Early Goal Research Articles

Curriculum Framework and Assessment Approach for Computational Thinking in the Early Years

In light of current developments, there is an increasing effort to integrate computing-oriented activities into the education of children as young as two years old. Although the computing strand is not officially addressed in the Early Years Foundation Stage Statutory Framework (DfES, 2024), a small number of early years teachers in England implement computing-oriented activities to ensure that young children progress from early years to Key Stage 1. A particular gap in the field is that previous research on computational thinking concepts never or rarely establish curriculum links in a way that teachers can utilise in their practices. This theoretical article therefore proposes a curriculum-based framework for both teaching and assessing computational thinking (CT) in early years education as assessment is not possible without pedagogic guidelines. Offering a sample lesson plan with links to the Early Learning Goals, this framework aims to encourage teachers, including those without specific computing training, to integrate CT concepts more explicitly into their teaching and enables them to monitor and assess their pupils' progress in relevant skills.

Executive function is associated with the development of math performance in children born at

To describe associations between executive function (EF) domains (attentional control, information processing, cognitive flexibility, and goal setting) and concurrent math computation performance at age 7 and 13 years in children born <30 weeks' gestation or weighing <1,250 g, and second, to examine the impact of 7-year EF on math performance at 13 years. In a prospective, longitudinal cohort of children born <30 weeks' gestation or with a birthweight <1,250 g, assessment of EF and math performance was undertaken at 7 (n = 187) and 13 years (n = 174). Linear regression models were used to describe associations between EF domains with math performance at both time points, as well as to examine the impact of EF at 7 years on math performance at 13 years. At 7 and 13 years, all EF domains were positively and strongly associated with concurrent math performance (β = 11.35, 95% CI [9.28, 13.41] to β = 13.79, 95% CI [11.59, 15.98]). All EF domains at age 7 years were positively associated with math performance at 13 years, with the strongest associations observed for cognitive flexibility (β = 10.79 [8.64, 12.94]) and goal setting (β = 10.37 [8.08, 12.67]). This study provides evidence that EF is strongly associated with math performance in children born <30 weeks' gestation or with a birthweight <1,250 g and highlights the importance of early cognitive flexibility and goal setting performance for future math performance. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Early Rehabilitation Activity and Rehabilitation in ICU Wards in Central China: A Cross-Sectional Survey.

Patients in Intensive Care Units (ICUs) face high risks of physical, functional, cognitive, and mental impairments. Early rehabilitation activities are crucial for reducing mortality and complication rates. This survey investigates the characteristics, current implementation, and detailed status of early rehabilitation activities in ICUs across Central China. A cross-sectional survey was conducted involving 158hospitals, with 131 responding. Data on institutional characteristics and early rehabilitation activities were collected through questionnaires. Descriptive statistical analysis described the current status, and a univariate regression model identified factors associated with the implementation of early rehabilitation measures. A total of 131 ICUs completed the survey, with a response rate of 82.91% (131/158). Results indicated that 82.44% (108/131) of ICUs implemented early rehabilitation activities, but only 65 (49.62%) had explicit early rehabilitation exercise protocols or standards/procedures. Before implementing early rehabilitation activities, approximately 89.97% (110/131) of ICUs conducted assessments, and 46.56% (61/131) regularly held structured interdisciplinary rounds to discuss early activity measures and goals. More than half of the participating adult ICUs reported screening patients for swallowing function (64.89%; 85/131), and 55.73% (73/131) of adult ICUs reported having a nutrition therapy specialist conduct regular consultations/visits. Only 26.72% (35/131) of adult ICUs reported having a speech therapist conduct consultations/visits. A total of 81.68% (107/131) of ICUs believed that the current implementation of early rehabilitation activities was insufficient. In the analysis of influencing factors, the presence of rehabilitation therapists in the ICU was a significant factor for the implementation of early rehabilitation activities (P<0.05). The majority of ICUs in hospitals in central China have implemented early rehabilitation activities; however, less than half have explicit early rehabilitation exercise protocols or standards/procedures. The presence of professional rehabilitation therapists in the ICU is a key factor in the implementation of early rehabilitation activities in ICUs in hospitals in Central China.

