Early Mathematics Learning and Teaching in Chinese Preschools: A Content Analysis of Teaching Reference Books for Preschool Teachers

Since the 1980s, Chinese children have consistently been found to perform well in mathematics in cross-national studies of academic achievement. This study is one of the first to systematically examine Chinese children’s early mathematics learning experiences through a content analysis of eight sets of preschool teacher’s teaching reference books that are commonly used in China. A total of 2038 mathematics activities were selected from these classic teaching reference books and analyzed in terms of (i) suggested teaching approaches, (ii) the mathematical concepts covered, and (iii) their integration of a problem-solving component. The results showed that early mathematics teaching in Chinese preschools emphasize the mastery of key mathematical concepts and skills, while less attention is paid to the application of these key concepts in real-life and non-routine problem-solving settings. Collective teaching was found to be the major teaching mode for early mathematics activities in Chinese preschools, with teachers playing a leading role in the collective teaching activities described in the reference books. However, the teacher’s role is not described in detail in the learning corner activities, and few activities were found to integrate a problem-solving component. The implications of these findings for early mathematics education and the need for a more comprehensive review of mathematics education from the pre-primary to secondary stages are discussed.

Why Choose a Pathology Career?

Context.— There is a global decline in medical graduates pursuing pathology careers, resulting in a broadening gap between workforce demand and supply. Objective.— To determine causes of low popularity of pathology as a career and develop strategies to avoid a workforce crisis. Design.— An online survey was distributed and yielded 1247 responses, including 609 Australian medical students from 10 medical schools, 119 prevocational doctors from 10 major teaching hospitals in New South Wales, 175 residents, and 344 pathologists throughout Australia. Results.— Compared with pathology-uninterested peers, students and prevocational doctors interested in pathology careers were more likely to value research opportunities (57 of 166 [34.3%] pathology-interested respondents versus 112 of 521 [21.5%] pathology-uninterested respondents; odds ratio [OR] = 1.91, P < .001), have children (19 of 165 respondents [11.5%] versus 22 of 522 respondents [4.2%]; OR = 2.96, P < .001), and self-identify as introverted (87 of 167 respondents [52.1%] versus 179 of 526 respondents [34%]; OR = 2.1, P < .001). Those uninterested in pathology were more likely to value patient interaction (363 of 524 respondents [69.3%] versus 71 of 166 respondents [42.8%]; OR = 3.02, P < .001). Lack of exposure to pathology was the most-cited reason for rejecting pathology (after lack of patient interaction). There was poor understanding of the role of pathologists and low confidence in the ability to interpret histopathology reports among medical students and prevocational doctors. Negative stereotypes regarding pathologists were identified. Conclusions.— Active interventions increasing exposure of medical students and prevocational doctors to pathology as a career, as well as promotion of research opportunities and potential for work–life balance, are needed to address pending workforce shortages.

Impact of External Environmental Dimensions on Financial Performance of Major Teaching Hospitals in the U.S.

Teaching hospitals have a unique mission to not only deliver graduate medical education but to also provide both inpatient and ambulatory care and to conduct clinical medical research; therefore, they are under constant financial pressure, and it is important to explore what types of external environmental components affect their financial performance. This study examined if there is an association between the short-term and long-term financial performance of major teaching hospitals in the United States and the external environmental dimensions, as measured by the Resource-Dependence Theory. Data for 226 major teaching hospitals spanning 46 states were analyzed. The dependent variable for short-term financial performance was days cash on hand, and dependent variable for long-term financial performance was return on assets, both an average of most recently available 4-year data (2014–2017). Utilizing linear regression model, results showed significance between outpatient revenue and days cash on hand as well as significant relationship between population of the metropolitan statistical area, unemployment rate of the metropolitan statistical area, and teaching hospital’s return on assets. Additionally, system membership, type of ownership/control, and teaching intensity also showed significant association with return on assets. By comprehensively examining all major teaching hospitals in the U.S. and analyzing the association between their short-term and long-term financial performance and external environmental dimensions, based upon Resource-Dependence Theory, we found that by offering diverse outpatient services and novel delivery options, administrators of teaching hospitals may be able to increase organizational liquidity.

