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Context: Faced with deep challenges with access to formal education, many West African countries are increasingly taking steps to reform their informal apprenticeship systems to make them a quality skills development alternative for their teeming youth. A review of the literature shows that although different countries in the region are deploying different reform strategies, what is emerging as a dominant reform model is the "dual training model" (DTM), a collaborative arrangement in which the task of training apprentices is shared between informal trainers (master craftspersons, under their respective trade associations) and formal vocational training institutions (FVTIs). This paper presents an outcome-process evaluation of a DTM-based apprenticeship reform programme piloted in Ghana. Methods: Designed as a case study, the paper adopts an interpretivist approach, relying on diverse sources of data, both secondary and primary. Secondary data includes journal articles, attendance registers of participants, memorandums of understanding, relevant media reports, websites, and official reports by all relevant actors. The primary data originated from in-depth interviews with fourteen (14) key informants, as well as from overt and covert observations of respondents. Results: At the outcome level, the paper shows that the programme has largely failed in transferring new skills or in changing dominant poor practices among trainees, foundational objectives of the programme. At the process level, the paper revealed deep flaws in implementation; these are discussed in detail in an attempt to clarify the programme outcomes. Conclusion: The paper concludes that although the dual training model remains a potentially viable reform model in informal apprenticeships, its success ultimately depends on the quality of implementation, which in turn depends on the strength and quality of inter-stakeholder collaboration in programme design and implementation.

Systems of correlated particles appear in many fields of modern science and represent some of the most intractable computational problems in nature. The computational challenge in these systems arises when interactions become comparable to other energy scales, which makes the state of each particle depend on all other particles1. The lack of general solutions for the three-body problem and acceptable theory for strongly correlated electrons shows that our understanding of correlated systems fades when the particle number or the interaction strength increases. One of the hallmarks of interacting systems is the formation of multiparticle bound states2-9. Here we develop a high-fidelity parameterizable fSim gate and implement the periodic quantum circuit of the spin-½ XXZ model in a ring of 24 superconducting qubits. We study the propagation of these excitations and observe their bound nature for up to five photons. We devise a phase-sensitive method for constructing the few-body spectrum of the bound states and extract their pseudo-charge by introducing a synthetic flux. By introducing interactions between the ring and additional qubits, we observe an unexpected resilience of the bound states to integrability breaking. This finding goes against the idea that bound states in non-integrable systems are unstable when their energies overlap with the continuum spectrum. Our work provides experimental evidence for bound states of interacting photons and discovers their stability beyond the integrability limit.

AbstractThe integration and mandatory study of research method courses by university students is a global phenomenon. However, students demonstrate apprehension and disinterest in research methods courses. Consequently, this study investigated the interplay among research methods anxiety, positive disposition toward research, perception of usefulness, self-efficacy, and academic effort in research. Paper-and-pencil questionnaires were used to collect data from a convenience sample of 636 technical university students in Ghana. Based on partial least squares structural equation modeling results, research anxiety reduces students’ self-beliefs (β = −0.172; t = 2.729; p = .000) and negatively affects perception of research usefulness (β = −0.172; t = 2.729; p = .000). A positive disposition towards research enhances students’ academic efforts in research (β = 0.919; t = 3.308; p = 0.001). Furthermore, self-efficacy drives students’ efforts (β = −0.172; t = 2.729; p = .000), enhances positive disposition toward research (β = 0.191; t = 3.308; p = .001) and perception of research usefulness among students (β = 0.224; t = 3.064; p = .002). Students’ perception of research usefulness mediates the relationship between anxiety and effort in research (β = −0.075; t = 3.653; p = .000), positive research disposition and effort (β = −0.056; t = 2.519; p = .012) as well as research self-efficacy and effort in studies (β = 0.083; t = 3.02; p = .003).

Quantum computing can become scalable through error correction, but logical error rates only decrease with system size when physical errors are sufficiently uncorrelated. During computation, unused high energy levels of the qubits can become excited, creating leakage states that are long-lived and mobile. Particularly for superconducting transmon qubits, this leakage opens a path to errors that are correlated in space and time. Here, we report a reset protocol that returns a qubit to the ground state from all relevant higher level states. We test its performance with the bit-flip stabilizer code, a simplified version of the surface code for quantum error correction. We investigate the accumulation and dynamics of leakage during error correction. Using this protocol, we find lower rates of logical errors and an improved scaling and stability of error suppression with increasing qubit number. This demonstration provides a key step on the path towards scalable quantum computing.

