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أهداف التعلم : مساعدة الطلاب على استهداف الفهم في درس اليوم /
وضع أهداف التعلـم في نظرية إجرائية يمكن أن يستخدمها الطلاب، والمعلمون، والمديرون، واداريو المكاتب المركزية لتوحيد جهودهم في رفع تحصيل الطلاب وإيجاد ثقافة مبنية على البينة وممارسة موجهة بالنتائج تقديم استراتيجيات لتصميم أهداف تعلـم تفعل مهارات التفكير العليا وتنمي لدى الطالب ومنها: رسم الأهداف، والتقويم الذاتي، والتنظيم الذاتي توضيح كيفية تصميم أداء قوي للفهم، كنشاط تنتج عنه بينة عن تقدم الطالب نحو أهداف التعلـم وتحقيقها توضيح كيفية استخدام أهداف التعلـم في توجيه التقويم الختامي ووضع الدرجات.
Book
Effect of population breast screening on breast cancer mortality up to 2005 in England and Wales: an individual-level cohort study
Background:
Population breast screening has been implemented in the UK for over 25 years, but the size of benefit attributable to such programmes remains controversial. We have conducted the first individual-based cohort evaluation of population breast screening in the UK, to estimate the impact of the NHS breast screening programme (NHSBSP) on breast cancer mortality.
Methods:
We followed 988 090 women aged 49–64 years in 1991 resident in England and Wales, who because of the staggered implementation of the NHSBSP, included both invited subjects and an uninvited control group. Individual-level breast screening histories were linked to individual-level mortality and breast cancer incidence data from national registers. Risk of death from breast cancer was investigated by incidence-based mortality analyses in relation to intention to screen and first round attendance. Overdiagnosis of breast cancer following a single screening round was also investigated.
Results:
Invitation to NHSBSP screening was associated with a reduction in breast cancer mortality in 1991–2005 of 21% (RR=0.79, 95% CI: 0.73–0.84,
P
<0·001) after adjustment for age, socioeconomic status and lead-time. Breast cancer deaths among first invitation attenders were 46% lower than among non-attenders (RR=0.54, 95% CI: 0.51–0·57,
P
<0.001) and 32% lower following adjustment for age, socioeconomic status and self-selection bias (RR=0.68, 95% CI: 0.63–0·73,
P
<0.001). There was little evidence of overdiagnosis associated with invitation to first screen.
Conclusions:
The results indicate a substantial, statistically significant reduction in breast cancer mortality between 1991 and 2005 associated with NHSBSP activity. This is important in public health terms.
Journal Article
Association Between Ozone-Polluted Air and Birth Weight in Rural and Suburban Spain
Low birth weight (LBW) is associated with neonatal morbidity, mortality and long-term health complications. Global studies report an association between air pollution, such as tropospheric ozone, and LBW. This study aims to analyze the association between ozone exposure during pregnancy and LBW in 130 municipalities in rural and semi-urban Spain. We conducted a retrospective population-based cohort study using data from the Instituto Nacional de Estadística (INE) and air quality data from the Spanish Government for the 2001–2017 period. We performed descriptive analysis, logistic regression and linear regression analyses adjusted for various covariates. In addition, we fitted generalized additive models (GAMs) to estimate non-linear relationships. An association between decreased neonatal weight and high ozone exposure was found, especially in the first and second trimester. An increase in ozone concentration could lower neonatal weight but not enough evidence demonstrates an association with LBW. More research is needed to understand the impact of ozone exposure on neonates during pregnancy.
Journal Article
Randomised controlled trial of faecal-occult-blood screening for colorectal cancer
There is growing evidence that faecal-occult-blood (FOB) screening may reduce colorectal cancer (CRC) mortality, but this reduction in CRC mortality has not been shown in an unselected population-based randomised controlled trial. The aim of this study was to assess the effect of FOB screening on CRC mortality in such a setting.
Between February, 1981, and January, 1991, 152 850 people aged 45–74 years who lived in the Nottingham area of the UK were recruited to our study. Participants were randomly allocated FOB screening (76 466) or no screening (controls; 76 384). Controls were not told about the study and received no intervention. Screening-group participants were sent a Haemoccult FOB test kit with instructions from their family doctor. FOB tests were not rehydrated and dietary restrictions were imposed only for retesting borderline results. Individuals with negative FOB tests at the first screening, together with those who tested positive but in whom no neoplasia was found on colonoscopy, were invited to take part in further screening every 2 years. Screening was stopped in February, 1995, by which time screening-group participants had been offered FOB tests between three and six times. Screening-group participants who had a positive test were offered full colonoscopy. All participants were followed up until June, 1995. The primary outcome measure was CRC mortality.
