Nearshore mixing and nutrient delivery along the western Antarctic Peninsula

The surface waters of the Southern Ocean play a key role in the global climate and carbon cycles by promoting growth of some of the world’s largest phytoplankton blooms. Several studies have emphasized the importance of glacial and sediment inputs of Fe that fuel the primary production of the Fe-limited Southern Ocean. Although the fertile surface waters along the shelf of the western Antarctic Peninsula (WAP) are influenced by large inputs of freshwater, this freshwater may take multiple pathways (e.g. calving, streams, groundwater discharge) with different degrees of water-rock interactions leading to variable Fe flux to coastal waters. During the summers of 2012–13 and 2013–14, seawater samples were collected along the WAP, near Anvers Island, to observe water column dynamics in nearshore and offshore waters. Tracers (223,224Ra, 222Rn, 18O, 2H) were used to evaluate the source and transport of water and nutrients in coastal fjords and across the shelf. Coastal waters are compared across two field seasons, with increased freshwater observed during 2014. Horizontal mixing rates of water masses along the WAP ranged from 110–3600 m2 s-1. These mixing rates suggest a rapid transport mechanism for moving meltwater offshore.ECU Open Access Publishing Support Fun

A Knowledge Graph Enhanced Learner Model to Predict Outcomes to Questions in the Medical Field

International audienceThe training curriculum for medical doctors requires the intensive and rapid assimilation of a lot of knowledge. To help medical students optimize their learning path, the SIDES 3.0 national French project aims to extend an existing platform with intelligent learning services. This platform contains a large number of annotated learning resources, from training and evaluation questions to students' learning traces, available as an RDF knowledge graph. In order for the platform to provide personalized learning services, the knowledge and skills progressively acquired by students on each subject should be taken into account when choosing the training and evaluation questions to be presented to them, in the form of customized quizzes. To achieve such recommendation , a first step lies in the ability to predict the outcome of students when answering questions (success or failure). With this objective in mind, in this paper we propose a model of the students' learning on the SIDES platform, able to make such predictions. The model extends a state-of-the-art approach to fit the specificity of medical data, and to take into account additional knowledge extracted from the OntoSIDES knowledge graph in the form of graph embeddings. Through an evaluation based on learning traces for pediatrics and cardiovascular specialties, we show that considering the vector representations of answers, questions and students nodes substantially improves the prediction results compared to baseline models

Delay in seeking care for tuberculosis symptoms among adults newly diagnosed with HIV in rural Malawi.

SETTING: Ten primary health clinics in rural Thyolo District, Malawi. OBJECTIVE: Tuberculosis (TB) is a common initial presentation of human immunodeficiency virus (HIV) infection. We investigated the time from TB symptom onset to HIV diagnosis to describe TB health-seeking behaviour in adults newly diagnosed with HIV. DESIGN: We asked adults (18 years) about the presence and duration of TB symptoms at the time of receiving a new HIV diagnosis. Associations with delayed health seeking (defined as >30 and >90 days from the onset of TB symptoms) were evaluated using multivariable logistic regression. RESULTS: TB symptoms were reported by 416 of 1265 participants (33%), of whom 36% (150/416) had been symptomatic for >30 days before HIV testing. Most participants (260/416, 63%) were below the poverty line (US$0.41 per household member per day). Patients who first sought care from informal providers had an increased odds of delay of >30 days (adjusted odds ratio [aOR] 1.6, 95%CI 0.9-2.8) or 90 days (aOR 2.0, 95%CI 1.1-3.8). CONCLUSIONS: Delayed health seeking for TB-related symptoms was common. Poverty was ubiquitous, but had no clear relationship to diagnostic delay. HIV-positive individuals who first sought care from informal providers were more likely to experience diagnostic delays for TB symptoms

Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis

Improving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Home-based voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here

The Sensitivity and Specificity of Loop-Mediated Isothermal Amplification (LAMP) Assay for Tuberculosis Diagnosis in Adults with Chronic Cough in Malawi.

