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New surgical procedures can expose patients to harm and should be carefully evaluated before widespread use. The InSpace balloon (Stryker, USA) is an innovative surgical device used to treat people with rotator cuff tears that cannot be repaired. We aimed to determine the effectiveness of the InSpace balloon for people with irreparable rotator cuff tears.We conducted a double-blind, group-sequential, adaptive randomised controlled trial in 24 hospitals in the UK, comparing arthroscopic debridement of the subacromial space with biceps tenotomy (debridement only group) with the same procedure but including insertion of the InSpace balloon (debridement with device group). Participants had an irreparable rotator cuff tear, which had not resolved with conservative treatment, and they had symptoms warranting surgery. Eligibility was confirmed intraoperatively before randomly assigning (1:1) participants to a treatment group using a remote computer system. Participants and assessors were masked to group assignment. Masking was achieved by using identical incisions for both procedures, blinding the operation note, and a consistent rehabilitation programme was offered regardless of group allocation. The primary outcome was the Oxford Shoulder Score at 12 months. Pre-trial simulations using data from early and late timepoints informed stopping boundaries for two interim analyses. The primary analysis was on a modified intention-to-treat basis, adjusted for the planned interim analysis. The trial was registered with ISRCTN, ISRCTN17825590.Between June 1, 2018, and July 30, 2020, we assessed 385 people for eligibility, of which 317 were eligible. 249 (79%) people consented for inclusion in the study. 117 participants were randomly allocated to a treatment group, 61 participants to the debridement only group and 56 to the debridement with device group. A predefined stopping boundary was met at the first interim analysis and recruitment stopped with 117 participants randomised. 43% of participants were female, 57% were male. We obtained primary outcome data for 114 (97%) participants. The mean Oxford Shoulder Score at 12 months was 34·3 (SD 11·1) in the debridement only group and 30·3 (10·9) in the debridement with device group (mean difference adjusted for adaptive design -4·2 [95% CI -8·2 to -0·26];p=0·037) favouring control. There was no difference in adverse events between the two groups.In an efficient, adaptive trial design, our results favoured the debridement only group. We do not recommend the InSpace balloon for the treatment of irreparable rotator cuff tears.Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health and Care Research partnership.

BACKGROUND The prevalence of myopia is increasing globally including in Europe and parts of Asia but Australian data are lacking. This study aim described the change in myopia prevalence in middle-aged Australian adults over approximately a 20-year period. METHODS Two contemporary Western Australian studies (conducted in mid-late 2010s): the coastal-regional Busselton Healthy Ageing Study (BHAS) and the urban Gen1 of the Raine Study (G1RS) were compared to two earlier studies (early-mid 1990s) in Australia: the urban Blue Mountains Eye Study (BMES) and urban/regional Melbourne Visual Impairment Project (MVIP). Refractive error was measured by autorefraction, vertometry, or subjective refraction. Participants (49-70 years) of European descent without self-reported/diagnosed cataract, corneal disease, or refractive or corneal surgery were included. RESULTS After exclusions, data were available from 2217, 1760, 700, 2987 and 756 participants from BMES, urban MVIP, regional MVIP, BHAS, and G1RS, respectively. The mean age ranged from 57.1 ± 4.6 years in the G1RS to 60.1 ± 6.0 years in the BMES; 44-48% of participants were male. When stratified by location, the contemporary urban G1RS cohort had a higher age-standardised myopia prevalence than the urban MVIP and BMES cohorts (29.2%, 16.4%, and 23.9%, p

Project Teacher Leadership is a PDS initiative, which has formed university–school teams to foster collaboration, inquiry, and leadership. University professors, intern teachers, and veteran K-12 teachers engaged in collaborative conversations about authentic experiences in their work to uncover troubling problems of practice and develop strategies for addressing them. In doing so, participants began to develop increased professional agency and leadership. The project drew strength from examining problems through varied perspectives and systematic inquiry, and the inquiry process motivated participants to advocate for changed practices better suited to ensure all students’ learning.

The Raine Eye Health Study (REHS) was conceived to determine the prevalence of and risk factors for eye disease in young adults, and to characterize ocular biometric parameters in a young adult cohort. This article summarizes the rationale and study design of REHS and outlines the baseline prevalence of ophthalmic disease in this population.The Western Australian Pregnancy Cohort (Raine) Study originated as a randomized-controlled trial of 2900 women recruited from the state's largest maternity hospital. Their offspring (N = 2868) have been followed at birth, ages 1, 2, 3, 5, 8, 10, 14, 17 and 20 years of age in a prospective cohort study. DNA has been collected from participants for genome-wide association studies. At the 20-year follow-up participants completed a comprehensive eye assessment that included visual acuity, orthoptic assessment and cycloplegic autorefraction, as well as several ocular biometric variables and multiple ophthalmic photographs of the anterior and posterior segments.A total of 1344 participants (51.3% male) were assessed over a 24-month period. For the majority of examined participants (85.5%) both parents were Caucasian, 63.3% had completed school year 12 or equivalent, 5.5% had myopia (spherical equivalent ≤-3 diopters) and 15 participants (1.2%) had unilateral or bilateral pterygia. Keratoconus, cataract, keratitis and uveitis were rare.The REHS design and methodology allow comparison with other population-based studies of eye disease. The study established the prevalence of eye disorders in a large sample of predominantly Caucasian young Australian adults.

