Differentiated instruction (DI) is an educational praxis that is built on the premise that all students can be engaged in learning and achieve positive academic outcomes. Previous research in ...secondary schools has shown promise in the success of DI practices and outlines the importance of sustained professional development (PD) for teachers. There is, however, little research on DI within senior‐secondary classrooms in the Australian context. This research is part of a larger study which recruited 12 participants from three schools across two states in Australia, and aimed to investigate teachers’ perceptions of school leadership and support in implementing DI in their classrooms as well as awareness of relevant policies. Findings indicated that when teachers were aware of policies involving DI, they tended to describe policies relating to special education. This suggests that DI is viewed by these teachers as an approach for students with additional needs rather than seen as a whole class philosophy. Similarly, the results indicated that when teachers said that leadership supported them in using DI, this support was commonly reported as isolated professional development in supporting students with additional needs. Discrepancies around awareness of DI policies were also found between teachers at the same school, with those in leadership roles indicating that requirements to utilise DI were embedded in their general teaching and learning policy. Implications for future practice and policy are discussed.
Students with learning difficulties form the largest group of students with additional needs in Australian mainstream classrooms. However the terminology surrounding these students differs broadly ...across the country. A consistent and
shared understanding of the term learning difficulties is vital, as this impacts the identification and equitable provision of support for students experiencing difficulties with learning. The website of each Australian state/territory
government education department was examined to determine to how students with learning difficulties are formally identified and supported. It was found that considerable differences, and even conflicting information, exist both within
and across education systems. Implications and the significance of this situation are discussed. Author abstract
Differentiated instruction is a proactive teaching model and philosophy with demonstrated potential to cater for diverse learners and create inclusive classrooms. There is little research, however, ...into the implementation of this approach in the senior secondary classroom. Teachers’ implementation of differentiated instruction has been shown to be linked to teacher attitudes and self‐efficacy in other settings. This study investigated the impact of teachers’ self‐efficacy and attitudes towards the implementation of differentiated instruction in the senior secondary context across two Australian states with a total of five participating teachers. The A (Affective) B (Behaviour) C (Cognitive) model was employed to define teacher attitudes from interviews concerning differentiated instruction. Findings indicated that teacher knowledge was a major factor influencing differentiation, in addition to attitude and self‐efficacy. The discourse analysis demonstrated that teachers held a greater knowledge of differentiation strategies than the concepts that underpin the differentiated instruction framework. Additionally, time constraints and feelings of failure in implementing differentiation strategies impacted teacher attitudes. Teacher knowledge, attitude and self‐efficacy were interrelated and impacted on teachers’ implementation of differentiated instruction in the senior secondary classroom. Implications for professional development to address student needs through differentiated instruction in the inclusive senior secondary classroom teacher are discussed.
The safety, effectiveness, and cost-effectiveness of molnupiravir, an oral antiviral medication for SARS-CoV-2, has not been established in vaccinated patients in the community at increased risk of ...morbidity and mortality from COVID-19. We aimed to establish whether the addition of molnupiravir to usual care reduced hospital admissions and deaths associated with COVID-19 in this population.
PANORAMIC was a UK-based, national, multicentre, open-label, multigroup, prospective, platform adaptive randomised controlled trial. Eligible participants were aged 50 years or older—or aged 18 years or older with relevant comorbidities—and had been unwell with confirmed COVID-19 for 5 days or fewer in the community. Participants were randomly assigned (1:1) to receive 800 mg molnupiravir twice daily for 5 days plus usual care or usual care only. A secure, web-based system (Spinnaker) was used for randomisation, which was stratified by age (<50 years vs ≥50 years) and vaccination status (yes vs no). COVID-19 outcomes were tracked via a self-completed online daily diary for 28 days after randomisation. The primary outcome was all-cause hospitalisation or death within 28 days of randomisation, which was analysed using Bayesian models in all eligible participants who were randomly assigned. This trial is registered with ISRCTN, number 30448031.
