James P. Davis

Impact of Premorbid Undernutrition on Outcome in Stroke Patients

Background and Purpose— To assess the prevalence of premorbid undernutrition and its impact on outcomes 1 month after stroke. Methods— The study recruited from consecutive stroke admissions during a 10-month period. Premorbid nutritional status (using the subjective global assessment [SGA]), premorbid functioning (modified Rankin scale [MRS]), and stroke severity (National Institutes of Health Stroke Scale [NIHSS] score) were assessed at admission. The associations between premorbid nutritional status, poor outcome (defined as MRS ≥3), and mortality were examined before and after adjustment for confounding variables, including age, gender, stroke risk factors, stroke severity, and admission serum albumin. Results— Thirty of 185 patients were assessed as having undernutrition at admission. Significant unadjusted associations were observed between undernutrition and poor outcome (odds ratio [OR], 3.4; 95% CI, 1.3 to 8.7; P =0.01), and mortality (OR, 3.1, 95% CI, 1.3 to 7.7; P =0.02) at 1 month. NIHSS, age, and premorbid MRS were also significantly associated with poor outcomes. After adjustment for these factors, the effect size of associations remained important but not significant (poor outcome: OR, 2.4; 95% CI, 0.7 to 9.0, P =0.18; mortality: OR, 3.2; 95% CI, 1.0 to 10.4, P =0.05). Conclusions— Premorbid undernutrition, as assessed using the SGA, appears to be an independent predictor of poor stroke outcome. Stroke prevention strategies should target undernutrition in the population at risk for stroke to improve outcomes.

The time course and determinants of temperature within the first 48 h after ischaemic stroke

Background and Purpose: Previous research has attempted to analyze the relationship between post-stroke hyperthermia and prognosis. These analyses have been hindered by a lack of information about the time course and determinants of temperature change after stroke. Methods: Serial temperatures were measured until 48 h after ischaemic stroke in a prospectively recruited cohort. Potential determinants of temperature, including stroke severity [measured using the National Institutes of Health Stroke Scale (NIHSS)], infection and paracetamol use were recorded. Mixed-effects models were used to model serial temperature measurements over time, adjusted for significant determinants. Results: In 155 patients the mean temperature rose from 36.5°C at the time of stroke to 36.7°C approximately 36 h later. The factors with significant multivariable associations with serial temperatures were: first- and second-order time components, infection, paracetamol administration and the interaction between stroke severity (NIHSS ≧6) and time (all p < 0.1). Patients with admission NIHSS ≧6 had a mean temperature rise of 0.35°C during the first 36 h after stroke, compared with a rise of 0.17°C in those with NIHSS ≤5. Conclusions: Temperature spontaneously rises during the first 36 h after stroke, particularly after severer stroke and in the presence of infection.

The effect of admission physiological variables on 30 day outcome after stroke

INTRODUCTION Potentially modifiable physiological variables may influence stroke prognosis but their independence from modifiable factors remains unclear. METHODS Admission physiological measures (blood pressure, heart rate, temperature and blood glucose) and other unmodifiable factors were recorded from patients presenting within 48 hours of stroke. These variables were compared with the outcomes of death and death or dependency at 30 days in multivariate statistical models. RESULTS In the 186 patients included in the study, age, atrial fibrillation and the National Institutes of Health Stroke Score were identified as unmodifiable factors independently associated with death and death or dependency. After adjusting for these factors, none of the physiological variables were independently associated with death, while only diastolic blood pressure (DBP) > or = 90 mmHg was associated with death or dependency at 30 days (p = 0.02). CONCLUSIONS Except for elevated DBP, we found no independent associations between admission physiology and outcome at 30 days in an unselected stroke cohort. Future studies should look for associations in subgroups, or by analysing serial changes in physiology during the early post-stroke period.

