Search

This paper reports findings from a research study at The Open University, UK into the quality of distance learners' online exam experience and the differences in experience between online (pandemic) and in-person (pre-pandemic) modes of examination. Our research responds to the ongoing need for greater insight into the exam experience and is?uniquely positioned in two ways. First, we made use of a robust reference dataset collected before the COVID-19 pandemic and compared this with a second survey administered a year after the pandemic started; second, we asked students about their experience preparing and revising for the exam as well as the exam itself. Exam revision represents an important transitional period for learners. Our results show that, overall, the shift to online remote exams did not impact the quality of distance learners' experience of revising for exams or taking the exam itself. We found no significant change in the revision experience across six of eight measures, including the learning benefits of learning while revising, enjoyment, and support. However, students reported feeling less anxious when revising for online exams. The quality of the exam experience itself was largely unaffected by the move from in-person to online remote exams. No significant differences were found for seven of the nine measures of exam experience. However, we found satisfaction with the exam environment was significantly higher for online exams and that learners felt the online exam was harder than they expected. Age and gender differences are also explored.

Abstract Background Community health workers (CHWs) are vital yet often invisible contributors to care coordination, health equity, and public health (PH) in medically underserved areas. The Atlanta Regional Community Health Workforce Advancement (ARCHWAy) Program leverages cross-sector partners to increase the number of CHWs on integrated care teams in metro Atlanta in the United States. Methods The ARCHWAy Program provides an innovative educational curriculum guided by United States Department of Labor CHW competencies and cross-walked with the Georgia CHW Initiative competencies. The 12-week in-person/online curriculum includes 155 h of content on becoming a CHW, mental health first aid, social determinants of health, trauma informed care, population health, community outreach, engagement, and capacity building, resiliency, communication, care coordination, advocacy, emergency preparedness, health promotion/disease prevention, 20 h of simulation including motivational interviewing, point of care testing, first aid, and 80 h of experiential learning through field placements. Project team members represent racial, ethnic, linguistic, and gender diversity ensuring culturally congruent content. Results Since program inception, the public health workforce in the region has been expanded by over 200 CHWs to date (goal of 446 CHWs) with specialized training offered in both English and Spanish. Discussion Positioning well-trained CHWs as members of integrated care teams promotes health equity by advancing PH, strengthening the PH workforce, reducing health disparities, and helping underserved populations address social determinants that can undermine health. The ARCHWAy program, by increasing CHW employment readiness through developing field placements with cross-sector partners, aspires to set the standard for apprenticeships in CHW training programs.

Appropriate management requires timely and accurate confirmation of non-small cell lung cancer (NSCLC) recurrence in patients who have had curative-intent surgical resection. We assessed the association between circulating tumor DNA (ctDNA) identified using amplicon sequencing and evidence of recurrence on CT surveillance. A prospective cohort study of NSCLC patients with early-stage disease undergoing curative-intent resection was conducted. Surveillance was performed post-operatively at pre-defined intervals with both liquid biopsy and chest CT imaging. Amplicon panel next-generation sequencing was performed on DNA and RNA from tumor tissue and on plasma cell-free DNA for tumor-informed ctDNA detection. Resected tumors from 78 NSCLC patients were analyzed. Alterations were detected on the DNA assay for 65 tumors and only on the RNA assay for 4 tumors. Of the 65 patients with alterations detected on the tumor DNA assay, 29 completed post-operative liquid biopsy testing. Four of those 29 patients had evidence of recurrence on imaging, of whom two had biopsy confirmation of recurrence and detectable ctDNA at the 12-month follow-up. Molecular confirmation of NSCLC recurrence can be provided through amplicon sequencing of plasma cell-free DNA in cases with imaging evidence of recurrence. Invasive tissue diagnosis may be avoidable in patients with ctDNA confirmation of recurrence that is suspected based on imaging. Further study of ctDNA assessment technologies in the setting of suspected recurrence is necessary to inform post-operative lung cancer surveillance guidelines.

