346 research outputs found
Adapt or preserve: Lecturersâ experiences of teaching and learning during the COVID-19 pandemic in South Africa and their self-directedness
The COVID-19 pandemic that has engulfed the whole world has given rise to a number of previously disguised challenges to higher educational institutions (HEIs). In the blink of an eye, lecturers had to facilitate learning in remote environments without any prior training. What aroused the interest in this study was the need to know how lecturers at one university dealt with the sudden shift to remote teaching during the pandemic. The way in which lecturers dealt with the shift may reveal their self-directedness. Using a qualitative open-ended questionnaire, we explored lecturersâ experiences of facilitating remote learning during the pandemic with the aim of uncovering their experiences and exploring how these experiences revealed lecturersâ self-directedness. The findings suggest that lecturers had both positive and negative experiences about facilitating online learning in their remote areas. We concluded that, even though lecturers experienced challenges in facilitating remote learning, most of them were able to introduce solutions to those challenges, indicating some element of being self-directed learners
The burden of proof: the current state of atrial fibrillation prevention and treatment trials
Atrial fibrillation (AF) is an age-related arrhythmia of enormous socioeconomic significance. In recent years, our understanding of the basic mechanisms that initiate and perpetuate AF has evolved rapidly, catheter ablation of AF has progressed from concept to reality, and recent studies suggest lifestyle modification may help prevent AF recurrence. Emerging developments in genetics, imaging, and informatics also present new opportunities for personalized care. However, considerable challenges remain. These include a paucity of studies examining AF prevention, modest efficacy of existing antiarrhythmic therapies, diverse ablation technologies and practice, and limited evidence to guide management of high-risk patients with multiple comorbidities. Studies examining the long-term effects of AF catheter ablation on morbidity and mortality outcomes are not yet completed. In many ways, further progress in the field is heavily contingent on the feasibility, capacity, and efficiency of clinical trials to incorporate the rapidly evolving knowledge base and to provide substantive evidence for novel AF therapeutic strategies. This review outlines the current state of AF prevention and treatment trials, including the foreseeable challenges, as discussed by a unique forum of clinical trialists, scientists, and regulatory representatives in a session endorsed by the Heart Rhythm Society at the 12th Global CardioVascular Clinical Trialists Forum in Washington, DC, December 3â5, 2015
Hypertension: Development of a prediction model to adjust self-reported hypertension prevalence at the community level
Abstract
Background
Accurate estimates of hypertension prevalence are critical for assessment of population health and for planning and implementing prevention and health care programs. While self-reported data is often more economically feasible and readily available compared to clinically measured HBP, these reports may underestimate clinical prevalence to varying degrees. Understanding the accuracy of self-reported data and developing prediction models that correct for underreporting of hypertension in self-reported data can be critical tools in the development of more accurate population level estimates, and in planning population-based interventions to reduce the risk of, or more effectively treat, hypertension. This study examines the accuracy of self-reported survey data in describing prevalence of clinically measured hypertension in two racially and ethnically diverse urban samples, and evaluates a mechanism to correct self-reported data in order to more accurately reflect clinical hypertension prevalence.
Methods
We analyze data from the Detroit Healthy Environments Partnership (HEP) Survey conducted in 2002 and the National Health and Nutrition Examination (NHANES) 2001â2002 restricted to urban areas and participants 25 years and older. We re-calibrate measures of agreement within the HEP sample drawing upon parameter estimates derived from the NHANES urban sample, and assess the quality of the adjustment proposed within the HEP sample.