The Time Course and Determinants of Blood Pressure within the First 48 h after Ischemic Stroke

Background and Purpose: Previous research suggests that blood pressure falls acutely after ischemic stroke. We aimed to further characterize this fall with a statistical technique that allows the application of regression techniques to serial blood pressure outcome data. Methods: In a prospectively recruited ischemic stroke cohort, systolic (SBP) and diastolic (DBP) blood pressure was recorded every 4 h until 48 h after stroke. Potential determinants of blood pressure, including stroke severity and acute infection, were also recorded. Mixed effects models were used to model serial blood pressure measurements over time, adjusted for significant determinants. Results: In 156 patients, SBP and DBP fell by 14.9 mm Hg (95% CI 6.2–22.6 mm Hg) and 6.2 mm Hg (95% CI 1.4–10.6 mm Hg), respectively, over the first 48 h after stroke. SBP was higher in patients with premorbid hypertension, a previous history of stroke or TIA, current alcohol use, increasing age, stroke of mild to moderate severity (NIHSS 3–13) and in patients treated with antihypertensives. SBP was lower in smokers. There was a progressive rise in SBP in patients with acute infection. No factors other than time were associated with DBP. Conclusions: The use of mixed effects models has identified a linear SBP and DBP fall over the first 48 h after stroke. The timing and magnitude of this fall should be accounted for in the design of future prognostic and intervention studies.

Emotions, Social Beings, and Ethnomethods: Understanding Analogical Reasoning in Everyday Science Classrooms

This study illustrates analytical resources used in an ethnomethodological study of analogical reasoning as a collection of practices indigenous to the everyday science classroom. These tools included a social ontological perspective redefining our sense of human dualism and making it possible to see analogical reasoning from a new perspective. To enhance this perspective, I used ethnomethodology to capture living (in vivo) data and improve my understanding of analogical reasoning as an achievement of localized, indigenous social practices. My use of ethnomethodology was a strategic choice, as it enabled me to understand the lived experiences of collective emotion throughout these moments of achievement. This chapter outlines how my use of the social being and ethnomethodology assisted in establishing my understanding of emotions as an integral part of analogical reasoning in everyday science classrooms.

Beyond performativity: a pragmatic model of teacher professional learning

Abstract The intent and content of teacher professional learning has changed in recent times to meet the demands of performativity. In this article, we offer and demonstrate a pragmatic way to map teacher professional learning that both meets current demands and secures a place for teacher-led catalytic learning. To achieve this, we position identified characteristics of performative professional learning on intersecting continua modelled on Bourdieu’s mapping of social capital, which we have called a Pragmatic Model of Teacher Professional Learning. The continua are labelled (after) as: domain of influence, sphere of action, and autonomy-transformation. While the pragmatic model is illustrated through three examples of teacher professional learning in use in Australia and its characteristics have been drawn from Australian regulatory requirements for teacher registration, it will be applicable in other national jurisdictions. The model aims to move ‘beyond performativity’ and to define a systematic and pro-active approach for regulators, managers, professional learning providers and teachers to actively contribute to ongoing innovation and directedness of teacher professional learning toward real student outcomes.

[Book Review] "Epistemic fluency and professional education: Innovation, knowledgeable action and actionable knowledge" by L. Markauskaite and P. Goodyear

A book review of Epistemic fluency and professional education: Innovation, knowledgeable action and actionable knowledge . With a strong emphasis on epistemic games, this book is iself a game changer by defining transdisciplinary perspecives of professional education and professional learning. For educators of pre-service or in-service teachers, this book is even more important as it offers an alternative to conventional understandings of cognition and learning, and an array of strategies that may also be relevant to the way we teach in secondary and primary contexts. While the authors tend to approach thinking and learning from a cognitive science perspective, it is the adoption of perspectives from diverse epistemological and ontological origins that makes this book unique: as the author ’ s contend with broadening the conventional cognitive sciences world-view...

Epistemic fluency and professional education: innovation, knowledgeable action and actionable knowledge by L. Markauskaite and P. Goodyear: Springer, Singapore, 2017, 636 p.

A book review of Epistemic fluency and professional education: Innovation, knowledgeable action and actionable knowledge . With a strong emphasis on epistemic games, this book is iself a game changer by defining transdisciplinary perspecives of professional education and professional learning. For educators of pre-service or in-service teachers, this book is even more important as it offers an alternative to conventional understandings of cognition and learning, and an array of strategies that may also be relevant to the way we teach in secondary and primary contexts. While the authors tend to approach thinking and learning from a cognitive science perspective, it is the adoption of perspectives from diverse epistemological and ontological origins that makes this book unique: as the author ’ s contend with broadening the conventional cognitive sciences world-view...