Looking beyond changes in averages in evaluating foundational learning: Some inequality measures.

This paper uses measurements of learning inequality to explore whether learning interventions that are aimed at improving means also reduce inequality, and if so, under what conditions. There is abundant evidence that learning levels are generally low in low- and middle-income countries (LMIC), but there is less knowledge about how learning achievement is distributed within these contexts, and especially about how these distributions change as mean levels increase. We use child-level data on foundational literacy outcomes to quantitatively explore whether and how learning inequality using metrics borrowed from the economics and inequality literature can help us understand the impact of learning interventions. The paper deepens recent work in several ways. First, it extends the analysis to six LMIC, displaying which measures are computable and coherent across contexts and baseline levels. This extension can add valuable information to program evaluation, without being redundant with other metrics. Second, we show the large extent to which the disaggregation of inequality of foundational skills between- and within-schools and grades varies by context and language. Third, we present initial empirical evidence that, at least in the contexts of analysis of foundational interventions, improving average performance can reduce inequality as well, across all levels of socioeconomic status (SES). The data show that at baseline, the groups with the highest internal inequality tend to be the groups with lowest SES and lowest reading scores, as inequality among the poor themselves is higher than among their wealthier counterparts. Regardless of which SES groups benefit more in terms of a change in mean levels of reading, there is still a considerable reduction in inequality by baseline achievement as means increase. These results have policy implications in terms of targeting of interventions: much can be achieved in terms of simultaneously improving averages and increasing equality. This seems particularly true when the initial learning levels are as low as they currently are the developing world.

Patterns and correlates of attempted suicide amongst heroin users: 11-year follow-up of the Australian treatment outcome study cohort.

Lifetime and recent rates of attempted suicide and suicidal ideation amongst the Australian Treatment Outcome Study cohort of heroin users at 11-year follow-up were examined. The mean elapsed time since heroin initiation was 20.4 years. At 11-year follow-up, 42.2% of the cohort reported ever having made a suicide attempt, 11.1% having made a first attempt subsequent to baseline. In the year preceding 11-year follow-up, 1.6% had made an attempt, suicidal ideation was reported by 10.4%, and 4.2% had a current suicide plan. After controlling for other variables, past 12 month attempts, current ideation or plans were independently associated with a current diagnosis of Major Depression (odds ratios (OR) 1.67) and more extensive polydrug use (OR 1.39), while each standard deviation higher on the SF12 physical health scale (reflecting better health) was associated with reduced odds (OR 0.66). Suicide and suicidal ideation remained a significant clinical issue for heroin users, some 20 years after their heroin use commenced.

Top tips for a teaching fellowship.

BACKGROUND: Dedicated medical education posts are an exciting opportunity for doctors to focus on their development as clinical teachers. Within the seven hospital trusts that host students from the University of Bristol there are now 19 clinical teaching fellowship (CTF) posts. On starting a dedicated medical education post, the opportunities available can seem overwhelming, and on reflection many of the local 2012-13 CTFs would have changed their initial practice. The purpose of this article was to explore and collate the experiences of CTFs to produce a selection of practical 'top tips'. METHODS: A questionnaire was sent to all 19 CTFs via e-mail, asking them to state what they would do the same and what they would do differently if they had their time again. Dedicated medical education posts are an exciting opportunity for doctors to focus on their development as clinical teachers RESULTS: Eight themes were drawn from the 13 (68%) returned questionnaires, with each theme mentioned between four and 11 times. The themes included: keeping a portfolio of evidence; personal development; undertaking educational research; developing as a clinical teacher; and administration. CONCLUSION: Our aim for this article was to generate practical top tips for those doctors considering, about to start or having just commenced a dedicated teaching role, helping individuals to get the most from their time. It also explains what these teaching fellowships can involve, and gives those thinking of undertaking a dedicated teaching role a better idea of what to expect.

Patterns and correlates of non-fatal heroin overdose at 11-year follow-up: findings from the Australian Treatment Outcome Study.

