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Given that universities have significant choices to make about what is retained from our emergency measures, the authors set out to use the record of our biweekly meetings to examine the choices that we have made during the pandemic and how we have made them. In this collaborative reflective article from authors from five different institutions in the UK and Australia, we demonstrate that student-centred decision making emerged unanimously as the core value driving our decision making during the pandemic. In our reflections, supported by our diary notes, we explore and document our decision-making processes relating to educational technology through the lens of agile values and principles in the context of crisis leadership during the COVID-19 pandemic. We discuss four prominent drivers for student-centred decision making: a) collecting and rapidly sharing student voice data, b) offering more choice in anticipation of diverse needs, c) giving a high priority to equalising access to technology and d) taking responsibility for students in difficult circumstances. In addition, we discuss five emerging data-driven themes – leadership, operational continuity, student welfare, pedagogy and technology infrastructure – and offer insights into student-driven decision making with examples from our respective institutions. The ultimate aim for our reflection is to establish approaches that we value in higher education leadership that we should sustain and to formulate principles for student-centred agile leadership for university education which can serve us during the pandemic and beyond.

Despite optimism about new technologies for learning, e-learning innovation has been slow to scale up. This research set out to investigate whether an e-learning environment designed by students themselves would scale easily in schools. To do so, the GENESIS Project, a collaborative undertaking between three schools and a University, created the opportunity for students as researchers to conceive, prototype, and test an e-learning environment in which they and other students could explore ideas of interest to them. Preliminary findings show that students are able to design e-learning environments that provide good contexts for learning. Furthermore, such an approach appears to set in motion deep and lasting change in schools in ways that align with Coburn’s (2003) four ways of thinking about scaling up. The Project demonstrates, in all its phases, a way in which students themselves can take information leadership of curriculum in a culture of change.

Background Pediatric obesity is a serious, but clinically neglected, chronic health problem. Despite the high prevalence, excess weight problems are rarely managed when children attend clinical services. It is recommended that obesity treatment uses a “chronic-care” approach to management, with different types and intensity of treatment dependent upon severity of obesity. There are several new secondary and tertiary weight management services being implemented within New South Wales (NSW), Australia in 2017/2018 with differing models of care. This study will ascertain what factors affect acceptability, reach, and participation, as well as measure the clinical effectiveness of these services. Methods This is a acceptability and effectiveness study building upon existing and planned secondary and tertiary level service delivery in several health districts. This study will recruit participants from seven different pediatric weight management services (PWMS) across five Local Health Districts in NSW, Australia. Using a mixed-methods approach we will document a range of process, impact and clinical outcome measures in order to better understand the context and the effectiveness of each PWMS model. The project development and implementation is guided by the Theoretical Domains Framework. Participants will include parents of children less than 18 years of age attending PWMS, clinicians working as part of PWMS and health service managers. Data will be captured using a combination of anthropometric measures, questionnaires, one-on-one semi-structured interviews and focus groups. Discussion Results from this study will assess the acceptability and effectiveness of different models of care for pediatric weight management. Such information is required to inform long-term sustainability and scalability of secondary and tertiary care services to the large number of families with children above a healthy weight.

Short cervix at midgestation, the presence of intraamniotic debris, and cervical funneling are risk factors for preterm birth; however, cervical length measurements and cutoffs are not well documented among pregnant patients of different gestational ages and self-reported races and ethnicities.This study aimed to describe the distribution of cervical length and frequency of funneling and debris at midgestation in nulliparous women by gestational age and race/ethnicity.This secondary analysis of screening data from a multicenter treatment trial of singleton nulliparous patients with short cervix was conducted at 14 geographically distributed, university-affiliated medical centers in the United States. Singleton nulliparous patients with no known risk factors for preterm birth were screened for trial participation and asked to undergo a transvaginal ultrasound to measure cervical length by a certified sonographer. The distribution of cervical length and the frequency of funneling and debris were assessed for each gestational age week (16-22 weeks) and stratified by self-reported race and ethnicity, which for this study were categorized as White, Black, Hispanic, and other. Patients enrolled in the randomized trial were excluded from this analysis.A total of 12,407 nulliparous patients were included in this analysis. The racial or ethnic distribution of the study participants was as follows: White, 41.6%; Black, 29.6%; Hispanic, 24.2%; and others, 4.6%. The 10th percentile cervical length for the entire cohort was 31.1 mm and, when stratified by race and ethnicity, 31.9 mm for White, 30.2 mm for Black, 31.4 mm for Hispanic, and 31.2 mm for patients of other race and ethnicity (P.001). At each gestational age, the cervical length corresponding to the tenth percentile was shorter in Black patients. The 25 mm value commonly used to define a short cervix and thought to represent the 10th percentile ranged from 1.3% to 5.4% across gestational age weeks and 1.0% to 3.8% across race and ethnicity groups. Black patients had the highest rate of funneling (2.6%), whereas Hispanic and Black patients had higher rates of intraamniotic debris than White and other patients (P.001).Black patients had shorter cervical length and higher rates of debris and funneling than White patients. The racial and ethnic disparities in sonographic midtrimester cervical findings may provide insight into the racial disparity in preterm birth rates in the United States.

