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\"Explores the principles and implications of the Coombes School's innovative 'outdoor classroom' approach to all aspects of nursery and infant schooling\"-- Provided by publisher.

Yoga-based interventions have been implemented in schools and demonstrated promising results on students’ self-regulation outcomes. Nevertheless, there is limited literature on the effects that yoga may have for children in the early primary grades, despite the evidence demonstrating that this is an opportune period in development for early self-regulation. Few studies have focused on young children living in the context of economic difficulty, which can hinder children’s development of self-regulatory skills and educational trajectories. The effects of an eight-week yoga intervention on economically disadvantaged pre-kindergarten and kindergarten children’s self-regulation and emotion regulation were examined via a paired within-subjects comparison study. Nine classrooms were assigned to the yoga intervention (Treatment First, TxFirst; n  = 90) or a wait-list control group (Treatment Second, TxSecond; n  = 64). All children were assessed at pre-intervention (Time 1), post-intervention assessment for TxFirst (Time 2), and post-intervention assessment for TxSecond (Time 3). Children demonstrated significant predicted gains on a behavioral task of self-regulation and declines in teacher-rated submissive venting and total behavior problems. Implications for future research are discussed, with a focus on including follow-up assessments and multiple dimensions of fidelity of implementation. Highlights Yoga-based interventions have been implemented in schools and demonstrated promising results on students’ self-regulation outcomes. There is limited literature on the effects that yoga may have for children in the early primary grades, despite the evidence demonstrating that this is an opportune period for early self- regulation. Effects of an eight-week yoga intervention on economically disadvantaged pre-kindergarten and kindergarten children’s self-regulation and emotion regulation were examined via a paired within- subjects comparison study. Children demonstrated significant predicted gains on a behavioral task of self-regulation and declines in teacher-rated submissive venting and total behavior problems.

This paper discusses elementary, and secondary (K-12) teachers’ perceptions of cross-reality (XR) tools for data visualization and use of sensor data from the built environment in classroom curricula. Our objective was to explore the use of sensor-informed XR in the built environment and civil engineering (BECE) field to support K-12 science, technology, engineering, and mathematics (STEM) experiential learning and foster BECE-related career awareness. We conducted surveys and informal questionnaires with 33 primary and secondary teachers attending an annual two-day university-based teacher professional development workshop as part of a statewide STEM afterschool program serving students in rural communities. We assessed teachers’ familiarity with, knowledge about, and appraisal of using cross-reality platforms and sensor data in classrooms and after school curricula. Findings show that, while all teachers reported relatively high interest in learning about sensor applications and innovative interactive techniques, middle school teachers in particular were most likely to see value in using these applications for teaching and learning. Implications for teacher professional development are discussed.

Radiographer preliminary image evaluation, within strong governance and audit systems, can help reduce diagnostic errors in the emergency setting. Radiographers, clinicians and radiologists should work together as a team to improve patient care and outcomes.

Background Diagnostic capacity and suboptimal logistics are consistently identified as barriers to timely diagnosis of cancer, especially lung cancer. Immediate chest X-ray (CXR) reporting for patients referred from general practice is advocated in the National Optimal Lung Cancer Pathway to improve time to diagnosis of lung cancer and to reduce inappropriate urgent respiratory medicine referral for suspected cancer (2WW) referrals. The aim of radioX is to examine the impact of immediate reporting by radiographers of CXRs requested by general practice (GP) on lung cancer patient pathways. Methods A two-way comparative study that will compare the time to diagnosis of lung cancer for patients. Internal comparison will be made between those who receive an immediate radiographer report of a GP CXR compared to standard radiographer GP CXR reporting over a 12-month period. External comparison will be made with a similar, neighbouring hospital trust that does not have radiographer CXR reporting. Primary outcome is the effect on the speed of the lung cancer pathway (diagnosis of cancer or discharge). Secondary outcomes include the effect of the pathway on efficiency including the number of repeat CXRs performed in a timely fashion for suspected infection and the effect of immediate reporting of GP CXRs on patient satisfaction. Discussion The radioX trial will examine the hypothesis that immediate reporting of CXRs referred from GP reduces the time to diagnosis of lung cancer or discharge from the lung cancer pathway. Trial registration International Standard Randomised Controlled Trial Number ISRCTN21818068 . Registered on 20 June 2017.

Rejection sensitivity (RS) has been defined as the tendency to readily perceive and overreact to interpersonal rejection. The primary aim of this study was to test key propositions of RS theory, namely that rejecting experiences in relationships with parents are antecedents of early adolescents' future RS and symptomatology. We also expanded this to consider autonomy-restrictive parenting, given the importance of autonomy in early adolescence. Participants were 601 early adolescents (age 9 to 13 years old, 51 % boys) from three schools in Australia. Students completed questionnaires at school about parent and peer relationships, RS, loneliness, social anxiety, and depression at two times with a 14-month lag between assessments. Parents also reported on adolescents' difficulties at Time 1 (T1). It was anticipated that more experience of parental rejection, coercion, and psychological control would be associated with adolescents' escalating RS and symptoms over time, even after accounting for peer victimisation, and that RS would mediate associations between parenting and symptoms. Structural equation modelling supported these hypotheses. Parent coercion was associated with adolescents' increasing symptoms of social anxiety and RS over time, and parent psychological control was associated with increasing depressive symptoms over time. Indirect effects via RS were also found, with parent rejection and psychological control linked to higher T1 RS, which was then associated with increasing loneliness and RS. Lastly, in a separate model, peer victimisation and RS, but not parenting practices, were positively associated with concurrent parent reports of adolescents' difficulties.

