Use of biochemical parameters for non-invasive screening of oesophageal varices in comparison to elastography-based approach in patients with compensated advanced chronic liver disease

IntroductionOesophageal varices are routinely diagnosed by esophagogastroduodenoscopy (EGD), and their bleeding has high mortality. We aimed to evaluate diagnostic performance of biochemical tests in comparison to elastography-based approaches, as non-invasive alternatives to EGD, for ruling-out high risk oesophageal varices (HRV).Material and methodsRetrospective analysis of patients (N = 861) who underwent liver stiffness measurement (LSM) by transient elastography (TE) in a single centre over 5-year period, with available results of EGD (within 3 months from LSM). Only patients with suspicion of compensated advanced chronic liver disease (cACLD) defined by LSM ≥ 10 kPa were included comprising the final cohort of 73 subjects. Original and expanded Baveno VI criteria (B6C), controlled attenuation parameter (CAP), platelet count (PLT), aspartate aminotransferase to PLT ratio index (APRI), Fibrosis-4 index (FIB4), model for end stage liver disease (MELD) score were evaluated against the results of EGD that served as the reference method.ResultsAnalysed patients had median age 62 years, 59/73 (0.81) were males, 54/73 (0.74) had alcoholic/non-alcoholic fatty liver disease, and 21/73 (0.29) had HRV. In multivariate logistic regression analysis only LSM and PLT were independently associated with HRV. The best performing tests for ruling-out HRV (% of spared EGD; % of missed HRV) were respectively: LSM < 20 kPa (53.4%; 0%), B6C (38%; 0%), Expanded B6C (47.9%; 4.8%); PLT > 214x10⁹/L (21.9%; 0%); FIB4 ≤ 1.8 (21.4%; 0%), APRI ≤ 0.34 (12.3%; 0%). CAP, MELD = 6 alone or combined with PLT > 150(x10⁹/L) did not show acceptable performance.ConclusionThe best performing biochemical tests for ruling-out HRV in our cohort of patients were PLT and FIB-4, but they were still outperformed by elastography-based approaches.Keyword: portal hypertension, cirrhosis, platelet count, esophageal varices, non-invasive tests     

Proposals for an Associate Degree - the search for the 'missing link' of British higher education

This paper revisits debates about the place of an intermediate qualification in British higher education and suggests that arguments can be revitalised to meet the criticisms of earlier proposals. The paper maintains that a suitably defined interim award remains necessary for the establishment of a national qualifications framework facilitating student choice and progression, and as a vehicle to deliver the next stage of expansion in higher education and beyond. Support for an 'Associate Degree' is likely to depend on characteristics which offer advantages to students and their employers, making it different from previous proposals and other international versions.     

Stress, Burnout and Workload in Teachers of Children with Special Educational Needs

Whilst stress in teaching has received much attention in recent years, for teachers of children with special educational needs (SEN) specific stress-related research is relatively rare. This study sought to address this issue by investigating stress, burnout and workload in teachers of children with special educational needs. A postal questionnaire was sent to 56 ordinary schools and eight schools for children with moderate learning difficulties (MLD), eight for children with severe learning difficulties (SLD) and eight for children with emotional and behavioural difficulties (EBD). The schools were situated in inner city, urban and rural areas in the south-east of England. A total of 221 teachers responded. Results indicated that, whilst generalised claims for burnout may not be justified, within all three special school settings there was evidence of a high level of emotional exhaustion as measured by the education version of the Maslach Burnout Inventory (MBI). In addition, all groups were subject to long hours of work, and work overload was high for ordinary school SEN teachers and teachers working in MLD and SLD settings. Reference to sources of intense stress indicated some differences according to setting but generally implicated workload and challenging behaviour. The conclusions are that further research into stress and burnout of SEN teachers is required if effective coping and preventative strategies are to be designed.     

The use of examples in expository texts: Outline of an interpretation theory for text analysis

Much has been made about the difficulties students have in transferring their learning from one context to another. We suggest that students learning from examples use imitation, a subtype of analogical problem solving (APS). Whereas APS involves manipulating a mental representation, imitation involves mapping the surface features of a source example to a target problem and no assumptions are made about what a student knows. Often imitating a close variant of a source problem is likely to be relatively successful; however, trying to solve a distant variant by imitating an example creates difficulties in mapping values and adapting the source example to the target. In this paper we argue that some students' inability to transfer their learning is very often due to the teaching material rather than any failure on the part of the student. To this end, we have developed an interpretation theory based on the proportional analogy framework (a:b::c:d) which can be applied to text analysis. The theory is demonstrated using examples taken mainly from computer programming textbooks.     

The Training and Professional Development of School Leaders in Europe

The article reviews the activities that have been taking place in Europe in the field of senior staff training, particularly headteacher training, based on a study undertaken by the author in 1980 in Norway, Sweden, Denmark, the Netherlands and France. It goes on to consider some of the underlying problems and some major areas of study that require further examination, i.e. it is difficult to define the job to be undertaken by the trainer; to analyse the nature of the organisation and school system in which he works; to identify ‘leadership'; to provide relevant training and to then evaluate that training and its real impact on the school and on the quality, effectiveness and relevance of education offered to pupils and students.

Finally it describes some of the possibilities for fruitful cooperation and collaboration over the next few years through the efforts of a wide variety of international organisations.

Cet article fait un tour d'horizon des actions qui ont été entreprises en Europe dans le domaine de la formation des directeurs d'établissement et des maîtres chargés d'une responsabilité particulière dans l'enseignement. Il s'appuie sur une étude entreprise par l'auteur au Danemark, en France, en Norvège et dans les Pays‐Bas en 1980.

L'article étudie ensuite certains problèmes fondamentaux et quelques grands sujets d'étude qui demandent une analyse plus poussée: par exemple la difficulté à définir le travail que doit entreprendre le formateur, pour analyser la nature de l'organisation du système scolaire dans lequel il travaille, la difficulté à identifier les fonctions de ‘leadership’, à etablir une formation appropriée, puis à évaluer cette formation et son impact réel sur l'école et sur la qualité, enfin l'efficacité et l'appropriation de l'enseignement qui est offert aux élèves et étudiants.

Finalement, l'auteur expose quelques possibilités de collaboration fructueuse pour les prochaines années grâce aux efforts de différentes organisations internationales.