Results
Both self-reported and clinically assessed prevalence of hypertension were higher in the HEP sample (29.7 and 40.1, respectively) compared to the NHANES urban sample (25.7 and 33.8, respectively). In both urban samples, self-reported and clinically assessed prevalence is higher than that reported in the full NHANES sample in the same year (22.9 and 30.4, respectively). Sensitivity, specificity and accuracy between clinical and self-reported hypertension prevalence were âmoderate to goodâ within the HEP sample and âgood to excellentâ within the NHANES sample. Agreement between clinical and self-reported hypertension prevalence was âmoderate to goodâ within the HEP sample (kappa =0.65; 95% CIâ=â0.63-0.67), and âgood to excellentâ within the NHANES sample (kappa = 0.75; 95%CIâ=â0.73-0.80). Application of a âcorrectionâ rule based on prediction models for clinical hypertension using the national sample (NHANES) allowed us to re-calibrate sensitivity and specificity estimates for the HEP sample. The adjusted estimates of hypertension in the HEP sample based on two different correction models, 38.1% and 40.5%, were much closer to the observed hypertension prevalence of 40.1%.
Conclusions
Application of a simple prediction model derived from national NHANES data to self-reported data from the HEP (Detroit based) sample resulted in estimates that more closely approximated clinically measured hypertension prevalence in this urban community. Similar correction models may be useful in obtaining more accurate estimates of hypertension prevalence in other studies that rely on self-reported hypertension.http://deepblue.lib.umich.edu/bitstream/2027.42/112834/1/12913_2011_Article_2187.pd
Liraglutide and weight loss among patients with advanced heart failure and a reduced ejection fraction: Insights from the FIGHT trial
Statins and Exercise Training Response in Heart Failure Patients: Insights From HF-ACTION.
OBJECTIVES: The aim of this study was to assess for a treatment interaction between statin use and exercise training (ET) response.
BACKGROUND: Recent data suggest that statins may attenuate ET response, but limited data exist in patients with heart failure (HF).
METHODS: HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) was a randomized trial of 2,331 patients with chronic HF with ejection fraction â€35% who were randomized to usual care with or without ET. We evaluated whether there was a treatment interaction between statins and ET response for the change in quality of life and aerobic capacity (peak oxygen consumption and 6-min walk distance) from baseline to 3 months. We also assessed for a treatment interaction among atorvastatin, simvastatin, and pravastatin and change in these endpoints with ET. Multiple linear regression analyses were performed for each endpoint, adjusting for baseline covariates.
RESULTS: Of 2,331 patients in the HF-ACTION trial, 1,353 (58%) were prescribed statins at baseline. Patients treated with statins were more likely to be older men with ischemic HF etiology but had similar use of renin angiotensin system blockers and beta-blockers. There was no evidence of a treatment interaction between statin use and ET on changes in quality of life or exercise capacity, nor was there evidence of differential association between statin type and ET response for these endpoints (all p values \u3e0.05).
CONCLUSIONS: In a large chronic HF cohort, there was no evidence of a treatment interaction between statin use and short-term change in aerobic capacity and quality of life with ET. These findings contrast with recent reports of an attenuation in ET response with statins in a different population, highlighting the need for future prospective studies. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437)
Particulate matter concentrations in residences: an intervention study evaluating standâalone filters and air conditioners
This study, a randomized controlled trial, evaluated the effectiveness of freeâstanding air filters and window air conditioners (ACs) in 126 lowâincome households of children with asthma. Households were randomized into a control group, a group receiving a freeâstanding HEPA filter placed in the childâs sleeping area, and a group receiving the filter and a windowâmounted AC. Indoor air quality (IAQ) was monitored for weekâlong periods over three to four seasons. High concentrations of particulate matter (PM) and carbon dioxide were frequently seen. When IAQ was monitored, filters reduced PM levels in the childâs bedroom by an average of 50%. Filter use varied greatly among households and declined over time, for example, during weeks when pollutants were monitored, filter use was initially high, averaging 84â±â27%, but dropped to 63â±â33% in subsequent seasons. In months when households were not visited, use averaged only 34â±â30%. Filter effectiveness did not vary in homes with central or room ACs. The study shows that measurements over multiple seasons are needed to characterize air quality and filter performance. The effectiveness of interventions using freeâstanding air filters depends on occupant behavior, and strategies to ensure filter use should be an integral part of interventions. Practical Implications Environmental tobacco smoke (ETS) increased particulate matter (PM) levels by about 14âÎŒg/m 3 and was often detected using ETSâspecific tracers despite restrictions on smoking in the house as reported on questionnaires administered to caregivers. PM concentrations depended on season, filter usage, relative humidity, air exchange ratios, number of children, outdoor PM levels, sweeping/dusting, and presence of a central air conditioner (AC). Freeâstanding air filters can be an effective intervention that provides substantial reductions in PM concentrations if the filters are used. However, filter use was variable across the study population and declined over the study duration, and thus strategies are needed to encourage and maintain use of filters. The variability in filter use suggests that exposure misclassification is a potential problem in intervention studies using filters. The installation of a room AC in the bedroom, intended to limit air exchange ratios, along with an air filter, did not lower PM levels more than the filter alone.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91183/1/j.1600-0668.2011.00761.x.pd
Learning through assessment
This book aims to contribute to the discourse of learning through assessment within a self-directed learning environment. It adds to the scholarship of assessment and self-directed learning within a face-to-face and online learning environment. As part of the NWU Self-Directed Learning Book Series, this book is devoted to scholarship in the field of self-directed learning, focusing on ongoing and envisaged assessment practices for self-directed learning through which learning within the 21st century can take place. This book acknowledges and emphasises the role of assessment as a pedagogical tool to foster self-directed learning during face-to-face and online learning situations. The way in which higher education conceptualises teaching, learning and assessment has been inevitably changed due to the COVID- 19 pandemic, and now more than ever we need learners to be self-directed in their learning. Assessment plays a key role in learning and, therefore, we have to identify innovative ways in which learning can be assessed, and which are likely to become the new norm even after the pandemic has been brought under control. The goal of this book, consisting of original research, is to assist with the paradigm shift regarding the purpose of assessment, as well as providing new ideas on assessment strategies, methods and tools appropriate to foster self-directed learning in all modes of delivery
Effects of exenatide and open-label SGLT2 inhibitor treatment, given in parallel or sequentially, on mortality and cardiovascular and renal outcomes in type 2 diabetes:insights from the EXSCEL trial
Background Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) improve cardiovascular and renal outcomes in patients with type 2 diabetes through distinct mechanisms. However, evidence on clinical outcomes in patients treated with both GLP-1 RA and SGLT2i is lacking. We aim to provide insight into the effects of open-label SGLT2i use in parallel with or shortly after once-weekly GLP-1 RA exenatide (EQW) on cardiorenal outcomes. Methods In the EXSCEL cardiovascular outcomes trial EQW arm, SGLT2i drop-in occurred in 8.7% of participants. These EQW+SGLT2i users were propensity-matched to: (1) placebo-arm participants not taking SGLT2i (n = 572 per group); and to (2) EQW-arm participants not taking SGLT2i (n = 575), based on their last measured characteristics before SGLT2i initiation, and equivalent study visit in comparator groups. Time-to-first major adverse cardiovascular event (MACE) and all-cause mortality (ACM) were compared using Cox regression analyses. eGFR slopes were quantified using mixed model repeated measurement analyses. Results In adjusted analyses, the risk for MACE with combination EQW+SGLT2i use was numerically lower compared with both placebo (adjusted hazard ratio 0.68, 95% CI 0.39-1.17) and EQW alone (0.85, 0.48-1.49). Risk of ACM was nominally significantly reduced compared with placebo (0.38, 0.16-0.90) and compared with EQW (0.41, 0.17-0.95). Combination EQW+SGLT2i use also nominally significantly improved estimated eGFR slope compared with placebo (+ 1.94, 95% CI 0.94-2.94 mL/min/1.73 m(2)/year) and EQW alone (+ 2.38, 1.40-3.35 mL/min/1.73 m(2)/year). Conclusions This post hoc analysis supports the hypothesis that combinatorial EQW and SGLT2i therapy may provide benefit on cardiovascular outcomes and mortality. Trial registration Clinicaltrials.gov, Identifying number: NCT01144338, Date of registration: June 15, 2010
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