Although preterm birth37 weeks' gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates.We sought to describe the contemporary frequencies of neonatal death, neonatal morbidities, and neonatal length of stay across the spectrum of preterm gestational ages.This was a secondary analysis of an obstetric cohort of 115,502 women and their neonates who were born in 25 hospitals nationwide, 2008 through 2011. All liveborn nonanomalous singleton preterm (23.0-36.9 weeks of gestation) neonates were included in this analysis. The frequency of neonatal death, major neonatal morbidity (intraventricular hemorrhage grade III/IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II/III, bronchopulmonary dysplasia, persistent pulmonary hypertension), and minor neonatal morbidity (hypotension requiring treatment, intraventricular hemorrhage grade I/II, necrotizing enterocolitis stage I, respiratory distress syndrome, hyperbilirubinemia requiring treatment) were calculated by delivery gestational age; each neonate was classified once by the worst outcome for which criteria was met.In all, 8334 deliveries met inclusion criteria. There were 119 (1.4%) neonatal deaths. In all, 657 (7.9%) neonates had major morbidity, 3136 (37.6%) had minor morbidity, and 4422 (53.1%) survived without any of the studied morbidities. Deaths declined rapidly with each advancing week of gestation. This decline in death was accompanied by an increase in major neonatal morbidity, which peaked at 54.8% at 25 weeks of gestation. As frequencies of death and major neonatal morbidity fell, minor neonatal morbidity increased, peaking at 81.7% at 31 weeks of gestation. The frequency of all morbidities fell32 weeks. After 25 weeks, neonatal length of hospital stay decreased significantly with each additional completed week of pregnancy; among babies delivered from 26-32 weeks of gestation, each additional week in utero reduced the subsequent length of neonatal hospitalization by a minimum of 8 days. The median postmenstrual age at discharge nadired around 36 weeks' postmenstrual age for babies born at 31-35 weeks of gestation.Our data show that there is a continuum of outcomes, with each additional week of gestation conferring survival benefit while reducing the length of initial hospitalization. These contemporary data can be useful for patient counseling regarding preterm outcomes.

Childhood obesity remains one the most important public health challenges globally, potentially affecting 60 million children by 2020. Increasingly, children are becoming overweight at a relatively young age, which affects metabolic health, both in childhood and later life. In New South Wales NSW, Australia, one in four school-aged children and adolescents are overweight or have obesity. Noticeably, the prevalence of severe obesity continues to increase in this age group. Despite this prevalence, weight issues are rarely recognised or managed when patients attend clinical services and there are few appropriate clinical services available. Several Local Health Districts LHDs, across socio-economic and culturally diverse populations, are implementing a new service aiming to deliver integrated weight management services for children and adolescents. This presents a unique opportunity to research the implementation and integration of these new services alongside established services to determine the clinical effectiveness and impact of the services. No such research has been undertaken previously in Australia. Methods: This study will ascertain what factors affect acceptability, reach, and participation and retention rates and measure clinical effectiveness through changes in child weight outcomes. The study aims to: Audit existing tertiary and secondary care models for managing children above a healthy weight. Evaluate the newly established secondary care clinics, models of care and healthcare pathways. Determine what factors, including acceptability, reach, participation and retention rates, effectiveness and sustainability, are important for different models of care through focus groups and stakeholder interviews. Undertake economic analysis to determine cost of services. A range of process and economic cost measures will be collected from: i routinely collected data; ii document review; and iii surveys, key informant interviews and focus groups with clinical staff, health service managers, and patients and families. For the clinical effectiveness component, the primary outcome will be change in body mass index, adjusted for age and sex, at 6 months from baseline. The secondary outcomes will be change in key food and physical activity behaviours at 6 months from baseline. The study has successfully secured funding through the NSW Health Translational Research Grant Scheme. Outcomes: The findings will provide an understanding of the most effective design and delivery of local services, enhancing the accessibility, acceptability, reach and impact of paediatric weight management services. This will enable recommendations to be made for future services planning to optimise scalability and sustainability of integrated, responsive and effective care of paediatric patients with overweight or obesity.

