This Campbell systematic review examines the impact of class size on academic achievement. The review summarises findings from 148 reports from 41 countries. Ten studies were included in the meta‐analysis. Included studies concerned children in grades kindergarten to 12 (or the equivalent in European countries) in general education. The primary focus was on measures of academic achievement. All study designs that used a well‐defined control group were eligible for inclusion. A total of 127 studies, consisting of 148 papers, met the inclusion criteria. These 127 studies analysed 55 different populations from 41 different countries. A large number of studies (45) analysed data from the Student Teacher Achievement Ratio (STAR) experiment which was for class size reduction in grade K‐3 in the US in the eighties. However only ten studies, including four of the STAR programme, could be included in the meta‐analysis. Overall, the evidence suggests at best a small effect on reading achievement. There is a negative, but statistically insignificant, effect on mathematics. For the non‐STAR studies the primary study effect sizes for reading were close to zero but the weighted average was positive and statistically significant. There was some inconsistency in the direction of the primary study effect sizes for mathematics and the weighted average effect was negative and statistically non‐significant. The STAR results are more positive, but do not change the overall finding. All reported results from the studies analysing STAR data indicated a positive effect of smaller class sizes for both reading and maths, but the average effects are small Plain language summary Small class size has at best a small effect on academic achievementReducing class size is seen as a way of improving student performance. But larger class sizes help control education budgets. The evidence suggests at best a small effect on reading achievement. There is a negative, but statistically insignificant, effect on mathematics, so it cannot be ruled out that some children may be adversely affected. What is this review about?Increasing class size is one of the key variables that policy makers can use to control spending on education.But the consensus among many in education research is that smaller classes are effective in improving student achievement which has led to a policy of class size reductions in a number of US states, the UK, and the Netherlands. This policy is disputed by those who argue that the effects of class size reduction are only modest and that there are other more cost‐effective strategies for improving educational standards.Despite the important policy and practice implications of the topic, the research literature on the educational effects of class‐size differences has not been clear.This review systematically reports findings from relevant studies that measure the effects of class size on academic achievement. What are the main findings of this review?What studies are included?Included studies concerned children in grades kindergarten...

Mental health psychiatric advance directives, advance statements, and similar documents are designed to convey a person's treatment preferences to their treating clinicians at times when, due to their mental health, their ability to communicate or make decisions might be impaired. This paper explores the current debates in the literature and presents the findings of a small qualitative study that explored the experiences of people who had completed advance statements in Victoria, Australia. Data was collected through interviews with participants and analysis of their advance statement. Participants completed their advance statements for two main reasons; to authorise future treatment or to limit the power of their treating team. Participants also included non-treatment preferences that were linked to their recovery and pragmatic considerations, such as contact details and dietary requirements. Participants who had used their advance statement reported a lack of acceptance or inclusion from clinicians. Further consideration of the legal enforceability of advance statements is necessary, and if they are to continue to lack legal force, much work remains to be done to support acceptance by clinicians.

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