Proactive approaches in congestive heart failure: the significance of early goals of care discussion and palliative care.

Congestive Heart Failure (CHF) poses significant challenges to the healthcare system due to its high rates of morbidity and mortality as well as frequent readmissions. All of these factors contribute to increased healthcare delivery costs. Besides the burden on the healthcare system, CHF has far deeper effects on the patient in terms of psychological burden along with debilitating symptoms of dyspnea, all of which reduce quality of life. Prognostic awareness among patients about their disease along with initiating early goals of care discussion by those involved in the care (physicians, nurses, social worker and patient themselves) can help mitigate these challenges. Adopting a proactive approach to address patient preferences, values and end-of-life goals improves patient-centred care, enhances quality of life and reduces the strain on healthcare resources. In this narrative review, studies have been identified using PubMed search to shed knowledge on what is preventing the initiation of goals of care discussions. Some barriers include lack of knowledge about prognosis in both patients and caregivers, inexperience or discomfort in having those conversations and delaying it until CHF becomes too advanced.

Impact of an Early Goals of Care Discussion on Patient Satisfaction and Quality of Life among Seriously Ill Patients Admitted to the Medical Wards – A Quality Improvement Project

Objectives: The objective of this study was to achieve integration of goals of care discussion (GOCD) as a routine part of assessment among seriously ill patients admitted to medical wards and assess its impact on patient satisfaction, caregiver satisfaction and quality of life (QOL). Materials and Methods: This was non-randomised before and after study – A quality improvement project involving three plan-do-study-act (PDSA) cycles each of 6 weeks duration. The study included a total of 60 patients and their caregivers admitted to the Internal Medicine Unit in a tertiary care hospital in South India. Junior residents from Internal Medicine were trained in conducting a GOCD through a face to face training session and through an online training program using capc.org modules. Through a process of three PDSA cycles, we introduced the documentation of GOCD as a routine part of the assessment of seriously ill patients and assessed its impact on QOL and patient satisfaction. Results: Following the introduction of GOCD, patient and caregiver satisfaction had a statistically significant improvement across the majority of the assessed domains, and there was an overall improvement in the mean World Health Organization QOL Brief Version QOL scores by 4.8% Conclusion: Among patients with serious illness, GOCD improved patient and caregiver satisfaction and QOL. Such conversations are essential to align the care delivery with patient preferences and help in providing patient-centred care.

Deictic Gesture Production in Children with Autism Spectrum Disorder, Down Syndrome, and Typically Developing Children During Dyadic Interaction

Background: Deictic gestures are the first intentional form of communication that predict the emergence of first words. Deictic gestures include reaching, pointing, giving, and showing. Method: Forty-five Tamil-speaking children (28 male and 17 female) and their parents participated in this study. They were divided into three groups (ASD, DS, and TD). The parents were instructed to play and interact with their children, as they do at home, using the provided toy set, and this session was video-recorded. Deictic gestures such as reaching, pointing, giving, and showing were analyzed with a specific coding scheme. Results: On a Kruskal–Wallis test, a statistically significant difference across the three groups ( P &lt; .05) was obtained for the total frequency of deictic gestures, use of pointing, giving, and showing gestures. The total frequency of deictic gestures and their types, such as pointing, giving, and showing gestures, used by the ASD group was less compared to the DS and TD groups. Conclusion: This study highlighted that, along with speech and language difficulties, children with ASD have deficits in producing deictic gestures. Children with DS have speech and language difficulties, but they use deictic gestures in order to communicate with their parents during interaction. This varied profile of deictic gesture use can be used for early identification, differential diagnosis, and setting intervention goals.