Context: Faced with deep challenges with access to formal education, many West African countries are increasingly taking steps to reform their informal apprenticeship systems to make them a quality skills development alternative for their teeming youth. A review of the literature shows that although different countries in the region are deploying different reform strategies, what is emerging as a dominant reform model is the "dual training model" (DTM), a collaborative arrangement in which the task of training apprentices is shared between informal trainers (master craftspersons, under their respective trade associations) and formal vocational training institutions (FVTIs). This paper presents an outcome-process evaluation of a DTM-based apprenticeship reform programme piloted in Ghana. Methods: Designed as a case study, the paper adopts an interpretivist approach, relying on diverse sources of data, both secondary and primary. Secondary data includes journal articles, attendance registers of participants, memorandums of understanding, relevant media reports, websites, and official reports by all relevant actors. The primary data originated from in-depth interviews with fourteen (14) key informants, as well as from overt and covert observations of respondents. Results: At the outcome level, the paper shows that the programme has largely failed in transferring new skills or in changing dominant poor practices among trainees, foundational objectives of the programme. At the process level, the paper revealed deep flaws in implementation; these are discussed in detail in an attempt to clarify the programme outcomes. Conclusion: The paper concludes that although the dual training model remains a potentially viable reform model in informal apprenticeships, its success ultimately depends on the quality of implementation, which in turn depends on the strength and quality of interstakeholder collaboration in programme design and implementation. [ABSTRACT FROM AUTHOR]

ObjectiveEpratuzumab, a monoclonal antibody that targets CD22, modulates B cell signaling without substantial reductions in the number of B cells. The aim of this study was to report the results of 2 phase III multicenter randomized, double-blind, placebo-controlled trials, the EMBODY 1 and EMBODY 2 trials, assessing the efficacy and safety of epratuzumab in patients with moderately to severely active systemic lupus erythematosus (SLE).MethodsPatients met ≥4 of the American College of Rheumatology revised classification criteria for SLE, were positive for antinuclear antibodies and/or anti-double-stranded DNA antibodies, had an SLE Disease Activity Index 2000 (SLEDAI-2K) score of ≥6 (increased disease activity), had British Isles Lupus Assessment Group 2004 index (BILAG-2004) scores of grade A (severe disease activity) in ≥1 body system or grade B (moderate disease activity) in ≥2 body systems (in the mucocutaneous, musculoskeletal, or cardiorespiratory domains), and were receiving standard therapy, including mandatory treatment with corticosteroids (5-60 mg/day). BILAG-2004 grade A scores in the renal and central nervous system domains were excluded. Patients were randomized 1:1:1 to receive either placebo, epratuzumab 600 mg every week, or epratuzumab 1,200 mg every other week, with infusions delivered for the first 4 weeks of each 12-week dosing cycle, for 4 cycles. Patients across all 3 treatment groups also continued with their standard therapy. The primary end point was the response rate at week 48 according to the BILAG-based Combined Lupus Assessment (BICLA) definition, requiring improvement in the BILAG-2004 score, no worsening in the BILAG-2004 score, SLEDAI-2K score, or physician's global assessment of disease activity, and no disallowed changes in concomitant medications. Patients who discontinued the study medication were classified as nonresponders.ResultsIn the EMBODY 1 and EMBODY 2 trials of epratuzumab, 793 patients and 791 patients, respectively, were randomized, 786 (99.1%) and 788 (99.6%), respectively, received study medication, and 528 (66.6%) and 533 (67.4%), respectively, completed the study. There was no statistically significant difference in the primary end point between the groups, with the week 48 BICLA response rates being similar between the epratuzumab groups and the placebo group (response rates ranging from 33.5% to 39.8%). No new safety signals were identified.ConclusionIn patients with moderate or severely active SLE, treatment with epratuzumab + standard therapy did not result in improvements in response rates over that observed in the placebo + standard therapy group.