Between Dec 8, 2021, and April 27, 2022, 26 411 participants were randomly assigned, 12 821 to molnupiravir plus usual care, 12 962 to usual care alone, and 628 to other treatment groups (which will be reported separately). 12 529 participants from the molnupiravir plus usual care group, and 12 525 from the usual care group were included in the primary analysis population. The mean age of the population was 56·6 years (SD 12·6), and 24 290 (94%) of 25 708 participants had had at least three doses of a SARS-CoV-2 vaccine. Hospitalisations or deaths were recorded in 105 (1%) of 12 529 participants in the molnupiravir plus usual care group versus 98 (1%) of 12 525 in the usual care group (adjusted odds ratio 1·06 95% Bayesian credible interval 0·81–1·41; probability of superiority 0·33). There was no evidence of treatment interaction between subgroups. Serious adverse events were recorded for 50 (0·4%) of 12 774 participants in the molnupiravir plus usual care group and for 45 (0·3%) of 12 934 in the usual care group. None of these events were judged to be related to molnupiravir.
Molnupiravir did not reduce the frequency of COVID-19-associated hospitalisations or death among high-risk vaccinated adults in the community.
UK National Institute for Health and Care Research
In February 2005 residents of Edinburgh in Scotland, UK, were given the opportunity to vote in a referendum on the introduction of a road user charging scheme, which had been in development for ...almost a decade. The public voted against the scheme by a ratio of 3:1 and it was consequently abandoned. The objective of this research was to determine the principal factors responsible for the public's overwhelming opposition to the scheme. A postal self-completion questionnaire was distributed to 1300 randomly selected households along a transect from central to south Edinburgh. The 368 completed questionnaires returned were analysed to assess the influence of several factors on the way respondents voted in the referendum. Car use was shown to be the principal determinant of voting behaviour, with car owners strongly opposing the scheme and non-car owners only weakly supporting it. The public's limited understanding of the scheme increased the strength of the opposing vote. Further, the public were largely unconvinced that the scheme would have achieved its dual objectives of reducing congestion and improving public transport. The findings suggest that more attention should have been paid to designing a simpler, more easily communicated scheme and convincing residents, particularly public transport users, of its benefits.
Students with learning difficulties form the largest group of students with additional needs in Australian mainstream classrooms. However the terminology surrounding these students differs broadly ...across the country. A consistent and shared understanding of the term learning difficulties is vital, as this impacts the identification and equitable provision of support for students experiencing difficulties with learning. The website of each Australian state/territory government education department was examined to determine to how students with learning difficulties are formally identified and supported. It was found that considerable differences, and even conflicting information, exist both within and across education systems. Implications and the significance of this situation are discussed.
Patients with intermediate and high-risk oropharyngeal cancer (OPC) have poorer response to standard treatment and poorer overall survival compared to low-risk OPC. CompARE is designed to test ...alternative approaches to intensified treatment for these patients to improve survival.
CompARE is a pragmatic phase III, open-label, multicenter randomised controlled trial with an adaptive multi-arm, multi-stage design and an integrated QuinteT Recruitment Intervention. Eligible OPC patients include those with human papillomavirus (HPV) negative, T1-T4, N1-N3 or T3-4, N0, or HPV positive N3, T4, or current smokers (or ≥ 10 pack years previous smoking history) with T1-T4, N2b-N3. CompARE was originally designed with four arms (one control arm 1 and three experimental: arm 2-induction chemotherapy followed by arm 1; arm 3-dose-escalated radiotherapy plus concomitant cisplatin; and arm 4-resection of primary followed by arm 1). The three original experimental arms have been closed to recruitment and a further experimental arm opened (arm 5-induction durvalumab followed by arm 1 and then adjuvant durvalumab). Currently recruiting are arm 1 (control): standard treatment of 3-weekly cisplatin 100 mg/m
or weekly 40 mg/m
with intensity-modulated radiotherapy using 70 Gy in 35 fractions ± neck dissection determined by clinical and radiological assessment 3 months post-treatment, and arm 5 (intervention): one cycle of induction durvalumab 1500 mg followed by standard treatment then durvalumab 1500 mg every 4 weeks for a total of 6 months. The definitive and interim primary outcome measures are overall survival time and event-free survival (EFS) time, respectively. Secondary outcome measures include quality of life, toxicity, swallowing outcomes, feeding tube incidence, surgical complication rates, and cost-effectiveness. The design anticipates that after approximately 7 years, 84 required events will have occurred to enable analysis of the definitive primary outcome measure for this comparison. Planned interim futility analyses using EFS will also be performed.
CompARE is designed to be efficient and cost-effective in response to new data, emerging new treatments or difficulties, with the aim of bringing new treatment options for these patients.
