Design, development and implementation of a mobile learning strategy for undergraduate medical education

This paper describes the process of introducing a mobile learning strategy into a medical school by issuing iPads to clinical students. Data was collected from focus groups, surveys and by engaging a number of student “iPad champions”. Students had a positive attitude and experience with the iPads for learning and highlighted some areas for improvement particularly for electronic sign-off. Introduction of mobile technology into medical education is proving to be popular with medical students. Early adoption of mobile technology brings medical students closer to the digital healthcare environment which is rapidly adopting the use of electronic health records, electronic xray and laboratory order and online evidence-based practice tools to support patient care

V-QBA vs. QBA—How Do Video and Live Analysis Compare for Qualitative Behaviour Assessment?

Animal welfare is an inextricable part of livestock production and sustainability. Assessing welfare, beyond physical indicators of health, is challenging and often relies on qualitative techniques. Behaviour is a key component of welfare to consider and Qualitative Behaviour Assessment (QBA) aims to achieve this by systematically scoring behaviour across specific terms. In recent years, numerous studies have conducted QBA by using video footage, however, the method was not originally developed using video and video QBA (V-QBA) requires validation. Forty live QBAs were conducted, by two assessors, on housed beef cattle to help fill this validation gap. Video was recorded over the assessment period and a second video assessment was conducted. Live and video scores for each term were compared for both correlation and significant difference. Principle component analysis (PCA) was then conducted and correlations and differences between QBA and V-QBA for the first two components were calculated. Of the 20 terms, three were removed due to an overwhelming majority of scores of zero. Of the remaining 17 terms, 12 correlated significantly, and a significant pairwise difference was found for one (“Bored”). QBA and V-QBA results correlated across both PC1 (defined as “arousal”) and PC2 (defined as “mood”). Whilst there was no significant difference between the techniques for PC1, there was for PC2, with V-QBA generally yielding lower scores than QBA. Furthermore, based on PC1 and PC2, corresponding QBA and V-QBA scores were significantly closer than would be expected at random. Results found broad agreement between QBA and V-QBA at both univariate and multivariate levels. However, the lack of absolute agreement and muted V-QBA results for PC2 mean that caution should be taken when implementing V-QBA and that it should ideally be treated independently from live QBA until further evidence is published. Future research should focus on a greater variety of animals, environments, and assessors to address further validation of the method

Planet Hunters: New Kepler planet candidates from analysis of quarter 2

We present new planet candidates identified in NASA Kepler quarter two public release data by volunteers engaged in the Planet Hunters citizen science project. The two candidates presented here survive checks for false-positives, including examination of the pixel offset to constrain the possibility of a background eclipsing binary. The orbital periods of the planet candidates are 97.46 days (KIC 4552729) and 284.03 (KIC 10005758) days and the modeled planet radii are 5.3 and 3.8 R_Earth. The latter star has an additional known planet candidate with a radius of 5.05 R_Earth and a period of 134.49 which was detected by the Kepler pipeline. The discovery of these candidates illustrates the value of massively distributed volunteer review of the Kepler database to recover candidates which were otherwise uncatalogued.Comment: Accepted to A

Masses, radii, and orbits of small Kepler planets : The transition from gaseous to rocky planets

We report on the masses, sizes, and orbits of the planets orbiting 22 Kepler stars. There are 49 planet candidates around these stars, including 42 detected through transits and 7 revealed by precise Doppler measurements of the host stars. Based on an analysis of the Kepler brightness measurements, along with high-resolution imaging and spectroscopy, Doppler spectroscopy, and (for 11 stars) asteroseismology, we establish low false-positive probabilities (FPPs) for all of the transiting planets (41 of 42 have an FPP under 1%), and we constrain their sizes and masses. Most of the transiting planets are smaller than three times the size of Earth. For 16 planets, the Doppler signal was securely detected, providing a direct measurement of the planet's mass. For the other 26 planets we provide either marginal mass measurements or upper limits to their masses and densities; in many cases we can rule out a rocky composition. We identify six planets with densities above 5 g cm-3, suggesting a mostly rocky interior for them. Indeed, the only planets that are compatible with a purely rocky composition are smaller than 2 R ⊕. Larger planets evidently contain a larger fraction of low-density material (H, He, and H2O).Peer reviewedFinal Accepted Versio