Abstract Introduction Evidence regarding the potentiating effects of intravenous dexamethasone on peripheral regional anesthesia in children is sparse. The objective of the current study was to investigate the potentiating effect of intravenous dexamethasone upon pudendal block during surgical correction of hypospadias using Snodgrass technique. Methods The study consisted of a monocentric, randomized controlled, double-blinded study. Patients were randomized to receive either intravenous dexamethasone 0.15 mg.kg− 1 (D group) or a control solution (C group). Both groups received standardized anesthesia including a preemptive pudendal block performed after the induction of anesthesia. The primary outcome was the proportion of patients needing rescue analgesia. Secondary outcomes were other pain outcomes over the first 24 postoperative hours. Results Overall, 70 patients were included in the study. Age were 24 [24; 36] and 26 [24; 38] months in the D and C groups, respectively (p = 0.4). Durations of surgery were similar in both groups (60 [30; 60], p = 1). The proportion of patients requiring rescue analgesia was decreased in the D group (23% versus 49%, in D and C groups respectively, p = 0.02). The first administration of rescue analgesia was significantly delayed in the D group. Postoperative pain was improved in the D group between 6 and 24 h after surgery. Opioid requirements and the incidence of vomiting did not significantly differ between groups. Conclusion Associating intravenous dexamethasone (0.15 mg.kg− 1) to pudendal block during hypospadias surgery improves pain control over the first postoperative day. Further studies are needed in order to confirm these results. ClinicalTrials.gov Identifier NCT03902249. A. What is already known dexamethasone has been found to potentiate analgesia obtained with regional anesthesia in children. B. What this article adds intravenous dexamethasone was found to improve analgesia with a preemptive pudendal block during hypospadias surgery. C. Implications for translation results of this study indicate that intravenous dexamethasone could be used as an adjunct to pudendal block.

Marsh terraces, constructed as a restoration and protection strategy, consist of a series of earthen berms in open water areas of the coastal wetland landscape and are being implemented across the Louisiana coast. To assess the efficacy of the marsh terraces as a nature-based solution, a small-scale, high-resolution hydrodynamic model was developed based on field sampling of vegetation and physical parameters (water level, waves, sediment, turbidity, and terrace elevation). This study tested common marsh terrace designs (e.g., chevron, linear, box, T-shape, etc.), ultimately selecting a preferred design based on the evaluation of factors such as vegetation, water depth, and sediment type on terrace stability and sediment retention under calm and storm conditions. The model results revealed that the 100 m box and the chevron designs exhibited greatest terrace stability and sediment trapping, particularly when installed perpendicular to prevailing wind and waves. The preferred terrace design was the box design due to its higher modeled resilience to wind and waves from multiple directions. Vegetation presence enhanced terrace resistance to erosion, with variations depending on vegetation type. Higher vegetation biomass, especially during the summer, contributed to the greatest stability of terraces. Greater water depth between terraces led to increased sediment retention, and terraces predominantly composed of organic-rich mud demonstrated greater stability than those with higher proportions of sand. Overall, vegetation had the greatest impact on sediment retention in the terrace field compared to water depth and sediment type. However, the potential habitat for submerged aquatic vegetation (SAV) was more influenced by water depth (i.e., 0.1 m < depth

IntroductionThroughout the COVID-19 pandemic, the need to address digital inclusion and social well-being for older adults was particularly apparent for those from disadvantaged communities. This pilot program provided access to technology and intergenerational mentorship to older adult participants interested in receiving and learning how to utilize an iPad. Pre/post-changes were examined for social well-being in the areas of quality of life, social isolation, and loneliness.MethodsThis study conducted pre- and post-surveys with older participants (n = 145) from five disadvantaged communities in the United States utilizing standardized measures. One-on-one interviews were conducted post-program (n = 98) to examine participants’ perceptions of the program and evaluate its impact on social measures.ResultsThe study sample included older adults (Mean age = 72.3) who were mostly lower income (82.3%) and self-reported as Black (13.6%), Hispanic (21.7%), and White (56.5%). Significant differences were identified in participant pre/post-survey scores for social isolation, loneliness, and a global measure of quality of life. Qualitative analyses suggest improvements in various aspects of social well-being. Themes showed that participants believed the program contributed to (1) enhanced mood and mental health, (2) improved quality of life, (3) sense of purpose and feelings of being less alone, (4) ability to use video calling to connect with others; and (5) ability to more freely use email, texting, and messaging to communicate with others.DiscussionThis research demonstrates that this pilot program seemed to contribute to reduced social isolation and loneliness for participants, and participants stated more positive social well-being following program participation. However, future research with larger samples is needed to expand upon these findings. Future studies will examine the pathways between technology improvements and social well-being and examine group differences.

Maintaining and improving the health and well-being of older people in rural communities through integrated care is essential to address this cohort’s frailty risk. The Indigo 4Ms Tool for health workers is a rural-specific approach to providing care that addresses the common conditions of ageing. With Australian government funding, five small rural health services are implementing the tool. This paper describes the protocol for a hybrid type 2 implementation-effectiveness study to evaluate the tool’s impact on multidisciplinary comprehensive care planning and the implementation strategies that enhance the adoption and sustainability of the tool across diverse rural health settings.

