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This article presents an original simulation, called Tick, Tick, Boom, which is designed to help students examine the use of torture in counterterrorism interrogations. The simulation is designed to be embedded in a larger array of course content but needs only one 50-minute class period to play. Unlike many similar games, students participate individually, learning the consequences of their actions through dice rolls. The article summarizes the gameplay and debriefing, presents a brief assessment of the simulation as an activity, and offers suggestions for future extensions.

The giant freshwater crayfish, Astacopsis gouldi Clark, 1936, is an endangered endemic freshwater species native to Northern Tasmania. Habitat loss, fishing pressure, and climate change have been identified as threatening processes. The Australian government approved a recovery plan for A. gouldi in 2017 that requires routine population surveys to assess the impact of ongoing threats and recovery actions. We developed a novel species‐specific probe‐based assay targeting a 219 bp fragment in the Cytochrome Oxidase 1 gene region to detect traces of A. gouldi DNA in environmental samples as a cost‐effective, sensitive, and non‐invasive surveillance method to assess the presence of this endangered species. We tested assay specificity against ten crayfish species commonly found in Tasmania within the Astacopsis, Cherax, Geocharax, Engaeus, and Ombrastacoides genera and determined assay sensitivity using tissue‐derived genomic DNA and synthetic oligo standards designed for A. gouldi. We then tested water samples collected from aquaria and natural freshwater streams in Northern Tasmania with known occurrence of A. gouldi, as well as one site with no known A. gouldi occurrence. The probe‐based assay designed in this study successfully detected A. gouldi DNA and eDNA with a 10 copies/µl limit of detection and showed no amplification of non‐targeted co‐existing crayfish species. We successfully detected the presence of A. gouldi eDNA in water samples from six sites with known occurrences of the species. There was no detection from the negative site. This study validates the use of eDNA‐based detection of A. gouldi by real‐time PCR as a non‐invasive monitoring tool to assist field monitoring, assessment, and complement ongoing recovery actions to protect habitable ecosystems of A. gouldi.

Supplemental digital content is available in the text., Background Nurses are concerned for their safety and conflicted about their career, because their duty to care for patients during the pandemic involved competing ethical obligations, including their own personal safety. Purpose The aim was to explore the impact of COVID-19 on new nurses and nursing students in terms of safety and interest in nursing specifically related to self-efficacy, geographic region case density, and frontline experience in health care. Methods New nurses and nursing students (N = 472) responded to an online survey examining self-efficacy, sense of safety, and interest in nursing. The survey included an open-ended question to support response interpretation. Results Researchers identified significant differences among new nurses and students from contrasting case-dense regions in terms of safety and interest in nursing. Conclusion Concerns about personal safety and the safety of others were apparent. Over time, this may lead to a decrease in willingness to enter or remain in the nursing profession.

Botulinum toxin has been used for the past few decades to treat conditions in the head and neck. In recent years, its use is expanding. This article presents a summary of the wide range of uses in the laryngeal, pharyngeal, cervical, oromandibular and facial muscles. As well as the uses discussed in this article, botulinum toxin has also been used more recently for a newly recognized condition: retrograde cricopharyngeus dysfunction. The condition and its treatment are discussed. Botulinum toxin is a safe and generally successful treatment for spasmodic dysphonia, Meige syndrome and oromandibular and cervical dystonia; neurological conditions, such as multiple system atrophy and migraine; and finally the oropharynx, post-laryngectomy, cricopharyngeal dysphagia, Zenker’s diverticulum and retrograde cricopharyngeal dysfunction disorder.

Objective To explore the burdens experienced by family carers who support older relatives to manage their medications at home. Methods This study, based on a larger UK medication management study: MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation (MEMORABLE), reports on findings from family carer interviews (n = 16). The five stages of medication management, identified in MEMORABLE, were used to inform the analysis. Results Family carers described being involved in some or all five of the MEMORABLE stages to help manage older relatives’ medications. Their capacity to undertake this role was sometimes limited by the complex workload involved as well personal circumstances such as time, distance and relationships. Family carers perceived that their knowledge and skills in medication management improved with experience, but also described stress associated with information lag and gaps, risk and responsibility, and loss. They described medication management burdens that needed mitigation: ambiguity, concealment, unfamiliarity, fragmentation and in particular exclusion, conflicted interests and expectation of coping. Conclusion To help mitigate these burdens, family carers should receive better information, training and support for this role. Practice implications Continued reliance on family carers for medication management requires strategic recognition in policy, funding and practice.

