Towards Implementing Gamification in MOOCs

Gamification is well known as a design strategy used to generate a change in users’ behaviour, such as motivation. However, while in recent years interest in it has been growing, empirical evidence on the effects that the application of game elements can generate on users’ behaviour is still lacking. We present the results of a study as a step towards designing gamification with better understanding of the possible effects that each game element could generate on end users. By involving three groups of experts: game designers, learning scientists and specialists in technology-enhanced learning (TEL), we assessed a selected number of 21 game design patterns in relation to the effects these could generate on learning performance, goal achievement and engagement of learners if implemented in a Massive Online Open Course (MOOC). Based on quantitative and qualitative data collected, 9 game elements have been selected to be further investigated

Recommendations for headache service organisation and delivery in Europe.

Headache disorders are a major public-health priority, and there is pressing need for effective solutions to them. Better health care for headache—and ready access to it—are central to these solutions; therefore, the organisation of headache-related services within the health systems of Europe becomes an important focus. These recommendations are the result of collaboration between the European Headache Federation and Lifting The Burden: the Global Campaign against Headache. The process of development included wide consultation. To meet the very high level of need for headache care both effectively and efficiently, the recommendations formulate a basic three-level model of health-care organisation rationally spread across primary and secondary health-care sectors, taking account of the different skills and expertise in these sectors. They recognise that health services are differently structured in countries throughout Europe, and not always adequately resourced. Therefore, they aim to be adaptable to suit these differences. They are set out in five sections: needs assessment, description of the model, adaptation, standards and educational implications

Recommendations for headache service organisation and delivery in Europe.

Headache disorders are a major public-health priority, and there is pressing need for effective solutions to them. Better health care for headache-and ready access to it-are central to these solutions; therefore, the organisation of headache-related services within the health systems of Europe becomes an important focus. These recommendations are the result of collaboration between the European Headache Federation and Lifting The Burden: the Global Campaign against Headache. The process of development included wide consultation. To meet the very high level of need for headache care both effectively and efficiently, the recommendations formulate a basic three-level model of health-care organisation rationally spread across primary and secondary health-care sectors, taking account of the different skills and expertise in these sectors. They recognise that health services are differently structured in countries throughout Europe, and not always adequately resourced. Therefore, they aim to be adaptable to suit these differences. They are set out in five sections: needs assessment, description of the model, adaptation, standards and educational implications

Proposals for the organisation of headache services in Europe.

The mission of the European Headache Federation (EHF) is to improve life for those affected by headache disorders in Europe. Progress depends upon improving access to good headache-related health care for people affected by these disorders. Education about headache-its nature, causes, consequences and management-is a key activity of EHF that supports this aim. It is also important to achieve an organisation of headache-related services within the health systems of Europe in order that they can best deliver care in response to what are very high levels of need. This publication assesses this need, and sets out proposals for service organisation, on three levels, to meet the resultant demand

Application of unmanned aerial vehicle data and discrete fracture network models for improved rockfall simulations

In this research, we present a new approach to define the distribution of block volumes during rockfall simulations. Unmanned aerial vehicles (UAVs) are utilized to generate high-accuracy 3D models of the inaccessible SW flank of the Mount Rava (Italy), to provide improved definition of data gathered from conventional geomechanical surveys and to also denote important changes in the fracture intensity. These changes are likely related to the variation of the bedding thickness and to the presence of fracture corridors in fault damage zones in some areas of the slope. The dataset obtained integrating UAV and conventional surveys is then utilized to create and validate two accurate 3D discrete fracture network models, representative of high and low fracture intensity areas, respectively. From these, the ranges of block volumes characterizing the in situ rock mass are extracted, providing important input for rockfall simulations. Initially, rockfall simulations were performed assuming a uniform block volume variation for each release cell. However, subsequent simulations used a more realistic nonuniform distribution of block volumes, based on the relative block volume frequency extracted from discrete fracture network (DFN) models. The results of the simulations were validated against recent rockfall events and show that it is possible to integrate into rockfall simulations a more realistic relative frequency distribution of block volumes using the results of DFN analyse

