Roles and student identities in online large course forums: implications for practice.

The use of large online discussion forums within online and distance learning continues to grow. Recent innovations in online learning the MOOC (Massive Open Online Course) and concomitant growth in the use of online media for the delivery of courses in traditional campus based universities provides both opportunity and challenge for online tutors and learners alike. The recognition of the role that online tutor and student identity plays in the field of retention and progression of distance learners is also well documented in the field of distance learning. Focusing on a course forum linked to a single level 2 undergraduate module and open to over a thousand students, this ideographic case study, set in a large distance learning university, uses qualitative methodology to examine the extent to which participation in a large forum can be considered within community of practice frameworks (COP) and contributes to feelings of efficacy, student identity and motivation. The paper draws on current theory pertaining to online communities and examines this in relation to the extent to which the forum adds to feelings of academic and social integration. The study concludes that although the large forum environment facilitates a certain degree of academic integration and identity there is evidence that it also presents a number of barriers producing negative effects on student motivation and online identity

A Pilot Study for Enhancing Postpartum Discharge Instructions for Incision Care: Assessment of Comprehension

Literacy and Health Care • 14.5% of United States is illiterate 1 • Reading level of most medical forms is 10th grade 2 Improving Outcomes with a Visual Aid • Cesarean Surgical Site Infection (SSI) rate is 5% 3 • A patient with a SSI can be 2 times as expensive 4 • Visual aids improve information recall 8 and confidence in wound care 5 Study Objectives 1. To evaluate the readability of the cesarean wound care discharge instructions relative to the patient population’s reading level 2. To conduct a pilot Randomized Control Trial (RCT) to evaluate the effectiveness of a visual aid on improving comprehension of the cesarean wound care instructionshttps://jdc.jefferson.edu/cwicposters/1034/thumbnail.jp

Persistent Cryptococcal Brain Infection despite Prolonged Immunorecovery in an HIV-Positive Patient.

Background. HIV-positive people starting combined antiretroviral therapy may develop immune reconstitution to latent or treated opportunistic infections. Immune reconstitution to cerebral Cryptococcus is poorly understood and can be fatal. Case Presentation. A 33-year-old Zimbabwean female presented with cryptococcal meningitis and newly diagnosed HIV with a CD4 count of 51 cells/ μ L (4%). She was treated with amphotericin and flucytosine. Combined antiretroviral therapy was started four weeks later and she showed early improvement. However, over the ensuing 18 months, her clinical course was marked by periodic worsening with symptoms resembling cryptococcal meningitis despite having achieved CD4 counts ≥400 cells/ μ L. Although initially treated for relapsing cryptococcal immune reconstitution syndrome, a brain biopsy taken 17 months after initial presentation showed budding Cryptococci. Conclusion. This unusually protracted case highlights the difficulties in differentiating relapsing cryptococcal meningitis from immune reconstitution and raises questions concerning the optimum timing of initiation of combined antiretroviral therapy in such patients

Factors influencing community case management and care hours for clients with traumatic brain injury living in the UK

Objective: To investigate the relationship between deficits associated with traumatic brain injury (TBI) and case management (CM) and care/support (CS) in two UK community samples. Research design: Prospective descriptive study. Method: Case managers across the UK and from a single UK CM service contributed client profiles to two data sets (Groups 1 and 2, respectively). Data were entered on demographics, injury severity, functional skills, functional-cognition (including executive functions), behaviour and CM and CS hours. Relationships were explored between areas of disability and service provision. Results: Clients in Group 2 were more severely injured, longer post-injury and had less family support than clients in Group 1. There were few significant differences between Groups 1 and 2 on measures of Functionalskill, Functional-cognition and Behaviour disorder. Deficits in Functionalskills were associated with CS, but not CM. Deficits in measures of executive functions (impulsivity, predictability, response to direction) were related to CM, but not to CS. Insight was related to both CM and CS. Variables related to behaviour disorder were related to CM, but were less often correlated to CS. Conclusions: The need for community support is related not only to Functionalskills (CS), but also to behaviour disorder, self-regulatory skills and impaired insight (CM)