PURPOSE OF REVIEW: Dysphonia has been described as a major symptom of coronavirus disease-2019 (COVID-19). A literature review examining this topic was undertaken and is presented here, combined with insights from our experience in managing patients with laryngeal complications following mechanical ventilation for severe COVID-19 pneumonitis. RECENT FINDINGS: Naunheim et al. reported that patients who are most at risk of needing intubation with COVID-19 disease are those with patient-specific risk factors and these are at an increased risk for subsequent laryngotracheal injury following intubation (1). In our cohort of 105 patients referred with laryngological symptoms postintubation for COVID-19 pneumonitis, 40% presented as urgent reviews, of which almost half had severe postintubation complications requiring surgery. Perceptual voice ratings and patient-reported voice ratings varied widely, but there was no significant change in voice scores postoperatively. The reflux symptom index (RSI) scores did improve significantly (p = 0.0266). The need for surgery was associated with the presence of comorbidities for instance hypertension, diabetes and obesity in our cohort. This is in support of reported association of comorbidity as a risk factor for intubation and subsequent development of postintubation airway complications. SUMMARY: Dysphonia following COVID-19 infection may have multiple causes. Literature reports demonstrate intubation injury, sensory neuropathy, and postviral neuropathy are associated with voice changes. Our personal experience has confirmed postintubation injury markedly affects glottic function with resultant dysphonia attributable to scar formation, posterior glottic stenosis, granulation and subglottic stenosis. Frequent surgical intervention is required for airway patency and may have short-term further deleterious effects on phonation, although in our cohort this is not statistically significant analysing Grade, Roughness, Breathiness, Asthenia, Strain, Voice Handicap Index-10 or Airway, Voice, Swallow scores. Maximal antireflux medications and advice statistically improved RSI scores postoperatively.

Wetland ecosystems are critical to the regulation of the global carbon cycle, and there is a high demand for data to improve carbon sequestration and emission models and predictions. Decomposition of plant litter is an important component of ecosystem carbon cycling, yet a lack of knowledge on decay rates in wetlands is an impediment to predicting carbon preservation. Here, we aim to fill this knowledge gap by quantifying the decomposition of standardised green and rooibos tea litter over one year within freshwater and coastal wetland soils across four climates in Australia. We also captured changes in the prokaryotic members of the tea-associated microbiome during this process. Ecosystem type drove differences in tea decay rates and prokaryotic microbiome community composition. Decomposition rates were up to 2-fold higher in mangrove and seagrass soils compared to freshwater wetlands and tidal marshes, in part due to greater leaching-related mass loss. For tidal marshes and freshwater wetlands, the warmer climates had 7-16% less mass remaining compared to temperate climates after a year of decomposition. The prokaryotic microbiome community composition was significantly different between substrate types and sampling times within and across ecosystem types. Microbial indicator analyses suggested putative metabolic pathways common across ecosystems were used to breakdown the tea litter, including increased presence of putative methylotrophs and sulphur oxidisers linked to the introduction of oxygen by root in-growth over the incubation period. Structural equation modelling analyses further highlighted the importance of incubation time on tea decomposition and prokaryotic microbiome community succession, particularly for rooibos tea that experienced a greater proportion of mass loss between three and twelve months compared to green tea. These results provide insights into ecosystem-level attributes that affect both the abiotic and biotic controls of belowground wetland carbon turnover at a continental scale, while also highlighting new decay dynamics for tea litter decomposing under longer incubations. UIDB/04326/2020/ CEECINST/00114/2018 info:eu-repo/semantics/publishedVersion

Background Nurses are concerned for their safety and conflicted about their career, because their duty to care for patients during the pandemic involved competing ethical obligations, including their own personal safety. Purpose The aim was to explore the impact of COVID-19 on new nurses and nursing students in terms of safety and interest in nursing specifically related to self-efficacy, geographic region case density, and frontline experience in health care. Methods New nurses and nursing students (N = 472) responded to an online survey examining self-efficacy, sense of safety, and interest in nursing. The survey included an open-ended question to support response interpretation. Results Researchers identified significant differences among new nurses and students from contrasting case-dense regions in terms of safety and interest in nursing. Conclusion Concerns about personal safety and the safety of others were apparent. Over time, this may lead to a decrease in willingness to enter or remain in the nursing profession.