Venous return physiology applied to post-cardiac arrest haemodynamic management: a post hoc analysis of the NEUROPROTECT trial

BackgroundThe European Resuscitation Council 2021 guidelines for haemodynamic monitoring and management during post-resuscitation care from cardiac arrest call for an individualised approach to therapeutic interventions. Combining the cardiac function and venous return curves with the inclusion of the mean systemic filling pressure enables a physiological illustration of intravascular volume, vasoconstriction and inotropy. An analogue mean systemic filling pressure (Pmsa) may be calculated once cardiac output, mean arterial and central venous pressure are known. The NEUROPROTECT trial compared targeting a mean arterial pressure of 65 mmHg (standard) versus an early goal directed haemodynamic optimisation targeting 85 mmHg (high) in ICU for 36 h after cardiac arrest. The trial data were used in this study to calculate post hoc Pmsa and its expanded variables to comprehensively describe venous return physiology during post-cardiac arrest management. A general estimating equation model was used to analyse continuous variables split by standard and high mean arterial pressure groups.ResultsData from 52 patients in each group were analysed. The driving pressure for venous return, and thus cardiac output, was higher in the high MAP group (p < 0.001) along with a numerically increased estimated stressed intravascular volume (mean difference 0.27 [− 0.014–0.55] L, p = 0.06). The heart efficiency was comparable (p = 0.43) in both the standard and high MAP target groups, suggesting that inotropy was similar despite increased arterial load in the high MAP group (p = 0.01). The efficiency of fluid boluses to increase cardiac output was increased in the higher MAP compared to standard MAP group (mean difference 0.26 [0.08–0.43] fraction units, p = 0.01).ConclusionsCalculation of the analogue mean systemic filling pressure and expanded variables using haemodynamic data from the NEUROPROTECT trial demonstrated an increased venous return, and thus cardiac output, as well as increased volume responsiveness associated with targeting a higher MAP. Further studies of the analogue mean systemic filling pressure and its derived variables are warranted to individualise post-resuscitation care and evaluate any clinical benefit associated with this monitoring approach.

DAP discourses: hubris, hegemony, or heuristic for teacher education?

ABSTRACT This essay entails a critical review of the origins, discourses and contemporary manifestations of NAEYC’s enduring commitment to ‘developmentally appropriate practice’ (DAP); and proposes a reconceptualisation of DAP as an open question and incentive for place-based collaborative inquiry. Brief discussion of ECE’s early history highlights transnational feminist exchanges, charitable activism, competing interpretations of early childhood programme goals and pedagogies; and a mutually-beneficial relationship between two emerging fields – child development research and ECE as a scientifically-based profession. Decades of child development research are described in relation to evolving iterations of DAP Guidelines (1987). Discourse analysis posits DAP as a weapon against push-down academics, and a hubristic code signifying professional sanction and membership. Challenges to DAP hegemony include research on the cultural embeddedness of developmental standards and examples of collaborative place-based inquiry into ‘appropriate’ ways to care for and educate young children. The essay concludes by proposing DAP as a dynamic heuristic in the reform of ECE teacher education as a profession committed to multiple sources of knowledge and equity-focused social action on behalf of actual and imagined childhoods.

Exploring perceptions of online calculators for identifying community-dwelling older people at risk of dying: A qualitative study

ObjectivesThis study aimed to assess the acceptability, value, and perceived barriers of using electronic risk calculators for predicting and communicating the risk of death in community-dwelling older adults. MethodsOne focus group and eight interviews were conducted with 16 participants with experience caring for patients or family members at end of life. A prototype mortality risk tool was used to anchor discussions. Data were analysed using a qualitative content analysis approach. ResultsFive themes emerged: acceptability, communication, barriers to use, broadening the circle of care, and tool limitations. Participants found the tool helpful for preparation, planning, and providing care, but disagreed on its community availability. Personalized risk estimates were valued for facilitating early goals of care conversations and normalizing discussions about death. However, concerns were raised about the tool's interpretation for individuals with different language, cultural, or educational backgrounds. ConclusionsWhile electronic risk calculators were found to be acceptable, balancing autonomy with varying preferences for receiving the information and potential need for support is crucial. InnovationProviding patient-oriented life-expectancy estimates can enhance decisional capacity and facilitate shared decision-making between patients, their families, and healthcare professionals. Further research is needed to explore effective communication of personalized risk tools and additional benefits, harms, and barriers to implementation.

