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Abstract Background Previous studies have demonstrated the feasibility of primary percutaneous coronary intervention (PPCI) in carefully selected nonagenarians. Although current guidelines recommend immediate revascularization in patients with ST elevation myocardial infarction (STEMI) it remains unclear whether PPCI reduces mortality in nonagenarians. The objective of this study is to compare mortality in nonagenarians presenting via the PPCI pathway who undergo coronary intervention, versus those who are managed medically. Methods and results A total of 111 consecutive nonagenarians who presented to our tertiary center via the PPCI pathway between July 2013 and December 2018 with myocardial infarction were included. Clinical and angiographic details were collected alongside data on all-cause mortality. The final diagnosis was STEMI in 98 (88.3%) and NSTEMI in 13 (11.7%). PPCI was performed in 42 (37.8%), while 69 (62.2%) were medically managed. A significant number of the medically managed cohort had atrial fibrillation (23.2% vs 2.4% p = 0.003) and presented with a completed infarct (43.5% vs 4.8% p = 0.001). Other baseline and clinical variables were well matched in both groups. There was a trend towards increased 30-day mortality in the medically managed group (40.6% vs 23.8% p = 0.07). Kaplan Meier survival analysis demonstrated a significant difference in survival by 3 years (48.1% vs 21.7% p = 0.01). This was the case even when those with completed infarcts were excluded (44.3% vs 14.6%, p = 0.01). Conclusion In this series of selected nonagenarians presenting with acute myocardial infarction, those undergoing PPCI appeared to have a lower mortality compared to those managed medically.

Abstract Background What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL). Method The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times. Results A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content. Discussion UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training.

Abstract Background Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors. Method Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail. Results Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p

Abstract Introduction COVID‐19 has triggered a global pandemic and is an emerging situation. Diabetes has been associated with significant mortality in SARS and MERS‐COV infections. Patients with diabetes are at risk of COVID‐19 triggering diabetic emergencies due to known and unknown mechanisms. There is little evidence overviewing the clinical course of COVID‐19 patients who either present or have diabetic emergencies during their disease course. Methods We conducted a retrospective case analysis of all patients admitted to our hospital during the COVID‐19 pandemic. The inclusion criteria were all patients receiving treatment for COVID‐19 and either presenting with a diabetic emergency on admission or developing an emergency during their admission. Data collected for the study were all routinely collected data as part of the admission. We compared these data to nine patients with no COVID‐19. Results Thirty patients received treatment for a diabetic emergency, of which 21 also received treatment for COVID‐19. Significant differences were found between pH and bicarbonate on admission between RT‐PCR‐positive and both RT‐PCR‐negative and non‐COVID‐19 patients. Other results approaching significance include ALP and eGFR. Discussion Patients suffering from COVID‐19 and diabetes concurrently can suffer from profound metabolic disturbance, with a significant difference in inpatient mortality. However further, prospective detailed investigation into biochemical processes is needed to fully elucidate underlying mechanisms that affect these patients' outcomes.

Abstract Background Fenoldopam mesylate, a selective dopamine1-receptor agonist, is used by intravenous infusion to treat hypertension in adults. Fenoldopam is not approved by the FDA for use in children; reports describing its use in pediatrics are limited. In a multi-institutional, placebo controlled, double-blind, multi-dose trial we determined the pharmacokinetic (PK) and pharmacodynamic (PD) characteristics and side-effect profile of fenoldopam in children. Methods Seventy seven (77) children from 3 weeks to 12 years of age scheduled for surgery in which deliberate hypotension would be induced were enrolled. Patients were randomly assigned to one of five, blinded treatment groups (placebo or fenoldopam 0.05, 0.2, 0.8, or 3.2 mcg/kg/min iv) for a 30-minute interval after stabilization of anesthesia and placement of vascular catheters. Following the 30-minute blinded interval, investigators adjusted the fenoldopam dose to achieve a target mean arterial pressure in the open-label period until deliberate hypotension was no longer indicated (e.g., muscle-layer closure). Mean arterial pressure and heart rate were continuously monitored and were the primary endpoints. Results Seventy-six children completed the trial. Fenoldopam at doses of 0.8 and 3.2 mcg/kg/min significantly reduced blood pressure (p < 0.05) during the blinded interval, and doses of 1.0–1.2 mcg/kg/min resulted in continued control of blood pressure during the open-label interval. Doses greater than 1.2 mcg/kg/min during the open-label period resulted in increasing heart rate without additional reduction in blood pressure. Fenoldopam was well-tolerated; side effects occurred in a minority of patients. The PK/PD relationship of fenoldopam in children was determined. Conclusion Fenoldopam is a rapid-acting, effective agent for intravenous control of blood pressure in children. The effective dose range is significantly higher in children undergoing anesthesia and surgery (0.8–1.2 mcg/kg/min) than as labeled for adults (0.05–0.3 mcg/kg/min). The PK and side-effect profiles for children and adults are similar.

