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Identification of key opportunities for optimising the management of high-risk COPD patients in the UK using the CONQUEST quality standards: an observational longitudinal study
Full text linkBackground
This study compared management of high-risk COPD patients in the UK to national and international management recommendations and quality standards, including the COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST). The primary comparison was in 2019, but trends from 2000 to 2019 were also examined.
Methods
Patients identified in the Optimum Patient Care Research Database were categorised as newly diagnosed (≤12 months after diagnosis), already diagnosed, and potential COPD (smokers having exacerbation-like events). High-risk patients had a history of ≥2 moderate or ≥1 severe exacerbations in the previous 12 months.
Findings
For diagnosed patients, the median time between diagnosis and first meeting the high-risk criteria was 617 days (Q1-Q3: 3246). The use of spirometry for diagnosis increased dramatically after 2004 before plateauing and falling in recent years. In 2019, 41% (95% CI 39–44%; n = 550/1343) of newly diagnosed patients had no record of spirometry in the previous year, and 45% (95% CI 43–48%; n = 352/783) had no record of a COPD medication review within 6 months of treatment initiation or change. In 2019, 39% (n = 6893/17,858) of already diagnosed patients had no consideration of exacerbation rates, 46% (95% CI 45–47%; n = 4942/10,725) were not offered or referred for pulmonary rehabilitation, and 41% (95% CI 40–42%; n = 3026/7361) had not had a COPD review within 6 weeks of respiratory hospitalization.
Interpretation
Opportunities for early diagnosis of COPD patients at high risk of exacerbations are being missed. Newly and already diagnosed patients at high-risk are not being assessed or treated promptly. There is substantial scope to improve the assessment and treatment optimisation of these patients.
Funding
This study is conducted by the Observational & Pragmatic Research International Ltd and was co-funded by Optimum Patient Care and AstraZeneca. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution
Entrepreneurship Education and Political Change: An Exploratory Study
Full text linkThis study explores the extent to which entrepreneurship education (EE) impacts individual political attributes at the level of the individual student. The rationale here is EE’s alignment with an emancipatory principle that can also be found in Critical Pedagogy (CP). This emancipatory principle resonates with the individual recognizing their place within a socioeconomic system and subsequently seeking to change the system; i.e., they become politically engaged. Drawing on a sample of entrepreneurship students in Denmark, scores on a range of political measures were compared at the start and at the end of a semester in which students engaged in entrepreneurship education. The political measures comprised “political interest,” “political orientation,” “civic engagement,” and “sociopolitical control.” Overall, results indicate a shift toward more politically interested and engaged students. This exploratory study sets the scene for more research in this area that seeks to understand the potential inherent in EE for political change
‘COVID couldn’t catch him there’: can outdoor learning benefit primary school-aged children after a global health crisis?
No full textThis study investigates the impact of the COVID-19 pandemic on pupils and the potential value of outdoor learning (OL) as a strategy to overcome some of the challenges educators face in helping their pupils get ‘back on track’. Interviews with nine primary school staff in the South West of England explored the impact of the pandemic on pupil wellbeing, academic attainment, friendships/social skills, and behaviour. We report on the effectiveness of OL in this context. Findings indicate that OL is being deployed as a useful post-pandemic pedagogical tool. Barriers to consistently implementing OL as a teaching strategy are discussed
An Examination of the Influence of Age on Behavioural Thermoregulation Responses During Heat Exposure
Full text linkHeat wave events are increasing in frequency and severity, resulting in many heat-related deaths in older adults. This thesis aimed to develop an understanding of how increasing age impacts thermoregulatory behaviour while exercising during heat exposure. The thesis also looked to identify what, if any, factors influence this relationship.
The first study examined the relationship between age and behavioural thermoregulation during walking exercise in 35°C. Thermoregulatory behaviour was assessed by having participants walk at a self-selected speed that elicited an RPE of 13 in 22°C and 35°C conditions. The multiple regression model did not significantly predict thermoregulatory behaviour (p = 0.406, R2 = 0.156). None of the variables added statistical significance to the prediction (p > 0.05). For the male participants, the multiple regression model did significantly predict thermoregulatory behaviour (p = 0.038, R2 = 0.469).