Accelerating the elimination of hepatitis B virus infection: expert recommendations for expanding prevention and treatment

In order to achieve the early goal of "eliminating viral hepatitis as a public health threat by 2030" as proposed by the World Health Organization, the relevant issues that have not yet reached consensus on the aspects of hepatitis B prevention and treatment, including population-wide screening, adult hepatitis B vaccination, the evaluation of quantitative values of hepatitis B virus DNA, the alanine aminotransferase threshold for initiating antiviral therapy, the treatment of patients in the "indeterminate phase," the treatment of patients with co-infections and comorbidities, and others. Thus, experts have formulated recommendations to further expand hepatitis B prevention and treatment, with the aim of accelerating the elimination of hepatitis B virus infection.

Factors Associated with Costly Hospital Care among Patients with Dementia and Acute Respiratory Failure.

Rationale: Understanding contributors to costly and potentially burdensome care for patients with dementia is of interest to healthcare systems and may facilitate efforts to promote goal-concordant care. Objective: To identify risk factors, in particular whether an early goals-of-care discussion (GOCD) took place, for high-cost hospitalization among patients with dementia and acute respiratory failure. Methods: We conducted an electronic health record-based retrospective cohort study of 298 adults with dementia hospitalized with respiratory failure (receiving ⩾48 h of mechanical ventilation) within an academic healthcare system. We collected demographic and clinical characteristics, including clinical markers of advanced dementia (weight loss, pressure ulcers, hypernatremia, mobility limitations) and intensive care unit (ICU) service (medical, surgical, neurologic). We ascertained whether a GOCD was documented within 48 hours of ICU admission. We used logistic regression to identify patient characteristics associated with high-cost hospitalization measured using the hospital system accounting database and defined as total cost in the top third of the sample (⩾$145,000). We examined a path model that included hospital length of stay as a final mediator between exposure variables and high-cost hospitalization. Results: Patients in the sample had a median age of 71 (IQR, 62-79) years. Approximately half (49%) were admitted to a medical ICU, 29% to a surgical ICU, and 22% to a neurologic ICU. More than half (59%) had a clinical indicator of advanced dementia. A minority (31%) had a GOCD documented within 48 hours of ICU admission; those who did had a 50% lower risk of a high-cost hospitalization (risk ratio, 0.50; 95% confidence interval, 0.2-0.8). Older age, limited English proficiency, and nursing home residence were associated with a lower likelihood of high-cost hospitalization, whereas greater comorbidity burden and admission to a surgical or neurologic ICU compared with a medical ICU were associated with a higher likelihood of high-cost hospitalization. Conclusions: Early GOCDs for patients with dementia and respiratory failure may promote high-value care by ensuring aggressive and costly life support interventions are aligned with patients' goals. Future work should focus on increasing early palliative care delivery for patients with dementia and respiratory failure, in particular in surgical and neurologic ICU settings.

An assessment of barriers and facilitators of near-peer coaching on surgical clerkships: a mixed-methods study from resident’s perspective

PurposeWe implemented a near-peer (resident–student) coaching intervention in 2021–2022 to improve clerkship students’ health system science (HSS) learning and application. This study thus sought to identify implementation barriers and potential facilitators of an effective HSS near-peer coaching program for clerkship students from the resident coach’s perspective at a single tertiary-care institution.MethodsA mixed-methods study design was employed. Thirty surgical residents volunteered to serve as HSS coaches for rotating third-year medical students during the 2021–2022 academic year. Coaches were asked to complete an exit survey, and a subset was purposefully sampled to complete semi-structured interviews. Transcripts were coded and analyzed with a framework method to identify emergent themes indicative of the barriers and facilitators of effective implementation of this near-peer HSS coaching program.ResultsA total of 20/30 (67%) resident coaches completed the survey and 50% of these residents (n = 10/20) completed an interview. Coaches facilitated multiple meetings (ranging from 1 to more than 5 times) with their assigned students over the course of the 3-month surgical rotations. Most coaches who deemed themselves successful in coaching reported early prioritization of setting individualized clerkship goals. Rapport building and strong communication were also important factors identified in facilitating effective near-peer cognitive coaching relationships.ConclusionsOur study suggests that, from residents’ perspective, effective near-peer coaching by residents on surgical clerkships requires special emphasis on early goal setting, as well as training and development of coaches in skills, such as feedback delivery, and rapport building to encourage strong resident–student coaching relationships that cater to the individualized needs of the learner.

