Integrative evaluation of computer assisted learning in geography in schools and university

Evaluating CAL as part of an overall teaching and learning situation, can help school and university teachers to recognise strengths and weaknesses in their use and delivery of teaching method. This approach is called "integrative evaluation". This research extends the application of integrative evaluation methods to Computer Assisted Learning (CAL) in three ways: (1) to use the integrative approach at the secondary school level for the first time; (2) to investigate deep vs. surface learning in university students using CAL in conjunction with other resources; (3) to apply integrative evaluation to the field of CAL in Geography teaching for the first time. The research comprises four studies, each dealing with a different CAL package. Two of the studies were conducted in two secondary schools in the city of Glasgow, and two were carried out in the Geography Department at the University of Glasgow. The total sample population was 238 (74 school pupils and 164 university students). Various instruments besides classroom observation were used for evaluation purposes, including tests designed to measure learning outcomes, questionnaires designed to gauge pupils'/students' reactions, opinions and confidence levels and interviews. The software studied in this research comprised: (1) A database-like dealing with the geography of Japan. (2) An interactive CAL package related to the subject of the Weather. (3) A university-level CAL package on the subject of Glaciation which related theory to practical labs. (4) Five different application programs (including GIS and Minitab) being taught to university students in an IT course. In the 3 studies that measured learning, the evaluations showed definite gain due to the CAL, although with interesting variations from objective to objective. Among the other findings of the research are: (1) Two distinct patterns of correlation between CAL gains and pupils' geographical ability were detected in each of the school-based studies. It was concluded that low ability pupils gained more from a stimulating, interactive CAL package, but benefited less than more able pupils from a database-type package. (2) Students found the scheduled computer lab the most useful learning resource for learning about the five applications covered in the IT course. This finding clearly demonstrated that each resource had a specific role to play within the course, and that each resource is more suited to the achievement of certain learning objectives and less suitable for others. (3) Only a small shift from surface to deep learning was found by the end of the Glaciation course, even though the CAL package was specifically designed to link theoretical and practical knowledge. However, doubts raised about the design of questions used to determine the shift suggest that the shift may have been underestimated

Burden of bradycardia and barriers to accessing bradycardia therapy in underserved countries

Bradycardia, a condition characterized by an abnormally slow heart rate, poses significant challenges in terms of diagnosis and treatment. While it is a concern world-wide, low- and middle-income countries (LMICs) face substantial barriers in accessing appropriate bradycardia therapy. This article aims to explore the global aetiology and incidence of bradycardia, compare the prevalence and management of the condition in high-income countries versus LMICs, identify the key reasons behind the disparities in access to bradycardia therapy in LMICs, and emphasize the urgent need to address these disparities to ensure equitable healthcare on a global scal

Full-Body MRI in Patients With an Implantable Cardioverter-Defibrillator Primary Results of a Randomized Study

AbstractBackgroundMagnetic resonance imaging (MRI) of patients with conventional implantable cardioverter-defibrillators (ICD) is contraindicated.ObjectivesThis multicenter, randomized trial evaluated safety and efficacy of a novel ICD system specially designed for full-body MRI without restrictions on heart rate or pacing dependency. The primary safety objective was >90% freedom from MRI-related events composite endpoint within 30 days post-MRI. The primary efficacy endpoints were ventricular pacing capture threshold and ventricular sensing amplitude.MethodsSubjects received either a single- or dual-chamber ICD. In a 2:1 randomization, subjects either underwent MRI at 1.5-T of the chest, cervical, and head regions to maximize radiofrequency exposure up to 2 W/kg specific absorption rate and gradient field exposure to 200 T/m/s per axis (MRI group, n = 175), or they underwent a 1-h waiting period without MRI (control group, n = 88). A subset of MRI patients underwent ventricular fibrillation induction testing post-MRI to characterize defibrillation function.ResultsIn 42 centers, 275 patients were enrolled (76% male, age 60.4 ± 13.8 years). The safety endpoint was met with 100% freedom from the composite endpoint (p < 0.0001). Both efficacy endpoints were met with minimal differences in the proportion of MRI and control patients who demonstrated a ≤0.5 V increase in ventricular pacing capture threshold (100% MRI vs. 98.8% control, noninferiority p < 0.0001) or a ≤50% decrease in R-wave amplitude (99.3% MRI vs. 98.8% control, noninferiority p = 0.0001). A total of 34 ventricular tachyarrhythmia/ventricular fibrillation episodes (20 induced; 14 spontaneous) occurred in 24 subjects post-MRI, with no observed effect on sensing, detection, or treatment.ConclusionsThis is the first randomized clinical study of an ICD system designed for full-body MRI at 1.5-T. These data support that the system is safe and the MRI scan does not adversely affect electrical performance or efficacy. (Confirmatory Clinical Trial of the Evera MRI System for Conditionally-Safe MRI Access; NCT02117414

A delayed spontaneous expulsion of a three teeth bridge after 6 months period of aspiration in the right lung following cardiac surgery

Aspiration of loose teeth is a well-known complication of endo-tracheal intubation hence the importance of oral check by anesthetist prior to ventilation. Artificaial teeth crown (single) or bridges (multiple) can be fixed or removable by the patient. The presence of a foreign body in the lung tissue or airways is a clinical situation that needs aggressive management as it can lead to refractory infections and possible death. We report this unique case of aspirarin of a three bridge teeth (10 mm × 30 mm) following cardiac surgery. The case is complicated by pneumonia, chronic cough and severe bouts of cyanosis and finally removed by spontaneous expulsion after 6 months following forceful cough

Non-vitamin K oral antagonist (NOAC) compared to vitamin K antagonist (VKA) in left ventricular thrombus

Background: Thromboembolic events are serious left ventricular thrombus (LVT) complications. Despite the limitations of vitamin K antagonist (VKA) drugs, it continues to be the recommended oral anticoagulation for LVT. Recently, nonvitamin K oral antagonist (NOAC) has gained popularity as an off-labeled treatment for systemic embolism prevention in LVT. Objective: In this study, we aim to compare the outcomes (stroke and bleeding) of warfarin versus NOAC therapy in patients with LVT. Methods: This retrospective cohort study compares NOAC and VKA therapy in LVT patients. We enrolled 201 patients with an echocardiography-confirmed LVT from January 2018 to December 2022. Patients who received NOAC therapy (NOAC, n = 77) were compared to VKA patients (VKA, n = 124). The primary endpoint was a composite of stroke, minor and major bleeding. Results: The median follow-up time was 17 months (25th–75th percentiles: 8–38). On unmatched analysis, both groups had no difference in major bleeding (log-rank, P = 0.61) and stroke (log-rank, P = 0.77). However, all bleeding events were higher with NOAC (log-rank, P = 0.01). On matched analysis, there was no difference between both groups in the overall bleeding events (P = 0.08), major bleeding (P = 0.57), and stroke (P = 0.66). Minor bleeding was significantly lower in the VKA group (P = 0.04). Conclusion: In patients with LVT, NOAC was as effective as VKA in stroke prevention without increasing the risk of major bleeding