Prevention and management of osteoporotic fractures by non-physician health professionals: a systematic literature review to inform EULAR points to consider

Objective To perform a systematic literature review (SLR) about the effect of non-pharmacological interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures. Methods Eight clinical questions based on two criteria guided the SLR: (1) adults >= 50 years at high risk of osteoporotic fracture and (2) interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures. Interventions focused on diagnostic procedures to identify risk of falling, therapeutic approaches and implementation strategies. Outcomes included fractures, falls, risk of falling and change in bone mineral density. Systematic reviews and randomised controlled trials were preferentially selected. Data were synthesised using a qualitative descriptive approach. Results Of 15 917 records, 43 articles were included. Studies were clinically and methodologically diverse. We identified sufficient evidence that structured exercise, incorporating progressive resistance training delivered to people who had undergone hip fracture surgery, and multicomponent exercise, delivered to people at risk of primary fracture, reduced risk of falling. The effectiveness of multidisciplinary fracture liaison services in reducing refracture rate was confirmed. There was insufficient evidence found to support the effectiveness of nutrients and falls prevention programmes in this patient population. Conclusion Despite study heterogeneity, our SLR showed beneficial effects of some interventions delivered by non-physician health professionals and the positive impact of multidisciplinary team working and patient educational approaches to prevent and manage osteoporotic fractures. These results informed a EULAR taskforce that developed points to consider for non-physician health professionals to prevent and manage osteoporotic fractures.This study was funded by the EULAR. Grant reference HPR 032.info:eu-repo/semantics/publishedVersio

A weak characterization of slow variables in stochastic dynamical systems

We present a novel characterization of slow variables for continuous Markov processes that provably preserve the slow timescales. These slow variables are known as reaction coordinates in molecular dynamical applications, where they play a key role in system analysis and coarse graining. The defining characteristics of these slow variables is that they parametrize a so-called transition manifold, a low-dimensional manifold in a certain density function space that emerges with progressive equilibration of the system's fast variables. The existence of said manifold was previously predicted for certain classes of metastable and slow-fast systems. However, in the original work, the existence of the manifold hinges on the pointwise convergence of the system's transition density functions towards it. We show in this work that a convergence in average with respect to the system's stationary measure is sufficient to yield reaction coordinates with the same key qualities. This allows one to accurately predict the timescale preservation in systems where the old theory is not applicable or would give overly pessimistic results. Moreover, the new characterization is still constructive, in that it allows for the algorithmic identification of a good slow variable. The improved characterization, the error prediction and the variable construction are demonstrated by a small metastable system

Born to learn: The inspiration, progress, and future of evolved plastic artificial neural networks

Biological plastic neural networks are systems of extraordinary computational capabilities shaped by evolution, development, and lifetime learning. The interplay of these elements leads to the emergence of adaptive behavior and intelligence. Inspired by such intricate natural phenomena, Evolved Plastic Artificial Neural Networks (EPANNs) use simulated evolution in-silico to breed plastic neural networks with a large variety of dynamics, architectures, and plasticity rules: these artificial systems are composed of inputs, outputs, and plastic components that change in response to experiences in an environment. These systems may autonomously discover novel adaptive algorithms, and lead to hypotheses on the emergence of biological adaptation. EPANNs have seen considerable progress over the last two decades. Current scientific and technological advances in artificial neural networks are now setting the conditions for radically new approaches and results. In particular, the limitations of hand-designed networks could be overcome by more flexible and innovative solutions. This paper brings together a variety of inspiring ideas that define the field of EPANNs. The main methods and results are reviewed. Finally, new opportunities and developments are presented

Genomic Profiling of Childhood Tumor Patient-Derived Xenograft Models to Enable Rational Clinical Trial Design.