Finding Potential Adverse Events in the Unstructured Text of Electronic Health Care Records: Development of the Shakespeare Method

Background Big data tools provide opportunities to monitor adverse events (patient harm associated with medical care) (AEs) in the unstructured text of electronic health care records (EHRs). Writers may explicitly state an apparent association between treatment and adverse outcome (“attributed”) or state the simple treatment and outcome without an association (“unattributed”). Many methods for finding AEs in text rely on predefining possible AEs before searching for prespecified words and phrases or manual labeling (standardization) by investigators. We developed a method to identify possible AEs, even if unknown or unattributed, without any prespecifications or standardization of notes. Our method was inspired by word-frequency analysis methods used to uncover the true authorship of disputed works credited to William Shakespeare. We chose two use cases, “transfusion” and “time-based.” Transfusion was chosen because new transfusion AE types were becoming recognized during the study data period; therefore, we anticipated an opportunity to find unattributed potential AEs (PAEs) in the notes. With the time-based case, we wanted to simulate near real-time surveillance. We chose time periods in the hope of detecting PAEs due to contaminated heparin from mid-2007 to mid-2008 that were announced in early 2008. We hypothesized that the prevalence of contaminated heparin may have been widespread enough to manifest in EHRs through symptoms related to heparin AEs, independent of clinicians’ documentation of attributed AEs. Objective We aimed to develop a new method to identify attributed and unattributed PAEs using the unstructured text of EHRs. Methods We used EHRs for adult critical care admissions at a major teaching hospital (2001-2012). For each case, we formed a group of interest and a comparison group. We concatenated the text notes for each admission into one document sorted by date, and deleted replicate sentences and lists. We identified statistically significant words in the group of interest versus the comparison group. Documents in the group of interest were filtered to those words, followed by topic modeling on the filtered documents to produce topics. For each topic, the three documents with the maximum topic scores were manually reviewed to identify PAEs. Results Topics centered around medical conditions that were unique to or more common in the group of interest, including PAEs. In each use case, most PAEs were unattributed in the notes. Among the transfusion PAEs was unattributed evidence of transfusion-associated cardiac overload and transfusion-related acute lung injury. Some of the PAEs from mid-2007 to mid-2008 were increased unattributed events consistent with AEs related to heparin contamination. Conclusions The Shakespeare method could be a useful supplement to AE reporting and surveillance of structured EHR data. Future improvements should include automation of the manual review process.

Evaluation of Potential Drug-Drug Interactions among Patients of the Nephrology and Kidney Transplant Wards of a Major Teaching Hospital in Iran

Aims: This study was aimed to find the prevalence of potential DDIs in patients and identify factors associated with these interactions. Study design: All patients' medication regimens were screened for potential DDIs through Lexi-Interact® Online application. Place and Duration of Study: This study was conducted for five months in 2017-2018 at the nephrology and kidney transplant ward of Razi hospital, Rasht, Iran. Methodology: Each potential DDI was characterized based on severity, onset, mechanism, risk rating and reliability rating. The patient's comorbidity was assessed with the Charlson comorbidity index. The quality of patients' life was assessed with the Kidney Disease Quality of Life Instrument-SF36TM questionnaire. Results: The study included 191 patients (109 [57.07%] males and 82 [42.93%] females) with a mean age of 58.09 ± 17.76 years. The analysis revealed that 29.4 % of potential DDIs had good and 13.5% had excellent evidence. There was a statistically significant association among the number of prescribed medications (polypharmacy), hospital ward, age, Body Mass Index, education, history of drug addiction, length of hospitalization, dyslipidemia, and hypothyroidism. Conclusion Potential DDIs are common in patients of the nephrology and kidney transplant wards, so proper patient monitoring is essential for minimizing and preventing potential adverse outcomes of DDIs.

Evaluation of Albumin Utilization in a Major Teaching Hospital in Iran Before and After Guideline Implementation

Background: Inappropriate use of drugs is one of the major issues in health care system. Rational drug utilization based on the appropriate guidelines has an important role in management of use of expensive medications. We aimed to evaluate albumin usage's appropriateness based on evidence-based indications before and after implementing albumin prescription guideline in a teaching hospital. Methods: This study was performed in two phases. During two-month periods, all the patients who were ordered to receive albumin were evaluated. The first phase was done in November and December of 2017, during which, based on physicians' comments, the guideline was finalized and then implemented. Phase two was performed in May and June 2018. Results: Albumin was prescribed appropriately in 33 patients (55%) in the first phase and 43 (70%) patients in the second phase. 299 vials in the first phase and 456 vials in the second phase were prescribed which 198 vials (66%) and 394 (86%) vials were used with appropriate indications, respectively. The number of vials consumed with inappropriate indication decreased significantly from 101 vials (34%) in the first phase to 62 vials (14%) in the second phase (P-value=0.01). The average cost of the inappropriate indication per patient decreased from $197.3 ± 131.6 in the first phase to $183.5 ± 126.8 in the second phase (P-value=0.52). Conclusion: This study showed implementing a DUE program and designing a guideline for rational prescribing of albumin and interventional methods can optimize treatment duration, significantly decrease inappropriate usage, and avoid unnecessary hospital costs.

Final Thoughts

The final chapter briefly summarizes the major teaching points of the book and re-emphasizes the most salient take home points.