Sustainable Efficiency and Usability for E-Learning Systems: Practical guide

This Guide has been written as a continuation of the efforts made during the SF-HEAT project to apply usability best practices in the design and development of the e-learning system of the project. The main idea that underlies the methodology behind the Guide is that educational effectiveness and efficiency crucially depends on the usability of the e-learning system. The Guide focuses on a simple practical approach related to a modified ADDIE model for sustainable usability improvement of the e-learning system

Efficiency and Usability of E-Learning Systems : Project-Oriented Methodology Guide

The book presents the efforts of the NBU team to put forward an integralmethodology for evaluation of E-Learning systems. It has been created within the WELKOM project (2004-2006), financed by the Leonardo da Vinci EC program. The methodology given here has been applied successfully for deploying and optimizing three different E-Learning systems in three different contexts – a private industrial company (Turbomeca, France), a SAP training company (VBS, Bulgaria), and a university (NBU, Bulgaria)

Approaches for optimizing medical aid in acute ischemic stroke patients, hospitalized in UMHAT „Saint Marina` - Varna

In Bulgaria generally, treatment of acute ischemic strokes is done at the neurology wards and in smaller hospitals - in internal diseases wards, at intensive care wards in state regional hospitals; at ischemic stroke units and intensive care wards for treatment of neurological diseases at university hospitals. Between 2009 and 2013 in Varna, at the Neurology Clinic of UMHAT- St. Marina, a prospective research was carried out in view of optimizing the treatment of acute ischemic stroke (AIS) patients hospitalized at the clinic. After a stage-by-stage introduction into everyday clinical practice of innovative treatment methods, including intravenous thrombolysis and endovascular therapy of AIS patients, as well as organizational restructuring in view of optimizing the care for such patients, improvement in some of the quality indicators was observed

Impact of diabetes mellitus and admission hyperglycemia on outcomes after intravenous thrombolysis in acute ischemic stroke patients

Diabetes mellitus (DM) is a major risk factor for stroke, which is associated with unfavorable outcomeafter acute ischemic stroke (AIS) and disability. The potential harmful effect of DM, and the role and importance of blood glucose(BG) at admission are currently unclear for clinical outcome after АIS. Aim of this study is to look for correlations between the presence of DM and theinitial level of BG and the clinical outcome after an intravenous thrombolysis (IVT) in patients with acute AIS.Material and methods. IVT with Astylise has been conducted to 170 patients with AIS for the period 09.2011- 09.2015, from which 20% (n = 34) are with DM, 80% without DM (n = 136). According to the values of the BG at admission they have been divided into three groups: I group- (n = 34) 8,1 mmol/l.Results With mRs (0-2) at 3 months are 60.2% of patients without DM and 40% respectively, p= 0,05(OR-1,5, 95% CI 0,91-2,49). With mRs (0-1) are 35% and 24% respectively (p= 0.196). The probability of this outcome is 1.47 times higher in those without DM (OR 1,47, 95% CI: 0,7-3,09). Mortality about the third month is 20% in patients with DM and 8.8% in those without DM, p 0.05); With mRs (0-1) are respectively 38.2%, 32.3% and 30.8% (p> 0.05). Mortality is 15.4% in the III group compared to 9.2% in the II and 8.8% in the I (p> 0.05). With mRs(3-5) are 38.4% of the III group and 26.5% in the I (p> 0.05).Conclusion. Patients with DM have significantly higher mortality and lack of favorable functional outcome at third monthcompared to those without DM, which can not be explained by the presence of ICH. The initial HG not significantly associated with unfavorable clinical outcome, but she quickly identify patients with an increased risk of such an outcome in which blood sugar levels should be closely monitored

InteRhemispheric differences in clinical outcome after intravenous thrombolysis

Човешкият мозък се характеризира с функционална асиметрия, включваща междухемисферни, корови и подкорови взаимодействия. Пациентите с ИМИ в лява хемисфера и проведено тромболитично лечение (ТЛ) имат два пъти по-голяма вероятност за благоприятен клиничен изход на третия месец сравнено с дяснохемисферните инфаркти. Женският пол и левостранната локализация са предиктори на значимо подобрение на неврологичния дефицит на 24-я час след ТЛ. От друга страна асоциацията на мъжки пол и дяснохемисферна локализация на инсулта е свързана с по-голяма вероятност за благоприятен клиничен изход отколкото при жените със същата локализация. Също така дяснохемисферната локализация на инсулта при мъжете се свързва с по-добър изход отколкото при локализация налезията в лява хемисфера.The human brain is characterized by functional asymmetry including interhemispheric, cortical and subcortical interactions. Patients with acute ischemic stroke (AIS) in the left hemisphere and conducted thrombolytic therapy (IVT) have a two-fold greater likelihood of favorable clinical outcome of the third month compared with right hemispheric infarcts. Petticoats and left - sided location are predictors of significant improvement in neurological deficit 24 hours after IVT. On the other hand the association of male and right - sided location of stroke is associated with a greater likelihood of favorable clinical outcomes than women with the same location. In men it is associated with a better outcome than left-sided localization of the lesion

