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‘Co-production’ is advocated within UK legislation outlining children and young people’s right to be heard and to take part in the development of the services they use. This paper aims to explore u...

Responding to children's expressed needs and preferences can improve their self‐esteem and motivation for learning. However, some groups of children and young people may find it more difficult to express their needs and preferences. This article reviews the research evidence on methods used to gather the views of children with an autism spectrum disorder (ASD), who may have particular difficulties with social communication. From research databases, 20 relevant studies were identified. Semi‐structured interview was a frequently used method, but may be better suited to older, or more academically able, students. The effectiveness of interview methods can be improved by offering the student choice of interview location, by reducing distractions, and by the use of visual aids. Other potentially suitable methods included: oral, written or electronic diaries; use of drawings; use of photographs taken by the student; use of focus groups; and use of individually administered survey questionnaires. More focused evaluation by future researchers of the suitability of data‐gathering methods for participants with ASD would allow broader conclusions to be drawn about which methods work best and for whom. [ABSTRACT FROM AUTHOR]

As a response to calls for social justice and promotion of children’s rights across increasingly diverse communities, the need for ‘culturally competent’ services to children, families and schools ...

This chapter reviews the place of the Convention on the Rights of the Child within school psychology and, against that background, then evaluates three UK-based approaches to school and community capacity building work by UK school psychologists. Key aspects of process and outcomes of each capacity building activity are identified, with particular reference to the promotion of the provisions of the Convention. The implications of the evaluations for the work of school psychologists internationally within school and community contexts beyond the UK are addressed.

White light colonoscopy is the current gold standard for early detection and treatment of colorectal cancer, but emerging data suggest that this approach is inherently limited. Even the most experienced colonoscopists, under optimal conditions, miss at least 15–25% of adenomas. There is an unmet clinical need for an adjunctive modality to white light colonoscopy with improved lesion detection and characterization. Optical molecular imaging with exogenously administered organic fluorochromes is a burgeoning imaging modality poised to advance the capabilities of colonoscopy. In this proof-of-principle clinical trial, we investigated the ability of a custom-designed fluorescent colonoscope and indocyanine green, a clinically approved fluorescent blood pool imaging agent, to visualize polyps in high risk patients with polyposis syndromes or known distal colonic masses. We demonstrate (1) the successful performance of real-time, wide-field fluorescence endoscopy using off-the-shelf equipment, (2) the ability of this system to identify polyps as small as 1 mm, and (3) the potential for fluorescence imaging signal intensity to differentiate between neoplastic and benign polyps.

Ten years after an original survey, this article reports findings from a 2017 survey of secondary school staff involved in school‐based management of GCSE examination access arrangements. A total of 263 respondents, including specialist assessors and SENCos, explained their views on the manageability and fairness of processes for GCSE examination access arrangements. While the perceived fairness of GCSE access arrangements has increased, a majority of respondents do not consider current processes to be manageable at the school level or equally fair to students. However, almost two‐thirds of respondents would support some extension of access arrangements or use of technological assistance on the basis of student need. The researchers recommend promotion of partnership between the qualifications regulator, awarding bodies and schools; enhanced shared understanding of the purpose, place and limitations of access arrangements; and use of a school‐based protocol to manage roles and resource requirements for the organization of access arrangements. [ABSTRACT FROM AUTHOR]

The cocktail party problem requires listeners to infer individual sound sources from mixtures of sound. The problem can be solved only by leveraging regularities in natural sound sources, but little is known about how such regularities are internalized. We explored whether listeners learn source "schemas"-the abstract structure shared by different occurrences of the same type of sound source-and use them to infer sources from mixtures. We measured the ability of listeners to segregate mixtures of time-varying sources. In each experiment a subset of trials contained schema-based sources generated from a common template by transformations (transposition and time dilation) that introduced acoustic variation but preserved abstract structure. Across several tasks and classes of sound sources, schema-based sources consistently aided source separation, in some cases producing rapid improvements in performance over the first few exposures to a schema. Learning persisted across blocks that did not contain the learned schema, and listeners were able to learn and use multiple schemas simultaneously. No learning was evident when schema were presented in the task-irrelevant (i.e., distractor) source. However, learning from task-relevant stimuli showed signs of being implicit, in that listeners were no more likely to report that sources recurred in experiments containing schema-based sources than in control experiments containing no schema-based sources. The results implicate a mechanism for rapidly internalizing abstract sound structure, facilitating accurate perceptual organization of sound sources that recur in the environment.