Age added statistical significance to the prediction (p = 0.005). Men age ≥60 years were less able to implement thermoregulatory behaviours than men aged 0.05. The second study identified factors that influence the diminished ability to reduce exercise intensity in 35°C conditions in older men. No significant differences were evident between men aged 18-35 and ≥60 years in their anthropometry, physical activity and fitness, whole body sweat rate, cardiovascular, or thermal perceptual responses. The older men did not reduce walking speed when exposed to 35°C temperatures, but the young men did. Factors influencing thermoregulatory behaviour in men aged ≥60 years need to be identified as they offer potential intervention strategies to reduce heat stress and heat-related illness risk.
By using pre-warming and radiant heat lamps, the final study investigated the influence of skin and rectal temperature thermoregulatory behaviour in exercising men aged >65 years. Young and older men cycle at a fixed RPE of 13 for 30 min. Trials included a stable ambient control (22°C), changing ambient temperature (22 - 35°C), a pre-warmed stable ambient (rectal elevated 1°C, 22°C ambient), and a pre-warmed changing ambient (rectal elevated by 1°C, 22 - 35°C ambient). Young men implemented thermoregulatory behaviour in response to changing ambient conditions, whereas older men did not (thermoregulatory behaviour scores: Young CHC 1.09 ± 0.12, W+CHC 1.08 ± 0.16. Older CHC 0.94 ± 0.09, W+CHC 0.97 ± 0.07). This was despite similar skin and rectal temperature, and thermal perception responses between the two age groups. Older men are unable to adjust exercise intensity in response to changing ambient conditions, thus skin temperature is a less effective driver of thermoregulatory behaviours in older men than young men.
The primary outcome of this thesis is that older (≥60 years) men do not voluntarily implement thermoregulatory behaviours while exercising in 35°C conditions, whereas younger men do. No physiological or perceptual factors could be identified to explain this inability to implement thermoregulatory behaviours. This has public health implications, as older adults, particularly men, are unable, or unwilling to voluntarily reduce their heat exposure during heat wave events. This will increase their risk of heat-related illness putting strain on health and emergency services. Public health messaging should move to educate adults aged ≥60 years of their insensitivity to heat exposure, the reduced likelihood of them implementing necessary behavioural thermoregulation strategies, and the implications if they do not voluntarily adopt cooling strategies
“Beyond My Wildest Dreams”: The Reach and Impact of Sport Education
No full textThe connection between the name “Daryl Siedentop” and the model “Sport Education” has evolved over the past three decades to become a prominent brand of physical education. This paper attempts to capture the influence of Sport Education, not only within school physical education, but in ways and arenas far beyond Daryl’s original imagination. It is now used in university physical education courses and teacher preparation programs, in summer camps, and there is evidence of some use in after-school and community sports settings. This evolution has manifest pedagogical iterations of the model far beyond the essential features articulated in his initial vision, and teachers, students, prospective teachers, and coaches have all found a renewed vigor in their sport experience. The paper describes some of these “beyond” iterations of the model as a tribute to how Sport Education has served to realize multiple objectives for multiple practitioners in ways beyond his original aspirations
Expanding the scope of ethical research with and for children and young people – six viewpoints on crisis, cross-cultural working and reciprocity
Full text linkThis Viewpoints piece is a collection of six contributions to a wider Special Issue for Children’s Geographies on ‘Renewed questions of ethics in research with and for children and young people.’ The pieces extend the Issue in two key ways: i) by representing urgent questions of pandemic and crisis related ethics; and ii) extending the geographical and cultural scope of thinking ethically in research with children and young people
A Conceptual Framework of Different Eccentric Training Methods
No full textVarious methods of eccentric training that aim to increase muscle mass or reduce ground contact time during a landing task have been extensively researched and practically examined. However, multiple methods to implement eccentric training currently exist; they differ in execution and intended training adaptions. There is a clear differentiation between an eccentric muscle action and an eccentric motion whereby a motion alludes to a downward movement of an exercise. The proposed eccentric motions are dissipating eccentrics, deceleration eccentrics, overcoming eccentrics, maximal eccentrics, and rebound eccentrics. These motions formulate into training methods and cues to allow practitioners to clearly differentiate the various eccentric training methods used in research and practice. This review proposes a new conceptual framework that clearly outlines the different forms of eccentric motions that fall into a desired eccentric training method
