Background Although mental health difficulties can severely complicate the lives of children and young people (CYP) with long-term physical conditions (LTCs), there is a lack of evidence about the effectiveness of interventions to treat them. Objectives To evaluate the clinical effectiveness and cost-effectiveness of interventions aiming to improve the mental health of CYP with LTCs (review 1) and explore the factors that may enhance or limit their delivery (review 2). Data sources For review 1, 13 electronic databases were searched, including MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Science Citation Index. For review 2, MEDLINE, PsycINFO and CINAHL were searched. Supplementary searches, author contact and grey literature searches were also conducted. Review methods The first systematic review sought randomised controlled trials (RCTs) and economic evaluations of interventions to improve elevated symptoms of mental ill health in CYP with LTCs. Effect sizes for each outcome were calculated post intervention (Cohen’s d). When appropriate, random-effects meta-analyses produced pooled effect sizes (d). Review 2 located primary qualitative studies exploring experiences of CYP with LTCs, their families and/or practitioners, regarding interventions aiming to improve the mental health and well-being of CYP with LTCs. Synthesis followed the principles of metaethnography. An overarching synthesis integrated the findings from review 1 and review 2 using a deductive approach. End-user involvement, including topic experts and CYP with LTCs and their parents, was a feature throughout the project. Results Review 1 synthesised 25 RCTs evaluating 11 types of intervention, sampling 12 different LTCs. Tentative evidence from seven studies suggests that cognitive–behavioural therapy interventions could improve the mental health of CYP with certain LTCs. Intervention–LTC dyads were diverse, with few opportunities to meta-analyse. No economic evaluations were located. Review 2 synthesised 57 studies evaluating 21 types of intervention. Most studies were of individuals with cancer, a human immunodeficiency virus (HIV) infection or mixed LTCs. Interventions often aimed to improve broader mental health and well-being, rather than symptoms of mental health disorder. The metaethnography identified five main constructs, described in an explanatory line of argument model of the experience of interventions. Nine overarching synthesis categories emerged from the integrated evidence, raising implications for future research. Limitations Review 1 conclusions were limited by the lack of evidence about intervention effectiveness. No relevant economic evaluations were located. There were no UK studies included in review 1, limiting the applicability of findings. The mental health status of participants in review 2 was usually unknown, limiting comparability with review 1. The different evidence identified by the two systematic reviews challenged the overarching synthesis. Conclusions There is a relatively small amount of comparable evidence for the effectiveness of interventions for the mental health of CYP with LTCs. Qualitative evidence provided insight into the experiences that intervention deliverers and recipients valued. Future research should evaluate potentially effective intervention components in high-quality RCTs integrating process evaluations. End-user involvement enriched the project. Study registration This study is registered as PROSPERO CRD42011001716. Funding The National Institute for Health Research (NIHR) Health Technology Assessment programme and the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.

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Adaptive collaborative learning support (ACLS) involves collaborative learning environments that adapt their characteristics, and sometimes provide intelligent hints and feedback, to improve individual students' collaborative interactions. ACLS often involves a system that can automatically assess student dialogue, model effective and ineffective collaboration, and provide relevant support. While there is evidence that ACLS can improve student learning, little is known about why systems that incorporate ACLS are effective. Does relevant support improve student interactions by providing just-in-time feedback, or do students who believe they are receiving relevant support feel more accountable for the collaboration, and thus more motivated to improve their interactions? In this paper, we describe an adaptive system we have developed to support help-giving during peer tutoring in high school algebra: the Adaptive Peer Tutoring Assistant (APTA). To validate our approach, we conducted a controlled study that demonstrated that our system provided students with more relevant support and was more effective at improving student learning than parallel nonadaptive conditions. Our contributions involve generalizable techniques for implementing ACLS that can function adaptively and effectively, and the finding that adaptive support does indeed improve student learning because of the relevance of the support.

Adaptive collaborative learning support systems analyze student collaboration as it occurs and provide targeted assistance to the collaborators. Too little is known about how to design adaptive support to have a positive effect on interaction and learning. We investigated this problem in a reciprocal peer tutoring scenario, where two students take turns tutoring each other, so that both may benefit from giving help. We used a social design process to generate three principles for adaptive collaboration assistance. Following these principles, we designed adaptive assistance for improving peer tutor help-giving, and deployed it in a classroom, comparing it to traditional fixed support. We found that the assistance improved the conceptual content of help and the use of interface features. We qualitatively examined how each design principle contributed to the effect, finding that peer tutors responded best to assistance that made them feel accountable for help they gave.

Research on computer-supported collaborative learning has shown that students need support to benefit from collaborative activities. While classical collaboration scripts have been effective in providing such support, they have also been criticized for being coercive and not allowing students to self-regulate their learning. Adaptive collaboration support, which would provide students with assistance when and where they need it, is a possible solution. However, due to limitations of natural language processing, the development of adaptive support based on an analysis of student dialogue is difficult. To facilitate the implementation of adaptive collaboration support, we propose to leverage existing intelligent tutoring technology to provide support based on student problemsolving actions. The present paper gives two examples that demonstrate this approach and reports first experiences from the implementation of the systems in real classrooms. We conclude the paper with a discussion of possible future developments in adaptive collaboration support.Keywords Collaboration scripts . Adaptive collaborative learning systems . Intelligent tutoring While research on collaborative learning has generally shown that student interaction can increase group performance and individual learning outcomes, these positive effects are not always found (cf. meta-analysis by Lou et al. 2001). Often students show unequal engagement in the collaborative learning activity; a few group members take responsibility for the problem-solving, while others engage in social loafing and are not motivated to interact with their partners (e.g. O'Donnell 1999). Even if students are engaged in the interaction, they might not show the type of collaborative behaviour that is positively related to learning. For instance, students often answer a partner's question by merely telling