International comparative ethnographic studies of ECEC (Early Childhood Education and Care) are difficult to conduct but worth the effort. Comparative studies featuring thick description and polysemic interpretations can challenge taken-for-granted assumptions, expand the menu of the possible, expose the provincialism of national approaches, and illuminate the global circulation of ECEC practices and ideas. Based on reflections on four major comparative international studies I have led, in this paper I describe effective strategies for conducting comparative ethnographic research in ECEC settings, explicate the rationale for doing so, and provide examples of how this approach can impact research, practice, and policy. Issues I address include the rationale for selecting countries for comparison, the formation of a research team, and distributing interpretive voice and power.

This is an ethnographic study of how two Japanese kindergartens are implementing the "yohoichigenka" policy aimed at reforming the Japanese early childhood education system. The cases of these two kindergartens demonstrate what happens when a top-down mandate reaches the level of individual programs. The programs creatively find ways of responding to the reform mandate and to social change while maintaining what their administrators view as their pedagogical traditions. This paper also argues for the value of ethnographic methods to show how local programs are creative, resistant, and pragmatic in how they deal with top down pressures and directives.

"Children Crossing Borders" was an ambitious study of the intersection of im/migration and early childhood education in five countries: England, France, Germany, Italy, and the United States. This article looks back at this study a decade later, presenting the main findings and proposing suggestions about how in the contemporary climate ECEC programs might better address the needs of the im/migrant and refugee children and families they serve. Among the key findings of the study, as already presented in the main publications of the project (Tobin, Adair, Arzubiaga, 2013. "Children Crossing Borders: Immigrant Parents and Teacher Perspectives on Preschool for Children of Immigrants". New York: Russell Sage Foundation; Tobin, ed. 2016. "Preschool and Im/migrants in Five Countries". Brussels: Peter Lang), are that newly arriving parents tend to be pragmatic and strategic in their ECEC preferences; practitioners are often caught between being culturally responsive to parents and following their pedagogical beliefs and principles; bicultural staff play a crucial but also underappreciated role as cultural and linguistic mediators; parents find it difficult for their voices to be heard in their children's ECEC settings; and practitioners are underprepared to deal with the challenges of working with refugees, new im/migrants, and other second language learners.

Most qualitative studies in international education take place in a single site in a single nation. When studies are of more than one country, they most often use more quantitative than qualitative approaches. Beatrice and John Whiting conducted the most systematic of comparative cross-cultural studies of child rearing in their "Six Cultures" (1975) study. One of the six ethnographies that served as the foundation of that study was conducted by Robert A. LeVine (1966). Author Joseph Tobin has attempted to carry this comparative project forward, and to do so in a way that systematically deals with variation within, as well as among cultures, while also taking into account how cultures stay the same and change over time. For the past thirty years in his studies of preschools in Japan, China, the US and other countries, the approach he has employed is a method he calls "video cued multivocal ethnography," but which is better known as the "Preschool in Three Cultures method." The core idea of this method is that videos function in these studies not as data but as interviewing cues. In this article, Tobin compares the results of two studies where this approach was used: (1) The "Preschool in Three Cultures" study (Tobin, Wu, & Davidson, 1989) which emphasized differences in Chinese, Japanese, and US approaches to early childhood education, and argued for the importance of thinking about the role of what we call "implicit cultural beliefs and practices"; and (2) A second study, conducted twenty years later, where the investigators explored the power of globalization and other social, economic, and political forces on preschools by adding a diachronic dimension. The findings of the two studies showed that between the mid-1980s and the first decade of the millennia, early childhood education in China changed a lot and Japanese preschools stayed much the same. Understanding why a day at Komatsudani Day Care Center in Kyoto looks much the same in 2005 as it did twenty years earlier is as compelling a question as understanding why Daguan Preschool in Kunming China changed. Maintaining continuity in a program of early childhood education from one era to the next requires as much effort and creativity as it does to change. Herein, Tobin provides examples of the kind of change of preschool beliefs and practices they found in China and the kind of continuity they found in Japan, and why.