Quantitative human rights scholarship is increasing. New data sets and methods have helped researchers examine a broad array of research questions concerning the many human rights laid out in the United Nations’ 1948 Universal Declaration of Human Rights and related documents. These innovations have enabled quantitative human rights scholarship to better connect to existing qualitative and theoretical literatures and have improved advocacy efforts. Quantitative scholars have primarily operationalized the concept of human rights through the use of four kinds of data: events data (such as counts of abuses or attacks), standards-based data (such as coded scores), survey data, and socioeconomic statistics (such as maternal mortality or malnutrition rates). Each type of data poses particular challenges and weaknesses for analyses, including the biased undercounts of events data and the potential for human error or biases in survey or standards-based data. The human rights field has also seen a systematic overrepresentation of analyses of physical integrity rights, which have fewer component parts to measure. Furthermore, qualitative scholars have pointed out that it is difficult for quantitative data to capture the process of human rights improvement over time. The creation of new technologies and methodologies has allowed quantitative researchers to lessen the impact of these data weaknesses: Latent variables allow scholars to create aggregate measures from a variety of classes of quantitative data, as well as understandings from qualitative scholars, leading to the creation of new measures for rights other than physical integrity rights. New machine learning techniques and algorithms are giving scholars access to greater amounts of data than ever before, improving event counts. Expert surveys are pulling new voices into the data-generating process and incorporating practitioners into data processes that are too often restricted to academics. Experimental studies are furthering the field’s understanding of the processes underlying advocacy. Drawing on the lessons of past work, future scholars can use quantitative methods to improve the field’s theoretical and practical understandings of human rights.

he relationship between detritivore diversity and decomposition can provide information on how biogeochemical cycles are affected by ongoing rates of extinction, but such evidence has come mostly from local studies and microcosm experiments. We conducted a globally distributed experiment (38 streams across 23 countries in 6 continents) using standardised methods to test the hypothesis that detritivore diversity enhances litter decomposition in streams, to establish the role of other characteristics of detritivore assemblages (abundance, biomass and body size), and to determine how patterns vary across realms, biomes and climates. We observed a positive relationship between diversity and decomposition, strongest in tropical areas, and a key role of abundance and biomass at higher latitudes. Our results suggest that litter decomposition might be altered by detritivore extinctions, particularly in tropical areas, where detritivore diversity is already relatively low and some environmental stressors particularly prevalent., This study was part of the DecoDiv project conducted by the GLoBE network (www.globenetwork.es), which is coordinated by L. B. Most research was based on crowdfunding (details on specific funding sources at each region are given in Supplementary Information). Project coordination was funded by Basque Government funds (Ref. IT951-16) to the Stream Ecology Group (UPV/EHU, Spain).

In the Indigenous contexts described in this chapter efforts have been made to bring the whole of what it means to be human into the task of learning school mathematics. This motivates a discussion of relevance of mathematics and context, to be replaced by ‘entwinement’ of context with mathematics and the importance of community support for mathematical learning.

Several very different alternative mathematics education contexts are described; they have common features in: prioritising listening to learners; adapting teaching to support learning; incorporating emotional and social selves into learning; engagement with community; tasks that allow choice and support meaning-making; teachers being alongside learners; and supporting abstract reasoning. These contribute to combining care for mathematics with care for learners.

‘Alternative’ and ‘mainstream’ are defined, followed by an overview of recent history of mathematics education policy and provision in England. A description of current norms is given that contrasts a focus on testing and top-down expectations with the possibility of a more holistic view that includes other aims. There is an outline of contents that explore this idea.

Cognitive science has much to say about memory and executive function that might relate to some kinds of mathematical knowledge and cognition. There is a need to develop other forms of mathematical knowing, while cognitive science can explain classroom phenomena and affirm or challenge professional knowledge. Language shapes knowledge and supports reasoning.

Generic pedagogic approaches and their priorities are described avoiding dichotomies. School mathematics is situated within the psychological, emotional and social worlds of students, pointing out how mathematics relates to development and how the school context matters. A contrast between cognitive control and cognitive care is constructed.

This chapter presents examples of out-of-class provision and mainstream classes in which the qualities of cognitive care, meaning care for the learning of mathematics, developed in preceding chapters are evidenced. Teachers allow the responsibility for, and control of, the direction of mathematical ideas to flow between teachers and students depending on the mathematical thinking that takes place and the ideas that arise. The teacher prepares initial tasks and goals, adapting and extending as the lessons unfold. Interactions, both planned and spontaneous, support individual and class thinking.