Accelerating cures for children with cancer remains an immediate challenge as a result of extensive oncogenic heterogeneity between and within histologies, distinct molecular mechanisms evolving between diagnosis and relapsed disease, and limited therapeutic options. To systematically prioritize and rationally test novel agents in preclinical murine models, researchers within the Pediatric Preclinical Testing Consortium are continuously developing patient-derived xenografts (PDXs)-many of which are refractory to current standard-of-care treatments-from high-risk childhood cancers. Here, we genomically characterize 261 PDX models from 37 unique pediatric cancers; demonstrate faithful recapitulation of histologies and subtypes; and refine our understanding of relapsed disease. In addition, we use expression signatures to classify tumors for TP53 and NF1 pathway inactivation. We anticipate that these data will serve as a resource for pediatric oncology drug development and will guide rational clinical trial design for children with cancer

The use of photo elicitation to explore the role of the main street in Kirkwall in sustaining cultural identity, community, and a sense of place.

This paper explores the value of photo elicitation as a method for investigating the role played by small town main streets in Scottish island communities in sustaining cultural identity, community, and a sense of place. In particular, it critically evaluates the photo elicitation techniques used during a multidisciplinary pilot study, conducted in Kirkwall, Orkney, in 2010. A number of techniques were used, including a photographic exhibition, discussion groups, extended face-to-face interviews, and the creation of a special Facebook page. Throughout all approaches, participants were presented with old and current photographs of the main street, together with some novel merged images combining both historical and contemporary views. These elicitation techniques proved successful in obtaining rich, detailed, qualitative data from 164 informants, who each shared their personal memories and perceptions of the social and cultural role of the Kirkwall main street. Indeed, the very process of identifying familiar buildings, landmarks and faces from photographs (both past and present) appeared to reinforce the participants cultural identity

Association of nutritional status measures with self-efficacy and experiencing depressed mood among Pakistani young women (P10-090-19)

Objectives: We aimed to assess self-efficacy and the experience of depression-related emotions among non-pregnant adolescent and young women (15–23 years) living in rural Pakistan, and determine their association with measures of nutritional status. Methods: Outcomes were assessed from the Matiari emPowerment and Preconception Supplementation (MaPPS) Trial baseline data (n = 25,279). Self-efficacy and depression-related emotions were determined and categorized using the general self-efficacy scale (low, moderate, and high) and DASS-21 tool (normal, mild, moderate, severe, and extremely severe), respectively. Nutritional status was evaluated using hemoglobin concentration (HemoCue Hb 301 System) and body mass index (BMI). Associations were assessed using ordinal logistic regression, and multivariate models were adjusted for education, parity, wealth index, and clustering. Results: The majority of participants were categorized as having moderate self-efficacy (50.6%) and experienced normal range depression-related emotions (76.3%). The mean hemoglobin concentration and BMI were 11.5 ± 1.9 g/dL and 20.2 ± 3.8 kg/m2, respectively. Each unit of increase in hemoglobin was associated with having higher self-efficacy (β = 0.018; 95% confidence interval (CI): 0.005 to 0.031) and lower severe depression-like emotions (β = -0.018; 95% CI: - 0.033 to -0.002). Similarly, BMI was associated with higher self-efficacy (β = 0.010; 95% CI: 0.004 to 0.017) and lower severe depressionlike emotions (β = -0.014; 95% CI: -0.022 to -0.007). For all models, however, wealth index had a stronger effect on the outcomes of interest. Conclusions: Poor nutritional status is suggested to be associated with behavioral organization and one’s emotional state. In this setting with a high prevalence of micronutrient deficiencies, we observed associations between lower hemoglobin and BMI with low self-efficacy and experiencing depressed mood, although the effect sizes were small. Findings may reflect potential confounding in the link between empowerment and mood, and poverty. Funding Sources: Bill and Melinda Gates Foundation, World Food Programme