Improving the cost-effectiveness of a healthcare system for depressive disorders by implementing telemedicine: a Health Economic Modeling Study.

OBJECTIVE: Depressive disorders are important causes of disease burden and are associated with substantial economic costs. Therefore, it is important to design a health care system that can effectively manage depression at sustainable costs. This paper computes the benefit-to-costs ratio of the current Dutch health care system for depression, and investigates whether offering more online preventive interventions improves the cost-effectiveness overall. METHODS: A health economic (Markov) model was used to synthesize clinical and economic evidence and to compute population-level costs and effects of interventions. The model compares a base-case scenario without preventive telemedicine and alternative scenarios with preventive telemedicine. The central outcome is the benefit-to-cost ratio, also known as return-on-investment (ROI). RESULTS: In terms of ROI, a health care system with preventive telemedicine for depressive disorders offers better value for money than a health care system without internet-based prevention. Overall, the ROI increases from €1.45 ($1.72) in the base-case scenario to €1.76 ($2.09) in the alternative scenario where preventive telemedicine is offered. In a scenario where the costs of offering preventive telemedicine are balanced by cutting back on the expenditure for curative interventions, ROI increases to €1.77 ($2.10), while keeping the health care budget constant. CONCLUSION: In order for a health care system for depressive disorders to remain economically sustainable, its cost-benefit ratio needs to be improved. Offering preventive telemedicine at a large scale is likely to introduce such an improvement

A conducive learning environment in international higher education:A systematic review of research on students’ perspectives

Higher education institutions (HEIs) strive to meet international students' needs and expectations regarding their learning environments. Current literature covers a wide range of needs, expectations, and HEIs' responses. However, there doesn't seem to be a consensus about the needs and expectations to be addressed. A coherent theoretical framework may help HEIs identify areas of need and provide additional resources and comprehensive services. We performed a systematic review to obtain an overview of international students' needs, expectations, and experiences regarding their learning environments as described in the literature. We categorized students' perspectives into dimensions. Subsequently, we investigated whether these dimensions related to the three key domains outlined in the theoretical framework and the coverage of these key domains by HEIs. Sixty-three studies were eligible for inclusion. We identified 18 dimensions of international students' needs, expectations, and experiences that could be mapped onto the framework. Based on these results, the content of the three domains could be summarized as goal direction, relationships, and supporting services. Thirteen studies covered one domain, 14 covered two domains, and 36 covered three domains. To provide optimal support, HEIs should cover all three domains. Our study may help to better understand and optimize learning environments for international students

Genome sequences of human coronavirus OC43 and NL63, associated with respiratory infections in Kilifi, Kenya

Coding-complete genomes of two human coronavirus OC43 strains and one NL63 strain were obtained by metagenomic sequencing of clinical samples collected in 2017 and 2018 in Kilifi, Kenya. Maximum likelihood phylogenies showed that the OC43 strains were genetically dissimilar and that the NL63 strain was closely related to NL63 genotype B viruses. [Abstract copyright: Copyright © 2019 Kamau et al.

Comparison of the Conceptual Map and Traditional Lecture Methods on Students’ Learning Based on the VARK Learning Style Model: A Randomized Controlled Trial

Developing skills and knowledge in nursing education remains a considerable challenge. Nurse instructors need to be aware of students' learning styles so as to meet students' individual learning preferences and optimize knowledge and understanding. The aim of this study was to compare the effects of the conceptual map and the traditional lecture methods on students' learning based on the VARK learning styles model. In this randomized controlled trial, 160 students from nursing, nurse anesthetics, and midwifery disciplines with four different learning styles of visual, auditory, reading/writing, and kinesthetic were selected using the convenience sampling method. Participants were randomly assigned to the intervention (conceptual map method) or control (traditional lecture method) groups. A medical-surgical nursing course was taught to the students in both groups over 6 weeks. Data collection tools consisted of the VARK questionnaire and pre-and postassessments. Data were analyzed using descriptive and inferential statistics via the SPSS software. Teaching using the conceptual map method had different effects on the students' learning outcomes based on their learning styles. The conceptual map method had a statistically significant impact on the students' learning in the intervention group compared with the control group in the students with a visual learning style (p ¼ .036). No statistically significant differences were reported between the groups in other three learning styles. Nurse instructors should assess students' learning styles based on the VARK model before the application of a particular teaching method to improve the quality of nursing education and facilitate deeper learning