Ploughing the Field: Controversy and Censorship in US and UK YA Literature
Full text linkThe United States and the United Kingdom have faced a record number of book challenges in recent years. In the US, the American Library Association documented 1,269 demands to censor library books and materials in 2022, nearly double the number of challenges reported in 2021 (ALA n.p.). In the UK, a third of librarians have been asked to censor or remove books from their libraries (CILIP, qtd. in Shaffi n.p.). In both countries, YA texts are among the most banned and challenged books. The assaults on young people’s freedom to read represented by this form of censorship particularly target marginalised identities and experiences: “the majority of banned titles are authored by or about members of the LGBTQ and Black communities” (Diaz n.p.). The ideologies underpinning many book challenges can also be seen in the divisive attacks against transgender people and their right to exist, vitriolic responses to critical race theory, and the elimination of reproductive rights, to name but a few. In short, the personal has become political, as “book challenges represent the movement of a private act (determining what one’s own children should read) into the public sphere” and the attempt to transform personal convictions into “community values and beliefs” (Knox 132). In this iteration of “Ploughing the Field”, we brought together YA experts (see Table 1) who have lived and/or worked in the US and the UK to better understand: some of the recent trends in YA and why they have garnered such strong reactions in the Western milieu; the role that YA can play in the lives of young people; and our responsibilities as teachers and scholars of YA to young readers and each other
Implication of the Global Initiative for Chronic Obstructive Lung Disease 2023 report for resource-limited settings: tracing the G in the GOLD
Full text linkThe new Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 report provides a very useful synthesis of available scientific evidence to guide COPD management, research and prevention, as always [1, 2]. Important changes include the revision of the definition of the condition and the replacement of groups C and D with E, which highlights the importance of exacerbations in COPD [2]
The Great Teacher Supply Crisis: Can the Early Career Framework Appease Early Career Teacher Recruitment and Retention Challenges in England?
No full textIn July 2022 the Initial Teacher Training (ITT) monthly statistics (Department for Education, 2022) demonstrated that the recruitment of trainee teachers did not reach the government target, with the total application numbers lower than 2019 and the actual number of applicants achieving course places for September was down by 15%. The National Foundation for Education Research (NFER) have very recently (November 2022) reported on the challenge for schools in England to recruit and retain enough teachers:
National data on the teacher labour market suggests that the supply of new trainees is insufficient to meet future demand, which implies that schools are likely to face challenges recruiting teachers, perhaps leading to staff shortages. (Worth & Faulkner-Ellis, 2022a, p. 2)
This challenge to attract graduates to teacher training affects the number of early career teachers (ECTs) entering the profession. As we entered a new phase of recruitment to teacher training in September 2022, the situation has become even worse, suggesting we are in the midst of a teacher supply crisis. Primary trainee teacher applications are currently 8% lower, and Secondary 23% lower, than in 2019. The size of the problem is clearly articulated by Jack Worth:
It's very hard to overstate how dreadfully bad these ITT application numbers are. (Worth, 2022)
The Teacher Recruitment and Retention Strategy (Department for Education, 2019a) was launched by the DfE in January 2019 and included an Early Career Framework (ECF) (Department for Education, 2019b), which became mandatory in primary and secondary maintained schools in England in September 2021. The government recognised the challenge in attracting and retaining teachers, particularly ECTs, and the issues being caused in school by poor teacher supply. The hope was that structured, statutory ECT professional development, with a clear framework and mentor support (the ECF), would improve both teacher recruitment and retention. Educationalists welcomed the ECF reform, as it offered sustained, funded, professional development at the beginning of a teacher’s career in England (Ovenden-Hope, 2022a). However, ECT attrition currently stands at 12.5% after one year of teaching and 23% by year three of teaching (Department for Education, 2022). The ECF therefore has a formidable, and potentially impossible, task in appeasing the great supply crisis schools in England are experiencing