Pitfals in recognition and management of trigeminal neuralgia

BACKGROUND: Trigeminal neuralgia (TN) is a severe, disabling form of painful cranial neuropathy. Even though TN has a typical clinical picture, diagnosis it is often missed or delayed in clinical practice. In order to investigate the occurrence of diagnostic and therapeutic errors in TN, we studied 102 patients suffering from TN recruited through a multicentric survey. METHODS: We performed a Pubmed database search on errors and pittfalls in TN diagnosis and management. Then, patients with TN were consecutively enrolled in the period from February 2017 to October 2019, by several European Headache Centers participating in the study, following a call of the Headache and Pain Scientific Panels of the European Academy of Neurology (EAN). Diagnosis of Classical Trigeminal Neuralgia (CTN) was made according to the International Headache Society (IHS) criteria (Tölle et al., Pain Pract 6:153-160, 2006). All the patients were evaluated using telephone/frontal interviews conducted by headache/pain specialists using an ad hoc questionnaire. RESULTS: A number of 102 patients were recruited, mostly females (F:M ratio 2.64:1). Eighty-six percent of the patients consulted a physician at the time they experienced the first pain attacks. Specialists consulted before TN diagnosis were: primary care physicians (PCP) (43.1%), dentists (in 30.4%), otorhinolaryngologists (3.9%), neurosurgeons (3.9%), neurologists or headache specialists (14.7%), others (8%). The final diagnosis was made mainly by a neurologist or headache specialist (85.3%), and the mean interval between the disease onset and the diagnosis made by a specialist was 10.8 ± 21.2 months. The "diagnostic delay" was 7.2 ± 12.5 months, and misdiagnoses at first consultation were found in 42.1% of cases. Instrumental and laboratory investigations were carried out in 93.1% of the patients before the final diagnosis of TN. CONCLUSION: While TN has typical features and it is well defined by the available international diagnostic criteria, it is still frequently misdiagnosed and mistreated. There is a need to improve the neurological knowledge in order to promptly recognize the clinical picture of TN and properly adhere to the specific guidelines. This may result in a favorable outcome for patients, whose quality of life is usually severely impaired

Update on Hemicrania Continua

Hemicrania continua (HC) is a rare primary headache syndrome, characterized by unilateral pain and an absolute response to indometacin. Since the term was first coined in 1984, more than 100 cases have been described worldwide. Most recently, detailed case series that provide more detailed information concerning the sometimes complex clinical presentation of HC have been reported. Functional imaging studies suggest a unique pattern of subcortical involvement in HC: contralateral to the pain posterior hypothalamic region, ipsilateral dorsal pons and ipsilateral ventral midbrain, which, along with the particular effect of indometacin, probably justifies its classification as a unique entity. Increasing the awareness of this primary headache form among clinicians will aid in its diagnosis while further work is being undertaken to characterize the syndrome

Application of unmanned aerial vehicle data and discrete fracture network models for improved rockfall simulations

This is the final version. Available from the publisher via the DOI in this record.In this research, we present a new approach to define the distribution of block volumes during rockfall simulations. Unmanned aerial vehicles (UAVs) are utilized to generate high-accuracy 3D models of the inaccessible SW flank of the Mount Rava (Italy), to provide improved definition of data gathered from conventional geomechanical surveys and to also denote important changes in the fracture intensity. These changes are likely related to the variation of the bedding thickness and to the presence of fracture corridors in fault damage zones in some areas of the slope. The dataset obtained integrating UAV and conventional surveys is then utilized to create and validate two accurate 3D discrete fracture network models, representative of high and low fracture intensity areas, respectively. From these, the ranges of block volumes characterizing the in situ rock mass are extracted, providing important input for rockfall simulations. Initially, rockfall simulations were performed assuming a uniform block volume variation for each release cell. However, subsequent simulations used a more realistic nonuniform distribution of block volumes, based on the relative block volume frequency extracted from discrete fracture network (DFN) models. The results of the simulations were validated against recent rockfall events and show that it is possible to integrate into rockfall simulations a more realistic relative frequency distribution of block volumes using the results of DFN analyses

Bioética e direitos fundamentais: a recusa às transfusões de sangue pelas Testemunhas de Jeová

