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An attempt is made to elaborate upon Lev's results concerning the reliability of the point biserial coefficient of correlation in a manner that will be helpful to the psychological statistician. Procedures required in the use of the non-central t tables prepared by Johnson and Welch are described as they relate to the determination of the fiducial limits for a point biserial coefficient. A normal approximation technique for the estimation of fiducial limits is also suggested. Numerical evidence is presented which shows that relative to a given level of significance the width of the fiducial interval estimated from a point biserial coefficient of any size is smaller than that of the fiducial interval corresponding to an ordinary Pearsonian coefficient of the same magnitude.
Background: Parkland Health is a 900-bed safety-net hospital that serves Dallas County, Texas. It has an OPAT program in which patients are managed via self-administration (S-OPAT), home-health/hemodialysis (H-OPAT), and skilled nursing facilities (SNF-OPAT). We evaluated the reasons for unscheduled emergency department (ED) visits by patients in these groups to identify strategies to decrease unexpected healthcare utilization and to improve safety. Methods: We performed a retrospective chart review of all adult patients discharged from Parkland Health on OPAT between April and June 2021. Demographic, medical, and healthcare utilization information, including the date and reason of first unscheduled ED visit after discharge, was collected utilizing a standardized instrument. The institutional review board approved this study. Results: In total, 184 patients were discharged with OPAT. Among them, 32% were female and 55% identified as Hispanic; 41% were non-English speakers, and 45% were treated for a musculoskeletal infection. Among all OPAT models of care, 43.4% were S-OPAT patients, 31.5% were H-OPAT patients, and 25% were SNF-OPAT patients (Table 1). The groups differed, and fewer African Americans received H-OPAT. Also, 45% were being treated for musculoskeletal infections and were more likely to be discharged with H- or SNF-OPAT. In addition, 41% were being treated for endovascular infections and 21.7% were being treated for genitourinary infections. The total length of stay in the hospital was longer for SNF-OPAT patients and shorter for S-OPAT patients (Table 2). Among 184 OPAT patients, 41 patients (22.2%) had an ED visit: 17.3% SNF-OPAT patients, 27.6% H-OPAT patients, and 21.3% S-OPAT patients (Table 2). ED visits were attributed to intravenous (IV) access–related problems (12 of 41, 29.0%), worsening of known infection (3 of 41, 7.3%), and abnormal blood test results (2 of 41, 4.9%). Also, 24 ED visits (58%) were not related to underlying infection or OPAT. However, when examined by the OPAT care model, 41% of ED visits among S-OPAT patients, 20% among H-OPAT visits, and 25% among SNF-OPAT visits were related to IV access issues. Among S-OPAT ED visits pertaining to IV access, 71% were for minor issues such as dressing changes or line occlusion or malfunction. Conclusions: One-fifth of OPAT patients had an unscheduled ED visit, of whom 20%–41% had issues with IV access. Many of these visits could be avoided with enhanced outreach to patients discharged with OPAT and improved ambulatory capabilities to provide standard services related to maintenance of IV access.
The application and provision of prehospital care in disasters and mass-casualty incident response in Europe is currently being explored for opportunities to improve practice. The objective of this translational science study was to align common principles of approach and action and to identify how technology can assist and enhance response. To achieve this objective, the application of a modified Delphi methodology study based on statements derived from key findings of a scoping review was undertaken. This resulted in 18 triage, eight life support and damage control interventions, and 23 process consensus statements. These findings will be utilized in the development of evidence-based prehospital mass-casualty incident response tools and guidelines.
Student fees have saddled graduates with enormous debt, satisfaction rates are low, a high proportion of graduates are in non-graduate jobs, and public debt from unpaid loans is rocketing. This timely and challenging analysis gives robust new policy proposals to encourage excellence and ultimately benefit society.