Objectives: This study compared the short term (24 month) clinical outcomes in a prospective, comparative case series of participant selected hamstring autograft and synthetic (LARS) ACL reconstructions. Methods: 64 ACL reconstructed participants (32 hamstring,32 LARS), completed a “goal-oriented” rehabilitation protocol. They were assessed for joint laxity (KT1000), clinical outcome (IKDC Knee Examination) and activity (Tegner Activity Scale-TAS) pre-operatively and at 12,16,20 and 24 weeks, and at 12 and 24 months post-operatively. Results: KT 1000 results did not differ significantly between the 2 treatment groups at 24 months. Differences were noted in joint laxity measurements between the 2 groups at varying time points. The LARS group had immediate stability of the joint at 12 weeks followed by a gradual increase in laxity over the follow-up period, while the hamstring group showed an increase in laxity up to 16-20 weeks, followed by a gradual decrease over the follow-up period. The LARS group had significantly higher TAS scores in the early post-operative period, but there was no significant difference between the 2 groups at 12 months and beyond. At 24 months, 32 of the hamstring group and 30 of the LARS group achieved IKDC Scores “A” or “B”. There were 5 reported graft failures (15.6%) in the LARS group between 7 and 22 months post-op, and none in the hamstring group. Conclusion: ACL reconstruction using synthetic (LARS) grafts produced earlier return of some activities compared to autograft reconstructions, but this difference was no longer evident by 12 months post-op. When the substantially differing failure rates are taken into consideration, this early benefit does not appear to justify their use in place of autografts for ACL reconstruction.

Recent research has highlighted the conflict potential of both land deals and climate change mitigation projects, but generally the two phenomena are studied separately and the focus is limited to discrete cases of displacement or contested claims. We argue that research with a broader “landscape” perspective is needed to better understand the complex social, ecological and institutional interactions taking place in sites of land-based climate change projects (such as biofuel production or forest conservation) and large-scale investments (plantations or mines). Research that co-produces knowledge and capacity with local actors, and informs advocacy at multiple policy scales, will contribute better to preventing, resolving or transforming conflicts.

Background and study aims: Biopsy sampling error can be a problem for the diagnosis of certain gastrointestinal tract diseases. Spectrally-encoded confocal microscopy (SECM) is a high-speed reflectance confocal microscopy technology that has the potential to overcome sampling error by imaging large regions of gastrointestinal tract tissues. The aim of this study was to test a recently developed SECM endoscopic probe for comprehensively imaging large segments of the esophagus at the microscopic level in vivo. Methods: Topical acetic acid was endoscopically applied to the esophagus of a normal living swine. The 7 mm diameter SECM endoscopic probe was transorally introduced into the esophagus over a wire. Optics within the SECM probe were helically scanned over a 5 cm length of the esophagus. Confocal microscopy data was displayed and stored in real time. Results: Very large confocal microscopy images (length = 5 cm; circumference = 2.2 cm) of swine esophagus from three imaging depths, spanning a total area of 33 cm2, were obtained in about 2 minutes. SECM images enabled the visualization of cellular morphology of the swine esophagus, including stratified squamous cell nuclei, basal cells, and collagen within the lamina propria. Conclusions: The results from this study suggest that the SECM technology can rapidly provide large, contiguous confocal microscopy images of the esophagus in vivo. When applied to human subjects, the unique comprehensive, microscopic imaging capabilities of this technology may be utilized for improving the screening and surveillance of various esophageal diseases.

This paper reflects upon the developing role of educational psychologists (EPs) within the local authority Children’s Services, from the starting point that the EP role has, through numerous reviews, been clearly conceptualised. Detailing the philosophy and framework for the inception of Children’s Services in England, the authors propose two specific directions for EP work within this context. With an illustrative case study of one local authority EP service, it is argued that, whilst the core EP functions remain constant, it is the range and derivation of EP work which is being, and will continue to be, transformed. Reinforcing Stobie’s emphasis from 2002 upon EPs’ ability to respond flexibly to the changing socio‐political context, and the associated challenges for initial professional training, the authors highlight the significance of issues of role specialisation, commissioning of educational psychology services, and evaluation of the outcomes of EP work. A strategy for future EP role reviews is pro...

Many countries have established systems for identifying, and providing for, the range of students with disabilities during their formal educational assessments. Most systems include the provision of variously termed ‘special access arrangements’ (SAAs), such as the provision of extra time or practical assistance with some aspect of an examination. There is, however, a paucity of outcome monitoring data relating to such systems, particularly that relating to the student and parent perspective. Using a combination of focus group, questionnaire and interview methods, the present study reports the views of 86 students with disabilities, their parents and teachers, upon the students’ educational assessment experiences. Findings indicate four specific areas for development of current practice: individualization of assessment of needs; utilization of student and parent voice; consideration of test anxiety factors; improved communication between schools, parents and students. From this, the researchers propose a revised system for needs identification and provision for students with disabilities during their formal educational assessments, highlighting a proactive role for school psychologists.