The diffusion of domestic energy efficiency policies: A spatial perspective

National domestic energy-efficiency policies are unlikely to be implemented in a geographically uniform manner. This paper demonstrates the importance of socioeconomic, contextual, and local policy conditions in shaping the spatially heterogeneous response to a national policy. Through an assessment of the geographical and temporal variation in domestic energy-efficiency assessments provided under the United Kingdom’s Green Deal, the factors underpinning the spatial diffusion of this policy are identified. Spatial regression models show that the presence of young families, university educated residents, detached homes, and large households positively affects the uptake of energy-efficiency assessments whereas property market activity, personal incomes, the presence of self-employed residents, and the efficiency levels of the existing housing stock has a dampening effect. National incentives for policy implementation that are distributed through selected local authorities also work to promote the uptake of energy-efficiency assessments. Overall, the analysis clearly shows the importance of local factors in determining how national policies are implemented on the ground. This has important implications for policymakers in designing and administering national policy frameworks, in trading-off targeted implementation with fairness and uniformity, and in evaluating the local effectiveness of national policies

Planet Hunters: The First Two Planet Candidates Identified by the Public using the Kepler Public Archive Data

Planet Hunters is a new citizen science project, designed to engage the public in an exoplanet search using NASA Kepler public release data. In the first month after launch, users identified two new planet candidates which survived our checks for false- positives. The follow-up effort included analysis of Keck HIRES spectra of the host stars, analysis of pixel centroid offsets in the Kepler data and adaptive optics imaging at Keck using NIRC2. Spectral synthesis modeling coupled with stellar evolutionary models yields a stellar density distribution, which is used to model the transit orbit. The orbital periods of the planet candidates are 9.8844 \pm0.0087 days (KIC 10905746) and 49.7696 \pm0.00039 (KIC 6185331) days and the modeled planet radii are 2.65 and 8.05 R\oplus. The involvement of citizen scientists as part of Planet Hunters is therefore shown to be a valuable and reliable tool in exoplanet detection.Comment: Submitted to MNRAS, added 1 line to table

A model of human physiology and comfort for assessing complex thermal environments

The Berkeley Comfort Model is based on the Stolwijk model of human thermal regulation but includes several signi/cant improvements. Our new model allows an unlimited body segments (compared to six in the Stolwijk model). Each segment is modeled as four body layers (core, muscle, fat, and skin tissues) and a clothing layer. Physiological mechanisms such as vasodilation, vasoconstriction, sweating, and metabolic heat production are explicitly considered. Convection, conduction (such as to a car seat or other surface in contact with any part ofthe body) and radiation between the body and the environment are treated independently. The model is capable ofpredicting human physiological response to transient, non-uniform thermal environments. This paper describes the physiological algorithms as well as the implementation ofthe model. c 2001 Elsevier Science Ltd. All rights reserved

Genome-Wide Analysis of Glucocorticoid Receptor Binding Regions in Adipocytes Reveal Gene Network Involved in Triglyceride Homeostasis

Glucocorticoids play important roles in the regulation of distinct aspects of adipocyte biology. Excess glucocorticoids in adipocytes are associated with metabolic disorders, including central obesity, insulin resistance and dyslipidemia. To understand the mechanisms underlying the glucocorticoid action in adipocytes, we used chromatin immunoprecipitation sequencing to isolate genome-wide glucocorticoid receptor (GR) binding regions (GBRs) in 3T3-L1 adipocytes. Furthermore, gene expression analyses were used to identify genes that were regulated by glucocorticoids. Overall, 274 glucocorticoid-regulated genes contain or locate nearby GBR. We found that many GBRs were located in or nearby genes involved in triglyceride (TG) synthesis (Scd-1, 2, 3, GPAT3, GPAT4, Agpat2, Lpin1), lipolysis (Lipe, Mgll), lipid transport (Cd36, Lrp-1, Vldlr, Slc27a2) and storage (S3-12). Gene expression analysis showed that except for Scd-3, the other 13 genes were induced in mouse inguinal fat upon 4-day glucocorticoid treatment. Reporter gene assays showed that except Agpat2, the other 12 glucocorticoid-regulated genes contain at least one GBR that can mediate hormone response. In agreement with the fact that glucocorticoids activated genes in both TG biosynthetic and lipolytic pathways, we confirmed that 4-day glucocorticoid treatment increased TG synthesis and lipolysis concomitantly in inguinal fat. Notably, we found that 9 of these 12 genes were induced in transgenic mice that have constant elevated plasma glucocorticoid levels. These results suggested that a similar mechanism was used to regulate TG homeostasis during chronic glucocorticoid treatment. In summary, our studies have identified molecular components in a glucocorticoid-controlled gene network involved in the regulation of TG homeostasis in adipocytes. Understanding the regulation of this gene network should provide important insight for future therapeutic developments for metabolic diseases

Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials

Background: Statin therapy has been shown to reduce major vascular events and vascular mortality in a wide range of individuals, but there is uncertainty about its efficacy and safety among older people. We undertook a meta-analysis of data from all large statin trials to compare the effects of statin therapy at different ages. Methods: In this meta-analysis, randomised trials of statin therapy were eligible if they aimed to recruit at least 1000 participants with a scheduled treatment duration of at least 2 years. We analysed individual participant data from 22 trials (n=134 537) and detailed summary data from one trial (n=12 705) of statin therapy versus control, plus individual participant data from five trials of more intensive versus less intensive statin therapy (n=39 612). We subdivided participants into six age groups (55 years or younger, 56–60 years, 61–65 years, 66–70 years, 71–75 years, and older than 75 years). We estimated effects on major vascular events (ie, major coronary events, strokes, and coronary revascularisations), cause-specific mortality, and cancer incidence as the rate ratio (RR) per 1·0 mmol/L reduction in LDL cholesterol. We compared proportional risk reductions in different age subgroups by use of standard χ2 tests for heterogeneity when there were two groups, or trend when there were more than two groups. Findings: 14 483 (8%) of 186 854 participants in the 28 trials were older than 75 years at randomisation, and the median follow-up duration was 4·9 years. Overall, statin therapy or a more intensive statin regimen produced a 21% (RR 0·79, 95% CI 0·77–0·81) proportional reduction in major vascular events per 1·0 mmol/L reduction in LDL cholesterol. We observed a significant reduction in major vascular events in all age groups. Although proportional reductions in major vascular events diminished slightly with age, this trend was not statistically significant (ptrend=0·06). Overall, statin or more intensive therapy yielded a 24% (RR 0·76, 95% CI 0·73–0·79) proportional reduction in major coronary events per 1·0 mmol/L reduction in LDL cholesterol, and with increasing age, we observed a trend towards smaller proportional risk reductions in major coronary events (ptrend=0·009). We observed a 25% (RR 0·75, 95% CI 0·73–0·78) proportional reduction in the risk of coronary revascularisation procedures with statin therapy or a more intensive statin regimen per 1·0 mmol/L lower LDL cholesterol, which did not differ significantly across age groups (ptrend=0·6). Similarly, the proportional reductions in stroke of any type (RR 0·84, 95% CI 0·80–0·89) did not differ significantly across age groups (ptrend=0·7). After exclusion of four trials which enrolled only patients with heart failure or undergoing renal dialysis (among whom statin therapy has not been shown to be effective), the trend to smaller proportional risk reductions with increasing age persisted for major coronary events (ptrend=0·01), and remained non-significant for major vascular events (ptrend=0·3). The proportional reduction in major vascular events was similar, irrespective of age, among patients with pre-existing vascular disease (ptrend=0·2), but appeared smaller among older than among younger individuals not known to have vascular disease (ptrend=0·05). We found a 12% (RR 0·88, 95% CI 0·85–0·91) proportional reduction in vascular mortality per 1·0 mmol/L reduction in LDL cholesterol, with a trend towards smaller proportional reductions with older age (ptrend=0·004), but this trend did not persist after exclusion of the heart failure or dialysis trials (ptrend=0·2). Statin therapy had no effect at any age on non-vascular mortality, cancer death, or cancer incidence. Interpretation: Statin therapy produces significant reductions in major vascular events irrespective of age, but there is less direct evidence of benefit among patients older than 75 years who do not already have evidence of occlusive vascular disease. This limitation is now being addressed by further trials. Funding: Australian National Health and Medical Research Council, National Institute for Health Research Oxford Biomedical Research Centre, UK Medical Research Council, and British Heart Foundation

A comprehensive high cost drugs dataset from the NHS in England - An OpenSAFELY-TPP Short Data Report

Background: At the outset of the COVID-19 pandemic, there was no routine comprehensive hospital medicines data from the UK available to researchers. These records can be important for many analyses including the effect of certain medicines on the risk of severe COVID-19 outcomes. With the approval of NHS England, we set out to obtain data on one specific group of medicines, “high-cost drugs” (HCD) which are typically specialist medicines for the management of long-term conditions, prescribed by hospitals to patients. Additionally, we aimed to make these data available to all approved researchers in OpenSAFELY-TPP. This report is intended to support all studies carried out in OpenSAFELY-TPP, and those elsewhere, working with this dataset or similar data. Methods: Working with the North East Commissioning Support Unit and NHS Digital, we arranged for collation of a single national HCD dataset to help inform responses to the COVID-19 pandemic. The dataset was developed from payment submissions from hospitals to commissioners. Results: In the financial year (FY) 2018/19 there were 2.8 million submissions for 1.1 million unique patient IDs recorded in the HCD. The average number of submissions per patient over the year was 2.6. In FY 2019/20 there were 4.0 million submissions for 1.3 million unique patient IDs. The average number of submissions per patient over the year was 3.1. Of the 21 variables in the dataset, three are now available for analysis in OpenSafely-TPP: Financial year and month of drug being dispensed; drug name; and a description of the drug dispensed. Conclusions: We have described the process for sourcing a national HCD dataset, making these data available for COVID-19-related analysis through OpenSAFELY-TPP and provided information on the variables included in the dataset, data coverage and an initial descriptive analysis.</ns4:p