Of the 152 850 individuals recruited to the study, 2599 could not be traced or had emigrated and were excluded from the analysis. Thus, there were 75 253 participants in the screening group and 74 998 controls. 44 838 (59·6%) screening-group participants completed at least one screening. 28 720 (38·2%) of these individuals completed all the FOB tests they were offered and 16118 (21·4%) completed at least one screening but not all the tests they were offered. 30 415 (40·4%) did not complete any test. Of 893 cancers (20% stage A) diagnosed in screening-group participants (CRC incidence of 1·49 per 1000 person-years), 236 (26·4%) were detected by FOB screening, 249 (27·9%) presented after a negative FOB test or investigation, and 400 (44·8%) presented in non-responders. The incidence of cancer in the control group (856 cases, 11% stage A) was 1·44 per 1000 person-years. Median follow-up was 7·8 years (range 4·5–14·5). 360 people died from CRC in the screening group compared with 420 in the control group–a 15% reduction in cumulative CRC mortality in the screening group (odds ratio=0–85 [95% CI 0·74–0·98], p=0026).
Our findings together with evidence from other trials suggest that consideration should be given to a national programme of FOB screening to reduce CRC mortality in the general population.
Journal Article
Reducing the socioeconomic gradient in uptake of the NHS bowel cancer screening Programme using a simplified supplementary information leaflet: a cluster-randomised trial
Background
Uptake of colorectal cancer screening is low in the English NHS Bowel Cancer Screening Programme (BCSP). Participation in screening is strongly associated with socioeconomic status. The aim of this study was to determine whether a supplementary leaflet providing the ‘gist’ of guaiac-based Faecal Occult Blood test (gFOBt) screening for colorectal cancer could reduce the socioeconomic status (SES) gradient in uptake in the English NHS BCSP.
Methods
The trial was integrated within routine BCSP operations in November 2012. Using a cluster randomised controlled design all adults aged 59–74 years who were being routinely invited to complete the gFOBt were randomised based on day of invitation. The Index of Multiple Deprivation was used to create SES quintiles. The control group received the standard information booklet (‘SI’). The intervention group received the SI booklet and the Gist leaflet (‘SI + Gist’) which had been designed to help people with lower literacy engage with the invitation. Blinding of hubs was not possible and invited subjects were not made aware of a comparator condition. The primary outcome was the gradient in uptake across IMD quintiles.
Results
In November 2012, 163,525 individuals were allocated to either the ‘SI’ intervention (
n
= 79,104) or the ‘SI + Gist’ group (
n
= 84,421). Overall uptake was similar between the intervention and control groups (SI: 57.3% and SI + Gist: 57.6%; OR = 1.02, 95% CI: 0.92–1.13,
p
= 0.77). Uptake was 42.0% (SI) vs. 43.0% (SI + Gist) in the most deprived quintile and 65.6% vs. 65.8% in the least deprived quintile (interaction
p
= 0.48). The SES gradient in uptake was similar between the study groups within age, gender, hub and screening round sub-groups.
Conclusions
Providing supplementary simplified information in addition to the standard information booklet did not reduce the SES gradient in uptake in the NHS BCSP. The effectiveness of the Gist leaflet when used alone should be explored in future research.
Trial registration
ISRCTN74121020
, registered: 17/20/2012.
Journal Article
Advancing Formative Assessment in Every Classroom
Formative assessment is one of the best ways to increase student learning and enhance teacher quality. But effective formative assessment is not part of most classrooms, largely because teachers misunderstand what it is and don't have the necessary skills to implement it. In the updated 2nd edition of this practical guide for school leaders, authors Connie M. Moss and Susan M. Brookhart define formative assessment as an active, continual process in which teachers and students work together—every day, every minute—to gather evidence of learning, always keeping in mind three guiding questions: Where am I going? Where am I now? What strategy or strategies can help me get to where I need to go? Chapters focus on the six interrelated elements of formative assessment: (1) shared learning targets and criteria for success, (2) feedback that feeds learning forward, (3) student self-assessment and peer assessment, (4) student goal setting, (5) strategic teacher questioning, and (6) student engagement in asking effective questions. Using specific examples based on their extensive work with teachers, the authors provide- Strategic talking points and conversation starters to address common misconceptions about formative assessment; - Practical classroom strategies to share with teachers that cultivate students as self-regulated, assessment-capable learners; - Ways to model the elements of formative assessment in conversations with teachers about their professional learning; - \"What if\" scenarios and advice for how to deal with them; and - Questions for reflection to gauge understanding and progress. As Moss and Brookhart emphasize, the goal is not to \"do\" formative assessment, but to embrace a major cultural change that moves away from teacher-led instruction to a partnership of intentional inquiry between student and teacher, with better teaching and learning as the outcome.
