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Research suggests that the explicit teaching of morphological principles will improve children's spelling. Despite the fact that reference is made to morphology in English policy documents, teachers make limited use of morphology when teaching spelling, relying more heavily on phonic and visual strategies. After attending a course on role of morphemes in spelling, teachers' own awareness of morphology increased and this was reflected in their practice. This in turn caused their pupils to make significant gains in spelling, compared to a control group. This reinforces the proposition that explicit instruction about morphemes is helpful to children's learning. It demonstrates the fact that research can be transformed into teacher practice, but it also illustrates the difficulties. Policy documentation alone is insufficient. Professional development can effect change but this may be hard to sustain. Children's gains are contingent on teacher's continuing to dedicate class time to focussed intervention. BACKGROUND The role of morphemes in children's reading and spellingOur starting point is a desire to improve children's literacy skills. We have taken a particular theoretical position, that enabling children to understand underlying principles will be a powerful way of improving their performance in practical tasks.Foregrounding the power of conceptual understanding has a long tradition (eg. Piaget, 1978; Karmiloff-Smith, 1992). In the context of literacy, the importance of understanding the alphabetic principle is a well-known example of the significance of conceptual understanding (eg. Frith, 1985). A less well-researched concept, which is our focus here, is that of morphology.A morpheme is the smallest part of a word that carries meaning, so that can be a whole word, like "cat" or just part of a word like the "s" in "cats" or the suffix "less" in "careless". Our language is a morphological jigsaw which we manipulate all the time to increase our word power: eg. verbs created from nouns -paint balling, texting, etc. But despite the fact that morphemes are one of the key building blocks of words in any language, many of us are unconscious of our morphological expertise. This is frequently the case with skills that are learnt early in our development. We argue that if children's attention is explicitly drawn to the morphemic structure of English it will provide a conceptual base which will support their learning to read and spell. Jane Hurry Senior Lecturer in Research Methods Psychology and Human Development

ImportanceThe Stroke of Known Cause and Underlying Atrial Fibrillation (STROKE AF) trial found that approximately 1 in 8 patients with recent ischemic stroke attributed to large- or small-vessel disease had poststroke atrial fibrillation (AF) detected by an insertable cardiac monitor (ICM) at 12 months. Identifying predictors of AF could be useful when considering an ICM in routine poststroke clinical care.ObjectiveTo determine the association between commonly assessed risk factors and poststroke detection of new AF in the STROKE AF cohort monitored by ICM.Design, Setting, and ParticipantsThis was a prespecified analysis of a randomized (1:1) clinical trial that enrolled patients between April 1, 2016, and July 12, 2019, with primary follow-up through 2020 and mean (SD) duration of 11.0 (3.0) months. Eligible patients were selected from 33 clinical research sites in the US. Patients had an index stroke attributed to large- or small-vessel disease and were 60 years or older or aged 50 to 59 years with at least 1 additional stroke risk factor. A total of 496 patients were enrolled, and 492 were randomly assigned to study groups (3 did not meet inclusion criteria, and 1 withdrew consent). Patients in the ICM group had the index stroke within 10 days before insertion. Data were analyzed from October 8, 2021, to January 28, 2022.InterventionsICM monitoring vs site-specific usual care (short-duration external cardiac monitoring).Main Outcomes and MeasuresThe ICM device automatically detects AF episodes 2 or more minutes in length; episodes were adjudicated by an expert committee. Cox regression multivariable modeling included all parameters identified in the univariate analysis having P values <.10. AF detection rates were calculated using Kaplan-Meier survival estimates.ResultsThe analysis included the 242 participants randomly assigned to the ICM group in the STROKE AF study. Among 242 patients monitored with ICM, 27 developed AF (mean [SD] age, 66.6 [9.3] years; 144 men [60.0%]; 96 [40.0%] women). Two patients had missing baseline data and exited the study early. Univariate predictors of AF detection included age (per 1-year increments: hazard ratio [HR], 1.05; 95% CI, 1.01-1.09; P = .02), CHA2DS2-VASc score (per point: HR, 1.54; 95% CI, 1.15-2.06; P = .004), chronic obstructive pulmonary disease (HR, 2.49; 95% CI, 0.86-7.20; P = .09), congestive heart failure (CHF; with preserved or reduced ejection fraction: HR, 6.64; 95% CI, 2.29-19.24; P < .001), left atrial enlargement (LAE; HR, 3.63; 95% CI, 1.55-8.47; P = .003), QRS duration (HR, 1.02; 95% CI, 1.00-1.04; P = .04), and kidney dysfunction (HR, 3.58; 95% CI, 1.35-9.46; P = .01). In multivariable modeling (n = 197), only CHF (HR, 5.06; 95% CI, 1.45-17.64; P = .05) and LAE (HR, 3.32; 1.34-8.19; P = .009) remained significant predictors of AF. At 12 months, patients with CHF and/or LAE (40 of 142 patients) had an AF detection rate of 23.4% vs 5.0% for patients with neither (HR, 5.1; 95% CI, 2.0-12.8; P < .001).Conclusions and RelevanceAmong patients with ischemic stroke attributed to large- or small-vessel disease, CHF and LAE were associated with a significantly increased risk of poststroke AF detection. These patients may benefit most from the use of ICMs as part of a secondary stroke prevention strategy. However, the study was not powered for clinical predictors of AF, and therefore, other clinical characteristics may not have reached statistical significance.Trial RegistrationClinicalTrials.gov Identifier: NCT02700945

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