This paper will examine the Institute of Bioethics and fundamental rights in the face of the refusal of blood transfusions by Jehovah's Witnesses. Based on investigating the motives involved in this decision and what legal support they have for their will to be recognized. It is a right provided for in the Federal Constitution that guarantees the patient's autonomy to avail himself of his existential choices, however, that is in conflict with the divergent position of the doctors who seek the judicial route to impose on the patient the use of hemotherapy against his will , provoking state intervention based on the claim that the individual's decision causes the collision of fundamental principles, such as the right to life and the right to religious freedom. For this, we studied bibliographies, laws of the current legal order, articles and jurisprudence, what remained for demonstrating the non-occurrence of a collision of fundamental rights, bearing in mind that Jehovah's Witnesses do not want to have their right to life, for religious reasons, but to guarantee it in its integral form by accepting the use of alternative methods. The existence of legitimacy in refusing blood transfusions based on fundamental principles, especially on the right to life, made possible by the recognition of blood as a risk treatment and the use of alternatives to blood transfusion.Trabalho de Conclusão de Curso (Graduação)Este trabalho analisará o instituto da Bioética e direitos fundamentais diante da recusa das transfusões de sangue pelas Testemunhas de Jeová. Tendo por base investigar os motivos que envolvem essa decisão e qual o respaldo legal possuem para que se reconheça a sua vontade. Trata-se de direito previsto na Constituição Federal que garante a autonomia do paciente de se valer de suas escolhas existenciais, porém que se choca com o divergente posicionamento dos médicos que buscam a via judicial para impor ao paciente o uso da hemoterapia contra sua vontade provocando a intervenção estatal fundamentada na alegação de que a decisão do indivíduo causa a colisão de princípios fundamentais (direito à vida versus direito à liberdade religiosa). Para isso, foram estudadas bibliografias, leis do ordenamento jurídico vigente; artigos e jurisprudências; que restaram por demonstrar a não ocorrência de colisão de direitos fundamentais, tendo em vista que as Testemunhas de Jeová não querem dispor de seu direito à vida, por fundamento religioso, e sim de garanti-lo em sua forma integral por aceitar a utilização de melhores métodos. Portanto, comprovando-se a existência de legitimidade na recusa às transfusões de sangue com base nos princípios fundamentais, principalmente no direito à vida, possibilitada pelo reconhecimento do sangue como um tratamento de risco e a utilização de alternativas a estes

Does inter-vertebral range of motion increase after spinal manipulation? A prospective cohort study.

Background: Spinal manipulation for nonspecific neck pain is thought to work in part by improving inter-vertebral range of motion (IV-RoM), but it is difficult to measure this or determine whether it is related to clinical outcomes. Objectives: This study undertook to determine whether cervical spine flexion and extension IV-RoM increases after a course of spinal manipulation, to explore relationships between any IV-RoM increases and clinical outcomes and to compare palpation with objective measurement in the detection of hypo-mobile segments. Method: Thirty patients with nonspecific neck pain and 30 healthy controls matched for age and gender received quantitative fluoroscopy (QF) screenings to measure flexion and extension IV-RoM (C1-C6) at baseline and 4-week follow-up between September 2012-13. Patients received up to 12 neck manipulations and completed NRS, NDI and Euroqol 5D-5L at baseline, plus PGIC and satisfaction questionnaires at follow-up. IV-RoM accuracy, repeatability and hypo-mobility cut-offs were determined. Minimal detectable changes (MDC) over 4 weeks were calculated from controls. Patients and control IV-RoMs were compared at baseline as well as changes in patients over 4 weeks. Correlations between outcomes and the number of manipulations received and the agreement (Kappa) between palpated and QF-detected of hypo-mobile segments were calculated. Results: QF had high accuracy (worst RMS error 0.5o) and repeatability (highest SEM 1.1o, lowest ICC 0.90) for IV-RoM measurement. Hypo-mobility cut offs ranged from 0.8o to 3.5o. No outcome was significantly correlated with increased IV-RoM above MDC and there was no significant difference between the number of hypo-mobile segments in patients and controls at baseline or significant increases in IV-RoMs in patients. However, there was a modest and significant correlation between the number of manipulations received and the number of levels and directions whose IV-RoM increased beyond MDC (Rho=0.39, p=0.043). There was also no agreement between palpation and QF in identifying hypo-mobile segments (Kappa 0.04-0.06). Conclusions: This study found no differences in cervical sagittal IV-RoM between patients with non-specific neck pain and matched controls. There was a modest dose-response relationship between the number of manipulations given and number of levels increasing IV-RoM - providing evidence that neck manipulation has a mechanical effect at segmental levels. However, patient-reported outcomes were not related to this