Jejunoileal diverticulosis is a rare entity. Jejunoileal diverticulosis is not a disease that surgeons see often in clinical practice; however, it should remain on the differential diagnosis for any patient with an acute abdomen or gastrointestinal bleeding of unknown origin. It can present with a wide range of clinical scenarios and when patients experience chronic symptoms such as bloating, abdominal pain, nausea, bacterial overgrowth, or malabsorption, medical therapy is successful in most patients. However, when patients present with acute symptoms of bleeding, inflammation, perforation, or obstruction, surgical resection and primary anastomosis is often the treatment of choice. If patients are asymptomatic, they are better left alone, even when discovered incidentally in the operating room. In closing, the possibility of a patient having jejunal diverticular disease should be suspected whenever the symptoms of obscure abdominal pain, anemia, dilated jejunal loops on abdominal radiographs, a history of colonic diverticuli, and a history of acute appendicitis.

Background:Additional high-quality prospective studies are needed to better define the objective criteria used in relation to return-to-sport decisions after anterior cruciate ligament (ACL) reconstruction in active populations.Purpose:To investigate prospectively the relationship between functional performance test results at 24 weeks postoperative and return-to-sport activity (Tegner activity score) at 12 and 24 months, respectively, after synthetic (ligament advanced reinforcement system [LARS]) and autograft (doubled semitendinosus/gracilis [2ST/2GR]) ACL reconstructions.Study Design:Case series; Level of evidence, 4.Methods:A total of 64 patients who underwent ACL reconstruction (32 LARS, 32 2ST/2GR autograft; mean age, 27.9 years; body mass index [BMI], 24.9 kg/m2) were assessed preoperatively and at staged intervals postoperatively up to 24 weeks for isokinetic testing of quadriceps and hamstring average power per repetition at 60 deg/s and 180 deg/s, a battery of hop tests, peak vertical ground-reaction force (vGRF), and time to peak vGRF (in seconds) during a step- and jump-down task onto a force platform and peak speed (m/s) using a global positioning system (GPS unit) during a running task. A cohort of 32 healthy matched participants (mean age, 26.31 years; BMI, 25.7 kg/m2) were also tested to act as reference. Pearson correlation was calculated to assess correlation of each performance measure at 24 weeks postoperative with activity outcomes (Tegner score) at 12 and 24 months.Results:The strongest correlation between physical performance tests and return-to-sport outcomes was observed with peak speed during running. Large correlations were also observed for hamstring isokinetic power and hop test for distance. Moderate correlations were observed for timed hop, peak vGRF during a jump-down task, and quadriceps isokinetic power. No statistical correlations were observed for time to peak vGRF during a step-down and jump-down task as well as peak vGRF during a step-down task. When the performance tests were pooled together, mean postoperative improvements of 24% were observed from preoperative to 24 weeks within the surgical cohort. For each performance test, preoperative level of function strongly correlated with performance levels on the same test at 24 weeks.Discussion:The results of this study indicate that clinicians might seek to prioritize these tests and the rehabilitation themes they imply when seeking to maximize postoperative ACL activity outcomes. The observed strength between pre- and postoperative performance tests and return-to-sport outcomes within this study highlights the potential value of preoperative conditioning before undergoing ACL reconstruction. Future research should examine absolute predictive criterion thresholds for functional performance-based tests and reinjury risk reduction after ACL reconstruction.