Highlights • 13 patients with Meige (craniocervical dystonia) syndrome and breathing difficulties were identified, 6 with and 7 without laryngeal involvement. • 77% had a good (>50%) response to Botulinum toxin injection(s). • Among the 13 Meige patients, all patients, except one, had clinical signs of supra-hyoid muscles involvement, we believe this muscle group is the main cause of the dyspnoea in this specific Meige phenotype., Background Dyspnoea is rarely mentioned in the clinical description of adult-onset isolated dystonia. In this study, we present the clinical features of 13 patients with Meige syndrome (cranio-cervical dystonia) with breathing difficulties. Methods A retrospective case note review was performed of patients presenting with Meige syndrome and shortness of breath, to a neuro-laryngology MDT clinic. Results Some patients were severely limited by their breathlessness, but others did not volunteer these symptoms. The majority of patients were referred with the assumption that the larynx was the cause of the problem; however half the patients did not have evidence of laryngeal involvement. Of the patients who had laryngeal involvement, injecting the larynx alone did not always relieve the dyspnoea. The majority of our patients responded to injection of the suprahyoid muscles, including genioglossus, digastric and mylohyoid. Conclusion We recommend routinely establishing if the patient with Meige syndrome has signs or symptoms of breathlessness, and establishing the level of the problem, as this can be treated successfully.

Plant litter functional diversity effects on instream decomposition change across latitudes., Running waters contribute substantially to global carbon fluxes through decomposition of terrestrial plant litter by aquatic microorganisms and detritivores. Diversity of this litter may influence instream decomposition globally in ways that are not yet understood. We investigated latitudinal differences in decomposition of litter mixtures of low and high functional diversity in 40 streams on 6 continents and spanning 113° of latitude. Despite important variability in our dataset, we found latitudinal differences in the effect of litter functional diversity on decomposition, which we explained as evolutionary adaptations of litter-consuming detritivores to resource availability. Specifically, a balanced diet effect appears to operate at lower latitudes versus a resource concentration effect at higher latitudes. The latitudinal pattern indicates that loss of plant functional diversity will have different consequences on carbon fluxes across the globe, with greater repercussions likely at low latitudes.

This chapter examines the nature and value of mathematical knowledge and how it is contested. It identifies key differences of perspectives: on views and beliefs about purposes and aims; on the nature of school mathematics; on what is entailed in learning; on the malleability of learning capability. Roles of language in teaching and learning are described.

The use of botulinum toxin in the specialty of aesthetic surgery in the head and neck is well known. However, it has also been used for other conditions affecting the head and neck, and in recent years its use, as well as the number of relevant applications, has expanded enormously. This article presents a summary of the current range of uses in the laryngeal, pharyngeal, cervical, oromandibular and facial muscles and salivary glands. We highlight particular conditions focusing on dystonia (laryngeal, craniocervical, oromandibular and cervical), multiple system atrophy, migraines, facial nerve palsy, post-laryngectomy, cricopharyngeal dysphagia, Zenker’s diverticulum, retrograde cricopharyngeal dysfunction disorder, sialorrhea and gustatory sweating (Frey’s syndrome). This article should aid the ear, nose and throat surgeon garner knowledge about the range of uses for botulinum toxin in the head and neck.

Paediatric voice disorders in the normal paediatric population ranges from 6% to 20%. We outline the important features in the initial evaluation of a persistent altered cry or voice in children and highlight the subsequent management currently used by ear, nose and throat (ENT) surgeons and speech and language therapists (SLTs). It is important to appreciate that there are stark differences between a child and adult larynx due to anatomical and physiological changes during development. The voice history elicited from both child and parent includes birth and developmental history, hearing, early feeding and respiratory function. Red flag symptoms or signs presenting with dysphonia include stridor, dysphagia, failure to thrive and recurrent chest infections. The most likely cause for dysphonia in children presenting to general paediatric practice and primary care will be secondary to laryngitis, hyperfunction and vocal cord nodules, and laryngopharyngeal reflux. Regarding treatment, in most cases a non-surgical option is preferred with voice therapy preferably delivered by a specialist paediatric voice SLT. The maximum effectiveness of behavioural or direct therapy is to children over 7 years, for in excess of 8 weeks with additional rigorous home rehearsal.