The occurrence of code-switching in English as foreign language Classroom: An analysis of teacher’s and students’ conversations

Code-switching is an exciting phenomenon in the English classroom, especially in multilingual settings. While it is being practiced, several types of it have appeared. Dealing with the previous phenomenon, this research is intended to describe the types of code-switching used by the English teacher while conducting English classrooms. Descriptive research was used as the framework of this study to cope with the earlier goal. In collecting the data, the audio recording was used to record the classroom conversation and then transcribed into written form. After that, the data was analyzed. Furthermore, the findings highlight that the teacher uses three types of code-switching: tag-switching, inter-sentential switching, and intra-sentential switching. Also, this study reclassified the tag-switching into tag-switching with tag-phrase at the initial and the end of the sentence. Then, it regrouped inter-sentential switching into inter-sentential switching between clause and sentence and inter-sentential switching between two sentences. Last, it recategorized intra-sentential switching into intra-sentential switching with embedded words and intra-sentential switching with the inserted words. By describing the previous findings, it is hoped that types of code-switching can be clearly understood.

Early Goal of Care Discussions in Healthcare: A Survey Case Report on Benefits and Perceptions

Early Goal of Care Discussions in Healthcare: A Survey Case Report on Benefits and Perceptions

Early goal enteral nutrition associated with decreased in-hospital death in mechanically ventilated critically ill adults: a retrospective cohort study

IntroductionEarly enteral nutrition (EN) in critically ill adult patients is thought to improve mortality and morbidity; expert guidelines recommend early initiation of EN in critically ill adults. However, the ideal...

Analogues of the pan-selectin antagonist rivipansel (GMI-1070)

The selectin family consisting of E−, P- and L-selectin plays dominant roles in atherosclerosis, ischemia-reperfusion injury, inflammatory diseases, and metastatic spreading of some cancers. An early goal in selectin-targeted drug discovery campaigns was to identify ligands binding to all three selectins, so-called pan-selectin antagonists. The physiological epitope, tetrasaccharide sialyl Lewisx (sLex, 1) binds to all selectins, albeit with very different affinities. Whereas P- and L-selectin require additional interactions contributed by sulfate groups for high binding affinity, E-selectin can functionally bind sLex-modified glycolipids and glycoproteins. Rivipansel (3) marked the first pan-selectin antagonist, which simultaneously interacted with both the sLex and the sulfate binding site. The aim of this contribution was to improve the pan-selectin affinity of rivipansel (3) by leveraging a new class of sLex mimetics in combination with an optimized linker length to the sulfate bearing group. As a result, the pan-selectin antagonist 11b exhibits an approximatively 5-fold improved affinity for E−, as well as P-selectin.

A prospective randomized comparative study to evaluate efficacy of intrathecal dexamethasone and dexmedetomidine added as adjuvant to bupivacaine in pregnant patients posted for elective LSCS

