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In order to foster educational resilience in children who face adversity, adults need a clear grasp of which factors are most relevant and motivating for these children. This study asked 50 children (ages eight to 12) who face serious life difficulties to share their perspectives on which factors support academic performance and how those factors operate in their lives. Participants identified eight factors (intelligence, feelings, behaviours, home environment, family assistance, school support, community connections, organized programs) that improve academic performance and described three mechanisms (facilitating work, increasing understanding, preventing negative behaviour) by which the factors function. Implications for practice and further research are discussed.

Sesearch has identified many factors that can foster the educational resilience of students who are at risk for academic failure. Educators have organized many of the recommendations that arise from this data into curricula and programs for implementation at the district and school levels. Researchers and educators have given less attention to compiling recommendations for daily classroom practice. Thus, the present project reviewed findings from current educational resilience research that examined students and teachers in classroom contexts. The synthesis produced 12 specific recommendations for classroom practices that can help foster educational resilience and support the academic achievement of students placed at risk for failure. The author organized the 12 recommendations into 4 clusters-(a) teacher-student rapport, (b) classroom climate, (c) instructional strategies, and (d) student skills-and presents with them the insights and perspectives of over 30 practicing teachers who work with at-risk students every day.

In pursuit of innovative educational opportunities, district administration piloted competency-based education in their alternative program. This qualitative study used semi-structured interviews with school personnel to document perspectives of the programmatic shift. Analyses found local and national mandates, a catalyst, and a common moral purpose to be key factors for change. Challenges included: effective communication among all stakeholders; finding adequate time to develop and implement an alternative educational approach; and difficulties with alignment between two systems of accountability. Successes included increased teacher and student engagement and an increase in the academic rigor of the program. Evidence suggests successes far surpassed challenges.

Understanding patterns of educational attainment among rural youth is a critical concern for our nation as we seek to make postsecondary access and attainment more equitable across our increasingly diverse student population. The current study examines data collected in the Education Longitudinal Study of 2002 to identify contemporary patterns of educational attainment among rural youth, with a focus on associate degree attainment and bachelor's degree attainment. Findings reveal that education expected for occupation is a significant predictor for bachelor's degree attainment, with regional differences found among individuals earning a bachelor's degree. The results support a link between rural students' expectations for occupation and educational attainment and highlight differences in educational attainment by region of residence.

Vital signs monitoring is a universal tool for the detection of postoperative complications; however, unwell patients can be missed between traditional observation rounds. New remote monitoring technologies promise to convey the benefits of continuous monitoring to patients in general wards. The aim of this pilot study was to evaluate whether continuous remote vital signs monitoring is a practical and acceptable way of monitoring surgical patients and to optimize the delivery of a definitive trial. We performed a prospective, cluster-randomized, parallel-group, unblinded, controlled pilot study. Patients admitted to 2 surgical wards at a large tertiary hospital received either continuous and intermittent vital signs monitoring or intermittent monitoring alone using an early warning score system. Continuous monitoring was provided by a wireless patch, worn on the patient's chest, with data transmitted wirelessly every 2 minutes to a central monitoring station or a mobile device carried by the patient's nurse. The primary outcome measure was time to administration of antibiotics in sepsis. The secondary outcome measures included the length of hospital stay, 30-day readmission rate, mortality, and patient acceptability. Overall, 226 patients were randomized between January and June 2017. Of 226 patients, 140 were randomized to continuous remote monitoring and 86 to intermittent monitoring alone. On average, patients receiving continuous monitoring were administered antibiotics faster after evidence of sepsis (626 minutes, n=22, 95% CI 431.7-820.3 minutes vs 1012.8 minutes, n=12, 95% CI 425.0-1600.6 minutes), had a shorter average length of hospital stay (13.3 days, 95% CI 11.3-15.3 days vs 14.6 days, 95% CI 11.5-17.7 days), and were less likely to require readmission within 30 days of discharge (11.4%, 95% CI 6.16-16.7 vs 20.9%, 95% CI 12.3-29.5). Wide CIs suggest these differences are not statistically significant. Patients found the monitoring device to be acceptable in terms of comfort and perceived an enhanced sense of safety, despite 24% discontinuing the intervention early. Remote continuous vital signs monitoring on surgical wards is practical and acceptable to patients. Large, well-controlled studies in high-risk populations are required to determine whether the observed trends translate into a significant benefit for continuous over intermittent monitoring. International Standard Randomised Controlled Trial Number ISRCTN60999823; http://www.isrctn.com /ISRCTN60999823 (Archived by WebCite at http://www.webcitation.org/73ikP6OQz).