BACKGROUND: Overdose is a major cause of morbidity and mortality amongst opioid users. This paper reported recent non-fatal overdose amongst the Australian Treatment Outcome Study (ATOS) cohort at 11-year follow-up, and characteristics that predict recent overdose. METHODS: Longitudinal cohort, with 431 (70.1%) of the original 615 participants interviewed. Participants were administered the ATOS structured interview, addressing demographics, treatment history, drug use, heroin overdose, criminality, health and psychopathology. FINDINGS: Mean time since heroin initiation was 20.4 years. By 11-year follow-up, the proportion who had overdosed was 67.5%, and 24.4% had experienced five or more overdoses. In the 12 months preceding 11-year follow-up, 4.9% had overdosed (11.8% of those who had used heroin in that period). Of the 21 participants who had recently overdosed, 20 (95.2%) had overdosed previously, and 19 (90.5%) were not enrolled in a treatment programme at the time. Those who had recently overdosed reported higher levels of use of opiates other than heroin (57.1% vs 24.9%), benzodiazepines (61.9% vs 30.5%,), methamphetamine (38.1% vs 16.8%) and cocaine (19.0% vs 3.7%). They also had exhibited higher levels of heroin use and other drug use at baseline, 12 and 24 month follow-ups. CONCLUSIONS: While the prevalence had declined, overdoses still occurred. A history of overdose and polydrug use patterns continued to provide strong markers for those at continued risk.

Obturator externus pyomyositis.

Pyomyositis of the obturator externus muscle is a rare cause of limp and hip pain in children. The exact etiology of the condition remains poorly understood, although a mechanism of transient bacteremia in association with increased muscle susceptibility has been proposed. This case describes the course of a rather than 1 child from presentation to diagnosis and demonstrates the requirement for magnetic resonance imaging in establishing a diagnosis.

Dimensionality and the category of major depressive episode.

Major depressive episode (MDE) is a chronic disease typified by episodes that remit and recur. It is a major contributor to the burden of disease. The diagnosis of a disorder is an expert opinion that the disorder is present. The nine symptoms of MDE exist on dimensions of greater or lesser intensity, persistence over time, change in usual state, distress and impairment. It is the clinician's task to judge whether the elicited symptoms warrant the diagnosis. The surprise is that trained clinicians can do this reliably and that diagnostic interviews and questionnaires can emulate this process. The distribution of symptoms in community surveys is exponential, with no obvious discontinuity at the diagnostic threshold. Taxometric and primary care studies confirm this. The number of symptoms predicts severity, comorbidity, family history, disability, help seeking and treatment recommendations. The latent structure of mental disorders places MDE in the distress misery cluster. Measures of well-being, distress, disability and neuroticism correlate with the number of symptoms but the relation is not perfect. The Patient Health Questionnaire is derived from the diagnostic criteria and does not suffer this limitation. The introduction of measures like this would acknowledge dimensionality, would facilitate recognition, guide treatment, and be acceptable to consumers, providers and funders.

Developing oligodendrocytes express functional GABA(B) receptors that stimulate cell proliferation and migration.

GABA(B) receptors (GABA(B)Rs) are involved in early events during neuronal development. The presence of GABA(B)Rs in developing oligodendrocytes has not been established. Using immunofluorescent co-localization, we have identified GABA(B)R proteins in O4 marker-positive oligodendrocyte precursor cells (OPCs) in 4-day-old mouse brain periventricular white matter. In culture, OPCs, differentiated oligodendrocytes (DOs) and type 2 astrocytes (ASTs) express both the GABA(B1abcdf) and GABA(B2) subunits of the GABA(B)R. Using semiquantitative PCR analysis with GABA(B)R isoform-selective primers we found that the expression level of GABA(B1abd) was substantially higher in OPCs or ASTs than in DOs. In contrast, the GABA(B2) isoform showed a similar level of expression in OPCs and DOs, and a significantly higher level in ASTs. This indicates that the expression of GABA(B1) and GABA(B2) subunits are under independent control during oligodendroglial development. Activation of GABA(B)Rs using the selective agonist baclofen demonstrated that these receptors are functionally active and negatively coupled to adenylyl cyclase. Manipulation of GABA(B)R activity had no effect on OPC migration in a conventional agarose drop assay, whereas baclofen significantly increased OPC migration in a more sensitive transwell microchamber-based assay. Exposure of cultured OPCs to baclofen increased their proliferation, providing evidence for a functional role of GABA(B)Rs in oligodendrocyte development. The presence of GABA(B)Rs in developing oligodendrocytes provides a new mechanism for neuronal-glial interactions during development and may offer a novel target for promoting remyelination following white matter injury.