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This paper describes a collaborative approach to professional learning that has provided an opportunity for refreshed practices and growth in capacity in schools supporting students with various learning needs in several schools that are part of the Association of Independent Schools in the Australian Capital Territory. An action research approach to professional learning for school staff was facilitated with the participating schools in 2018/2019, centred on the Nationally Consistent Collection of Data on School Students with Disability.
In response to advancing clinical practice guidelines regarding concussion management, service members, like athletes, complete a baseline assessment prior to participating in high-risk activities. While several studies have established test stability in athletes, no investigation to date has examined the stability of baseline assessment scores in military cadets. The objective of this study was to assess the test–retest reliability of a baseline concussion test battery in cadets at U.S. Service Academies.
All cadets participating in the Concussion Assessment, Research, and Education (CARE) Consortium investigation completed a standard baseline battery that included memory, balance, symptom, and neurocognitive assessments. Annual baseline testing was completed during the first 3 years of the study. A two-way mixed-model analysis of variance (intraclass correlation coefficent (ICC)3,1) and Kappa statistics were used to assess the stability of the metrics at 1-year and 2-year time intervals.
ICC values for the 1-year test interval ranged from 0.28 to 0.67 and from 0.15 to 0.57 for the 2-year interval. Kappa values ranged from 0.16 to 0.21 for the 1-year interval and from 0.29 to 0.31 for the 2-year test interval. Across all measures, the observed effects were small, ranging from 0.01 to 0.44.
This investigation noted less than optimal reliability for the most common concussion baseline assessments. While none of the assessments met or exceeded the accepted clinical threshold, the effect sizes were relatively small suggesting an overlap in performance from year-to-year. As such, baseline assessments beyond the initial evaluation in cadets are not essential but could aid concussion diagnosis.
Catheter-associated urinary tract infections (CAUTIs) occur frequently in pediatric inpatients, and they are associated with increased morbidity and cost. Few studies have investigated ambulatory CAUTIs, despite at-risk children utilizing home urinary catheterization. This retrospective cohort and case-control study determined incidence, risk factors, and outcomes of pediatric patients with ambulatory CAUTI.
Broad electronic queries identified potential patients with ambulatory urinary catheters, and direct chart review confirmed catheters and adjudicated whether ambulatory CAUTI occurred. CAUTI definitions included clean intermittent catheterization (CIC). Our matched case-control analysis assessed risk factors.
Five urban, academic medical centers, part of the New York City Clinical Data Research Network.
Potential patients were age <22 years who were seen between October 2010 and September 2015.
In total, 3,598 eligible patients were identified; 359 of these used ambulatory catheterization (representing186,616 ambulatory catheter days). Of these, 63 patients (18%) experienced 95 ambulatory CAUTIs. The overall ambulatory CAUTI incidence was 0.51 infections per 1,000 catheter days (1.35 for indwelling catheters and 0.47 for CIC; incidence rate ratio, 2.88). Patients with nonprivate medical insurance (odds ratio, 2.5; 95% confidence interval, 1.1–6.3) were significantly more likely to have ambulatory CAUTIs in bivariate models but not multivariable models. Also, 45% of ambulatory CAUTI resulted in hospitalization (median duration, 3 days); 5% resulted in intensive care admission; 47% underwent imaging; and 88% were treated with antibiotics.
Pediatric ambulatory CAUTIs occur in 18% of patients with catheters; they are associated with morbidity and healthcare utilization. Ambulatory indwelling catheter CAUTI incidence exceeded national inpatient incidence. Future quality improvement research to reduce these harmful infections is warranted.
There are little data about renal follow-up of neonates after cardiovascular surgery and no guidelines for long-term renal follow-up. Our objectives were to assess renal function follow-up practice after neonatal cardiac surgery, evaluate factors that predict follow-up serum creatinine measurements including acute kidney injury following surgery, and evaluate the estimated glomerular filtration rate during follow-up using routinely collected laboratory values.
Two-centre retrospective cohort study of children 5–7 years of age with a history of neonatal cardiac surgery. Univariable and multivariable analyses were performed to determine factors associated with post-discharge creatinine measurements. Glomerular filtration rate was estimated for each creatinine using a height-independent equation.
Seventeen of 55 children (30%) did not have any creatinine measured following discharge after surgery until the end of study follow-up, which occurred at a median time of 6 years after discharge. Of the 38 children who had the kidney function checked, 15 (40%) had all of their creatinine drawn only in the context of a hospitalisation or emergency department visit. Acute kidney injury following surgery did not predict the presence of follow-up creatinine measurements.
A large proportion of neonates undergoing congenital heart repair did not have a follow-up creatinine measured in the first years following surgery. In those that did have a creatinine measured, there did not appear to be any identified pattern of follow-up. A follow-up system for children who are discharged from cardiac surgery is needed to identify children with or at risk of chronic kidney disease.
