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BackgroundEstimation of glomerular filtration rate (GFR) using estimated glomerular filtration rate creatinine (eGFRcr) is central to clinical practice but has limitations. We tested the hypothesis that serum metabolomic profiling can identify novel markers that in combination can provide more accurate GFR estimates.MethodsWe performed a cross-sectional study of 200 African American Study of Kidney Disease and Hypertension (AASK) and 265 Multi-Ethnic Study of Atherosclerosis (MESA) participants with measured GFR (mGFR). Untargeted gas chromatography/dual mass spectrometry- and liquid chromatography/dual mass spectrometry-based quantification was followed by the development of targeted assays for 15 metabolites. On the log scale, GFR was estimated from single- and multiple-metabolite panels and compared with eGFR using the Chronic Kidney Disease Epidemiology equations with creatinine and/or cystatin C using established metrics, including the proportion of errors >30% of mGFR (1-P30), before and after bias correction.ResultsOf untargeted metabolites in the AASK and MESA, 283 of 780 (36%) and 387 of 1447 (27%), respectively, were significantly correlated (P ≤ 0.001) with mGFR. A targeted metabolite panel eGFR developed in the AASK and validated in the MESA was more accurate (1-P30 3.7 and 1.9%, respectively) than eGFRcr [11.2 and 18.5%, respectively (P  0.05) and 9.1% (P

This paper uses a trial audit of history programs undertaken in 2011-­2012 to explore issues surrounding the attainment of Threshold Learning Outcomes (TLOs) in an emerging Australian national standards environment for the discipline of history. The audit sought to ascertain whether an accreditation process managed by the discipline under the auspices of the Australian Historical Association (AHA) could be based on a limited-­intervention, "light-­touch" approach to assessing attainment of the TLOs. The results of the audit show that successful proof of TLO attainment would only be possible with more active intervention into existing history majors and courses. Assessments across all levels of history teaching would have to be designed, undertaken, and marked using a rubric matched to the TLOs. It proved unrealistic to expect students to demonstrate acquisition of the TLOs from existing teaching and assessment practices. The failure of the "light-touch" audit process indicates that demonstrating student attainment under a national standards regime would require fundamental redevelopment of the curriculum. With standards-based approaches to teaching and learning emerging as international phenomena, this case study resonates beyond Australia and the discipline under investigation.

ImportanceCerebral amyloid-β aggregation is an early pathological event in Alzheimer disease (AD), starting decades before dementia onset. Estimates of the prevalence of amyloid pathology in persons without dementia are needed to understand the development of AD and to design prevention studies.ObjectiveTo use individual participant data meta-analysis to estimate the prevalence of amyloid pathology as measured with biomarkers in participants with normal cognition, subjective cognitive impairment (SCI), or mild cognitive impairment (MCI).Data sourcesRelevant biomarker studies identified by searching studies published before April 2015 using the MEDLINE and Web of Science databases and through personal communication with investigators.Study selectionStudies were included if they provided individual participant data for participants without dementia and used an a priori defined cutoff for amyloid positivity.Data extraction and synthesisIndividual records were provided for 2914 participants with normal cognition, 697 with SCI, and 3972 with MCI aged 18 to 100 years from 55 studies.Main outcomes and measuresPrevalence of amyloid pathology on positron emission tomography or in cerebrospinal fluid according to AD risk factors (age, apolipoprotein E [APOE] genotype, sex, and education) estimated by generalized estimating equations.ResultsThe prevalence of amyloid pathology increased from age 50 to 90 years from 10% (95% CI, 8%-13%) to 44% (95% CI, 37%-51%) among participants with normal cognition; from 12% (95% CI, 8%-18%) to 43% (95% CI, 32%-55%) among patients with SCI; and from 27% (95% CI, 23%-32%) to 71% (95% CI, 66%-76%) among patients with MCI. APOE-ε4 carriers had 2 to 3 times higher prevalence estimates than noncarriers. The age at which 15% of the participants with normal cognition were amyloid positive was approximately 40 years for APOE ε4ε4 carriers, 50 years for ε2ε4 carriers, 55 years for ε3ε4 carriers, 65 years for ε3ε3 carriers, and 95 years for ε2ε3 carriers. Amyloid positivity was more common in highly educated participants but not associated with sex or biomarker modality.Conclusions and relevanceAmong persons without dementia, the prevalence of cerebral amyloid pathology as determined by positron emission tomography or cerebrospinal fluid findings was associated with age, APOE genotype, and presence of cognitive impairment. These findings suggest a 20- to 30-year interval between first development of amyloid positivity and onset of dementia.