Adapted from [14].In the 1990s, the WHO used the term ‘globesity’ to warn of an escalating global epidemic, commenting that millions of people were at risk of developing serious chronic, noninfecti...

Despite active videogames' popularity and ability to increase a player's energy expenditure, research indicates their use sharply declines over time, which limits their utility in promoting physical activity. A frequent criticism is that a player's interest is quickly exhausted. At the preconference of the International Society of Behavioral Nutrition and Physical Activity 2014, a group of investigators and videogame developers gathered to share lessons learned from using serious videogames in health behavior change and offer insight to guide future efforts.

Objective We sought to describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route, and type of cesarean incision. Study Design Trained personnel abstracted data from maternal and neonatal charts for all deliveries on randomly selected days representing one third of deliveries across 25 US hospitals over 3 years (n = 115,502). All women delivering nonanomalous singletons between 23-33 weeks' gestation were included. Women were excluded for antepartum stillbirth and highly morbid conditions for which route of delivery would not likely impact morbidity including nonreassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe and unstable maternal conditions (cardiopulmonary collapse, acute respiratory distress syndrome, seizures). Serious maternal complications were defined as: hemorrhage (blood loss ≥1500 mL, blood transfusion, or hysterectomy for hemorrhage), infection (endometritis, wound dehiscence, or wound infection requiring antibiotics, reopening, or unexpected procedure), intensive care unit admission, or death. Delivery route was categorized as classic cesarean delivery (CCD), low transverse cesarean delivery (LTCD), low vertical cesarean delivery (LVCD), and vaginal delivery. Association of delivery route with complications was estimated using multivariable regression models yielding adjusted relative risks (aRR) controlling for maternal age, race, body mass index, hypertension, diabetes, preterm premature rupture of membranes, preterm labor, GA, and hospital of delivery. Results Of 2659 women who met criteria for inclusion in this analysis, 8.6% of women experienced serious maternal complications. Complications were associated with GA and were highest between 23-27 weeks of gestation. The frequency of complications was associated with delivery route; compared with 3.5% of vaginal delivery, 23.0% of CCD (aRR, 3.54; 95% confidence interval (CI), 2.29–5.48), 12.1% of LTCD (aRR, 2.59; 95% CI, 1.77–3.77), and 10.3% of LVCD (aRR, 2.27; 95% CI, 0.68–7.55) experienced complications. There was no significant difference in complication rates between CCD and LTCD (aRR, 1.37; 95% CI, 0.95–1.97) or between CCD and LVCD (aRR, 1.56; 95% CI, 0.48–5.07). Conclusion The risk of maternal complications after early preterm delivery is substantial, particularly in women who undergo cesarean delivery. Obstetricians need to be prepared to manage potential hemorrhage, infection, and intensive care unit admission for early preterm births requiring cesarean delivery.

Education has been slow to capitalize on the significant potential benefits to learning of the increased use of information technologies because teachers have, by and large, used them to automate existing classroom practices. A recent innovative Australian project sought to scale up the use of e-learning by giving students and teachers more equity in the development of projects. Students determined the questions that were of interest to them, and were then supported by teachers in designing an e-learning environment to support learning about those questions, in researching the questions, and then providing content for the final e-learning project using a range of information technologies. This approach to e-learning development has been successfully scaled-up to other topic areas within the participating schools.

A core goal for most learning analytic projects is to move from small scale research towards broader institutional implementation, but this introduces a new set of challenges because institutions are stable systems, resistant to change. To avoid failure and maximize success, implementation of learning analytics at scale requires explicit and careful consideration of the entire TEL technology complex: the different groups of people involved, the educational beliefs and practices of those groups, the technologies they use and the specific environments within which they operate. It is crucial to provide not only the analytics and their associated tools, but also to begin with a clear strategic vision, to critically assess institutional culture, to identify potential barriers to adoption, to develop approaches to overcome these and to put in place appropriate forms of support, training and community building. In this paper, we provide tools and case studies that will support educational institutions in deploying learning analytics at scale with the goal of achieving specified learning and teaching objectives. The ROMA Framework offers a step-by-step approach to the institutional implementation of learning analytics and this approach is grounded by case studies of practice from the UK and Australia.