Any individual undergoing surgery is concerned about postoperative discomfort. It modifies the body’s physiological reaction and impacts an individual’s psychological state. A physician can meet early mobilization goals by effectively managing postoperative pain and preventing related co-morbidities. Targeting different phases of the pain pathway, from perception to central modulation, is successfully accomplished through the use of different drug combinations and regional anesthetic block techniques. Local anaesthetics injected intrathecally in a single injection create a superb surgical field and can even make a patient pain-free two to three hours following surgery. By adding certain adjuncts, this period can be prolonged, and there will be long-term benefits in terms of decreasing the dosage of opioid analgesics. Because of its faster start of the action and low side effects, spinal anaesthesia is the procedure most frequently used for caesarean sections. Many intrathecal additives have been explored since it has a limited role in postoperative pain control. Adjuvants such as opioids, clonidine, adrenaline, and phenylephrine have been explored recently. These chemicals have been linked to several problems, including tachycardia, respiratory depression with opioids, hypertension with adrenaline and clonidine, and excessive sedation. In this study, our primary objective is to compare the duration of postoperative analgesia between Dexamethasone and dexmedetomidine, as Dexamethasone is an anti-inflammatory drug and dexmedetomidine is an alpha-two agonist that binds with a G protein-coupled receptor. our secondary objectives include comparing intraoperative hemodynamics, intraoperative sedation, and intraoperative shivering between Dexamethasone and dexmedetomidine. CTRI REF.NO-REF/2023/05/067283

Does goal revision undermine self-regulation through goals? An experiment

We offer a novel test of whether non-binding goals set ahead of a task are effective motivators, taking into account that individuals in principle could easily revise these goals. In our setting, subjects either set a goal some days prior to an online task (early goal) or right at the start of the task (late goal). Two further treatments allow for (unanticipated) explicit revision of the early goal. We observe that (i) early goals are larger than late goals; (ii) subjects who set early goals work more than those who only set a late goal if they explicitly revise their goal and are reminded about their revised goal. A secondary contribution of our paper is that our design addresses a treatment migration problem present in earlier studies on goals that stems from the fact that subjects in a ‘no goals’ control condition may privately set goals.

Selection of treatment strategies for lumbar Brucella spondylitis: a retrospective clinical study.

This study aims to investigate the treatment strategies for lumbar brucellar spondylitis by comparing the outcomes of pure pharmacological treatment with diseased intervertebral fixation fusion, with or without lesion clearance. A total of 157 patients with lumbar brucellar spondylitis were categorized into three groups: Group A (52 cases) received pure pharmacological treatment, Group B (53 cases) underwent posterior vertebral fixation fusion, and Group C (52 cases) received posterior (or anterior) lesion clearance followed by posterior vertebral fixation fusion. Clinical data were analyzed, and the efficacy of the three treatment methods was evaluated. The surgical groups showed better outcomes at various time points compared to the pharmacological treatment group (P < 0.05). The pure fixation group outperformed the lesion clearance fusion group during the perioperative period (P < 0.05). The ESR, CRP, ODI scores, imaging evaluation and complications of the lesion clearance followed by fixation group were all better than those of the other two groups (P < 0.05). Surgical treatment groups showed no statistically significant difference in VAS scores (P > 0.05), and both were superior to the pharmacological treatment group. There were no statistically significant differences in clinical efficacy among the three groups at the last follow-up. Surgical treatment achieves early recovery goals compared to pharmacological treatment for brucellar spondylitis. However, individualized treatment principles should guide surgical decisions to select the most suitable approach for patients.

Completion of multidose vaccine series in early childhood: current challenges and opportunities.

Completion of all doses in multidose vaccine series provides optimal protection against preventable infectious diseases. In this review, we describe clinical and public health implications of multidose vaccine series noncompletion, including current challenges to ensuring children receive all recommended vaccinations. We then highlight actionable steps toward achieving early childhood immunization goals. Although coverage levels are high for most early childhood vaccinations, rates of completion are lower for vaccinations that require multiple doses. Recent research has shown that lower family socioeconomic status, a lack of health insurance coverage, having multiple children in the household, and moving across state lines are associated with children failing to complete multidose vaccine series. These findings provide contextual evidence to support that practical challenges to accessing immunization services are impediments to completion of multidose series. Strategies, including reminder/recall, use of centralized immunization information systems, and clinician prompts, have been shown to increase immunization rates. Re-investing in these effective interventions and modernizing the public health infrastructure can facilitate multidose vaccine series completion. Completion of multidose vaccine series is a challenge for immunization service delivery. Increased efforts are needed to address remaining barriers and improve vaccination coverage in the United States.