In this study, we identify ways in which a sample of 18 graduates with mathematics-related first degrees found the nth term for quadratic sequences from the first values of a sequence of data, presented on a computer screen in various formats: tabular, scattered data pairs and sequential. Participants’ approaches to identifying the nth term were recorded with eye-tracking technology. Our aims are to identify their strategies and to explore whether and how format influences these strategies. Qualitative analysis of eye-tracking data offers several strategies: Sequence of Differences, Building a Relationship, Known Formula, Linear Recursive and Initial Conjecture. Sequence of Differences was the most common strategy, but Building a Relationship was more likely to lead to the right formula. Building from Square and Factor Search were the most successful methods of Building a Relationship. Findings about the influence of format on the range of strategies were inconclusive but analysis indicated sporadic evidence of possible influences.

Background The number and proportion of older people in the UK are increasing, as are multimorbidity (potentially reducing quality of life) and polypharmacy (increasing the risk of adverse drug events). Together, these complex factors are challenging for older people, informal carers, and health and care practitioners. Objectives MEMORABLE (MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation) aimed to understand how medication management works and propose improvements. Design A realist approach informed three work packages, combining a realist review of secondary data with a realist evaluation of primary interview data, in a theory-driven, causal analysis. Setting The setting was in the community. Participants Older people, informal carers, and health and care practitioners. Interventions Studies relating to medication management and to reviewing and reconciling medications; and realist-informed interviews. Main outcome measures Not applicable. Data sources MEDLINE, CINAHL (Cumulative Index of Nursing and Allied Health Literature) and EMBASE were searched (all searched from January 2009 to July 2017; searched on 1 August 2017). Supplementary articles were identified by the Research Team. Data were also obtained through interviews. Review methods Searches of electronic databases were supplemented by citation-tracking for explanatory contributions, as well as accessing topic-relevant grey literature. Following RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) guidelines, articles were screened and iteratively analysed with interview data, to generate theory-informed (normalisation process theory) explanations. Results Developing a framework to explain medication management as a complex intervention across five stages: identifying problem (Stage 1), starting, changing or stopping medications (Stage 3) and continuing to take medications (Stage 4), where older people, sometimes with informal carers, make individual decisions and follow routines that fit medication management into their day-to-day lives, engendering a sense of control. In getting diagnosis and/or medications (Stage 2) and reviewing/reconciling medications (Stage 5), older people and practitioners share decision-making in time-limited contacts: involving four steps – sense-making, relationships, action and reflection/monitoring (normalisation process theory); and conceptualising burden – through a detailed analysis of Stage 5, generating a theoretical framework and identifying five burden types amendable to mitigation: ambiguity, concealment, unfamiliarity, fragmentation and exclusion. Proposing interventions: risk identification – a simple way of identifying older people and informal carers who are not coping, at risk and who need appropriate help and support; and individualised information – a short, personalised record and reference point, co-produced and shared by older people, informal carers and practitioners that addresses the experience of living with multimorbidities and polypharmacy. Limitations Few studies directly address the complexity of medication management as a process and how it works. Limitations included, having identified the overall complexity, the need to focus the analysis on reviewing/reconciling medications (Stage 5), the exclusion of non-English-language literature, the focus on non-institutionalised populations and the broad definition of older people. Conclusions MEMORABLE explored the complexity of medication management. It highlighted the way interpersonal stages in the medication management process, notably reviewing/reconciling medications, contribute to the mitigation of burdens that are often hidden. Future work Co-produced studies to scope and trial the two proposed interventions; studies to extend the detailed understanding of medication management, linked to burden mitigation; and a study to clarify the medication management outcomes wanted by older people, informal carers and practitioners. Study registration This study is registered as PROSPERO CRD42016043506. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 26. See the NIHR Journals Library website for further project information.

This chapter problematises several aspects of the design and use of tasks to teach mathematics: the nature and role of tasks and the importance of associated teaching strategies; the authorship of tasks: who designs them and why; and differences of intentions and expectations between designers, teachers and learners. If learners are given tasks that ask them to make something, whether virtually on-screen or a physical object of some kind, they will come to see mathematics as a creative tool. However, the question of authority in task design is pertinent in the literature. However, there is a school of thought that claims task design as a specific skill that cannot be done by teachers, because teachers do not have the time or resources to undertake research-informed cycles of design that, following an engineering process, lead most effectively to learning.

We demonstrate the power of Variation Theory as an analytical tool used to understand the underlying conceptual structure of mathematics lessons taught by English primary school teachers. We study ...