Psilocybin is a tryptamine alkaloid found in some mushrooms, especially those of the genus Psilocybe. Psilocybin has four metabolites including the pharmacologically active primary metabolite psilocin, which readily enters the systemic circulation. The psychoactive effects of psilocin are believed to arise due to the partial agonist effects at the 5HT2A receptor. Psilocin also binds to various other receptor subtypes although the actions of psilocin at other receptors are not fully explored. Psilocybin administered at doses sufficient to cause hallucinogenic experiences has been trialed for addictive disorders, anxiety and depression. This review investigates studies of psilocybin and psilocin and assesses the potential for use of psilocybin and a treatment agent in neuropsychiatry. The potential for harm is also assessed, which may limit the use of psilocybin as a pharmacotherapy. Careful evaluation of the number needed to harm vs the number needed to treat will ultimately justify the potential clinical use of psilocybin. This field needs a responsible pathway forward.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
Children treated for brain tumors often experience social and emotional difficulties, including challenges with emotion regulation; our goal was to investigate the attention-related component processes of emotion regulation, using a novel eye-tracking measure, and to evaluate its relations with emotional functioning and white matter (WM) organization.
Method:
Fifty-four children participated in this study; 36 children treated for posterior fossa tumors, and 18 typically developing children. Participants completed two versions of an emotion regulation eye-tracking task, designed to differentiate between implicit (i.e., automatic) and explicit (i.e., voluntary) subprocesses. The Emotional Control scale from the Behavior Rating Inventory of Executive Function was used to evaluate emotional control in daily life, and WM organization was assessed with diffusion tensor imaging.
Results:
We found that emotional faces captured attention across all groups (F(1,51) = 32.18, p < .001, η2p = .39). However, unlike typically developing children, patients were unable to override the attentional capture of emotional faces when instructed to (emotional face-by-group interaction: F(2,51) = 5.58, p = .006, η2p = .18). Across all children, our eye-tracking measure of emotion regulation was modestly associated with the parent-report emotional control score (r = .29, p = .045), and in patients it was associated with WM microstructure in the body and splenium of the corpus callosum (all t > 3.03, all p < .05).
Conclusions:
Our findings suggest that an attention-related component process of emotion regulation is disrupted in children treated for brain tumors, and that it may relate to their emotional difficulties and WM organization. This work provides a foundation for future theoretical and mechanistic investigations of emotional difficulties in brain tumor survivors.
Nitrous oxide (N2O) misuse is widespread in the UK. Although it is well-known that it can cause devastating myeloneuropathy, psychiatric presentations are poorly described. There is little understanding of who it affects, how it presents, its mechanism of action and principles of treatment. We begin this article with a case study. We then review the literature to help psychiatrists understand this area and deal with this increasing problem, and make diagnosis and treatment recommendations. We describe a diagnostic pentad of weakness, numbness, paraesthesia, psychosis and cognitive impairment to alert clinicians to the need to urgently treat these patients. Nitrous oxide misuse is a pending neuropsychiatric emergency requiring urgent treatment with vitamin B12 to prevent potentially irreversible neurological and psychiatric symptoms.
The National Audit Office issued its report on ‘The higher education market’ in December 2017. This identifies that, despite a 50 per cent increase in upfront public funding for teaching, only 32 per cent of students believe that they are receiving value for money. The extension of higher education throughout less advantaged backgrounds is weak and concentrated in the less prestigious universities. There is little price competition and little financial reward for rising in the league tables. In introducing the new Office for Students (OfS) in the 2017 Higher Education and Research Act, the government noted the rampant grade inflation in degree classifications. Recently, there has been a sharp increase in ‘unconditional offers’ to 23 per cent of university applicants. The Higher Education minister is quoted as saying that this ‘undermines the credibility of the university system’ (BBC News, 26 July 2018). The new Office for Students is charged to: maintain autonomy of higher education providers; promote quality; encourage competition; promote value for money; and promote equality of opportunity.