Moderate feeding problems affect many children with autism spectrum disorder and often co-occur with disruptive mealtime behaviors. Although parent-mediated interventions have shown promise to support feeding problems, research has primarily occurred within randomized controlled trials when delivered by highly trained clinicians in specialty clinics. Thus, the alignment of these approaches within community settings is unclear. To address this limitation, this study explored adaptations to a parent-mediated intervention, Managing Eating Aversions and Limited Variety (i.e. MEAL Plan), to enhance its adoption, implementation, and sustainment within community settings, including factors that may support or hinder its translation. Participants were 14 multidisciplinary providers who attended one of the three workgroups that included semi-structured focus groups regarding the fit of MEAL Plan in their practice setting. Thematic analysis was used to determine emergent themes, which fell into the domains of content, contextual considerations, and training needs. Specific themes included the appropriateness MEAL Plan for autistic and non-autistic children, adaptations to MEAL Plan delivery, billing considerations, agency-level support, and the format of ongoing training and consultation. By proactively responding to these factors, it may be possible to enhance the implementation and sustainability of parent-mediated interventions, including MEAL Plan, within community practices that support autistic children.

Introduction Persistent symptoms after mild traumatic brain injury (mTBI) negatively affect daily functioning and quality of life. Fear avoidance behaviour, a coping style in which people avoid or escape from activities or situations that they expect will exacerbate their symptoms, maybe a particularly potent and modifiable risk factor for chronic disability after mTBI. This study will evaluate the efficacy of graded exposure therapy (GET) for reducing persistent symptoms following mTBI, with two primary aims: (1) To determine whether GET is more effective than usual care; (2) to identify for whom GET is the most effective treatment option, by evaluating whether baseline fear avoidance moderates differences between GET and an active comparator (prescribed aerobic exercise). Our findings will guide evidence-based care after mTBI and enable better matching of mTBI patients to treatments.Methods and analysis We will conduct a multisite randomised controlled trial with three arms. Participants (n=220) will be recruited from concussion clinics and emergency departments in three Canadian provinces and randomly assigned (1:2:2 ratio) to receive enhanced usual care, GET or prescribed aerobic exercise. The outcome assessment will occur remotely 14–18 weeks following baseline assessment, after completing the 12-week treatment phase. The primary outcome will be symptom severity (Rivermead Post-concussion Symptoms Questionnaire).Ethics and dissemination Informed consent will be obtained from all participants. All study procedures were approved by the local research ethics boards (University of British Columbia Clinical Research Ethics Board, University of Calgary Conjoint Health Research Ethics Board, University Health Network Research Ethics Board—Panel D). Operational approvals were obtained for Vancouver Coastal Health Research Institute and Provincial Health Services Authority. If GET proves effective, we will disseminate the GET treatment manual and present instructional workshops for clinicians.Trial registration number ClinicalTrials.gov #NCT05365776

Abstract Our aim was to describe shifts in autumn and winter harvest distributions of three species of dabbling ducks (blue‐winged teal [Spatula discors], mallard [Anas platyrhynchos], and northern pintail [Anas acuta]) in the Central and Mississippi flyways of North America during 1960–2019. We measured shifts in band recovery distributions corrected for changes in hunting season dates and zones by using kernel density estimators to calculate 10 distributional metrics. We then assessed interannual and intraspecific variation by comparing species‐specific changes in distributional metrics for 4 months (October–January) and three geographically based subpopulations. During 1960–2019, band recovery distributions shifted west‐ and southwards (blue‐winged teal) or east‐ and northwards (mallard and northern pintail) by one hundred to several hundred kilometers. For all three species, the broad (95% isopleth) and core distributions (50% isopleth) showed widespread decreases in overlap and increases in relative area compared to a 1960–1979 baseline period. Shifts in band recovery distributions varied by month, with southward shifts for blue‐winged teal most pronounced in October and northward shifts for mallard and northern pintail greatest during December and January. Finally, distributional metric response varied considerably among mallard subpopulations, including 2–4‐fold differences in longitude, latitude, and overlap, whereas differences among subpopulations were minimal for blue‐winged teal and northern pintail. Our findings support the popular notion that winter (December–January) distributions of duck species have shifted north; however, the extent and direction of distributional changes vary among species and subpopulations. Long‐term distributional changes are therefore complex and summarizing shifts across species, months, or subpopulations could mask underlying finer‐scale patterns that are important to habitat conservation and population management. A detailed understanding of how species distributions have changed over time will help quantify important drivers of species occurrence, identify habitat management options, and could inform decisions on where to focus conservation or restoration efforts.

Patients with diabetes mellitus (DM) have chronically increased blood glucose and multiple physiologic alterations that place them at elevated risk for vascular disease. Traditionally, this vascular risk has mainly referred to chronic atherosclerosis and embolic arterial disease. Retrospective studies have suggested an increased risk of a pulmonary embolism (PE) and deep vein thrombosis (DVT), collectively termed venous thromboembolism (VTE), in patients with DM, but this association has been difficult to demonstrate with comorbidities such as obesity in meta-analysis. Clinical studies have demonstrated worse outcomes for patients with DM who suffer from VTE. In vitro studies show multiple physiologic abnormalities with chronic inflammation, endothelial dysfunction, dysfunction in the coagulation cascade, as well as other changes that drive a vicious cycle of hypercoagulability. Aggressive medical management of DM can improve vascular outcomes, and some anti-hyperglycemic therapies may modify VTE risk as well. Anticoagulation strategies are similar for patients with DM, but with some added considerations, such as high rates of comorbid renal dysfunction. More research is needed to definitively categorize DM as a risk factor for VTE and elucidate specific therapeutic strategies.