The coronavirus disease 2019 (COVID-19) pandemic introduced challenges to the use of simulation, including limited personal protective equipment and restricted time and personnel. Our use of video for in situ simulation aimed to circumvent these challenges and assist in the development of a protocol for protected intubation and simultaneously educate emergency department (ED) staff. We video-recorded a COVID-19 respiratory failure in situ simulation event, which was shared by a facilitator both virtually and in the ED. The facilitator led discussions and debriefs. We followed this with in situ run-throughs in which staff walked through the steps of the simulation in the ED, handling medications and equipment and becoming comfortable with use of isolation rooms. This application of in situ simulation allowed one simulation event to reach a wide audience, while allowing participants to respect social distancing, and resulted in the education of this audience and successful crowdsourcing for a protocol amidst a pandemic.
There is strong evidence that foods containing dietary fibre protect against colorectal cancer, resulting at least in part from its anti-proliferative properties. This study aimed to investigate the effects of supplementation with two non-digestible carbohydrates, resistant starch (RS) and polydextrose (PD), on crypt cell proliferative state (CCPS) in the macroscopically normal rectal mucosa of healthy individuals. We also investigated relationships between expression of regulators of apoptosis and of the cell cycle on markers of CCPS. Seventy-five healthy participants were supplemented with RS and/or PD or placebo for 50 d in a 2 × 2 factorial design in a randomised, double-blind, placebo-controlled trial (the Dietary Intervention, Stem cells and Colorectal Cancer (DISC) Study). CCPS was assessed, and the expression of regulators of the cell cycle and of apoptosis was measured by quantitative PCR in rectal mucosal biopsies. SCFA concentrations were quantified in faecal samples collected pre- and post-intervention. Supplementation with RS increased the total number of mitotic cells within the crypt by 60 % (P = 0·001) compared with placebo. This effect was limited to older participants (aged ≥50 years). No other differences were observed for the treatments with PD or RS as compared with their respective controls. PD did not influence any of the measured variables. RS, however, increased cell proliferation in the crypts of the macroscopically-normal rectum of older adults. Our findings suggest that the effects of RS on CCPS are not only dose, type of RS and health status-specific but are also influenced by age.
Carbapenem-resistant Enterobacterales (CRE) are common causes of healthcare-associated infections and are often multidrug resistant with limited therapeutic options. Additionally, CRE can spread within and between healthcare facilities, amplifying potential harms.
To better understand the burden, risk factors, and source of acquisition of carbapenemase genes in clinical Escherichia coli and Klebsiella spp isolates from patients in Washington to guide prevention efforts.
Multicenter prospective surveillance study.
Escherichia coli and Klebsiella spp isolates meeting the Washington state CRE surveillance case definition were solicited from clinical laboratories and tested at Washington Public Health Laboratories using polymerase chain reaction (PCR) for the 5 most common carbapenemase genes: blaKPC, blaNDM, blaIMP, blaVIM, and blaOXA-48. Case patients positive by PCR were investigated by the public health department.
From October 2012 through December 2017, 363 carbapenem-resistant E. coli and Klebsiella spp isolates were tested. Overall, 45 of 115 carbapenem-resistant K. pneumoniae (39%), 1 of 8 K. oxytoca (12.5%), and 28 of 239 carbapenem-resistant E. coli (11.7%) were carbapenemase positive. Of 74 carbapenemase-positive isolates, blaKPC was most common (47%), followed by blaNDM (30%), blaOXA-48 (22%), and blaIMP (1%). Although all cases had healthcare exposure, blaKPC acquisition was associated with US health care, whereas non-blaKPC acquisition was associated with international health care or travel.
We report that blaKPC, the most prevalent carbapenemase in the United States, accounts for nearly half of carbapenemase cases in Washington state and that most KPC-cases are likely acquired through in-state health care.
The Apolipoprotein (APOE) ε4 allele increases the risk for mild cognitive impairment (MCI) and dementia, but not all carriers develop MCI/dementia. The purpose of this exploratory study was to determine if early and subtle preclinical signs of cognitive dysfunction and medial temporal lobe atrophy are observed in cognitively intact ε4 carriers who subsequently develop MCI.
Twenty-nine healthy, cognitively intact ε4 carriers (ε3/ε4 heterozygotes; ages 65–85) underwent neuropsychological testing and MRI-based measurements of medial temporal volumes over a 5-year follow-up interval; data were converted to z-scores based on a non-carrier group consisting of 17 ε3/ε3 homozygotes.
At follow-up, 11 ε4 carriers (38%) converted to a diagnosis of MCI. At study entry, the MCI converters had significantly lower scores on the Mini-Mental State Examination, Rey Auditory Verbal Learning Test (RAVLT) Trials 1–5, and RAVLT Immediate Recall compared to non-converters. MCI converters also had smaller MRI volumes in the left subiculum than non-converters. Follow-up logistic regressions revealed that left subiculum volumes and RAVLT Trials 1–5 scores were significant predictors of MCI conversion.