Key Clinical Message Fat embolism syndrome (FES) is a rare complication of sickle‐cell disease (SCD) associated with extremely high mortality rates. It affects predominantly non‐SS patients and those with previously mild disease. Rapid institution of exchange transfusion with an aim to reduce HbS to very low levels as soon as FES is suspected can be life‐saving. Fat embolism syndrome (FES) is a rare complication of sickle‐cell disease (SCD) associated with extremely high mortality rates. It affects predominantly non‐SS patients and those with previously mild disease. Rapid institution of exchange transfusion with an aim to reduce HbS to very low levels as soon as FES is suspected can be life‐saving.

This dissertation explored whether unnecessary linguistic complexity (LC) in mathematics and biology assessment items changes the direction and significance of differential item functioning (DIF) between subgroups emergent bilinguals (EBs) and English proficient students (EPs). Due to inconsistencies in measuring LC in items, Study One adapted a rubric counting instances of specific grammatical features in items and introduced a method for evaluating lexical features in items. Four raters were asked to count the presence of five grammatical features in assessment items and determine whether each feature contained construct-relevant vocabulary. The items were drawn from four content assessments administered to Massachusetts high school students: two biology assessments and two mathematics assessments. These counts of grammatical and lexical features were modeled in factor analyses to evaluate the multidimensionality of LC and subsequent fit of multidimensional LC models. While there were problems with raters consistently counting construct-irrelevant grammatical features, multidimensional models of LC fit acceptably well. Factor scores obtained from the measurement models for lexical complexity, relative clauses, and complex noun phrases created in Study One were used for Study Two. In Study Two, Rasch hierarchical generalized linear models (HGLMs) were created to evaluate DIF between different subgroups of EBs and EPs on a biology assessment and a mathematics assessment, as including LC as an item covariate may predict item responses differently by comparison group. Seven comparison groups were evaluated across two assessments (mathematics and biology): EPs versus EBs, EPs versus short-term EBs, EPs versus long-term EBs, short-term EBs versus long-term EBs, EPs versus Spanish-speaking EBs, EPs versus non-Spanish-speaking EBs, and non-Spanish-speaking EBs versus Spanish-speaking EBs (reference group versus focal group, respectively). For each comparison group, at least five models were created: a comparison model with all participants in the comparison group with that only accounts for the main effect of focal group status, a “base model” that evaluated DIF for the comparison groups with no LC item covariates, a model including lexical complexity as an item covariate (“LEX predictor”), a model including complex noun phrases as an item covariate (“NP predictor”), and a model including relative clauses as an item covariate (“RC predictor”). If LC predictor models improved model fit, models with multiple LC predictors were created. For the EP versus EB comparison groups on the mathematics assessment, model fit only improved with the NP predictor model, while the LEX, NP, and RC predictor models improved model fit for the EB versus EB comparison groups; a model with all LC predictors improved model fit for the EB versus EB comparison groups. For the biology assessment, the LEX, NP, and RC predictor models improved model fit for all comparison groups; a model with all LC predictors improved model fit for all comparison groups. The main effects of the item covariates (LC factor scores) and their interactions with focal group status were evaluated, as were the number of items within a comparison group that had changes in DIF significance or direction when including a LC predictor. All LC predictors had consistent main effects across comparison groups. For the mathematics assessment, items with higher complex noun phrases factor scores were consistently more difficult for all comparison groups (NP predictor model), and items with higher lexical complexity (LEX predictor model, all predictors model) or relative clauses factor scores (RC predictor model, all predictors model) were consistently more difficult for all EB versus EB comparison groups. For the biology assessment and all comparison groups, items with higher lexical complexity (LEX predictor model, all predictors model) or complex noun phrases factor scores (NP predictor model, all predictors model) were consistently more difficult, and items with lower relative clauses factor scores (RC predictor model, all predictors model) were consistently more difficult, with one exception. In the all predictors models for the EB versus EB comparison groups, only relative clauses had a significant main effect. There were some changes in interactions with LC predictors and focal group status. For the mathematics assessment and EP versus EB comparison groups, complex noun phrases interactions favored EPs. For the mathematics assessment and EB versus EB comparison groups, generally the interactions in the single LC predictor models generally favored STEBs compared to LTEBs and non-Spanish-speaking EBs compared to Spanish-speaking EBs, but when all LC predictors were included, no interactions between LC predictor and focal group status were significant. For the biology assessment and EP versus EB comparison groups, lexical complexity and complex noun phrases factor scores interactions generally favored EPs, and relative clauses factor scores interactions favored EBs and EB subgroups. For the biology assessment and EB versus EB comparison groups, regardless of whether examining the single LC predictor or all predictors models, no interactions between focal group status and LC predictor were significant. Changes in DIF significance and direction were compared between the base model and LC predictor models for all comparison groups. For the mathematics assessment and EP versus EB comparison groups, after conditioning on complex noun phrases, items with complex noun phrases generally exhibited significant DIF favoring EBs, regardless of whether the complex noun phrases factor scores were high (one standard deviation above the mean) or low (due to floor effects, the lowest complex noun phrases factor score). For the biology assessment, all items exhibited significant DIF favoring EBs after accounting for lexical complexity, most items exhibited non-significant DIF after accounting for complex noun phrases or relative clauses, and items were mixed between exhibiting non-significant DIF or significant DIF favoring EBs after accounting for all LC predictors. While items with high relative clauses factor scores exhibited non-significant DIF, some items with low relative clauses factor scores exhibited significant DIF favoring EPs after accounting for relative clauses. Items with two or more high factor scores exhibited non-significant DIF, but items with two or more low factor scores exhibited significant DIF favoring EBs after accounting for all LC predictors. These results were fairly consistent across different EP versus EB comparison groups, although different items were flagged for DIF in initial models not accounting for LC predictors. Items were less difficult for EBs than EPs after accounting for LC features, which suggests the abilities of EBs are underestimated due to LC in items, even if the items have low LC. Considering subgroup differences in these EIRMs, the key takeaway is that while different items are flagged as exhibiting significant DIF for different EP versus EB comparison groups when examining DIF with no LC predictors, there are few subgroup differences in items changing DIF significance or direction after accounting for LC predictors.