Over the past two decades, with recognition that the ocean's sea-ice cover is neither insensitive to climate change nor a barrier to light and matter, research in sea-ice biogeochemistry has accelerated significantly, bringing together a multi-disciplinary community from a variety of fields. This disciplinary diversity has contributed a wide range of methodological techniques and approaches to sea-ice studies, complicating comparisons of the results and the development of conceptual and numerical models to describe the important biogeochemical processes occurring in sea ice. Almost all chemical elements, compounds, and biogeochemical processes relevant to Earth system science are measured in sea ice, with published methods available for determiningbiomass, pigments, net community production, primary production, bacterial activity, macronutrients, numerous natural and anthropogenic organic compounds, trace elements, reactive and inert gases, sulfur species, the carbon dioxide system parameters, stable isotopes, and water-ice-Atmosphere fluxes of gases, liquids, and solids. For most of these measurements, multiple sampling and processing techniques are available, but to date there has been little intercomparison or intercalibration between methods. In addition, researchers collect different types of ancillary data and document their samples differently, further confounding comparisons between studies. These problems are compounded by the heterogeneity of sea ice, in which even adjacent cores can have dramatically different biogeochemical compositions. We recommend that, in future investigations, researchers design their programs based on nested sampling patterns, collect a core suite of ancillary measurements, and employ a standard approach for sample identification and documentation. In addition, intercalibration exercises are most critically needed for measurements of biomass, primary production, nutrients, dissolved and particulate organic matter (including exopolymers), the CO2 system, air-ice gas fluxes, and aerosol production. We also encourage the development of in situ probes robust enough for long-Term deployment in sea ice, particularly for biological parameters, the CO2 system, and other gases.

Om P Kurmi,1 Liming Li,2 Kourtney J Davis,3 Jenny Wang,1 Derrick A Bennett,1 Ka Hung Chan,1 Ling Yang,1 Yiping Chen,1 Yu Guo,4 Zheng Bian,4 Junshi Chen,5 Liuping Wei,6 Donghui Jin,7 Rory Collins,1 Richard Peto,1 Zhengming Chen1 On behalf of the China Kadoorie Biobank collaborative group 1Clinical Trial Service and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; 2Department of Epidemiology, School of Public Health, Peking University Health Science Center, Beijing, China; 3Real World Evidence and Epidemiology, GlaxoSmithKline, Collegeville, PA, USA; 4Chinese Academy of Medical Sciences, Beijing China; 5China National Center for Food Safety Risk Assessment, Beijing, China; 6NCDs Prevention and Control Department, Liuzhou CDC, Liuzhou, China; 7NCDs Prevention and Control Department, Hunan CDC, Changsha, China Background: China has high COPD rates, even among never-regular smokers. Little is known about nonrespiratory disease risks, especially vascular morbidity and mortality after developing airflow obstruction (AFO) in Chinese adults. Objective: We aimed to investigate the prospective association of prevalent AFO with major vascular morbidity and mortality. Materials and methods: In 2004–2008, a nationwide prospective cohort study recruited 512,891 men and women aged 30–79 years from 10 diverse localities across China, tracking cause-specific mortality and coded episodes of hospitalization for 9 years. Cox regression yielded adjusted HRs for vascular diseases comparing individuals with spirometry-defined prevalent AFO at baseline to those without. Results: Of 489,382 participants with no vascular disease at baseline, 6.8% had AFO, with prevalence rising steeply with age. Individuals with prevalent AFO had significantly increased vascular mortality (n=1,429, adjusted HR 1.29, 95% CI 1.21–1.36). There were also increased risks of hemorrhagic stroke (n=823, HR 1.18, 95% CI 1.09–1.27), major coronary events (n=635, HR 1.33, 95% CI 1.22–1.45), and heart failure (n=543, HR 2.19, 95% CI 1.98–2.41). For each outcome, the risk increased progressively with increasing COPD severity and persisted among never-regular smokers. Conclusion: Among adult Chinese, AFO was associated with significantly increased risks of major vascular morbidity and mortality. COPD management should be integrated with vascular disease prevention and treatment programs to improve long-term prognosis. Keywords: chronic obstructive pulmonary disease, exacerbation, vascular diseases, cohort, China