Background/Context In an era of high stakes accountability, public school districts struggle to improve teaching and learning for all students. As a result, effective professional development approaches for teachers are a high priority. Recently, teachers’ learning communities (LCs) have been recommended because successful LCs foster teacher collaboration and make practice public. At a deeper level, however, this type of professional development depends on teachers taking more control over their work, releasing tacit knowledge and expertise, developing critical judgment, and taking fuller responsibility for student learning. Such a construction of teachers’ roles and responsibilities sometimes collides with entrenched norms in school cultures. Purpose This article explores four core themes, which represent endemic challenges to sustaining teachers’ learning communities (LCs): 1) defining and fostering teacher agency, 2) determining purposes for teacher collaboration, 3) tracking the challenges to and impact on district culture, and 4) identifying enabling and constraining institutional and policy conditions. The author uncovers conflicts that frequently emerge when efforts at enhancing the professional autonomy, authority, and responsibility of teachers conflict with hierarchical and bureaucratic district and school cultures. Setting The study is located in a mid-Atlantic city in the United States, struggling with economic disparities, entrenched poverty in some sectors, a shifting economic base, and rapidly changing demographics largely due to immigration. The school district faces challenges typical of other urban districts—closing the achievement gap between middle class and poor children; developing culturally responsive educational practices, providing adequate resources in uncertain economic times; and meeting intensifying federal and state accountability demands. Population Research participants include the district superintendent, district administrators, principals, instructional coaches, and teachers. Research Design This article, based on two and a half years of data collection (October 2001 to April 2003), draws on site-visit interviews and focus groups of key players, observations of LC participants’ meetings and classrooms, e-mail correspondence with several key players, observations of LC coaches’ trainings, and reviews of relevant documents. The author served as an outside researcher to track the district's implementation of the initiative. Eventually, the field-based data was compared with survey data with responses from 251 LC participants in the district. Survey questions were designed by a research team, which included three other outside researchers studying the same initiative in three districts in other states. In all, the qualitative data required visits to LC coaches’ trainings and five on-site visits to the school district, each visit extending over two to four days. Conclusions/Recommendations From the data, the author draws several conclusions with implications for the initiative's success and sustainability. First, although the initiative sought to establish learning communities to mobilize practitioner expertise and build collective responsibility—all for the sake of student learning—most participants did not claim a connection between their collaborative work and student learning. Second, while the district has made considerable headway institutionalizing structural dimensions of the initiative, efforts to enhance teacher efficacy appeared to be constrained by high-stakes accountability policies requiring compliance. Third, within the groups, more time was devoted to community-building efforts than to critical inquiry aimed at improving practice. Fourth, because the initiative's practices and principles run counter to entrenched norms of district culture, its sustainability may be in question. Fifth, paradoxically, district leadership, though seeking a promising context for change, may be unwittingly causing conditions that threaten to undermine the initiative. Finally, if an initiative like this is to endure, districts must invest greater authority and autonomy in participants as well as adequate time and support.

biographers. We have all read the sort of biography that simply sets forth a sequence of events, "one damn thing after another." But in a really good biography, the documentation has been selected and shaped into an unfolding story; and the story has been infused with explanations, judgments, informed speculations. The presence of an explanation implies an explainer, a narrator, and I want to focus my essay today on the way that "explainer" arises as the defining literary characteristic in a biography. Imperative in a successful biographical narrative is the presence of a storyteller, who introduces her- or himself at the beginning of the book, steers the narrative through its exposition, and brings the story to a satisfying end. Sometimes that narrator appears in the book as a character, speaking in the first person; most often, however, the narrator is transparent, not personified - as in the phrase "then the Queen died of grief." In distinguishing the category "first person" from the category "transparent," I do not mean to imply that the transparent narrator is impersonal; to my ear, the words "then" and "of grief are inflected with a voice of authority, of judgment. That is, the transparent narrator is not the passive voice of scientific papers; nor the depersonalized "objective" voice to be found in works of social science, and in most works of literary criticism. I mean merely that the subjectivity of the transparent narrator in a biography is expressed in other ways than being associated with a speaker in the first person. Moreover, the subjectivity or point of view of that narrator is always contemporary, whether or not the subject of the book is contemporary, because the story of a life is always addressed to an audience in the present. These points can best be made with the help of a few examples from really good biographies; I'll begin with Ian Hamilton's biography of Robert Lowell.2 Hamilton's book opens with a quotation from Lowell's

Creating a professional work environment where nurses can develop the skills and expertise needed to be successful leaders is one strategy that can help ensure successful nursing leaders for the future. Understanding which factors influence leadership development is essential to create such an environment. The author considers what those factors may be and how they interact to facilitate the development of leadership skills and expertise among nurses.

