The provision of education and training for healthcare professionals through the medium of the internet

This paper describes a new initiative to provide Internet based courses to student and professional occupational therapists in four centres in the UK, Belgium the Netherlands and Sweden. The basis of this collaborative Occupational Therapy Internet School (OTIS) is the concept of the “Virtual College”. This comprises the design and implementation of a sophisticated Internet-based system through which courses can be managed, prepared and delivered online in an effective fashion, and where students can communicate both with the staff and their peers. The aim is to support and facilitate the whole range of educational activities within a remote electronic environment. A major feature of the course organisation is the adoption of a problem-based approach in which students will collaborate internationally to propose effective intervention in given case study scenarios. The paper outlines the rationale for OTIS, the content and structure of the courseware, the technical specification of the system and evaluation criteria. In addition to the more conventional web-based learning facilities generally offered, a number of agent-based approaches are being adopted to assist in the management of the course by ensuring the proper delivery of course materials and to assist the functioning of project groups. </p

Content analysis: What are they talking about?

Quantitative content analysis is increasingly used to surpass surface level analyses in Computer-Supported Collaborative Learning (e.g., counting messages), but critical reflection on accepted practice has generally not been reported. A review of CSCL conference proceedings revealed a general vagueness in definitions of units of analysis. In general, arguments for choosing a unit were lacking and decisions made while developing the content analysis procedures were not made explicit. In this article, it will be illustrated that the currently accepted practices concerning the ‘unit of meaning’ are not generally applicable to quantitative content analysis of electronic communication. Such analysis is affected by ‘unit boundary overlap’ and contextual constraints having to do with the technology used. The analysis of e-mail communication required a different unit of analysis and segmentation procedure. This procedure proved to be reliable, and the subsequent coding of these units for quantitative analysis yielded satisfactory reliabilities. These findings have implications and recommendations for current content analysis practice in CSCL research

Hooked on Classics: Oranges Are Not the Only Fruit 25 years on

This chapter sets out to to reassess the critical reception of Winterson’s Oranges Are Not the Only Fruit 25 years after its initial publication. It argues that the text operates on many different levels, circulating as a much loved comic novel of growing up, as teaching material, as an aspect of popular/literary culture, and as part of Winterson’s own mythobiography. Its success may be attributed to the ways in which the narrative ‘hooks’ itself onto classic texts, which circulate in the culture’s collective unconscious. This chapter will combine these emphases and consider the novel as a literary classic that both subverts the canon and inscribes the tradition in the process of reworking autobiography as art. It will draw on recent interviews with Winterson to suggest that the novel represents a ‘cover story’ that conceals the sense of loss intrinsic to Winterson’s origin story

Valuing Health Gain from Composite Response Endpoints for Multisystem Diseases

Objectives: This study aimed to demonstrate how to estimate the value of health gain after patients with a multisystem disease achieve a condition-specific composite response endpoint. Methods: Data from patients treated in routine practice with an exemplar multisystem disease (systemic lupus erythematosus) were extracted from a national register (British Isles Lupus Assessment Group Biologics Register). Two bespoke composite response endpoints (Major Clinical Response and Improvement) were developed in advance of this study. Difference-in-differences regression compared health utility values (3-level version of EQ-5D; UK tariff) over 6 months for responders and nonresponders. Bootstrapped regression estimated the incremental quality-adjusted life-years (QALYs), probability of QALY gain after achieving the response criteria, and population monetary benefit of response. Results: Within the sample (n = 171), 18.2% achieved Major Clinical Response and 49.1% achieved Improvement at 6 months. Incremental health utility values were 0.0923 for Major Clinical Response and 0.0454 for Improvement. Expected incremental QALY gain at 6 months was 0.020 for Major Clinical Response and 0.012 for Improvement. Probability of QALY gain after achieving the response criteria was 77.6% for Major Clinical Response and 72.7% for Improvement. Population monetary benefit of response was £1 106 458 for Major Clinical Response and £649 134 for Improvement. Conclusions: Bespoke composite response endpoints are becoming more common to measure treatment response for multisystem diseases in trials and observational studies. Health technology assessment agencies face a growing challenge to establish whether these endpoints correspond with improved health gain. Health utility values can generate this evidence to enhance the usefulness of composite response endpoints for health technology assessment, decision making, and economic evaluation

A panel of urinary proteins predicts active lupus nephritis and response to rituximab treatment