Objectives: This study aimed to determine if the presence of a pericardial effusion is associated with adverse outcomes among children admitted with juvenile idiopathic arthritis. Patients and methods: The multicenter, retrospective cohort study was conducted with 4,332 patients (1,554 males, 2,778 females; median age: 12 years; IQR, 7, 15 years) using the Pediatric Health Information System. Data from hospital admissions between January 1, 2004, and September 15, 2015, were obtained for patients with an International Disease Classification, Ninth Revision code for juvenile idiopathic arthritis. Pericardial effusion was the primary predictor variable; the outcomes of interest were length of stay, hospital costs, and readmission within 90 days. Multivariate models were created to evaluate associations between pericardial effusion and adverse outcomes. We also analyzed factors associated with increased odds of having pericardial effusion in juvenile idiopathic arthritis. Results: One hundred twenty (3%) patients had a code for pericardial effusion. Children with pericardial effusion had a longer median length of stay (7 days (IQR 3-12) vs. 3 days (IQR 2-6), p<0.001), higher median costs ($17,688 (IQR 8,657-40,623) vs. $8,456 (IQR 4,865-16,302), p<0.001), and greater rates of readmission (22% vs. 15%, p=0.045). Multivariate analysis demonstrated no significant association between pericardial effusion and outcomes of interest. Black race and male sex were associated with increased odds of having pericardial effusion. Conclusion: Pericardial effusion is rare among children admitted with juvenile idiopathic arthritis but is associated with significant morbidity; its presence may be a marker of disease severity. Black children and males admitted with juvenile idiopathic arthritis warrant special consideration and may benefit from screening echocardiography. [ABSTRACT FROM AUTHOR]

In the United States, fractions are an important part of the middle school curriculum, yet many middle school students struggle with fraction concepts. Teachers also have difficulty with the conceptual understanding needed to teach fractions and rely on textbooks when making instructional decisions. This reliance on textbooks, the idea that teaching and learning of fractions is a complex process, and that fraction understanding is the foundation for later topics such as proportionality, algebra, and probability, makes it important to examine the variation in presentation of fraction concepts in U.S. textbooks, especially the difference between traditional and standards-based curricula. The purpose of this study is to determine if differences exist in the presentation of fractions in conventional and standards-based textbooks and how these differences align with the recommendations of National Council of Teachers of Mathematics, Common Core State Standards, and the research on the teaching and learning of fractions.

Om P Kurmi,1 Liming Li,2,3 Jenny Wang,1 Iona Y Millwood,1 Junshi Chen,4 Rory Collins,1 Yu Guo,2 Zheng Bian,2 Jiangtao Li,5 Biyun Chen,6 Kaixu Xie,7 Weifan Jia,8 Yali Gao,9 Richard Peto,1 Zhengming Chen1 On behalf of the China Kadoorie Biobank Collaborative Group 1Nuffield Department of Population Health, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK; 2Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 3Chinese Academy of Medical Sciences, Dong Cheng District, 4China National Center for Food Safety Risk Assessment, Beijing, 5NCDs Prevention and Control Department, Huixian CDC, Huixian, Henan, 6NCDs Prevention and Control Department, Hunan CDC, Changsha, 7NCDs Prevention and Control Department, Tongxiang CDC, Zhejiang, 8NCDs Prevention and Control Department, Liuyang CDC, Baiyikengdao, Liuyang, Changsha, Hunan, 9NCDs Prevention and Control Department, Sichuan CDC, Sichuan, Mainland China Purpose: In adult Chinese men, smoking prevalence is high, but little is known about its association with chronic respiratory disease, which is still poorly diagnosed and managed. Methods: A nationwide study recruited 0.5 million men and women aged 30–79 years during 2004–2008 from ten geographically diverse areas across the Mainland China. Information was collected from each participant regarding smoking and self-reported physician diagnosis of chronic bronchitis/emphysema (CB/E), along with measurement of lung function indices. Logistic regression was used to yield sex-specific odds ratios (ORs) relating smoking to airflow obstruction (AFO), defined as forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC)