Identifying Player Types to Tailor Game-Based Learning Design to Learners:Cross-sectional Survey using Q Methodology

BACKGROUND: Game-based learning appears to be a promising instructional method because of its engaging properties and positive effects on motivation and learning. There are numerous options to design game-based learning; however, there is little data-informed knowledge to guide the choice of the most effective game-based learning design for a given educational context. The effectiveness of game-based learning appears to be dependent on the degree to which players like the game. Hence, individual differences in game preferences should be taken into account when selecting a specific game-based learning design. OBJECTIVE: We aimed to identify patterns in students' perceptions of play and games-player types and their most important characteristics. METHODS: We used Q methodology to identify patterns in opinions on game preferences. We recruited undergraduate medical and dental students to participate in our study and asked participants to sort and rank 49 statements on game preferences. These statements were derived from a prior focus group study and literature on game preferences. We used by-person factor analysis and varimax rotation to identify common viewpoints. Both factors and participants' comments were used to interpret and describe patterns in game preferences. RESULTS: From participants' (n=102) responses, we identified 5 distinct patterns in game preferences: the social achiever, the explorer, the socializer, the competitor, and the troll. These patterns revolved around 2 salient themes: sociability and achievement. The 5 patterns differed regarding cheating, playing alone, story-telling, and the complexity of winning. CONCLUSIONS: The patterns were clearly interpretable, distinct, and showed that medical and dental students ranged widely in how they perceive play. Such patterns may suggest that it is important to take students' game preferences into account when designing game-based learning and demonstrate that not every game-based learning-strategy fits all students. To the best of our knowledge, this study is the first to use a scientifically sound approach to identify player types. This can help future researchers and educators select effective game-based learning game elements purposefully and in a student-centered way

Surveillance of respiratory viruses among children attending a primary school in rural coastal Kenya

Background: Respiratory viruses are primary agents of respiratory tract diseases. Knowledge on the types and frequency of respiratory viruses affecting school-children is important in determining the role of schools in transmission in the community and identifying targets for interventions. Methods: We conducted a one-year (term-time) surveillance of respiratory viruses in a rural primary school in Kilifi County, coastal Kenya between May 2017 and April 2018. A sample of 60 students with symptoms of ARI were targeted for nasopharyngeal swab (NPS) collection weekly. Swabs were screened for 15 respiratory virus targets using real time PCR diagnostics. Data from respiratory virus surveillance at the local primary healthcare facility was used for comparison. Results: Overall, 469 students aged 2-19 years were followed up for 220 days. A total of 1726 samples were collected from 325 symptomatic students; median age of 7 years (IQR 5-11). At least one virus target was detected in 384 (22%) of the samples with a frequency of 288 (16.7%) for rhinovirus, 47 (2.7%) parainfluenza virus, 35 (2.0%) coronavirus, 15 (0.9%) adenovirus, 11 (0.6%) respiratory syncytial virus (RSV) and 5 (0.3%) influenza virus. The proportion of virus positive samples was higher among lower grades compared to upper grades (25.9% vs 17.5% respectively; χ2 = 17.2, P -value <0.001). Individual virus target frequencies did not differ by age, sex, grade, school term or class size. Rhinovirus was predominant in both the school and outpatient setting. Conclusion: Multiple respiratory viruses circulated in this rural school population. Rhinovirus was dominant in both the school and outpatient setting and RSV was of notably low frequency in the school. The role of school children in transmitting viruses to the household setting is still unclear and further studies linking molecular data to contact patterns between the school children and their households are required