OBJECTIVES: ∼30% of patients with SLE develop LN. Presence and/or severity of LN are currently assessed by renal biopsy, but biomarkers in serum or urine samples may provide an avenue for non-invasive routine testing. We aimed to validate a urinary protein panel for its ability to predict active renal involvement in SLE. METHODS: A total of 197 SLE patients and 48 healthy controls were recruited, and urine samples collected. Seventy-five of the SLE patients had active LN and 104 had no or inactive renal disease. Concentrations of lipocalin-like prostaglandin D synthase (LPGDS), transferrin, alpha-1-acid glycoprotein (AGP-1), ceruloplasmin, monocyte chemoattractant protein 1 (MCP-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) were quantified by MILLIPLEX® Assays using the MAGPIX Luminex platform. Binary logistic regression was conducted to examine whether proteins levels associate with active renal involvement and/or response to rituximab treatment. RESULTS: Urine levels of transferrin (P <0.005), AGP-1 (P <0.0001), MCP-1 (P <0.001) and sVCAM-1 (P <0.005) were significantly higher in SLE patients when compared with healthy controls. Furthermore, levels of transferrin, AGP-1, ceruloplasmin, MCP-1 and sVCAM-1 (all P <0.0001) were higher in SLE patients with active LN when compared with patients without active LN. A combination of five urine proteins, namely LPGDS, transferrin, ceruloplasmin, MCP-1 and sVCAM-1 was a good predictor of active LN (AUC 0.898). A combined model of LPGDS, transferrin, AGP-1, ceruloplasmin, MCP-1 and sVCAM-1 predicted response to rituximab treatment at 12 months (AUC 0.818). CONCLUSIONS: Findings support the use of a urinary protein panel to identify active LN and potentially predict response to treatment with rituximab in adult SLE patients. Prospective studies are required to confirm findings

Wind-Tunnel Simulation of Weakly and Moderately Stable Atmospheric Boundary Layers

The simulation of horizontally homogeneous boundary layers that have characteristics of weakly and moderately stable atmospheric flow is investigated, where the well-established wind engineering practice of using ‘flow generators’ to provide a deep boundary layer is employed. Primary attention is given to the flow above the surface layer, in the absence of an overlying inversion, as assessed from first- and second-order moments of velocity and temperature. A uniform inlet temperature profile ahead of a deep layer, allowing initially neutral flow, results in the upper part of the boundary layer remaining neutral. A non-uniform inlet temperature profile is required but needs careful specification if odd characteristics are to be avoided, attributed to long-lasting effects inherent of stability, and to a reduced level of turbulent mixing. The first part of the wind-tunnel floor must not be cooled if turbulence quantities are to vary smoothly with height. Closely horizontally homogeneous flow is demonstrated, where profiles are comparable or closely comparable with atmospheric data in terms of local similarity and functions of normalized height. The ratio of boundary-layer height to surface Obukhov length, and the surface heat flux, are functions of the bulk Richardson number, independent of horizontal homogeneity. Surface heat flux rises to a maximum and then decreases

The twentieth-century Gothic

Why, at a time when the majority of us no longer believe in ghosts, demons or the occult, does Gothic continue to have such a strong grasp upon literature, cinema and popular culture? This book answers the question by exploring some of the ways in which we have applied Gothic tropes to our everyday fears. The book opens with The Turn of the Screw, a text dealing in the dangers adults pose to children whilst simultaneously questioning the assumed innocence of all children. Staying with the domestic arena, it explores the various manifestations undertaken by the haunted house during the twentieth century, from the bombed-out spaces of the blitz ('The Demon Lover' and The Night Watch) to the designer bathrooms of wealthy American suburbia (What Lies Beneath). The monsters that emerge through the uncanny surfaces of the Gothic can also be terror monsters, and after a discussion of terrorism and atrocity in relation to burial alive, the book examines the relationship between the human and the inhuman through the role of the beast monster as manifestation of the evil that resides in our midst (The Hound of the Baskervilles and The Birds). It is with the dangers of the body that the Gothic has been most closely associated and, during the later twentieth century, paranoia attachesd itself to skeletal forms and ghosts in the wake of the HIV/AIDS crisis. Sexuality and/as disease is one of the themes of Patrick McGrath's work (Dr Haggard's Disease and 'The Angel') and the issue of skeletons in the closet is also explored through Henry James's 'The Jolly Corner'. However, sexuality is also one of the most liberating aspects of Gothic narratives. After a brief discussion of camp humour in the British television drama series Jekyll, the book concludes with a discussion of the apparitional lesbian through the work of Sarah Waters