The Relation Between Discipline Identity and Academic Achievement Within a Marketized Higher Education Context: A Serial Mediation Model of Approaches to Learning and Course Complaints.

Social-psychological dimensions of learning are under-researched, but they affect student achievement. Within a marketized higher education context in England, United Kingdom, this study examined whether the relation between students' social identities as members of their discipline and academic achievement could be further understood by considering the mediating roles of approaches to learning and frequency of making course complaints. Undergraduates (N = 679) completed a questionnaire to assess these constructs. As expected, approaches to learning and course complaining both acted as serial mediators of the link between discipline identification and academic achievement: stronger discipline identification was related to more deep approaches to learning, less complaining, and higher achievement, whereas weaker discipline identification was related to more surface approaches to learning, more complaining, and lower achievement. The findings suggest that addressing these social-psychological aspects of learning could improve students' academic achievement.

Humor style similarity and difference in friendship dyads.

This study assessed the concurrent and prospective (fall to spring) associations between four different humor styles to assess the degree to which stable friendships are characterized by similarity, and to assess whether best friends' humor styles influence each other's later use of humor. Participants were aged 11-13 years, with 87 stable, reciprocal best friend dyads. Self-report assessments of humor styles were completed on both occasions. Results indicated that there was no initial similarity in dyads' levels of humor. However, dyads' use of humor that enhances interpersonal relationships (Affiliative humor) became positively correlated by spring. Additionally, young people's use of this humor style was positively associated with their best friend's later use of the same. No such effects were present for humor which was aggressive, denigrating toward the self, or used to enhance the self. These results have clear implications for theories of humor style development, highlighting an important role for Affiliative humor within stable friendship dyads.

A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding.

BACKGROUND: Uterine polyps cause abnormal bleeding in women and conventional practice is to remove them in hospital under general anaesthetic. Advances in technology make it possible to perform polypectomy in an outpatient setting, yet evidence of effectiveness is limited. OBJECTIVES: To test the hypothesis that in women with abnormal uterine bleeding (AUB) associated with benign uterine polyp(s), outpatient polyp treatment achieved as good, or no more than 25% worse, alleviation of bleeding symptoms at 6 months compared with standard inpatient treatment. The hypothesis that response to uterine polyp treatment differed according to the pattern of AUB, menopausal status and longer-term follow-up was tested. The cost-effectiveness and acceptability of outpatient polypectomy was examined. DESIGN: A multicentre, non-inferiority, randomised controlled trial, incorporating a cost-effectiveness analysis and supplemented by a parallel patient preference study. Patient acceptability was evaluated by interview in a qualitative study. SETTING: Outpatient hysteroscopy clinics and inpatient gynaecology departments within UK NHS hospitals. PARTICIPANTS: Women with AUB - defined as heavy menstrual bleeding (formerly known as menorrhagia) (HMB), intermenstrual bleeding or postmenopausal bleeding - and hysteroscopically diagnosed uterine polyps. INTERVENTIONS: We randomly assigned 507 women, using a minimisation algorithm, to outpatient polypectomy compared with conventional inpatient polypectomy as a day case in hospital under general anaesthesia. MAIN OUTCOME MEASURES: The primary outcome was successful treatment at 6 months, determined by the woman's assessment of her bleeding. Secondary outcomes included quality of life, procedure feasibility, acceptability and cost per quality-adjusted life-year (QALY) gained. RESULTS: At 6 months, 73% (166/228) of women who underwent outpatient polypectomy were successfully treated compared with 80% (168/211) following inpatient polypectomy [relative risk (RR) 0.91, 95% confidence interval (CI) 0.82 to 1.02]. The lower end of the CIs showed that outpatient polypectomy was at most 18% worse, in relative terms, than inpatient treatment, within the 25% margin of non-inferiority set at the outset of the study. By 1 and 2 years the corresponding proportions were similar producing RRs close to unity. There was no evidence that the treatment effect differed according to any of the predefined subgroups when treatments by variable interaction parameters were examined. Failure to completely remove polyps was higher (19% vs. 7%; RR 2.5, 95% CI 1.5 to 4.1) with outpatient polypectomy. Procedure acceptability was reduced with outpatient compared with inpatient polyp treatment (83% vs. 92%; RR 0.90, 95% CI 0.84 to 0.97). There were no significant differences in quality of life. The incremental cost-effectiveness ratios at 6 and 12 months for inpatient treatment were £1,099,167 and £668,800 per additional QALY, respectively. CONCLUSIONS: When treating women with AUB associated with uterine polyps, outpatient polypectomy was non-inferior to inpatient polypectomy at 6 and 12 months, and relatively cost-effective. However, patients need to be aware that failure to remove a polyp is more likely with outpatient polypectomy and procedure acceptability lower. TRIAL REGISTRATION: Current Controlled Trials ISRCTN 65868569. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 61. See the NIHR Journals Library website for further project information.

Does the gender of the bully/victim dyad and the type of bullying influence children's responses to a bullying incident?