Background: Additional high-quality prospective studies are needed to better define the objective criteria used in relation to return-to-sport decisions after synthetic (ligament advanced reinforcement system [LARS]) and autograft (hamstring tendon [2ST/2GR]) anterior cruciate ligament (ACL) reconstruction in active populations. Purpose: To prospectively investigate and describe the recovery of objective clinical outcomes after autograft (2ST/2GR) and synthetic (LARS) ACL reconstructions, as well as to investigate the relationship between these clinimetric test outcomes and return-to-sport activity (Tegner activity scale [TAS] score) at 12 and 24 months postoperatively. Study Design: Case series; Level of evidence, 4. Methods: A total of 64 patients who underwent ACL reconstruction (32 LARS, 32 2ST/2GR autograft) and 32 healthy reference participants were assessed for joint laxity (KT-1000 arthrometer), clinical outcome (2000 International Knee Documentation Committee [IKDC] knee examination), and activity (TAS score) preoperatively and at 12, 16, 20, and 24 weeks and 12 and 24 months postoperatively. Results: There was no significant correlation observed between clinical results using the 2000 IKDC knee examination and TAS score at 24 months ( rs = 0.188, P = .137), nor were results for side-to-side difference ( rs = 0.030, P = .814) or absolute KT-1000 arthrometer laxity of the surgical leg at 24 months postoperatively ( rs = 0.076, P = .553) correlated with return-to-sport activity. Nonetheless, return-to-sport rates within the surgical cohort were 81% at 12 months and 83% at 24 months, respectively. No statistically significant differences were observed between physiological laxity of the uninjured knee within the surgical group compared with healthy knees within the reference group ( P = .522). Conclusion: The results indicate that although relatively high levels of return-to-sport outcomes were achieved at 24 months compared with those previously reported in the literature, correlations between objective clinical tests and return-to-sport outcomes may not occur. Clinical outcome measures may provide suitable baseline information; however, the results of this study suggest that clinicians may need to place greater emphasis on other outcome measures when seeking to objectively promote safe return to sport.

This chapter focuses on workplace learning for trainee educational psychologists, drawing upon data on students’ experiences. It is shown how the university-workplace learning partnership has been affected by the context of recent developments in national training arrangements and in the role of qualified educational psychologists, particularly their employment under models of ‘service trading’ and statutory registration. Implications for quality assurance of trainees’ workplace learning experiences, and in particular for effective practice supervision, have provided the opportunity for joint reflection on the interdependency within the university-workplace learning partnership. Partnership strategies are described which support effective workplace learning for trainee psychologists. Continued organisational learning will be important as socio-political factors shape the context in which partners negotiate workplace learning opportunities for trainee educational psychologists.

Spectrally encoded confocal microscopy (SECM) is a form of reflectance confocal microscopy that can achieve high imaging speeds using relatively simple probe optics. Previously, the feasibility of conducting large-area SECM imaging of the esophagus in bench top setups has been demonstrated. Challenges remain, however, in translating SECM into a clinically-useable device; the tissue imaging performance should be improved, and the probe size needs to be significantly reduced so that it can fit into luminal organs of interest. In this paper, we report the development of new SECM endoscopic probe optics that addresses these challenges. A custom water-immersion aspheric singlet (NA = 0.5) was developed and used as the objective lens. The water-immersion condition was used to reduce the spherical aberrations and specular reflection from the tissue surface, which enables cellular imaging of the tissue deep below the surface. A custom collimation lens and a small-size grating were used along with the custom aspheric singlet to reduce the probe size. A dual-clad fiber was used to provide both the single- and multi- mode detection modes. The SECM probe optics was made to be 5.85 mm in diameter and 30 mm in length, which is small enough for safe and comfortable endoscopic imaging of the gastrointestinal tract. The lateral resolution was 1.8 and 2.3 µm for the single- and multi- mode detection modes, respectively, and the axial resolution 11 and 17 µm. SECM images of the swine esophageal tissue demonstrated the capability of this device to enable the visualization of characteristic cellular structural features, including basal cell nuclei and papillae, down to the imaging depth of 260 µm. These results suggest that the new SECM endoscopic probe optics will be useful for imaging large areas of the esophagus at the cellular scale in vivo.

The authors' group has previously described successful transanal rectosigmoid resection via natural orifice translumenal endoscopic surgery (NOTES) in both porcine and cadaveric models using the transanal endoscopic microsurgery platform. This report describes the largest cadaveric series to date as optimization of this approach for clinical application continues.Between December 2008 and September 2011, NOTES transanal rectosigmoid resection with total mesorectal excision (TME) was successfully performed in 32 fresh human cadavers using transanal dissection alone (n = 19), with transgastric endoscopic assistance (n = 5), or with laparoscopic assistance (n = 8). The variables recorded were gender, body mass index (BMI), operative time, length of the mobilized specimen, integrity of the mesorectum and the resected specimen, and complications. Univariate statistical analysis was performed.Of the 32 cadavers, 22 were male with a mean BMI of 24 kg/m(2) (range 16.3-37 kg/m(2)). The mean operative time was 5.1 h (range 3-8 h), and the mean specimen length was 53 cm (range 15-91.5 cm). After the first five cadavers, specimen length significantly improved, and a trend toward decreased operative time was demonstrated. The mesorectum was intact in 100% of the specimens. In nine cadavers, endoscopic dissection was complicated by organ injury. Evaluation by the operative approach demonstrated a significantly longer specimen with laparoscopic assistance (67.7 cm) than with transgastric assistance (45.4 cm) or transanal dissection alone (49.2 cm) (p = 0.013). Comparison of the technique used for inferior mesenteric pedicle division demonstrated both significantly decreased operative time (4.8 vs 6 h; p = 0.024) and increased specimen length (57.7 vs 39.6 cm; p = 0.025) when a stapler was used in lieu of a bipolar cautery device.Transanal NOTES rectosigmoid resection with TME is feasible and demonstrates improvement in specimen length and operative time with experience. Transitioning to clinical application requires laparoscopic assistance to overcome limitations related to NOTES instrumentation, as well as procedural training with fresh human cadavers.

