Case-Based Collaborative Learning in Undergraduate Radiology Teaching-Are Essential Conditions for Group Discussions Met?

BACKGROUND: Delivering case-based collaborative learning (cCBL) at scale using technology that both presents the clinical problem authentically and seeks to foster quality group discussion is a challenge, especially argumentation which is critical for effective learning. The aim of this study was to investigate the presence of essential conditions to capitalize on a technology-enhanced cCBL scenario for teaching radiology and facilitating quality group discussion. METHODS: A questionnaire was administered to 114 fourth-year medical students who completed a technology-enhanced cCBL scenario for teaching neuroradiology. It consisted of individual online pre-class work and face-to-face in-class work, where group discussion followed individual work at a workstation. Items from the "Heedful Interrelating in Collaborative Educational Settings" scale and "positive emotional engagement" questionnaire assessed the quality of social-cognitive processes and emotional engagement during the group discussions. Structured interviews were used to explore the teachers' awareness of and engagement with the technology. RESULTS: The mean scores of most "heedfulness" items were below 3.5 (7-point scale), suggesting that participants did not enter the debriefing with a mindset conducive for argumentation. However, for the affective states "interest" and "enjoyment" the mean scores were above 5. Free text comments suggested participants enjoyed the superficial interactions, but did not necessarily engage in argumentation. Structured interviews revealed teachers were aware of the possibilities of the learning dashboard and used it as a common frame of reference, but did not really succeed to use it as a springboard for discussion. CONCLUSION: A technology-enhanced cCBL scenario is useful for teaching radiology in undergraduate medical education, but the added value of acquiring in-depth knowledge will only be achieved when students are aware of the importance of an "heedful" mind-set

Towards an Integrated Online Learning System for Microscopic Pathology: Two Teaching Examples

Microscopy is an essential basis for exploring and understanding pathological disease mechanisms. As a discipline, pathology is highly dependent on visual imaging technologies. Currently, digital pathology is a standard method with special advantages in both clinical histopathological diagnostics as well as the education of (undergraduate and postgraduate) medical students and pathology residents. However, to date, the available digital applications lack features to optimally support online collaborative learning and teaching of histopathology, such as possibilities for learners to individually perform tasks (e.g. annotate) on digital slides, opportunities for groups to reflect on their work and to receive feedback from more knowledgeable peers or supervisors. Such shortcomings have recently become more imminent, due to shifts toward more online learning in pathology education. Therefore, the cLovid (collaborative learning of viewing and decision-making skills) project set out to build an integrated online learning system featuring • an open-source webmicroscope (an extension to the OMERO viewer) with enhanced features for annotating whole-slide images, allowing integration with assessment and feedback software; • an online assessment software—e.g., VQuest, in our design—for constructing assignments using various types of responses (e.g. marker questions, which are ideal for visual domains), suitable for developing image interpretation skills through active learning with large images • an open-source software dashboard (PRISMA) for synthesizing and visualizing students’ responses in tasks using various types of responses, allowing teachers to provide collective feedback to groups of students, as well as a joint platform for communication for both on-site and remote settings. Subsequently, the project team carried out two teaching pilots to demonstrate how this system can be used for teaching with guided activity, collaboration, feedback, reflection and possibilities for the teachers to model diagnostic reasoning. The teaching examples involved the pathology curriculum of second-year undergraduate medical students (N=70) in two European universities and the training of pathology residents (N=16) in Finland. In this paper, we present the development of the integrated system for online teaching and learning of histopathology and exemplify its use in the two scenarios. Lessons learned from the teaching pilots will be discussed

Constraints to Economic Development and Growth in the Middle East and North Africa