ObjectiveTo validate whether a wearable remote vital signs monitor could accurately measure heart rate (HR), respiratory rate (RR) and temperature in a postsurgical patient population at high risk of complications.DesignManually recorded vital signs data were paired with vital signs data derived from the remote monitor set in patients participating in the Trial of Remote versus Continuous INtermittent monitoring (TRaCINg) study: a trial of continuous remote vital signs monitoring.SettingSt James’s University Hospital, UK.Participants51 patients who had undergone major elective general surgery.InterventionsThe intervention was the SensiumVitals monitoring system. This is a wireless patch worn on the patient’s chest that measures HR, RR and temperature continuously. The reference standard was nurse-measured manually recorded vital signs.Primary and secondary outcome measuresThe primary outcomes were the 95% limits of agreement between manually recorded and wearable patch vital sign recordings of HR, RR and temperature. The secondary outcomes were the percentage completeness of vital sign patch data for each vital sign.Results1135 nurse observations were available for analysis. There was no clinically meaningful bias in HR (1.85 bpm), but precision was poor (95% limits of agreement −23.92 to 20.22 bpm). Agreement was poor for RR (bias 2.93 breaths per minute, 95% limits of agreement −8.19 to 14.05 breaths per minute) and temperature (bias 0.82°C, 95% limits of agreement −1.13°C to 2.78°C). Vital sign patch data completeness was 72.8% for temperature, 59.2% for HR and 34.1% for RR. Distributions of RR in manually recorded measurements were clinically implausible.ConclusionsThe continuous monitoring system did not reliably provide HR consistent with nurse measurements. The accuracy of RR and temperature was outside of acceptable limits. Limitations of the system could potentially be overcome through better signal processing. While acknowledging the time pressures placed on nursing staff, inaccuracies in the manually recorded data present an opportunity to increase awareness about the importance of manual observations, particularly with regard to methods of manual HR and RR measurements.

PurposeEmergency laparotomy is associated with high morbidity for the surgical patient. Understanding patients’ health-related quality of life after their surgery is important to enhance the informed consent process, and to enable the evaluation and improvement of surgical care. This review aims to summarise the use of health-related quality of life tools in clinical trials involving patients undergoing emergency laparotomy.MethodsA systematic review was undertaken of the scientific literature published in the MEDLINE® and PubMed databases between January 2011 and July 2021. A narrative synthesis approach was chosen to synthesise the diverse range of studies in a structured manner. All included papers were evaluated using the Cochrane Collaboration’s tool for assessing risk of bias.ResultsEleven studies were selected for inclusion. Most of the studies had a low risk of bias. Two of the studies used health-related quality of life as the primary outcome measure. A variety of health-related quality of life measurement tools were used; the EQ-5D tool was the most popular questionnaire. Protocol adherence was dependent on the length of time which had elapsed after emergency surgery.ConclusionThere are many perceived challenges to collecting health-related quality of life data in the emergency surgery setting. Many of these can be offset with progressive trial designs. There is a need for further research in the systematic development of patient-reported outcomes for use in emergency surgery.

Early detection of physiological deterioration has been shown to improve patient outcomes. Due to recent improvements in technology, comprehensive outpatient vital signs monitoring is now possible. This is the first review to collate information on all wearable devices on the market for outpatient physiological monitoring.A scoping review was undertaken. The monitors reviewed were limited to those that can function in the outpatient setting with minimal restrictions on the patient’s normal lifestyle, while measuring any or all of the vital signs: heart rate, ECG, oxygen saturation, respiration rate, blood pressure and temperature.A total of 270 papers were included in the review. Thirty wearable monitors were examined: 6 patches, 3 clothing-based monitors, 4 chest straps, 2 upper arm bands and 15 wristbands. The monitoring of vital signs in the outpatient setting is a developing field with differing levels of evidence for each monitor. The most common clinical application was heart rate monitoring. Blood pressure and oxygen saturation measurements were the least common applications. There is a need for clinical validation studies in the outpatient setting to prove the potential of many of the monitors identified.Research in this area is in its infancy. Future research should look at aggregating the results of validity and reliability and patient outcome studies for each monitor and between different devices. This would provide a more holistic overview of the potential for the clinical use of each device.

This paper aims to navigate the complexity inherent in the concept of place by defining and highlighting the role of place-informed education across different international contexts: the periphery in Northern Israel, coastal areas of England, and rural Montana in the United States. Using a thematic analytic framework, we conducted a cross-context comparison of three case studies in order to identify each locale’s unique definitions and meanings of place, producing a portrait of the similarities and differences among the three international contexts. Following the ‘Simplicity–Accuracy Paradox’ and recognizing the ‘cost of oversimplification’, we explored complexity as a basis for action, which enables the creation of a process in which the strengths and limitations of the place both have an important role to play in any intervention or action to mitigate and/or enhance the consequences of distance from urban centers. The proposed strategies presented in the paper are based on embracing the complexity of place for place-informed education, and include context-responsive policy design, targeted workforce strategies, international learning exchanges, and policy and classification reform. These processes may serve as a guide for action among educators, policymakers and researchers, supporting a mindset of place-informed education where complexity is embraced and where challenges of place may also offer solutions.

Among the many challenges facing rural administrators, recruiting and retaining teachers is often at the top of the list. Given the time and energy they must invest to successfully attract, recruit, and hire a new teacher, there is a significant need to adopt strategies that will help to retain those new teachers. Rural administrators can support new teachers so that they stay — and thrive — in rural districts by connecting teachers with the community, supporting place-based practices in the classroom, and helping new teachers build relationships both in and out of school.