Medicare for all

OBJECTIVES: Interferon (IFN) alpha is a key immunoregulatory cytokine secreted by activated plasmacytoid dendritic cells (PDC) that constitute less than 1% of leucocytes. IFNalpha plays an important role in the pathogenesis of systemic lupus erythematosus (SLE). Nevertheless, the natural IFNalpha inducers in SLE as well as the different IFNalpha secreting cell types are only partially characterised. METHODS: Chromatin was purified from calf thymus. Human peripheral blood mononuclear cells (PBMC), neutrophils and mouse bone marrow neutrophils were purified and cultured with different stimuli. IFNalpha production was estimated by flow cytometry, ELISA and a bioassay, and gene expression by quantitative real time PCR. Neutrophil activation and NETosis were analysed by flow cytometry, ELISA and confocal microscopy. RESULTS: Neutrophils produced a bioactive IFNalpha on stimulation with purified chromatin. IFNalpha secretion was observed with steady state neutrophils purified from 56 independent healthy individuals and autoimmune patients in response to free chromatin and not chromatin containing immune complexes. Chromatin induced IFNalpha secretion occurred independently of Toll-like receptor 9 (TLR9). Neutrophil priming by granulocyte-colony stimulating factor, granulocyte macrophage-colony stimulating factor or IFNalpha was not necessary but PBMC sustained IFNalpha secretion by neutrophils. PDC were 27 times more efficient than neutrophils but blood neutrophils were 100 times more frequent than PDC. Finally, neutrophil activation by chromatin was associated with NETosis and DNA sensor upregulation. CONCLUSIONS: Neutrophils have the capability of producing IFNalpha on selective triggering, and we identified a natural lupus stimulus involved, unveiling a new mechanism involved in SLE. Neutrophils represent another important source of IFNalpha and important targets for future therapies aimed at influencing IFNalpha levels

Molecular epidemiology of human rhinovirus from one-year surveillance within a school setting in rural coastal Kenya

Background Human rhinovirus (HRV) is the most common cause of the common cold but may also lead to more severe respiratory illness in vulnerable populations. The epidemiology and genetic diversity of HRV within a school setting have not been previously described. Objective To characterise HRV molecular epidemiology in primary school in a rural location of Kenya. Methods Between May 2017 to April 2018, over three school terms, we collected 1859 nasopharyngeal swabs (NPS) from pupils and teachers with symptoms of acute respiratory infection in a public primary school in Kilifi County, coastal Kenya. The samples were tested for HRV using real-time RT-PCR. HRV positive samples were sequenced in the VP4/VP2 coding region for species and genotype classification. Results A total of 307 NPS (16.4%) from 164 individuals were HRV positive, and 253 (82.4%) were successfully sequenced. The proportion of HRV in the lower primary classes was higher (19.8%) than upper primary classes (12.2%), p-value &0.001. HRV-A was the most common species (134/253, 53.0%), followed by HRV-C (73/253, 28.9%) and HRV-B (46/253, 18.2%). Phylogenetic analysis identified 47 HRV genotypes. The most common genotypes were A2 and B70. Numerous (up to 22 in one school term) genotypes circulated simultaneously, there was no individual re-infection with the same genotype, and no genotype was detected in all three school terms. Conclusion HRV was frequently detected among school-going children with mild ARI symptoms, and particularly in the younger age groups (&5-year-olds). Multiple HRV introductions were observed characterised by the considerable genotype diversity

Influence of online collaborative learning on social network and academic performance of medical students: lessons learned from the COVID-19 pandemic

IntroductionThe social distancing restrictions due to the COVID-19 pandemic have changed students’ learning environment and limited their social interactions. Therefore, the objective of this study was to investigate the influence of the social distancing restrictions on students’ social networks, wellbeing, and academic performance.MethodsWe performed a questionnaire study in which 102 students participated before and 167 students during the pandemic. They completed an online questionnaire about how they formed their five peer social networks (study-related support, collaboration, friendship, share information, and learn-from) out-of-class. We performed social network analysis to compare the sizes, structures, and compositions of students’ five social networks before and during the pandemic, between first- and second-year students, and between international and domestic students. Additionally, we performed Kruskal–Wallis H test to compare students’ academic performance before and during the pandemic. We performed thematic analysis to answers for two open-end questions in the online questionnaire to explore what difficulties students encountered during the COVID-19 pandemic and what support they needed.ResultsThe results showed that the size of students’ social networks during the pandemic was significantly smaller than before the pandemic. Besides, the formation of social networks differed between first- and second-year students, and between domestic and international students. However, academic performance did not decline during the COVID-19 pandemic. Furthermore, we identified three key areas in which students experienced difficulties and needed support by thematic analysis: social connections and interactions, learning and studying, and physical and mental wellbeing.ConclusionWhen institutions implement learning with social distancing, such as online learning, they need to consider changes in students’ social networks and provide appropriate support