ISRCTN ISRCTN41478539 . Registered on 29 April 2015.
Objectives
Investigate the relationship between quantified terminal ileal (TI) motility and histopathological activity grading, Crohn Disease MRI Index (CDMI) and faecal calprotectin.
Methods
...Retrospective review of children with Crohn disease or unclassified inflammatory bowel disease, who underwent MR enterography. Dynamic imaging for 25 patients (median age 12, range 5 to 16) was analysed with a validated motility algorithm. The TI motility score was derived. The primary reference standard was TI Endoscopic biopsy Assessment of Inflammatory Activity (eAIS) within 40 days of the MR enterography. Secondary reference standards: (1) the Crohn Disease MRI Index (CDMI) and (2) faecal calprotectin levels.
Results
MR enterography median motility score was 0.17 a.u. (IQR 0.12 to 0.25; range 0.05 to 0.55), and median CDMI was 3 (IQR 0 to 5.5). Forty-three percent of patients had active disease (eAIS > 0) with a median eAIS score of 0 (IQR 0 to 2; range 0 to 5). The correlation between eAIS and motility was
r
= − 0.58 (
p
= 0.004,
N
= 23). Between CDMI and motility,
r
= − 0.42 (
p
= 0.037,
N
= 25). Motility score was lower in active disease (median 0.12 vs 0.21,
p
= 0.020) while CDMI was higher (median 5 vs 1,
p
= 0.04). In a subset of 12 patients with faecal calprotectin within 3 months of MR enterography, correlation with motility was
r
= − 0.27 (
p
= 0.4).
Conclusions
Quantified terminal ileum motility decreases with increasing histopathological abnormality in children with Crohn disease, reproducing findings in adults. TI motility showed a negative correlation with an MRI activity score but not with faecal calprotectin levels.
Key Points
• It is feasible to perform MRI quantified bowel motility assessment in children using free-breathing techniques.
• Bowel motility in children with Crohn disease decreases as the extent of intestinal inflammation increases.
• Quantified intestinal motility may be a candidate biomarker for treatment efficacy in children with Crohn disease.
Comprehensive imaging using ultrasound and MRI of placenta accreta spectrum (PAS) aims to prevent catastrophic haemorrhage and maternal death. Standard MRI of the placenta is limited by between-slice ...motion which can be mitigated by super-resolution reconstruction (SRR) MRI. We applied SRR in suspected PAS cases to determine its ability to enhance anatomical placental assessment and predict adverse maternal outcome.
Suspected PAS patients (n = 22) underwent MRI at a gestational age (weeks + days) of (32+3±3+2, range (27+1-38+6)). SRR of the placental-myometrial-bladder interface involving rigid motion correction of acquired MRI slices combined with robust outlier detection to reconstruct an isotropic high-resolution volume, was achieved in twelve. 2D MRI or SRR images alone, and paired data were assessed by four radiologists in three review rounds. All radiologists were blinded to results of the ultrasound, original MR image reports, case outcomes, and PAS diagnosis. A Random Forest Classification model was used to highlight the most predictive pathological MRI markers for major obstetric haemorrhage (MOH), bladder adherence (BA), and placental attachment depth (PAD).
At delivery, four patients had placenta praevia with no abnormal attachment, two were clinically diagnosed with PAS, and six had histopathological PAS confirmation. Pathological MRI markers (T2-dark intraplacental bands, and loss of retroplacental T2-hypointense line) predicting MOH were more visible using SRR imaging (accuracy 0.73), in comparison to 2D MRI or paired imaging. Bladder wall interruption, predicting BA, was only easily detected by paired imaging (accuracy 0.72). Better detection of certain pathological markers predicting PAD was found using 2D MRI (placental bulge and myometrial thinning (accuracy 0.81)), and SRR (loss of retroplacental T2-hypointense line (accuracy 0.82)).
The addition of SRR to 2D MRI potentially improved anatomical assessment of certain pathological MRI markers of abnormal placentation that predict maternal morbidity which may benefit surgical planning.
•Advanced MRI provides enhanced assessment in suspected placenta accreta spectrum.•Additional pathological MRI markers are identified that predict adverse outcome.•Prenatal prediction of adverse events is key to minimising operative complications.•It can aid surgical planning by ensuring availability of appropriate clinical teams.•This can improve maternal outcome and reduce cost of increased hospitalisation.
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