David Kolb’s conception of experiential learning has informed wide-ranging studies and practices ineducation, business, organizational development, and leadership studies for over two decades now.His work has guided the work of trainers, teachers, and scholars, affording significant insights into bothindividual and organizational learning. Because deep and sustained change in human settings requiresthat people learn, Kolb’s penetrating analysis of the complexities involved in human learning hasprovided clues about the notorious difficulties surrounding change in both individuals andorganizations. In an era where the newest ideas tend to have special cache, Kolb’s work has hadremarkable staying power. Perhaps this is because his ideas have repeatedly served as a foundationfor theorists and practitioners to understand and influence institutions and the people in them(Sandmire, Vroman & Sanders, 2000; Loo, 2002; Pauleen, Marshall & Ergort, 2004). In a rapidly changingworld, contemporary institutions and organizations must foster human learning. Indeed, theymust be led by effective learners if they are to be relevant and enduring.

The judge has no choice but to study the economic evidence that is presented by the parties and to come to a conclusion that is consistent with that evidence. This paper considers whether judges have been up to that task.

This article focuses on one systematic design model—Planned Instructional Emphasis —and the principal's function in its use. In addition, some leadership strategies for use when implementing an instructional design model are outlined.

A multi-assessment approach was used to examine problems in social development involving the interaction of the cognitive and affect domains. Teachers identified 30 aggressive, 30 withdrawn and 30 popular girls by the Behavioral Description Form, and then administered the Children's Friendship Expectancy Inventory that taps conventional morality, mutual activities, loyalty and empathy. A TAT-type projective test evaluated psychosocial adaptation on five ego stages. In the affect domain, the withdrawn and the aggressives were similar in the inadequacy of their conflict resolutions, a possible development delay problem. The best discriminator of the low and high status girls was group identity versus alienation, posited by Newman and Newman (1975) as the basic conflict of early adolescence. The withdrawn and the aggressives differed in their conceptions of friendship. The withdrawns placed less value on empathy and more value on loyalty than the aggressives, whose social cognitions were more like the populars than the withdrawns.

When attempting to research and document a topic such as ‘women as victims’, the magnitude and complexity of the task is, at the outset, an overwhelming consideration. This issue is comprised of numerous facets which each merit serious scrutiny by those who are concerned with the right of all individuals to a life free of abuse, harassment, and coercion.

This collection of 16 essays discusses the broad relationship of women poets to the American literary tradition

IN April 1960, Anne Sexton for the first time wrote "poet" rather than "housewife" in the "occupation" block of her income tax return. Married since 1948, mother of two daughters, Sexton had been publishing poetry for three years. The change in her status as citizen was significant for Sexton and for American literature. No poet before her had written so frankly of the female realm of family life, nor of its pathologies. And few poets, women or men, achieved success so expeditiously: nine years from drafting her first poem to being awarded the Pulitzer Prize. Sexton's unprecedented metamorphosis from suburban housewife into major poet appears, at first glance, a fairy tale. The real interest of its improbability, though, lies in Sexton's exemplary struggle against two seemingly unrelated handicaps: that of being a suburban wife and mother without a college education and that of being, at recurring intervals, certifiably mad. At age twenty-eight, Anne Sexton quite unexpectedly began turning herself into an artist. During the years of her apprenticeship, in which she produced two highly regarded books, Sexton's good fortune included working with several established younger poets-W. D. Snodgrass, Robert Lowell, James Wright-who immediately recognized her originality and with the Boston poet-teacher John Holmes, who censured it. Friend and adversary, Holmes measured Sexton's work by the literary standards and conventions of an older generation. The chronicle of their relationship provides

The brutal and tragic end of the writings of Goldmann, just when people were still expecting that theoretical synthesis that he was one day planning to publish, necessitates a return to disparate texts asking aesthetic questions in order to seize the outlines of a firm theory concerning the quality of artistic works. The absence of a theoretical formulation by Goldmann himself immediately creates difficulties. The most fruitful source we may tap indeed remains the article "L'esthbtique du jeune Lukics," which appeared in Meditations in 1961 and was reprinted in Marxisme et sciences humaines. For in this essay where he examines the first three works of Lukacs1, Goldmann immediately presents the problem of the essay as a genre as it is developed by Lukics beginning in 1910. In this mirror through which he meditates, Goldmann questions himself about his own work and informs us about the status of his own discourse. Speaking of Lukacs' aesthetics, he defines his own in so far as it is true that "the essay remains an intermediary form to the extent that it only presents its problems because of a particular reality. Thus it is always a work with two dimensions. That of the object it refers to and that of the problem it raises."2 That Goldmann preferred to enunciate the problems of a sociological aesthetic which is his own "because of" the aesthetics of Lukics rather than to present an autonomous theoretical exposition in itself defines one of the dimensions of this aesthetic. The aesthetic does not possess theoretical autonomy, it can only be the object of a particular science.