The National Optimal Lung Cancer Pathway recommends rapid progression from abnormal chest X-rays (CXRs) to CT. The impact of the more rapid reporting on the whole pathway is unknown. The aim of this study was to determine the impact of immediate reporting of CXRs requested by primary care by radiographers on the time to diagnosis of lung cancer.MethodPeople referred for CXR from primary care to a single acute district general hospital in London attended sessions that were prerandomised to either immediate radiographer (IR) reporting or standard radiographer (SR) reporting within 24 hours. CXRs were subsequently reported by radiologists blind to the radiographer reports to test the reliability of the radiographer report. Radiographer and local radiologist discordant cases were reviewed by thoracic radiologists, blinded to reporter.Results8682 CXRs were performed between 21 June 2017 and 4 August 2018, 4096 (47.2%) for IR and 4586 (52.8%) for SR. Lung cancer was diagnosed in 49, with 27 (55.1%) for IR. The median time from CXR to diagnosis of lung cancer for IR was 32 days (IQR 19, 70) compared with 63 days (IQR 29, 78) for SR (p=0.03).8258 CXRs (95.1%) were reported by both radiographers and local radiologists. In the 1361 (16.5%) with discordance, the reviewing thoracic radiologists were equally likely to agree with local radiologist and radiographer reports.ConclusionsImmediate reporting of CXRs from primary care reduces time to diagnosis of lung cancer by half, likely due to rapid progress to CT. Radiographer reports are comparable to local radiologist reports for accuracy.Trial registrationInternational Standard Randomised Controlled Trial Number ISRCTN21818068. Registered on 20 June 2017.

To determine the kinetics and mechanism of hydrolysis of efavirenz [(S)-6-chloro-4-(cyclopropylethynyl)-1,4-dihydro-4-(trifluoromethyl)-2H-3,1-benzoxazin-2-one] in aqueous solutions. The solution stability was examined at 60 degrees C and an ionic strength of 0.3 M over the pH range of 0.6 to 12.8. The loss of efavirenz and the appearance of degradants were followed with a reverse-phase high-performance liquid chromatography assay. Characterization of the degradants was accomplished with liquid chromatography-mass spectrometry. The degradation of efavirenz followed apparent first-order kinetics over the pH range of 0.6 to 12.8 at 60 degrees C. The catalytic effect of phosphate and borate buffers was negligible while acetate and citrate demonstrated buffer catalysis. The overall rate constant indicated a pH minimum (the pH of maximum stability) of approximately 4. Mass spectra data identified a degradant with a molecular weight consistent with hydrolysis of the cyclic carbamate to the corresponding amino alcohol. The degradation route was confirmed with spiking experiments with an authentic sample of the amino alcohol indicating that the carbamate hydrolysis pathway was the predominant reaction throughout the pH range studied. Subsequent degradation of the amino alcohol proceeded at the extremes of the pH range studied via rearrangement to the quinoline. The pH-rate profile was consistent with a combination of a V-shaped profile in the pH range of 0-9 and a sigmoid-shaped profile in the pH range of 4-13. The plateau that began at pH 10-11 is a result of the ionization of the amine of the carbamate inhibiting the base-catalyzed hydrolysis of efavirenz, given that the ionized form of the carbamate is resonance-stabilized toward hydroxide-catalyzed degradation. Thus, increasing the pH resulted in a parallel decrease in the unionized fraction and increase in hydroxide ion concentration resulting in a constant k(obs) value.