The use of computer-based assessments in a field biology module

Formative computer-based assessments (CBAs) for self-instruction were introduced into a Year-2 field biology module. These CBAs were provided in ‘tutorial’ mode where each question had context-related diagnostic feedback and tutorial pages, and a self-test mode where the same CBA returned only a score. The summative assessments remained unchanged and consisted of an unseen CBA and written reports of field investigations. When compared with the previous three year-cohorts, the mean score for the summative CBA increased after the introduction of formative CBAs, whereas mean scores for written reports did not change. It is suggested that the increase in summative CBA mean score reflects the effectiveness of the formative CBAs in widening the students’ knowledge base. Evaluation of all assessments using an Assessment Experience Questionnaire indicated that they satisfied the ‘11 conditions under which assessment supports student learning’. Additionally, evidence is presented that the formative CBAs enhanced self-regulated student learning

Learning support for mature, part-time, evening students: providing feedback via frequent, computer-based assessments

A new module in our first year Biology curriculum was used as a vehicle to test strategies for improving learning support. To this end, we have administered frequent CBA, incorporating extensive feedback, both to pace the students’ study efforts and to pinpoint areas in which additional help from lecturers may be required. Three of the 7 CBA provided through the 15-week course were initially given as open-book summative tests, thus contributing to the overall mark for the module. Other CBA were formative: these included repeats of the summative CBA made available for revision purposes, as well as other CBA which focused mainly on aspects of the course that were summatively assessed by other means. A closedbook final exam, also computer-based, was given in the final week as a comprehensive assessment. We have evaluated the utility and effectiveness of our approach by surveying student opinion via questionnaires, examining patterns and extent of student use of formative assessments, and by analysing grades for the summative CBA. We have found the students’ perceptions of the approach to be largely positive and that the formative CBA were well-used, especially as revision aids for the final exam. Our analysis further indicates that the style of the assessments may have been especially helpful to students whose first language is not English

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Learning Support for Mature, Part-Time, Evening Students: Providing Feedback via Frequent, Computer-Based Assessments

A new module in our first year Biology curriculum was used as a vehicle to test strategies for improving learning support. To this end, we have administered frequent CBA, incorporating extensive feedback, both to pace the students&apos; study efforts and to pinpoint areas in which additional help from lecturers may be required. Three of the 7 CBA provided through the 15-week course were initially given as open-book summative tests, thus contributing to the overall mark for the module. Other CBA were formative: these included repeats of the summative CBA made available for revision purposes, as well as other CBA which focused mainly on aspects of the course that were summatively assessed by other means. A closedbook final exam, also computer-based, was given in the final week as a comprehensive assessment. We have evaluated the utility and effectiveness of our approach by surveying student opinion via questionnaires, examining patterns and extent of student use of formative assessments, and by analysing grades for the summative CBA. We have found the students&apos; perceptions of the approach to be largely positive and that the formative CBA were well-used, especially as revision aids for the final exam. Our analysis further indicates that the style of the assessments may have been especially helpful to students whose first language is not English

The effects of intracellular signalling pathway inhibitors on phagocytosis by haemocytes of Manduca sexta

The intracellular signalling pathways activated during phagocytosis by larval haemocytes of a lepidopteran, Manduca sexta, were investigated. Using fluorescein-labelled Escherichia coli as bioparticles, a fluorescence-based assay was used to quantify phagocytosis by haemocytes in monolayers in vitro, and the intracellular signalling pathways involved in phagocytosis were examined using inhibitors. Pathways known to be involved in phagocytosis by mammalian cells were selected for the study in haemocytes, and the amino acid sequences of human isoforms of the selected protein targets were used to conduct searches of two completed databases of insect proteins, those of Drosophila melanogaster and Anopheles gambiae and EST databases of moths Bombyx mori and M. sexta. Decreases in phagocytosis produced by pathway inhibitors indicated that tyrosine phosphorlylation phosphatidylinositol 3-kinase (PI3-kinase) and mitogen-activated protein kinase/extracellular-regulated kinase (ERK/MAPK) were required for internalisation of bacteria. Inhibition of Syk, a mammalian kinase, also decreased phagocytosis. JNK/SAPK did not seem to be involved in phagocytosis. The presence of protein phosphatases probably regulates phagocytosis at the intracellular level by dephosphorlyation of serine/threonine residues

Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection

BackgroundEnd colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection.MethodsThis study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model.ResultsIn total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P &lt; 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P &lt; 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P &lt; 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P &lt; 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P &lt; 0·001).ConclusionGlobal differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone