Addition of 24‐hour heart rate variability parameters to the Cardiovascular Health Study stroke risk score and prediction of incident stroke: The Cardiovascular Health Study

Background Heart rate variability (HRV) characterizes cardiac autonomic functioning. The association of HRV with stroke is uncertain. We examined whether 24‐hour HRV added predictive value to the Cardiovascular Health Study clinical stroke risk score (CHS‐SCORE), previously developed at the baseline examination. Methods and Results N=884 stroke‐free CHS participants (age 75.3±4.6), with 24‐hour Holters adequate for HRV analysis at the 1994–1995 examination, had 68 strokes over ≤8 year follow‐up (median 7.3 [interquartile range 7.1–7.6] years). The value of adding HRV to the CHS‐SCORE was assessed with stepwise Cox regression analysis. The CHS‐SCORE predicted incident stroke (HR=1.06 per unit increment, P=0.005). Two HRV parameters, decreased coefficient of variance of NN intervals (CV%, P=0.031) and decreased power law slope (SLOPE, P=0.033) also entered the model, but these did not significantly improve the c‐statistic (P=0.47). In a secondary analysis, dichotomization of CV% (LOWCV% ≤12.8%) was found to maximally stratify higher‐risk participants after adjustment for CHS‐SCORE. Similarly, dichotomizing SLOPE (LOWSLOPE <−1.4) maximally stratified higher‐risk participants. When these HRV categories were combined (eg, HIGHCV% with HIGHSLOPE), the c‐statistic for the model with the CHS‐SCORE and combined HRV categories was 0.68, significantly higher than 0.61 for the CHS‐SCORE alone (P=0.02). Conclusions In this sample of older adults, 2 HRV parameters, CV% and power law slope, emerged as significantly associated with incident stroke when added to a validated clinical risk score. After each parameter was dichotomized based on its optimal cut point in this sample, their composite significantly improved prediction of incident stroke during ≤8‐year follow‐up. These findings will require validation in separate, larger cohorts. Keywords: autonomic nervous system, clinical stroke risk model, heart rate variability, prediction, predictors, risk prediction, risk stratification, strok

Analysing the Impact of Built-In and External Social Tools in a MOOC on Educational Technologies

Proocedings of: 8th European Conference on Technology Enhanced Learning: Scaling Up Learning for Sustained Impact (EC-TEL 2013). Paphos, Cyprus, September 17-21, 2013MOOCs have been a disruptive educational trend in the last months. Some MOOCs just replicate traditional teaching pedagogies, adding multimedia elements like video lectures. Others go beyond, trying to engage the massive number of participants by promoting discussions and relying on their contributions to the course. MOOC platforms usually provide some built-in social tools for this purpose, although instructors or participants may suggest others to foster discussions and crowdsourcing. This paper analyses the impact of two built-in (Q&A and forum) and three external social tools (Facebook, Twitter and MentorMob) in a MOOC on educational technologies. Most of the participants agreed on the importance of social tools to be in touch with their partners and share information related to the course, the forum being the one preferred. Furthermore, the lessons learned from the enactment of this MOOC employing social tools are summarized so that others may benefit from them.This work has been funded by the Spanish Ministry of Economy and Competitiveness Project TIN2011-28308-C03-01, the Regional Government of Madrid project S2009/TIC-1650, and the postdoctoral fellowship Alianza 4 Universidades.Publicad

Investigating Self-Directed Learning Dimensions: Adapting the Bouchard Framework

Self-Directed Learning (SDL) is gaining interest, as online learning is increasingly learner-centered. FutureLearn courses provide an array of online interactions and content deliveries, which have allowed the authors to investigate a diversity of SDL elements. This preliminary research examines the SDL taking place in three FutureLearn courses, and categorises those learner actions into meaningful elements and dimensions for the learners. The SDL framework by Bouchard [1] is used to interpret the self-reported findings coming from active learners. The research uses a grounded theory approach to look for learner experiences related to four dimensions (algorithmic, conative, semiotic, and economic) of the Bouchard [1] framework, and to discover new dimensions. Various research instruments are used: online surveys, learning logs, and one-on-one interviews, all collected pre-, during, or post-course. The initial adaptation of Bouchard’s framework offers insights into SDL, its meaning, and value as perceived by the learners

An analysis of pupil concerns regarding transition into higher education.

Transitioning to higher education is often a stressful experience, with incoming students facing similar issues year after year. This chapter presents two years of data collection regarding the concerns of Computing secondary school pupils when considering their upcoming transition into the first year of higher education. Over the two-year period, it can be seen that pupils continue to demonstrate concerns regarding topics related to money, jobs and course achievement as opposed to those related to environment or social issues. The consistency between relative areas of concern over the two years is striking, further suggesting that an understanding of these issues might help higher education institutions to better support their incoming students

Changes in perceived stress and lifestyle behaviors in response to the COVID-19 pandemic in The Netherlands:An online longitudinal survey study

The COVID-19 pandemic has substantial implications for physical and mental wellbeing. This study investigated changes, over time, in lifestyle behaviors and perceived stress during the initial phase of the pandemic and associations with COVID-19 symptoms, in the Dutch general population. An online longitudinal survey study was performed with pre-lockdown measurements in February, and subsequently in April and June 2020 (n = 259, mean age 59 ± 14 years, 59% women). Self-report questionnaires were used to assess weight, diet quality, physical activity, alcohol intake, and smoking. Perceived stress was measured using the validated perceived stress scale (PSS-10). The presence of COVID-19 symptoms (yes/no) was defined as fever, or >3 of the following symptoms: weakness/tiredness, muscle ache, dry cough, loss of smell/taste, and breathing difficulties. Data were analyzed using linear mixed models, adjusted for age, sex, educational level, marital status and (change in) employment status. Minimal increases over time were observed in alcohol intake (0.6 ± 0.7 to 0.7 ± 1.1 glasses/day, p = 0.001) and smoking (9.5 ± 8.7 to 10.9 ± 9.4 cigarettes/day among 10% smokers, p = 0.03), but other lifestyle behaviors remained stable. In April 2020, 15% reported COVID-19-related symptoms, and in June 2020, this was 10%. The presence of COVID-19 symptoms was associated with increased perceived stress (p interaction = 0.003) and increased alcohol consumption (p interaction = 0.03) over time. In conclusion, in this prospective study, COVID-19 symptoms were associated with increases in perceived stress and alcohol consumption. Future research on biopsychosocial determinants and underlying mechanisms of lifestyle changes, as a response to the COVID-19 pandemic, is needed

Detailed assessment of benefits and risks of retrievable inferior vena cava filters on patients with complicated injuries: the da Vinci multicentre randomised controlled trial study protocol

Introduction Retrievable inferior vena cava (IVC) filters have been increasingly used in patients with major trauma who have contraindications to anticoagulant prophylaxis as a primary prophylactic measure against venous thromboembolism (VTE). The benefits, risks and cost-effectiveness of such strategy are uncertain. Methods and analysis Patients with major trauma, defined by an estimated Injury Severity Score >15, who have contraindications to anticoagulant VTE prophylaxis within 72 hours of hospitalisation to the study centre will be eligible for this randomised multicentre controlled trial. After obtaining consent from patients, or the persons responsible for the patients, study patients are randomly allocated to either control or IVC filter, within 72 hours of trauma admission, in a 1:1 ratio by permuted blocks stratified by study centre. The primary outcomes are (1) the composite endpoint of (A) pulmonary embolism (PE) as demonstrated by CT pulmonary angiography, high probability ventilation/perfusion scan, transoesophageal echocardiography (by showing clots within pulmonary arterial trunk), pulmonary angiography or postmortem examination during the same hospitalisation or 90-day after trauma whichever is earlier and (B) hospital mortality; and (2) the total cost of treatment including the costs of an IVC filter, total number of CT and ultrasound scans required, length of intensive care unit and hospital stay, procedures and drugs required to treat PE or complications related to the IVC filters. The study started in June 2015 and the final enrolment target is 240 patients. No interim analysis is planned; incidence of fatal PE is used as safety stopping rule for the trial. Ethics and dissemination Ethics approval was obtained in all four participating centres in Australia. Results of the main trial and each of the secondary endpoints will be submitted for publication in a peer-reviewed journal. Trial registration number ACTRN12614000963628; Pre-results