterial suspension of 108 colony forming unit (CFU)/mL was inoculated on each dressing in excess Luria-Bertani broth and incubated at 35 – 37°C for 30 and 60 minutes and 24 hours. After each incubation time, bacteria were recovered in sodium thioglycolate solution (STS) and the CFU/mL determined on LB agar. Dressings were cut into circular shapes (2cm diameter and placed on Mueller Hinton agar plates pre-inoculated with bacterial suspensions to determine their zones of inhibition (ZOI) after 24 hours incubation. None of the dressings was effective to significantly inhibit bacterial growth or biofilm formation at all the times tested. Acticoat and Medihoney™ Apinate produced ZOIs between 1.5 – 15 mm against both Staphylococcus aureus and Proteus mirabilis. It is possible that, dressings augmented with antibiotics can significantly reduce quasi-biofilms on standard agar.

Challenges in the creation and development of a mathematics MOOC

The fast development of distance learning tools such as Open Educational Resources (OER) and Massive Open Online Courses (MOOC or MOOCs) are indicators of a shift in the way in which digital teaching and learning are understood. MOOC are a new style of online classes that allow any person with web access, anywhere, usually free of charge, to participate through video lectures, computer graded tests and discussion forums. They have been capturing the attention of many higher education institutions around the world. This paper will give us an overview of the “Introduction to Differential Calculus” a MOOC Project, created by an engaged volunteer team of Mathematics lecturers from four schools of the Polytechnic Institute of Oporto (IPP). The MOOC theories and their popularity are presented and complemented by a discussion of some MOOC definitions and their inherent advantages and disadvantages. It will also explore what MOOC mean for Mathematics education. The Project development is revealed by focusing on used MOOC structure, as well as the quite a lot of types of course materials produced. It ends with a presentation of a short discussion about problems and challenges met throughout the development of the project. It is also our goal to contribute for a change in the way teaching and learning Mathematics is seen and practiced nowadays, trying to make education more accessible to as many people as possible and increase our institution (IPP) recognition.