Children's responses to bullying are context related; they will vary depending on the specific bullying episode. The aim of the present study was to explore whether children's responses to bullying vary depending on the gender of the bully and victim and the type of bullying portrayed. In total, 437 children aged 9-11 years from four primary schools in the UK took part in the study. Each child read a story about one child bullying another. There were 12 different versions of the story, varying the type of bullying (verbal, physical, or relational/indirect) and the gender of the bully and victim (i.e., male bully-female victim, female bully-male victim, male bully-male victim, female bully-female victim). Each child was randomly allocated to one of the 12 stories. After reading the story the children then responded to a series of questions to assess their perceptions of the victim and bully and situation. Overall females liked the bully more than males; females also reported liking the female victim more than the male victim and females were more likely than males to intervene with a female victim. The bullying was viewed as more serious, more sympathy was shown to the victim, and there was a greater likelihood of intervention when the incident involved a female bully. There was less liking for the bully if the situation involved a female victim of physical bullying. The findings are explained in terms of social identity theory and social norms about typical male and female behavior.

The influence of norms and social identities on children's responses to bullying.

BACKGROUND: Research on bullying increasingly focuses on social processes, showing that group membership affects children's responses to bullying scenarios. Additionally, correlational research has shown links between norms of cooperation and prosocial behaviour, and between competition and more aggressive forms of behaviour. AIMS: This paper focuses on how children's peer group membership affects their group-based emotions in response to an intergroup bullying incident, and the action tendencies that these emotions predict, in the context of different background norms (for competitive or cooperative behaviour). SAMPLE: Italian schoolchildren, 10-13 years old (N= 128, 65 males) took part in this study. METHODS: Participants were randomly assigned to the group of a perpetrator, target, or third-party group member described in a scenario. Next, they played a game designed to induce a cooperative, competitive, or neutral norm, and read the scenario. They then answered a questionnaire measuring their group-based emotions. RESULTS: Results underscored the role of norms and group processes in responses to bullying. In particular, children exposed to a cooperative norm expressed less pride and more regret and anger about the bullying than those in other conditions. CONCLUSIONS: This study indicates that the influence peer groups have on bullying may be tempered by the introduction of a cooperative normative context to the school setting.

Ganging up or sticking together? Group processes and children's responses to text-message bullying.

Drawing on social identity theory and intergroup emotion theory (IET), we examined group processes underlying bullying behaviour. Children were randomly assigned to one of three groups: a perpetrator's group, a target's group, or a third party group. They then read a gender-consistent scenario in which the norm of the perpetrator's group (to be kind or unkind towards others) was manipulated, and an instance of cyberbullying between the perpetrator's group and a member of the target's group was described. It was found that group membership, group norms, and the proposed antecedents of the group-based emotions of pride, shame, and anger (but not guilt) influenced group-based emotions and action tendencies in ways predicted by social identity and IET. The results underline the importance of understanding group-level emotional reactions when it comes to tackling bullying, and show that being part of a group can be helpful in overcoming the negative effects of bullying.

Birds of a feather bully together: group processes and children's responses to bullying.

Recent research has shown that a group-level analysis can inform our understanding of school bullying. The present research drew on social identity theory and intergroup emotion theory. Nine- to eleven-year olds were randomly assigned to the same group as story characters who were described as engaging in bullying, as being bullied, or as neither engaging in bullying nor being bullied. Participants read a story in which a bully, supported by his or her group, was described as acting unkindly towards a child in a different group. Gender of protagonists and the bully's group norm (to be kind or unkind to other children) were varied. Identification affected responses to the bullying incident, such that those who identified more highly with each group favoured this group. Moreover, children's group membership predicted the group-based emotions they reported, together with the associated action tendencies. Implications for understanding the processes underlying bullying behaviour are discussed.

Rate, type, and cost of invasive interventions for uterine myomas in Germany, France, and England.

STUDY OBJECTIVE: The objective of our study was to quantify the rate, type, and cost of interventions for uterine myomas to payers in Germany, France, and England. DESIGN: Computations using data from national hospital activity databases. DESIGN CLASSIFICATION: II-3. SETTING: Hospital admissions in Germany, France, and England. PATIENTS: Women admitted for a surgical or radiologic intervention for uterine myomas. INTERVENTIONS: Surgical or radiologic interventions for uterine myomas. MEASUREMENTS AND MAIN RESULTS: We identified the number and type of hospital admissions involving surgical or radiologic interventions for uterine myomas, through the analysis of national hospital activity databases from each country. We calculated the costs of these hospitalizations to payers in these countries using the diagnosis-related group reimbursement rates. In 2005, the number (rate) of hospital admissions involving interventions for uterine myomas was 64 299 (1.53/1000 women) in Germany, 37 787 (1.17/1000 women) in France, and 18 274 (0.71/1000 women) in England. The annual costs of these interventions to payers were euro212 313 090 in Germany, euro73 278 270 in France (excluding surgeon and anesthetist fees for interventions in the private sector), and euro52 674 672 in England. The percentage of interventions for uterine myomas that included a hysterectomy was 84.9% in Germany, 59.7% in France, and 64.1% in England. CONCLUSION: The number of admissions and costs associated with interventions for uterine myomas are substantial in the 3 European countries studied. Hysterectomy is the most frequent surgical intervention used to treat uterine myomas. The results in this article provide useful information for policy makers wishing to evaluate the cost effectiveness and budget impact of new, less invasive interventions.