eBook
Depression and CD4 Cell Count Among Persons with HIV Infection in Uganda
Despite the importance of mental illness and the high prevalence of HIV in Africa, few studies have documented depressive symptoms among HIV-infected persons in Africa. We assessed factors associated with depression among HIV-infected adults undergoing anti-retroviral eligibility screening in Eastern Uganda. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Univariate and multiple regression analyses were conducted to identify socio-demographic characteristics and disease-related factors associated with depression. Among 1017 HIV-infected participants assessed for depression, 47% (476/1017) reported depressive symptoms (CES-D >/= 23). Adjusting for age, gender, education, and source of income, patients with CD4 counts <50 cells/microl were more likely to be depressed (odds ratio 2.34, 95% confidence interval, 1.39-3.93, P = 0.001). Women, participants >50 years, and those without an income source were more likely to be depressed. Depression was common among HIV-infected persons in rural Uganda and was associated with low CD4 cell counts. Appropriate screening and treatment for depression should be considered for comprehensive HIV care.
Journal Article
Standardizing Oral Anticancer Medication Initiation to Improve Clinician Compliance with National Guidelines
Standardizing Oral Anticancer Medication Initiation to Improve Clinician Compliance with National Guidelines (Under the direction of Tracy Vernon-Platt) The aim of this quality improvement project was to standardize the process for initiating oral anticancer medications (OAMs) to align with American Society of Clinical Oncology (ASCO) and Oncology Nursing Society (ONS) guidelines. A quality improvement team was created in accordance with the Iowa Model for Evidence Based Practice. A review of the literature was completed to find effective interventions for initiating OAMs. Next, an anticipatory checklist and standardized EHR documentation tool were created to guide patient education, documentation, and follow up in the initiation of OAMs. These tools were piloted with breast cancer patients of one oncologist at Duke Women’s Cancer Care Raleigh over an 8-week implementation period.By implementing an anticipatory checklist and standardized EHR documentation tool, the QI team improved documentation of ASCO/ONS-mandated topics for 86% of patients initiating an OAM. Comprehensive education using the checklist helped to reduce the patient-initiated phone calls and EHR system messages by 35%. Anticipatory checklists and EHR documentation tools are effective methods for standardizing the process of initiating OAMs. Standardized tools like these should be incorporated into health system policies for OAMs to ensure quality care and patient safety.
Dissertation
Sexually Transmitted Infections and Hepatitis in Men With a History of Incarceration
Background: Men entering correctional facilities have high rates of human immunodeficiency virus, sexually transmitted infections (STI), and hepatitis. Many prisons offer screening, treatment, and vaccination services; however, little is known about the rates of these infections in men after release to the community. Methods: Young men were recruited from prisons in Mississippi, Rhode Island, and Wisconsin as part of a human immunodeficiency virus/STI/hepatitis intervention study. Participants were offered screening for Neisseria gonorrhoeae (GC), Chlamydia trachomatis, trichomoniasis, syphilis, hepatitis B (HBV) and C (HCV) 6 months after release. Logistic regression was performed to identify associations with prevalent infections. Results: Of 248 eligible men, 178 (71.8%) participated. Their mean age was 22.5 years, and 92% reported multiple lifetime incarcerations. At 6-month postrelease, 79% reported unprotected vaginal or anal sex, and 26% tested positive for 1 or more infections (GC, 1%; C. trachomatis, 12%; trichomoniasis, 8%; syphilis, 0%; HCV, 6%; HBV, 1%). Of all, 55% were susceptible to HBV infection. Active STI (GC, C. trachomatis, or trichomoniasis) was associated with less education (odds ratios [OR], 2.25; P < 0.05). HCV infection was associated with injection drug use (OR, 69.70; P < 0.05) and being white (OR, 7.54; P < 0.05). HBV susceptibility was associated with older age (OR, 3.02; P < 0.05), more education (OR, 2.39; P < 0.05), or incarceration in Mississippi (OR, 6.69; P < 0.05) or Rhode Island (OR, 2.84; P < 0.05). Conclusions: Effective screening and prevention programs are needed for this population before and after release from custody to prevent acquisition and further transmission of these infections.
Journal Article
Overseeing Research on Therapeutic Cloning: A Private Ethics Board Responds to Its Critics
Green et al describe their experience as members of Advanced Cell Technology's Ethics Advisory Board, and respond to criticisms. Among other things, they address the claim that the impartiality of board members is severely compromised by stock options or consultant fees.
Journal Article