Introduction Previous studies have shown an association between number of stroke admissions and outcomes. Small hospitals often support more remote areas and we studied national data to determine if an association exists between hospital remoteness and stroke care. Methods Data from the Irish National Audit of Stroke (INAS) on average stroke admissions, adjusted mortality for ischaemic stroke, thrombolysis rate and proportion with door to needle (DTN) ≤45 min were analysed. Hospital remoteness was quantified by distance to the next hospital, nearest neurointerventional centre and location within 10 km of the national motorway network. Results Data for 23 of 24 stroke services were evaluated. Median number of strokes admitted per year was 186 (range 84–497). Nine hospitals (39%) admitted ≥200 stroke patients per year (mean 332). Average adjusted mortality (7.0 vs. 7.3, P  = 0.67 t -test), mean thrombolysis rate (12.1% vs. 9.2%, P  = 0.09) and mean proportion of patients treated ≤45 min (40.4% vs. 31.3%, P  = 0.2) did not differ significantly between higher and lower volume hospitals. Hospitals close to the motorway network (n  = 15) had a higher mean thrombolysis rate (11.9% vs. 7.5%, P  = 0.01 t -test) and proportion DTN ≤45 min (43.7–18.4%, P  < 0.001). Number of stroke admissions did not correlate with mortality (r  = 0.06, P  = 0.78), DTN (r  = 0.12, P  = 0.95) or thrombolysis rate (r  = 0.35, P  = 0.20). Distance to next hospital correlated strongly negatively with DTN (r  = −0.47, P  = 0.02) and thrombolysis rate (−0.43, P  = 0.04). Conclusion Remoteness of hospitals is associated with worse measures of stroke outcome and management. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Children with Alagille syndrome often have complex forms of congenital heart defects with the majority having peripheral pulmonary artery stenosis (PPAS) and pulmonary valve atresia (PA) or pulmonary valve stenosis. Children with Alagille syndrome also have variable amounts of liver dysfunction. The purpose of this study was to evaluate the impact of liver dysfunction on outcomes in children with Alagille syndrome undergoing congenital heart surgery. METHODS This was a retrospective review of 69 patients with Alagille syndrome who underwent congenital heart surgery at our institution. The underlying diagnoses included PPAS (n  = 29), tetralogy of Fallot with PPAS (n  = 14), tetralogy with PA (n  = 3), PA with ventricular septal defect and major aortopulmonary collateral arteries (n  = 21) and one each with D-transposition and supravalvar aortic stenosis. RESULTS The median age at surgery was 16 months (range 0–228 months). Procedures performed included PPAS repair (n  = 43), tetralogy with PA repair (n  = 3), unifocalization procedures (n  = 21) and other (n  = 2). Forty-two (61%) patients had mild or no liver dysfunction, while 26 (38%) had moderate or severe liver dysfunction. The median cardiopulmonary bypass time was 345 min (341 with liver dysfunction, 345 without liver dysfunction). There were a total of 8 operative (12%) deaths and 3 late (4%) deaths. Six operative and 2 late deaths occurred in patients with liver dysfunction (combined 30.7%) versus 2 operative and 1 late death (combined 7.1%) for patients without liver dysfunction (P  < 0.05). CONCLUSIONS These results suggest that liver dysfunction has a profound impact on survival in children with Alagille syndrome undergoing congenital heart surgery. [ABSTRACT FROM AUTHOR]

BackgroundThe bias toward immediate gratification is associated with maladaptive eating behaviors and has been cross-sectionally and prospectively related to obesity. Engaging in episodic future thinking, which involves mental self-projection to pre-experience future events, reduces this bias and energy intake in overweight/obese adults and children. To examine how episodic future thinking can be incorporated into clinical interventions, a Web-based system was created to provide training for adults and children in their everyday lives. ObjectiveOur study examined the technical feasibility, usability, and acceptability of a Web-based system that is accessible by mobile devices and adapts episodic future thinking for delivery in family-based obesity interventions. MethodsWe recruited 20 parent-child dyads (N=40) from the surrounding community and randomized to episodic future thinking versus a nutritional information thinking control to test the feasibility of a 4-week Web-based intervention. Parents were 44.1 (SD 7.8) years of age with BMI of 34.2 (SD 6.8) kg/m2. Children were 11.0 (SD 1.3) years of age with BMI percentile of 96.0 (SD 1.8). Families met weekly with a case manager for 4 weeks and used the system daily. Adherence was collected through the Web-based system, and perceived acceptance of the Web-based system was assessed postintervention. Measurements of body composition and dietary intake were collected at baseline and after the 4 weeks of intervention. ResultsAll 20 families completed the intervention and attended all sessions. Results showed parents and children had high adherence to the Web-based system and perceived it to be easy to use, useful, and helpful. No differences between conditions were found in adherence for parents (P=.65) or children (P=.27). In addition, results suggest that basic nutrition information along with episodic future thinking delivered through our Web-based system may reduce energy intake and weight. ConclusionsWe showed that our Web-based system is an accepted technology and a feasible utility. Furthermore, results provide initial evidence that our system can be incorporated into family-based treatments targeting behaviors related to weight control. These results show promising utility in using our Web-based system in interventions.