Background Research studies to inform clinical practice and policy in children and young people with appendicitis are hampered by inconsistent selection and reporting of outcomes. The aim of this study was to develop a core outcome set for reporting all studies of uncomplicated acute appendicitis in children and young people. Methods Systematic literature reviews, qualitative interviews with parents and patients treated for uncomplicated acute appendicitis, and a Study‐Specific Advisory Group informed a long list of outcomes. Outcomes were then prioritized by stakeholders based in the UK (patients, parents, and paediatric and general surgeons) in an online three‐round Delphi consensus process, followed by face‐to‐face consensus meetings. Results A long list of 40 items was scored by 147 key stakeholders in the first Delphi round, of whom 90 completed the two subsequent Delphi rounds. The final core outcome set comprises 14 outcomes: intra‐abdominal abscess, reoperation (including interventional radiology procedure), readmission to hospital, bowel obstruction, wound infection, antibiotic failure, wound complication, negative appendicectomy, recurrent appendicitis, death, patient stress/psychological distress, length of hospital stay, time away from full activity and child's quality of life. Conclusion A core outcome set comprising 14 outcomes across five key domains has been developed for reporting studies in children and young people with uncomplicated acute appendicitis. Further work is required to determine how and when to measure these outcomes.

Background Although non-operative treatment is known to be effective for the treatment of uncomplicated acute appendicitis in children, randomised trial data comparing important outcomes of non-operative treatment with those of appendicectomy are lacking. Objectives The objectives were to ascertain the feasibility of conducting a multicentre randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of a non-operative treatment pathway with appendicectomy for the treatment of uncomplicated acute appendicitis in children. Design This was a mixed-methods study, which included a feasibility randomised controlled trial, embedded and parallel qualitative and survey studies, a parallel health economic feasibility study and the development of a core outcome set. Setting This study was set in three specialist NHS paediatric surgical units in England. Participants Children (aged 4–15 years) clinically diagnosed with uncomplicated acute appendicitis participated in the feasibility randomised controlled trial. Children, their families, recruiting clinicians and other health-care professionals involved in caring for children with appendicitis took part in the qualitative study. UK specialist paediatric surgeons took part in the survey. Specialist paediatric surgeons, adult general surgeons who treat children, and children and young people who previously had appendicitis, along with their families, took part in the development of the core outcome set. Interventions Participants in the feasibility randomised controlled trial were randomised to a non-operative treatment pathway (broad-spectrum antibiotics and active observation) or appendicectomy. Main outcome measures The primary outcome measure was the proportion of eligible patients recruited to the feasibility trial. Data sources Data were sourced from NHS case notes, questionnaire responses, transcribed audio-recordings of recruitment discussions and qualitative interviews. Results Overall, 50% (95% confidence interval 40% to 59%) of 115 eligible patients approached about the trial agreed to participate and were randomised. There was high acceptance of randomisation and good adherence to trial procedures and follow-up (follow-up rates of 89%, 85% and 85% at 6 weeks, 3 months and 6 months, respectively). More participants had perforated appendicitis than had been anticipated. Qualitative work enabled us to communicate about the trial effectively with patients and families, to design and deliver bespoke training to optimise recruitment and to understand how to optimise the design and delivery of a future trial. The health economic study indicated that the main cost drivers are the ward stay cost and the cost of the operation; it has also informed quality-of-life assessment methods for future work. A core outcome set for the treatment of uncomplicated acute appendicitis in children and young people was developed, containing 14 outcomes. There is adequate surgeon interest to justify proceeding to an effectiveness trial, with 51% of those surveyed expressing a willingness to recruit with an unchanged trial protocol. Limitations Because the feasibility randomised controlled trial was performed in only three centres, successful recruitment across a larger number of sites cannot be guaranteed. However, the qualitative work has informed a bespoke training package to facilitate this. Although survey results suggest adequate clinician interest to make a larger trial possible, actual participation may differ, and equipoise may have changed over time. Conclusions A future effectiveness trial is feasible, following limited additional preparation, to establish appropriate outcome measures and case identification. It is recommended to include a limited package of qualitative work to optimise recruitment, in particular at new centres. Future work Prior to proceeding to an effectiveness trial, there is a need to develop a robust method for distinguishing children with uncomplicated acute appendicitis from those with more advanced appendicitis, and to reach agreement on a primary outcome measure and effect size that is acceptable to all stakeholder groups involved. Trial registration Current Controlled Trials ISRCTN15830435. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 10. See the NIHR Journals Library website for further project information.

Technology has the promise to transform educational practices worldwide. In particular, cognitive tutoring systems are an example of educational technology that has been extremely effective at improving mathematics learning over traditional classroom instruction. However, studies on the effectiveness of tutor software have been conducted mainly in the United States, Canada, and Western Europe, and little is known about how these systems might be used in other contexts with differing classroom practices and values. To understand this question, we studied the usage of mathematics tutoring software for middle school at sites in three Latin American countries: Brazil, Mexico, and Costa Rica. While cognitive tutors were designed for individual use, we found that students in these classrooms worked collaboratively, engaging in interdependently paced work and conducting work away from their own computer. In this paper we present design recommendations for how cognitive tutors might be incorporated into different classroom practices, and better adapted for student needs in these environments.