Background: Previous results on amyloid‐PET imaging for predicting functional decline are conflicting. Given that the Centiloid approach (CL) may serve for inclusion in anti‐amyloid trials, we investigated the extent to which CL may predict functional decline in the AMYPAD‐Prognostic and Natural History Study (PNHS), including 1094 participants. Method: We analyzed, cross‐sectionally and longitudinally, the associations between CL and global and sum‐of‐boxes (SOB) Clinical Dementia Rating (CDR), and Instrumental Activity of Daily Living (IADL) scores. Mean follow‐up duration ranged from 2.7‐3.0 years (±1.1‐1.6) depending on the functional score. Longitudinal CDR‐SOB and IADL changes were modeled using linear mixed‐effects models with random intercepts and slopes, covarying age and sex, stratified by CDR global score. Analyses included comparisons between three CL groups (Aβ‐: CL<12; grey‐zone: CL = 12‐50; Aβ+: CL>50) and correlation between the baseline CL and the time for progression on the CDR global score. Result: The baseline CL was significantly higher in CDR = 0 (Mdn = 6.6) than in CDR = 0.5 participants (Mdn = 17.2; p<.001). Baseline CDR‐SOB was significantly higher in Aβ+ (M = 0.48) than in Aβ‐ (M = 0.12) and grey‐zone participants (M = 0.13, p‐values <.001). Baseline IADL was (marginally) significantly lower in Aβ+ (Mdn = 81.3) than in Aβ‐ (Mdn = 82.8, p =.02) and grey‐zone participants (Mdn = 83.5, p =.08, Table 1). Baseline CL significantly predicted subsequent changes in CDR‐SOB and IADL, both in CDR = 0 and CDR = 0.5 participants, but only in the CL>50 groups (βCL12‐50 = 0.03, p =.32,βCL>50 = 0.14, p<.001 for CDR‐SOB in CDR = 0 participants;βCL12‐50 = 0.19, p =.31,βCL>50 = 1.04, p =.01 for CDR‐SOB in CDR = 0.5 participants;βCL12‐50 = ‐0.002, p =.99, βCL>50 = ‐1.00, p =.08 for IADL in CDR = 0 participants; Fig.1). The participants who progressed from global CDR = 0 to CDR = 0.5 (N = 90) had a higher baseline CL (Mdn = 15.16) than stable participants (Mdn = 5.95, p =.002). However, the baseline CL was not associated with a shorter time of clinical progression (rs= ‐.02, p =.8; Fig.2). Conclusion: Cross‐sectionally, amyloid burden expressed in CL units was associated with functional outcomes. A baseline CL>50 predicted subsequent functional decline in CDR‐SOB and IADL scores in clinically normal and mildly clinically impaired participants. At lower CL values, no functional decline was observed during a three‐year follow‐up. Clinically normal individuals with increasing global CDR scores had higher baseline CL values, but these values were not associated with faster clinical progression. [ABSTRACT FROM AUTHOR]

Higher education in Australia is currently in a state of flux, with the Federal Government's Tertiary Education Quality and Standards Agency commencing operations in January 2012. The "After Standards Project" has been working with Australian university history departments and the Australian Historical Association, educating and empowering the discipline to act as a united community and assert ownership of a standards process. This article provides a stocktake of the achievements and challenges the After Standards Project has faced in coming to terms with the new environment and resultant new demands around compliance and accountability. It discusses the After Standards Project's work in terms of both quality assurance and quality improvement, with reference to the establishment of a set of discipline standards and the trial of an accreditation scheme. (Contains 1 table and 6 notes.)

Research suggests that nursing students have many anxieties about dealing with death and dying and feel unprepared to care for these patients as newly registered nurses. Effective education has been found to be an important factor in preparing nursing students for end of life care. Simulation is a pedagogical strategy widely used within nursing education and can provide an opportunity for students to develop their end of life care skills in the absence of opportunities in the practice setting. The purpose of this qualitative study was to explore how BSc (Hons) Nursing (Child) students learn about end of life care through simulation. A new simulation pedagogy was designed and delivered to eight second year child nursing students, and case study methodology was used to explore student learning. Data was collected through a focus group discussion and individual interviews and was analysed through the process of thematic analysis. The findings revealed that during simulation, students learned about end of life care through a combination of hands-on practice and reflection, collaborating with their peers and facilitators, and by engaging in the experience through the provision of a safe and authentic environment. Learning theory was applied to the findings in order to explain the simulation learning process. In conclusion, learning through simulation is socially constructed, occurring through experiential learning which promotes perspective transformation. Student engagement in the simulation learning process is influenced by effective and supportive facilitation. [ABSTRACT FROM AUTHOR]

This study featured validity evidence for scores from states' alternate assessments of alternate academic achievement standards (AA-AASs). It evaluated students from 6 states who were eligible for an AA-AAS concurrently with measures of academic competence and adaptive behavior. The investigators also assessed students with disabilities who were not eligible for an AA-AAS by using the same measures, as well as by using general achievement tests. The main findings included that AA-AAS reading and math scores may reflect a unitary construct, that AA-AAS scores are highly related to adaptive behavior but also relate to academic competence and achievement, and that all these scores represent unique but overlapping constructs. These results have implications for AA-AAS developers and teachers working with students with significant cognitive disabilities. (Contains 6 tables.)