California has won case for nurse-patient ratios.

I admit it: in the argument about mandated nurse-to-patient ratios I was concerned that the ratio would become an end in itself.

Secret quality of love.

Many of us can recite three Donabedian dimensions of the quality of care of structure, process and outcome. Recently, I was introduced to another of Avedis Donabedian's quotes about the 'secret quality of love'.

An immune dysfunction score for stratification of patients with acute infection based on whole-blood gene expression.

Dysregulated host responses to infection can lead to organ dysfunction and sepsis, causing millions of global deaths each year. To alleviate this burden, improved prognostication and biomarkers of response are urgently needed. We investigated the use of whole-blood transcriptomics for stratification of patients with severe infection by integrating data from 3149 samples from patients with sepsis due to community-acquired pneumonia or fecal peritonitis admitted to intensive care and healthy individuals into a gene expression reference map. We used this map to derive a quantitative sepsis response signature (SRSq) score reflective of immune dysfunction and predictive of clinical outcomes, which can be estimated using a 7- or 12-gene signature. Last, we built a machine learning framework, SepstratifieR, to deploy SRSq in adult and pediatric bacterial and viral sepsis, H1N1 influenza, and COVID-19, demonstrating clinically relevant stratification across diseases and revealing some of the physiological alterations linking immune dysregulation to mortality. Our method enables early identification of individuals with dysfunctional immune profiles, bringing us closer to precision medicine in infection.

Scale-dependent loss of global form perception in strabismic amblyopia.

Amblyopic humans are known to have a range of spatial vision abnormalities. Prior studies have documented amblyopic deficits in global form perception but have typically used only one set of stimulus parameters. Our aim in this study was to examine the extent and nature of global form perception deficits in strabismic amblyopia using a range of spatial scales and pattern types. Glass patterns are random dot stimuli in which the local orientations of paired dots must be integrated over space to yield a global form percept. We measured coherence thresholds for discrimination of pattern structure in translational (linear) and concentric Glass patterns at three spatial scales in two control and six amblyopic observers. We found that sensitivity to Glass patterns depended on both spatial scale and pattern type in all observers. Participants with a history of abnormal early visual experience showed greater interocular threshold difference when the discrimination was based on translational patterns than when it was based on concentric patterns, and the degree of amblyopic loss was greatest at fine spatial scale. Our results show that the nature and extent of global form vision deficits vary substantially with stimulus parameters and are greatest at fine spatial scales.

Enhancing learning experiences.

Equine thermographer Elaine Hall wanted to improve her teaching skills so she enrolled on a course that could equip her with the skills she needed to improve her students' learning experience.

Noise in schools: a holistic approach to the issue.

Much of the research evidence relating to the physical learning environment of schools is inconclusive, contradictory or incomplete. Nevertheless, within this confusing area, research from a number of disciplines, using a range of methodologies, points to the negative impact of noise on students' learning. In this paper, drawing on our systematic review of learning environments we review the weight of evidence in relation to noise, considering what implications the results of these studies have for the design and use of learning spaces in schools. We make four key points. Firstly that noise over a given level does appear to have a negative impact on learning. Secondly that beneath these levels noise may or may not be problematic, depending on the social, cultural and pedagogical expectations of the students and teachers. Thirdly we argue that when noise is deemed to be a difficulty, this finding cannot simply be translated into design prescriptions. The reasons for this indeterminacy include differing understandings of the routes through which noise produces learning deficits, as well as relationships between noise and other elements of the environment, particularly the impacts of physical solutions to noise problems. Finally, we suggest that solutions to noise problems will not be produced by viewing noise in isolation, or even as part of the physical environment, but through participatory approaches to understanding and adapting the structure, organisation and use of learning spaces in schools.

Joined-up working' between early years professionals and speech and language therapists: moving beyond 'normal' roles.

This paper draws on research conducted for the Nuffield Foundation (Mroz et at, 2002) which looked at the knowledge, skills and confidence of early years professionals in relation to young children's speech and language development. Key findings from the project are reported in relation to the efficacy of initial and post-qualification training in preparing professionals for the identification and support of children with communication problems. The discussion centres around early years practitioners' experiences of working with speech and language therapists and the needs which they expressed, both for inter-professional training and for modes of working together.