Summary This article considers educational psychologists’ proactivity and creativity in relation to influencing ‘special needs’ policy. It is argued that, by association and largely by omission, psychologists might be considered to be part of a problem with special needs concept formation, inconsistent special educational provisioning and the rise of statementing together with its attendant resource drawings and crises. Psychologists have not put forward a co‐ordinated response to these crucial issues and there have already been effects on their practice. With the move towards responses focusing upon definitive criteria for statements of special educational needs, the role of educational psychology in local education authorities might become more narrow and diminished. A strong professional response which realises that the problem for educational psychology is actually the problem with special education is urgently required.

It is well documented that breast cancer is frequently missed on mammograms, leading to delayed detection and potentially less successful treatment. Our studies show that approximately 32% of cancers can be detected early using mammograms. While current Computer-Assisted Detection (CAD) technology is designed to capture as many of these cancers as possible, it is not able to offer information specific enough to assist the radiologist in determining the best course of action once a suspicious region is identified. The use of additional clinically relevant information will help the radiologist determine the best course of treatment. Approximately 4.6 billion dollars was spent on breast biopsies in 2002, and only 10-30% of these biopsies resulted in the diagnosis of breast cancer. The use of all available sensor and patient history data in diagnosis will help to eliminate a significant number of these unnecessary biopsies. The technical objective of the Computer-Assisted Cancer Device project was to develop a platform technology that will allow for a significant improvement in the accuracy of interpreting mammograms through the use of Second Generation Computer-Assisted Detection (2nd Generation CAD) that is designed for using not only the current year's screening mammograms (as is common in 1st generation commercial CAD), but also any additional clinically relevant information (e.g., prior mammograms, other sensors like 3D ultrasound/MRI/IR, participant history information, etc.). Specifically, in this study, the authors added a 3-D breast ultrasound examination to the modalities already used in the clinical care of enrolled participants as additional input to the development of a CAD algorithm. Using additional sources of information will help move CAD technology from being a detection aid to becoming a diagnostic aid.

Possessing a wide mix of non-clinical competences is important for professionals involved in managed clinical networks (MCNs). Skills that stand out are related to interpersonal issues, problem solving, decision-making, and managing change. Interprofessional and interorganizational collaboration is important in health care generally and is not confined to MCNs. Skills are likely to have relevance in wider contexts. Training needs identified for professionals in MCNs relate to skills associated with working in challenging situations, including: ‘managing change,’ ‘conflict resolution,’ and ‘negotiation.’ Limited generalizations about profession-specific skills and training needs can be made. However, it is more appropriate to identify skills needed for the specific role(s) an individual is asked to perform, and to investigate if there are performance gaps between skills and competencies.

Advances in conceptual thinking have not kept up with advances in technology and precision. Much of the thinking about the uses of precision and stealth to create effects-based operations (EBO) has instead focused on the tactical employment of weapons systems. Military thinkers have focused on target destruction rather than on the psychological impact of military actions, despite evidence that war has remained a psychological endeavor. This paper examines how policy makers and military leaders should use EBO to achieve strategic, operational, and psychological effects, rather than focusing operations solely on the technological or tactical problems involved in hitting targets. Historically, leaders who were victorious in war (and its aftermath) had posed hard questions to their subordinates as to the possible strategic and political effects that potential military courses of action might have. From their examination of these historical examples, the authors of this paper conclude that the linking of the strategic outcome to means, military actions, and potential effects at least offers the possibility that the United States can proceed down a coherent path. Moreover, such a strategic framework offers the potential of overcoming or at least addressing the uncertainties and ambiguities that will always mark the making of strategy.

Integrated health care is a key policy aim of Scotland's newly devolved government. ‘Partnership working’ is the mechanism that has been selected to achieve this goal. Three illustrative examples of health care integration models developed in Scotland are considered; system organisation and structure; Local Health Care Co-operatives (LHCCs); and Managed Clinical Networks. Using these examples the paper explores the nature of ‘partnership’ and asks if it can deliver integrated care.