Results from this exploratory study suggest that ε4 carriers who convert to MCI exhibit subtle cognitive and volumetric differences years prior to diagnosis.
Scholars and policy makers need systematic assessments of the validity of the measures produced by V-Dem. In Chapter 6, we present our approach to comparative data validation – the set of steps we take to evaluate the precision, accuracy, and reliability of our measures, both in isolation and compared to extant measures of the same concepts. Our approach assesses the degree to which measures align with shared concepts (content validation), shared rules of translation (data generation assessment), and shared realities (convergent validation). Within convergent validity, we execute two convergent validity tests. First, we examine convergent validity as it is typically conceived – examining convergence between V-Dem measures and extant measures. Second, we evaluate the level of convergence across coders, considering the individual coder and country traits that predict coder convergence. Throughout the chapter, we focus on three indices included in the V-Dem data set: polyarchy, corruption, and core civil society. These three concepts collectively provide a “hard test” for the validity of our data, representing a range of existing measurement approaches, challenges, and solutions.
This chapter sets forth the conceptual scheme for the V–Dem project. We begin by discussing the concept of democracy. Next, we lay out seven principles by which this key concept may be understood – electoral, liberal, majoritarian, consensual, participatory, deliberative, and egalitarian. Each defines a “variety“ of democracy, and together they offer a fairly comprehensive accounting of the concept as used in the world today. Next, we show how this seven-part framework fits into our overall thinking about democracy, including multiple levels of disaggregation – to components, subcomponents, and indicators. The final section of the chapter discusses several important caveats and clarifications pertaining to this ambitious taxonomic exercise.
This chapter recounts how a project of this scale came together and why it has succeeded. Five main factors were responsible for V–Dem’s success: timing, inclusion, deliberation, administrative centralization, and fund–raising. First, planning for V-Dem began at a time when both social scientists and practitioners were realizing that they needed better democracy measures. This made it possible to recruit collaborators and find funding. Second, the leaders of the project were always eager to expand the team to acquire whatever expertise they lacked and share credit with everyone who contributed. Third, the project leaders practiced an intensely deliberative decision–making style to ensure that all points of view were consulted and only decisions that won wide acceptance were adopted. Fourth, centralizing the execution of the agreed–upon tasks helped tremendously by streamlining processes and promoting standardization, documentation, professionalization, and coordination of a large number of intricate steps. Finally, successful fund–raising from a mix of both research foundations and bilateral and multilateral organizations has been critical.
In this chapter we focus on the measurement of five key principles of democracy – electoral, liberal, participatory, deliberative, and egalitarian. For each principle, we discuss (1) the theoretical rationale for the selected indicators, (2) whether these indicators are correlated strongly enough to warrant being collapsed into an index, and (3) the justification of aggregation rules for moving from indicators to components and from components to higher–level indices. In each section we also (4) highlight the top– and bottom–five countries on each principle of democracy in early (1812 or 1912) and late (2012) years of our sample period, as well as the aggregate trend over the whole time period 1789–2017 (where applicable). Finally, we (5) look at how the different principles are intercorrelated in order to assess the trade–offs involved between the conceptual parsimony achieved by aggregating to a few general concepts and the retention of useful variation permitted by aggregating less.
Four characteristics of V-Dem data present distinct opportunities and challenges for explanatory analysis: (1) the large number of democracy indicators (i.e., variables), (2) the measurement of concepts by multiple coders filtered through the V-Dem measurement model, (3) the large number of years in the data set, and 4) the ex ante potential for dependence across countries (generically referred to as spatial dependence). This chapter discusses 3 challenges and 10 opportunities that are implied by these characteristics. At the end of this chapter, we also discuss three assumptions that are implicit in most analyses of observational indicators of macro-features at the national level, which aim to draw conclusions about causal relationships.
Varieties of Democracy is the essential user's guide to The Varieties of Democracy project (V-Dem), one of the most ambitious data collection efforts in comparative politics. This global research collaboration sparked a dramatic change in how we study the nature, causes, and consequences of democracy. This book is ambitious in scope: more than a reference guide, it raises standards for causal inferences in democratization research and introduces new, measurable, concepts of democracy and many political institutions. Varieties of Democracy enables anyone interested in democracy - teachers, students, journalists, activists, researchers and others - to analyze V-Dem data in new and exciting ways. This book creates opportunities for V-Dem data to be used in education, research, news analysis, advocacy, policy work, and elsewhere. V-Dem is rapidly becoming the preferred source for democracy data.
Users of V–Dem data should take care to understand how the data are generated because the data collection strategies have consequences for the validity, reliability, and proper interpretation of the values. Chapters 4 and 5 explain how we process the data after collecting the raw scores and how we aggregate the most specific indicators into more general indices. In this chapter we explain where the raw scores come from. We distinguish among the different types of data that V–Dem reports and describe the processes that produce each type and the infrastructure required to execute these processes.