Profound hypoxemia in pulmonary patients in airline-equivalent hypoxia: roles of VA/Q and shunt.

BACKGROUND: Airliners at cruise altitudes have cabin pressures of 84.3-75.2 kPa, equivalent to 5000-8000 ft. Supplementary oxygen in flight is generally advised for patients whose ground-level arterial oxygen saturation by pulse oximetry (SpO2) is < 92%. However, some pulmonary patients with values above that threshold nevertheless develop profound in-flight hypoxemia (SpO2 < or = 82%) as cabin pressure falls. This experiment measured the contributions of ventilation-perfusion ratio (VA/Q) and pulmonary shunt to that phenomenon. METHODS: Air/nitrogen mixtures were used to expose 18 patients with pulmonary dysfunction to PIO2 = 15 kPa. VA/Q was estimated from right shift of the steep phase of the PIO2 vs. SpO2 curve along the PO2 axis. Shunt was estimated from change of shape and downward shift of the same curve. RESULTS: During hypoxia, the lowest observed SpO2 was correlated with reduced VA/Q (R2 = 0.89). Of 10 patients with VA/Q < or = 0.69, 9 developed profound hypoxia even though 5 of those had SpO2 > or = 92% at ground level; patients with VA/Q > 0.75 maintained SpO2% > or = 84%. Hypoxemia did not correlate with shunt for the group as a whole, but eight patients with VA/Q > or = 0.73 and shunts in the range 6.6-20.8% showed such a correlation (R2 = 0.8). CONCLUSION: In patients with similar ground-level SpO2, profound hypoxemia was more likely to develop in those with reduced VA/Q (< or = 0.69) as opposed to those with shunts of 20%. Measurement of VA/Q and shunt during hypoxic hypoxia improves prediction of patient need for supplementary oxygen on airline flights.

Hysteroscopy in the diagnosis of postmenopausal bleeding.

Postmenopausal bleeding (PMB) accounts for 5% of gynaecology referrals. Investigations should exclude malignancy and pre-malignancy, and diagnose the benign conditions that need treatment. The three modalities that are most commonly used are transvaginal ultrasound scan (TVS), endometrial biopsy (EB) and hysteroscopy. Most authors agree that the first-line investigation should be TVS, followed by endometrial assessment (EB or hysteroscopy) if the endometrial thickness is >4 mm. When scanning demonstrates the possibility of pathology, outpatient hysteroscopy and biopsy are the gold standard for investigating the endometrial cavity. Focal pathology can be removed during the hysteroscopy, thereby reducing hospital admissions and costs.

Ambulatory hysteroscopy: evidence-based guide to diagnosis and therapy.

Healthcare providers are facing increasing demands for improvement in quality of life for patients. Improvements in service provision for women are being ensured by the introduction of minimally invasive technologies into all spheres of gynaecologic practice. Ambulatory hysteroscopy (direct endoscopic visualization of the endometrial cavity) is an extremely exciting and rapidly advancing field of gynaecologic practice. It advanced dramatically during the 1990s, shifting the focus in healthcare away from inpatient diagnosis and treatment. Hysteroscopy is used extensively in the evaluation of common gynaecological problems that were previously evaluated with blind and inaccurate techniques (e.g. premenopausal menstrual disorders, infertility and postmenopausal bleeding). It allows direct visualization of the uterine cavity and the opportunity for targeted biopsy, safe removal of endometrial polyps, and treatment of submucous fibroids, septa and adhesions. Ambulatory hysteroscopy is safe, with a low incidence of serious complications; it has a small failure rate. There is a general consensus that hysteroscopy is the current gold standard for evaluating intrauterine pathology, including submucous myomas, polyps, hyperplasia and cancer. Hysteroscopy in the ambulatory setting appears to have an accuracy and patient acceptability equivalent to inpatient hysteroscopy under general anaesthetic. The primary goal of this chapter is to provide a high-quality, evidence-based text on ambulatory diagnostic and operative hysteroscopy. The chapter includes in-depth analysis of the indications for outpatient hysteroscopy, its contraindications, the accuracy of diagnostic hysteroscopy, relevant risk management issues and, training and teaching.

The benefits of setting up a nurse hysteroscopy service.

Many nurses are extending their roles in line with the Government's NHS Plan. In the outpatient hysteroscopy service in one trust nurses are now undertaking diagnostic hysteroscopy. This has improved continuity of care for patients and allowed the nurses to combine their traditional nursing role of providing information and reassurance with performing the procedure.