When comparing the speed and extent of economic development in different geographic regions of the world over the past 20 years, the under-average performance of Arab countries in general and Arab Mediterranean countries in particular is striking. This is despite an overall favorable geo-strategic situation at the crossroads of three continents, with excellent connections to sea and waterways and in direct proximity to the European Union, one of the world’s economic hubs. It is also despite the minor importance of negative factors such as a high-burden diseases or high levels of ethnic fractionalization. In this paper, I focus on identifying the most important constraints on Arab Mediterranean economic development. I use state-of-the-art econometric tools to quantify constraints that have been identified through economic theory and studies of the political economy characteristics of the region. The empirical results offer support for the central hypothesis that limited technological capacities and political economy structures are the primary constraints on economic development. With a view to international structural adjustment efforts, my findings imply that the limited success of the Euro-Mediterranean policy to stimulate the economic development of the Arab Mediterranean countries might be because structural adjustment efforts do not tackle—or at least do not sufficiently tackle— these constraints.Vergleicht man Geschwindigkeit und Umfang der wirtschaftlichen Entwicklung der verschiedenen Weltregionen in den vergangenen zwanzig Jahren, so fällt insbesondere das unterdurchschnittliche Abschneiden der arabischen Länder im Allgemeinen und der arabischen Mittlemeerländer im Besonderen ins Auge, und dies trotz einer insgesamt vorteilhaften geographischen Lage im Schnittpunkt dreier Kontinente mit exzellenten Anschlussmöglichkeiten an See- und Wasserwege, trotz der direkten Nachbarschaft zum Weltwirtschaftsdrehkreuz Europäische Union und trotz der relativ geringen Bedeutung wichtiger entwicklungshemmender Faktoren, beispielsweise ethnische Zersplitterung oder massive Ausbreitung von Krankheiten wie AIDS oder Malaria. In diesem Aufsatz wird versucht, von den unterschiedlichen Hemmfaktoren wirtschaftlicher Entwicklung, die in der wirtschaftstheoretischen Literatur und/oder in MENARegionalstudien diskutiert werden, diejenigen herauszuarbeiten, die wirtschaftliche Entwicklung am stärksten behindern oder möglicherweise stärker als andere. Dabei benutze ich modernste ökonometrische Verfahren, um den Einfluss der verschiedenen erklärenden Variablen zu quantifizieren. Die Ergebnisse stützen die Eingangshypothese, dass insbesondere mangelnde technologische Kapazitäten und Fähigkeiten sowie regionalspezifische politökonomische Strukturen die wirtschaftliche Entwicklung in den arabischen Mittelmeerländern behindern

Camostat Mesylate Versus Lopinavir/Ritonavir in Hospitalized Patients With COVID-19—Results From a Randomized, Controlled, Open Label, Platform Trial (ACOVACT)

Background: To date, no oral antiviral drug has proven to be beneficial in hospitalized patients with COVID-19.Methods: In this randomized, controlled, open-label, platform trial, we randomly assigned patients ≥18 years hospitalized with COVID-19 pneumonia to receive either camostat mesylate (CM) (considered standard-of-care) or lopinavir/ritonavir (LPV/RTV). The primary endpoint was time to sustained clinical improvement (≥48 h) of at least one point on the 7-category WHO scale. Secondary endpoints included length of stay (LOS), need for mechanical ventilation (MV) or death, and 29-day mortality.Results: 201 patients were included in the study (101 CM and 100 LPV/RTV) between 20 April 2020 and 14 May 2021. Mean age was 58.7 years, and 67% were male. The median time from symptom onset to randomization was 7 days (IQR 5–9). Patients in the CM group had a significantly shorter time to sustained clinical improvement (HR = 0.67, 95%-CI 0.49–0.90; 9 vs. 11 days, p = 0.008) and demonstrated less progression to MV or death [6/101 (5.9%) vs. 15/100 (15%), p = 0.036] and a shorter LOS (12 vs. 14 days, p = 0.023). A statistically nonsignificant trend toward a lower 29-day mortality in the CM group than the LPV/RTV group [2/101 (2%) vs. 7/100 (7%), p = 0.089] was observed.Conclusion: In patients hospitalized for COVID-19, the use of CM was associated with shorter time to clinical improvement, reduced need for MV or death, and shorter LOS than the use of LPV/RTV. Furthermore, research is needed to confirm the efficacy of CM in larger placebo-controlled trials.Systematic Review Registration: [https://clinicaltrials.gov/ct2/show/NCT04351724, https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-001302-30/AT], identifier [NCT04351724, EUDRACT-NR: 2020–001302-30]

Sectoral Transformations in Neo-Patrimonial Rentier States: Tourism Development and State Policy in Egypt

This article challenges claims that liberalising state regulated markets in developing countries may induce lasting economic development. The analysis of the rise of tourism in Egypt during the last three decades suggests that the effects of liberalisation and structural adjustment are constrained by the neo-patrimonial character of the Egyptian political system. Since the decline of oil rent revenues during the 1980s tourism development was the optimal strategy to compensate for the resulting fiscal losses. Increasing tourism revenues have helped in coping with macroeconomic imbalances and in avoiding more costly adjustment of traditional economic sectors. Additionally, they provided the private elite with opportunities to generate large profits. Therefore, sectoral transformations due to economic liberalisation in neo-patrimonial Rentier states should be described as a process, which has led to the diversification of external rent revenues, rather than to a general downsizing of the Rentier character of the economy