The Labour Party promise, in its 2017 General Election Manifesto, to eliminate student fees is generally viewed as a significant political success. The Party gained seats, particularly in constituencies with high university student populations. Arguably in consequence, the government has instituted a Review of Post-18 Education and Funding to conclude in early 2019. This Review in particular maintains the principles of income-contingent contributions by students to education costs and the absence of a cap on post-18 education. It is presumed that the wording of both principles is carefully chosen to allow for significant changes to the current funding regime. Notably, the ‘absence of a cap on post-18 education’ need not imply the ‘absence of a cap on university students’. Students can instead follow their interests into first rate apprenticeships and technical programmes. While awaiting the findings of the Review, the government has already capped tuition fees from rising further and made the repayments on student loans less onerous.
As if all that wasn’t enough, academics went on strike in 2018 over proposed draconian cuts to the pension system. Despite the 50 per cent increase in upfront public funding for teaching, the employers’ organisation (Universities UK) was unwilling to cover the projected shortfall in the scheme with increased contributions (on the 2/3, 1/3 share between universities and academics that had previously been agreed).
In each chapter to this point, we have analysed shortcomings in the current university funding arrangements, but have stopped just at the point of making policy recommendations. This is because we have wanted to bring everything together in constructing holistic policies.
The objectives of changes of policy initiated by the Browne Report were:
1. to improve participation and in particular access from less advantaged groups;
2. to improve quality and student choice in a diverse system by creating a market leading to competition.
We believe that creating a market was neither necessary nor desirable in achieving the stated aims, which we otherwise completely support. However, we have taken the regime change on its own terms and will continue to do so in this chapter. It is for the government of the day to determine the funding regime, and the current government clearly supports the market elements arising from the Browne review.
Our problem is that the manner in which the Browne Report was implemented and the way in which subsequent policy has developed has led to a failure to achieve the stated objectives. The system constructed is simply inefficient in its inability to encourage competition and in how it rewards failure. Further, it has encouraged micromanagement of and within universities to the detriment of the traditional focus on the academic esprit that has been essential to the high standing traditionally enjoyed by our Higher Education system.
In the following, we present clear and concrete policies that follow recommendations made (for example) by Browne. Further, everything is not only ‘costed’ but we impose the rigorous rule that additional support from the taxpayer cannot be provided at this time. The sector has done extremely well in funding over the period of national austerity, and the priorities lie elsewhere.
The hierarchy of universities
The economics model of marriage is based upon the idea of ‘assortative matching’, where individuals of similar standing in characteristics form relationships. This model can be applied more widely and is relevant to universities. Suppose there are good and weak students. If learning is ‘complementary’, putting the good students together and the weak students together produces more learning than if there are two mixed groups. In this world, it is efficient to match together the good students. But, even if it is not efficient, this may be the outcome on the basis of individual interest.
Ironically, this grade inflation has the effect of further boosting the Russell Group universities, particularly at the expense of the non-Russell pre-1992 universities. Previously, a student might be advised to go to a non-Russell university because the course matched the student’s interests and abilities, the geographical location fitted the student’s preferences, smaller size and campus environments enabled easier socialising with students outside one’s own department and a good student would get additional attention that they might not get at the very top universities. The student would be able to signal by the classification of degree – a first or a strong upper second – that they had put in the effort, English universities are private charities that receive substantial public funding. For most institutions, this makes up the bulk of their income. Public funding comes through a buffer, given the acknowledged need to protect the independence of the individual university. This is partly a matter of efficiency – it is unhelpful to have the government of the day unduly micro-manage a university. It is also, however, a recognition of the special importance of protecting academic freedom and free speech, for both staff and students. It is ironic that the government has simultaneously issued the Prevent Duty on universities and has raised concerns about limitations to free speech on campus.
Nonetheless, the taxpayer has a right – through the government of the day – to have university expenditure reflect the taxpayers’ priorities. Sometimes, the majority of academics will be supportive, as with the ‘public sector equality duty’ applicable to UK universities and the corresponding ‘affirmative action’ programmes in the US. In other cases, the priorities may not be the ones that would be chosen by the university. The taxpayer has a right, for example, to emphasise STEM (Science, Technology, Engineering and Mathematics) degrees, or instead to wish to encourage Arts degrees.