University ranking systems are being implemented with the aim of assessing and comparing higher education institutions at a global level. Despite their being increasingly used, rankings are often strongly criticized for their social and economic implications, as well as for limitations in their technical implementation. One of these limitations is that they do not consider the specific characteristics of online education. This study used a participatory approach to define a set of criteria and indicators suitable to reflect the specific nature of distance education. This endeavour will help evaluate and rank online higher education institutions more appropriately than in current practice, where indicators are devised for traditional universities. To this end, several stakeholders and informants were involved in a Delphi study in an attempt to reach the broader higher education institutions (HEI) community. According to the study participants, apart from students' achievements and general quantitative measures of HEI performance, which are quite common in traditional ranking systems, teaching and student learning experience turned out to be the most important criteria. Student support, teacher support, technological infrastructure, research and organization were deemed middle ground criteria, while sustainability and reputation were regarded as the least important criteria.

Learning analytics involve the measurement, collection, analysis, and reporting of data about learners and their contexts, in order to understand and optimize learning and the environments in which it occurs. Since emerging as a distinct field in 2011, learning analytics has grown rapidly, and early adopters around the world are developing and deploying these new tools. This paper reports on a study that investigated how the field is likely to develop by 2025 in order to recommend actions to those concerned with the implementation of learning analytics. The study used a Policy Delphi approach, presenting a range of future scenarios to international experts in the field and asking for responses related to the desirability and feasibility of these scenarios, as well as actions that would be required. Responses were received from 103 people from 21 countries. Responses were coded thematically, inter-rater reliability was checked using Cohen's kappa coefficient, and data were recoded if kappa was below 0.6. The seven major themes identified within the data were power, pedagogy, validity, regulation, complexity, ethics, and affect. The paper considers in detail each of these themes and its implications for the implementation of learning analytics.

Comparing universities and courses is of interest to a variety of stakeholders including potential students, policy makers, news and media organisations, ranking providers, and universities themselves. There are a range of existing university ranking schemes that provide comparisons (e.g. Academic Ranking of World Universities) but typically these are designed with face-to-face teaching and learning in mind. There is also a growing number of quality assurance tools and approaches aimed at ensuring the quality of online education This article reports on an analysis of a range of quality assurance systems for online higher education institutions and courses, together with variety of ranking systems targeting conventional universities--with the aim of establishing what they measure, and the metrics used to assess quality. The findings from this analytical study were compared with a meta-analysis of the literature about how students choose their university in order to understand how these instruments influence current student opinion and can be used more proactively by universities themselves. The findings reveal: (1) current ranking systems are of limited value for most potential undergraduate students, particularly with reference to online education; (2) comparison systems that can be of value to students from a variety of different backgrounds are likely to be complex to set up and run; and (3) quality indicators that promote both formative and summative evaluation may be beneficial to both institutions and students.

Background: Active classroom engagement is at the heart of children's learning. The definition of active classroom engagement has broadened over time to incorporate aspects of social emotional learning (SEL). SEL -- a developmental process that supports student acquisition of skills to build healthy peer relationships and regulate emotions appropriately -- has increasingly become a priority for schools and educators. At the same time, classrooms have become increasingly diverse. There is a need for teachers to be equipped with suitable support tools to ensure that classroom diversity translates into successful social inclusion and student learning. Purpose: The aim of this study was to explore teachers' experiences and perceived effects of a professional development approach called Social Emotional Engagement -- Knowledge and Skills (SEE-KS), which aims to incorporate support for teachers to help them meet the diverse social-emotional and academic needs of their students. Methods: This study, conducted in the USA, used a qualitative descriptive research design. Participants were 61 teachers, whose practice ranged from preschool (ages 3-5) to high school (ages 14-18). A semi-structured interview guide was used to facilitate six focus group discussions. Focus group data were recorded, transcribed verbatim, and analysed by a team of qualitative experts. Findings: The analysis identified five main themes: 1) dynamic engagement of learning, 2) seeing more than was expected, 3) discovery of challenges and needs, 4) translation of SEE-KS to teaching practice, and 5) creating workable solutions for future implementation. These themes contributed to an overarching theme entitled 'achieving openness to social emotional engagement in teaching'. Conclusions: Teachers provided rich descriptions of their experiences in learning and implementing SEE-KS, including perceived benefits to students and teachers. These findings offer a starting point for future adaptations of and inquiry into SEE-KS as well as highlighting implications for teaching practice.