In 1982 I began using classroom videos as cues for ethnographic interviews. My colleagues and I asked practitioners in three countries to respond to videos shot in their own and each other's preschools. The video cues worked to produce conversations that we used in our 1989 book "Preschool in Three Cultures" to present perspectives on the same events by cultural insiders and outsiders. This article tells the story of the origins and evolution of the Preschool in Three Cultures method, a video-cued ethnographic method that has multiple influences, including Margaret Mead's use of film in comparative ethnography, psychological anthropology's use of projective tests, Mikhail Bakhtin's concepts of dialogism and multivocality, and Linda Connor's video-cued interviewing of a Balinese shaman.

"Guangbo ticao" (group exercise) is a daily routine in Chinese preschools characterized by collectivity, discipline, and conformity. In this article we explore the question of why "guangbo ticao" has survived in an era of progressive educational reform in contemporary China. We use interviews with Chinese preschool teachers and children to argue that "guangbo ticao" is an implicit embodied practice that carries traditional Chinese cultural, ethical, and aesthetic beliefs, produces distinct meanings and pleasures, and meets important social needs.

This study explores how the process of making and reviewing videos of their own instruction impacts the development of preservice teachers. The study looks at the impacts, both positive and negative, of a video portfolio assignment implemented in a teaching methods course, and of the uses and meanings these videos have for preservice teachers, their instructors, and the teacher preparation program. Findings suggest that the videotaping assignment has the virtue of shifting attention to the often-overlooked embodied dimensions of teaching (e.g., gesture, posture, gaze, tone of voice, facial expressions, use of materials, and positioning). On the other hand, the requirement to videotape themselves teaching can produce anxiety that can make preservice teachers tend towards self-conscious, teacher-centered versions of teaching. The article concludes with implications for how initial teacher preparation programs can implement the videotaping requirement of edTPA in ways that best support preservice teachers' growth.

For the past six years the authors have been working together on a major study of early childhood education in China, Japan, and the United States. This study, "Continuity and Change in Preschools in Three Cultures," is a sequel to "Preschools in Three Cultures," a book by Joseph Tobin, David Wu, and Dana Davidson that was published in 1989. In the new study, as in the original one, the authors have found major differences in how these three countries approach the education and care of young children. In this paper, the authors present examples of preschool practices from China and Japan that they suggest can be used to improve early childhood education in the US. They call these examples lessons for the US, but they are not suggesting that American early childhood educators should copy these approaches. Instead, they are hoping that American teachers who have read this paper and had the opportunity to reflect on the logic of the Chinese and Japanese approaches will find that they have a new way of thinking about their practice.

This paper uses examples from research conducted in preschools in Japan, China, and the United States to illustrate the features and virtues of return interviews with informants with whom ethnographers have long research engagements. Return interviews and long research engagements are powerful research strategies that help the ethnographers ask more insightful questions and make more sense of informants' replies, informants better understand the researchers and their agenda, and the research to achieve a more diachronic perspective.

This paper tells the story of the struggle to introduce a Japanese sign language program in a school for the deaf in Japan that until recently had followed the government's approach that emphasizes oral communication. Our method and conceptual framework is ethnographic, as we emphasize the cultural beliefs that underlie the three competing positions on deaf education that are in competition at Sapporo School for the Deaf.

This paper briefly reviews theories of embodiment and then provides an example from our recent work on how we use video in our comparative studies of preschools to highlight embodied and implicit cultural pedagogies. The example we present focuses on how Japanese preschool teachers use the Japanese cultural practice of "mimamoru" (teaching by watching and waiting) as an embodied technique that combines gaze, location, posture, and touch. We demonstrate how a microanalysis of video footage, when used in conjunction with ethnographic interviews, can draw attention to culturally patterned embodied practices that may otherwise be difficult to perceive.