Autonomic cardiovascular disorders in stroke - electrocardiographic changes and risk of sudden cardiac death

Нарушенията на кардиоваскуларните автономни функции са често срещани при мозъчно-съдова болест, имат голямо клинично значение и са най-отчетливо проявени в острата фаза на инсулта. При пациенти с мозъчен инсулт се наблюдават електрокардиографски промени; повишава се честотата на ритъмните нарушения на сърцето, плазмените нива на катехоламините и сърдечните ензими. Вариабилността на сърдечната честота (ВСЧ) предсказва в по-голяма степен ранната, внезапна смъртност.Disturbances of cardiovascular autonomic function are common in patients with cerebrovascular disease (CVDs), have great clinical importance and are most clearly manifested in the acute phase of stroke. In patients experienced stroke are observed electrocardiographic (ECG) changes, increased frequency of heart rhythm disorders, plasma catecholamine levels and cardiac enzymes. Heart rate variability (HRV) shows higher risk of sudden cardiac death

Quality indicators in the treatment of acute ischemic stroke

Cerebrovascular diseases are a global medical and social issue because of the high morbidity, disability and mortality they cause. WHO announces 15 million new ischemic strokes per year globally, with 5 million associated deaths and 5 million patients left permanently disabled. Thrombolysis (TL) with tissue plasminogen activator (rt-PA) is currently an approved differentiated pharmacotherapeutic treatment of ischemic stroke (IS) in its acute phase. There is irrefutable evidence of better health results and efficient clinical management of ischemic strokes within an integrated therapeutic approach as a key factor for improving the functional outcome in stroke patients. Quality is one of the most widely discussed issues in the theory and practice of disease management. Strict compliance with the standards for ischemic stroke treatment is an indicator of high quality patient management

Cortical regions connected with autonomic cardiovascular regulation

Violations of the autonomic nervous system are common in patients with cerebrovascular diseases and adversely affect the quality of life. The central autonomic network combines multiple reciprocally connected cortical, subcortical and stem structures. The insular cortex is involved in visceral motor and sensory regulation, including that of the cardiovascular system. Brain lesions including insula and other prefrontal cortical areas are particularly important in provoking arrhythmia. Stroke involving insular cortex is associated with poor prognosis. The right insular cortex plays a dominant role in modulating sympathetic tone and the left insular cortex in parasympathetic tone, which clinically correlates with more frequent arrhythmias and arrhythmic death after a stroke affecting the insula in the right hemisphere. The insular cortex is located in the middle cerebral artery and its structure is exposed to a high risk of injury

Cardiovascular autonomic dysfunction in acute stroke - Biochemical markers

Кардиоваскуларната автономна дисфункция след инсулт има голямо клинично значение, тъй като влошава прогнозата и може до доведе до внезапна ритъмна смърт. Повишената симпатикова активност след инсулт може да доведе до абнормности в ЕКГ, сърдечни аритмии и некроза на миокарда.Наред с проявите на метаболитна ацидоза се повишават плазмените нива на редица биохимични маркери- норепинефрин, епинефрин и допамин; сърдечни ензими и маркери:креатин киназата и креатин киназата -МВ, тропонин I и B-тип натриуретичен пептид.Повишените нива накатехоламинитесанай-ясно изразенипри пациенти с лезии в територията на дясна средна мозъчна артерия и са значимо по-високи по време на острата фаза на инсулт.Cardiovascular autonomic dysfunction after stroke has great clinical importance because worse prognosis and may lead to sudden arrhythmic death. Increased sympathetic activity after a stroke may lead to abnormalities in ECG, cardiac arrhythmias and myocardial necrosis. Along with the manifestations of metabolic acidosis increased plasma levels of several biochemical markers- norepinephrine, epinephrine and dopamine; cardiac enzymes and markers: creatine kinase and creatine kinase -MV, troponin I and B-type natriuretic peptide. Elevated levels of catecholamines are most pronounced in patients with lesions in the territory of the right middle cerebral artery, and were significantly higher during the acute phase of stroke

The Ship of Theseus Puzzle

Does the Ship of Theseus present a genuine puzzle about persistence due to conflicting intuitions based on “continuity of form” and “continuity of matter” pulling in opposite directions? Philosophers are divided. Some claim that it presents a genuine puzzle but disagree over whether there is a solution. Others claim that there is no puzzle at all since the case has an obvious solution. To assess these proposals, we conducted a cross-cultural study involving nearly 3,000 people across twenty-two countries, speaking eighteen different languages. Our results speak against the proposal that there is no puzzle at all and against the proposal that there is a puzzle but one that has no solution. Our results suggest that there are two criteria—“continuity of form” and “continuity of matter”— that constitute our concept of persistence and these two criteria receive different weightings in settling matters concerning persistence