BACKGROUND: Current tuberculosis diagnostics lack sensitivity, and are expensive. Highly accurate, rapid and cheaper diagnostic tests are required for point of care use in low resource settings with high HIV prevalence. OBJECTIVE: To investigate the sensitivity and specificity, and cost of loop-mediated isothermal amplification (LAMP) assay for tuberculosis diagnosis in adults with chronic cough compared to Xpert® MTB/RIF, fluorescence smear microscopy. METHODS: Between October 2013 and March 2014, consecutive adults at a primary care clinic were screened for cough, offered HIV testing and assessed for tuberculosis using LAMP, Xpert® MTB/RIF and fluorescence smear microscopy. Sensitivity and specificity (with culture as reference standard), and costs were estimated. RESULTS: Of 273 adults recruited, 44.3% (121/273) were HIV-positive and 19.4% (53/273) had bacteriogically confirmed tuberculosis. The sensitivity of LAMP compared to culture was 65.0% (95% CI: 48.3% to 79.4%) with 100% (95% CI: 98.0% to 100%) specificity. The sensitivity of Xpert® MTB/RIF (77.5%, 95% CI: 61.5% to 89.2%) was similar to that of LAMP, p = 0.132. The sensitivity of concentrated fluorescence smear microscopy with routine double reading (87.5%, 95% CI: 73.2% to 95.8%) was higher than that of LAMP, p = 0.020. All three tests had high specificity. The lowest cost per test of LAMP was at batch size of 14 samples (US$9.98); this was lower than Xpert® MTB/RIF (US$ 13.38) but higher than fluorescence smear microscopy (US$ 0.65). CONCLUSION: The sensitivity of LAMP was similar to Xpert® MTB/RIF but lower than fluorescence smear microscopy; all three tests had high specificity. These findings support the Malawi policy that recommends a combination of fluorescence smear microscopy and Xpert® MTB/RIF prioritised for people living with HIV, already found to be smear-negative, or being considered for retreatment of tuberculosis

A New Vaccine for Tuberculosis: The Challenges of Development and Deployment

Tuberculosis (TB) is one of the world’s leading causes of death due to infection and efforts to control TB would be substantially aided by the availability of an improved TB vaccine. There are currently nine new TB vaccines in clinical development, and the first efficacy trials are due to commence in 2009. There are many complex ethical issues which arise at all stages of TB vaccine development, from the need to conduct trials in developing countries to informed consent and the process of ethical review. While it is important that these issues are discussed, it may also be timely to consider the challenges which may arise if a vaccine in clinical development proves to be highly effective. We examine a number of scenarios where decisions on the deployment of a new TB vaccine may impact on the rights and liberty of the individual

Opening Up an Intelligent Tutoring System Development Environment for Extensible Student Modeling

ITS authoring tools make creating intelligent tutoring systems more cost effective, but few authoring tools make it easy to flexibly incorporate an open-ended range of student modeling methods and learning analytics tools. To support a cumulative science of student modeling and enhance the impact of real-world tutoring systems, it is critical to extend ITS authoring tools so they easily accommodate novel student modeling methods. We report on extensions to the CTAT/Tutorshop architecture to support a plug-in approach to extensible student modeling, which gives an author full control over the content of the student model. The extensions enhance the range of adaptive tutoring behaviors that can be authored and support building external, student- or teacher-facing real-time analytics tools. The contributions of this work are: (1) an open architecture to support the plugging in, sharing, re-mixing, and use of advanced student modeling techniques, ITSs, and dashboards; and (2) case studies illustrating diverse ways authors have used the architecture

Supporting self-regulated learning

Self-regulated learning (SRL) competences are crucial for lifelong learning. Their cultivation requires the right balance between freedom and guidance during the learning processes. Current learning systems and approaches, such as personal learning environments, give overwhelming freedom, but also let weak learners alone. Other systems, such as learning management systems or adaptive systems, tend to institutionalise learners too much, which does not support the development of SRL competences. This chapter presents possibilities and approaches to support SRL by the use of technology. After discussing the theoretical background of SRL and related technologies, a formal framework is presented that describes the SRL process, related competences, and guidelines. Furthermore, a variety of methods is presented, how learners can be supported to learn in a self-regulated way