The funding authorities, independently or following government directives, set up the framework for accessing state support. The 2011 policy switched most subsidy from a block teaching grant, plus fees at £3000, to student fees of £9000 financed through the contingent loan system and limited grant to support some subject areas. Since the previous block teaching grant averaged out in the vicinity of £3000 per student, this is a substantial increase in funding. It is also a significant shift in how funding flows from the taxpayer to the university.
The substantial increase in per student funding that came with the new fees and funding policy was predicated on increased and widening participation in universities. We have questioned the 50 per cent target, particularly given evidence that graduates are now frequently being placed in non-graduate jobs. Other forms of higher and further education, and apprenticeships, are valuable alternatives to university, depending upon students’ interests and abilities. In any case, we feel strongly that expansion should not be a reason for lowering standards, particularly under policies which provided more than sufficient additional unit of resource – if wisely used – to provide extra support for non-traditional students. Indeed, that was the policy quid pro quo for a university being allowed to raise fees beyond the base £6000 up to £9000.
We have already raised our concerns that the top universities simply cream off more of the best students in general and meet widening participation objectives by taking the best non-traditional applicants, without engaging in sufficient outreach to widen the pool. As we move through the hierarchy, both for the existential need to attract more students and the more honourable motive to offer better life chances, universities lower down the league tables may feel they have to offer low entry requirements. It is doubtful whether, however committed and talented their teaching may be, they will be able to bring students to the same level and on similar courses after three years as those admitted to the top universities.
For these reasons, if we are to maintain high standards throughout the system, we feel that the diversity of institutions has to be kept in mind. It may be that we are moving toward the varied post-compulsory offering that Dearing advocated but at the price that the term ‘university’ now has a wider meaning. This is not to say that those universities with world class researchers and courses which make the highest intellectual demands are making a more valuable contribution. It is not so much a question of ‘better’ or ‘worse’ but different. Quantum Physics is not available everywhere and neither should it be, but that is not to say that less academically demanding courses and those that do not require research activity within the department are not important – to the individual and to society – and they may open up opportunities for further study to those wanting it and whose potential is revealed.
The primary purpose of this book is to analyse the effects of recent policy decisions to attempt to introduce a market and competition into the university system in the belief that this will increase quality and reduce costs. Given the introduction of student fees as the overwhelming source of funding, it is a presumed consequence that students will increasingly ask questions about value for money. Students are leaving university with up to £60,000 in debt, at a punitive interest rate of up to 6.3 per cent. This will affect their ability to gain a foothold on the housing ladder, or other of the common rites of passage accessed by previous generations. It potentially limits labour market flexibility, both because graduates will not be able to afford to live in some areas of the country but also because they may make career choices limited by their debts.
Before we turn to these issues, this chapter is an attempt to sketch a brief description of historic changes in Higher Education policy and indicate the direction of travel that has led us to where we are. The emphasis will be on universities in England since the policies adopted elsewhere in the UK have recently differed. Scotland under devolution has taken the approach of maintaining free fees, as we discuss at the end of this chapter. This survey is by no means intended to be comprehensive, but an indication of policy issues that have culminated in those which are the main subject of our analysis.
Until the 1830s Oxford and Cambridge were the only universities in England. Early in the nineteenth century a number of medical schools and ‘mechanical institutes’ developed. These relied on private financial support from individuals and local business and were poorly funded compared to Oxford and Cambridge which had ancient endowments and a wealthy clientele. In London, the ‘London University’ and King’s College were established in 1826 and 1829 respectively, but without degree awarding powers. The funding for these new colleges came partly from an increasing concern for moral obligations to the underprivileged and partly for the need to enhance the nation’s capacity for medical, scientific and technical advance. This need was perceived also at government level by the advances in Germany in particular which was seen as a major economic and political threat.