Content and discontent: a qualitative exploration of obstacles to elearning engagement in medical students

BACKGROUND: Elearning is ubiquitous in healthcare professions education. Its equivalence to ‘traditional’ educational delivery methods is well established. There is a research imperative to clarify when and how to use elearning most effectively to mitigate the potential of it becoming merely a ‘disruptive technology.’ Research has begun to broadly identify challenges encountered by elearning users. In this study, we explore in depth the perceived obstacles to elearning engagement amongst medical students. Sensitising concepts of achievement emotions and the cognitive demands of multi-tasking highlight why students’ deeply emotional responses to elearning may be so important in their learning. METHODS: This study used focus groups as a data collection tool. A purposeful sample of 31 participated. Iterative data gathering and analysis phases employed a constant comparative approach to generate themes firmly grounded in participant experience. RESULTS: Key themes that emerged from the data included a sense of injustice, passivity and a feeling of being ‘lost at sea’. The actual content of the elearning resource provided important context. CONCLUSIONS: The identified themes have strong emotional foundations. These responses, interpreted through the lens of achievement emotions, have not previously been described. Appreciation of their importance is of benefit to educators involved in curriculum development or delivery. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12909-016-0710-5) contains supplementary material, which is available to authorized users

Outcome reporting bias in Cochrane systematic reviews: a cross-sectional analysis

Background Discrepancies in outcome reporting (DOR) between protocol and published studies include inclusions of new outcomes, omission of prespecified outcomes, upgrade and downgrade of secondary and primary outcomes, and changes in definitions of prespecified outcomes. DOR can result in outcome reporting bias (ORB) when changes in outcomes occur after knowledge of results. This has potential to overestimate treatment effects and underestimate harms. This can also occur at the level of systematic reviews when changes in outcomes occur after knowledge of results of included studies. The prevalence of DOR and ORB in systematic reviews is unknown in systematic reviews published post-2007. Objective To estimate the prevalence of DOR and risk of ORB in all Cochrane reviews between the years 2007 and 2014. Methods A stratified random sampling approach was applied to collect a representative sample of Cochrane systematic reviews from each Cochrane review group. DOR was assessed by matching outcomes in each systematic review with their respective protocol. When DOR occurred, reviews were further assessed if there was a risk of ORB (unclear, low or high risk). We classified DOR as a high risk for ORB if the discrepancy occurred after knowledge of results in the systematic review. Results 150 of 350 (43%) review and protocol pairings contained DOR. When reviews were further scrutinised, 23% (35 of 150) of reviews with DOR contained a high risk of ORB, with changes being made after knowledge of results from individual trials. Conclusions In our study, we identified just under a half of Cochrane reviews with at least one DOR. Of these, a fifth were at high risk of ORB. The presence of DOR and ORB in Cochrane reviews is of great concern; however, a solution is relatively simple. Authors are encouraged to be transparent where outcomes change and to describe the legitimacy of changing outcomes in order to prevent suspicion of bias

Defective axonal transport in motor neuron disease

Several recent studies have highlighted the role of axonal transport in the pathogenesis of motor neuron diseases. Mutations in genes that control microtubule regulation and dynamics have been shown to cause motor neuron degeneration in mice and in a form of human motor neuron disease. In addition, mutations in the molecular motors dynein and kinesins and several proteins associated with the membranes of intracellular vesicles that undergo transport cause motor neuron degeneration in humans and mice. Paradoxically, evidence from studies on the legs at odd angles (Loa) mouse and a transgenic mouse model for human motor neuron disease suggest that partial limitation of the function of dynein may in fact lead to improved axonal transport in the transgenic mouse, leading to delayed disease onset and increased life span

Long-Term Exercise in Older Adults: 4-Year Outcomes of Music-Based Multitask Training

Prospective controlled evidence supporting the efficacy of long-term exercise to prevent physical decline and reduce falls in old age is lacking. The present study aimed to assess the effects of long-term music-based multitask exercise (i.e., Jaques-Dalcroze eurhythmics) on physical function and fall risk in older adults. A 3-year follow-up extension of a 1-year randomized controlled trial (NCT01107288) was conducted in Geneva (Switzerland), in which 134 community-dwellers aged ≥65years at increased risk of falls received a 6-month music-based multitask exercise program. Four years following original trial enrolment, 52 subjects (baseline mean±SD age, 75±8years) who (i) have maintained exercise program participation through the 4-year follow-up visit ("long-term intervention group”, n=23) or (ii) have discontinued participation following original trial completion ("control group”, n=29) were studied. They were reassessed in a blind fashion, using the same procedures as at baseline. At 4years, linear mixed-effects models showed significant gait (gait speed, P=0.006) and balance (one-legged stance time, P=0.015) improvements in the long-term intervention group, compared with the control group. Also, long-term intervention subjects did better on Timed Up & Go, Five-Times-Sit-to-Stand and handgrip strength tests, than controls (P<0.05, for all comparisons). Furthermore, the exercise program reduced the risk of falling (relative risk, 0.69; 95% confidence interval, 0.5-0.9; P=0.008). These findings suggest that long-term maintenance of a music-based multitask exercise program is a promising strategy to prevent age-related physical decline in older adults. They also highlight the efficacy of sustained long-term adherence to exercise for falls prevention

Study of amorphous dielectric optical coatings deposited by plasma ion assisted electron beam evaporation for gravitational wave detectors

Coating thermal noise (CTN) in amorphous coatings is a drawback hindering their application in precision experiments such as gravitational wave detectors (GWDs). Mirrors for GWDs are Bragg’s reflectors consisting of a bilayer-based stack of high- and low-refractive-index materials showing high reflectivity and low CTN. In this paper, we report the characterization of morphological, structural, optical, and mechanical properties of high-index materials such as scandium sesquioxide and hafnium dioxide and a low-index material such as magnesium fluoride deposited by plasma ion-assisted electron beam evaporation. We also evaluate their properties under different annealing treatments and discuss their potential for GWDs

Mirror coating solution for the cryogenic Einstein telescope

Planned, cryogenic gravitational-wave detectors will require improved coatings with a strain thermal noise reduced by a factor of 25 compared to Advanced LIGO. In this article, we present investigations of HfO2 doped with SiO2 as a new coating material for future detectors. Our measurements show an extinction coefficient of k=6×10−6 and a mechanical loss of ϕ=3.8×10−4 at 10,K, which is a factor of 2 below that of SiO2, the currently used low refractive-index coating material. These properties make HfO2 doped with SiO2 ideally suited as a low-index partner material for use with a-Si in the lower part of a multimaterial coating. Based on these results we present a multimaterial coating design which, for the first time, can simultaneously meet the strict requirements on optical absorption and thermal noise of the cryogenic Einstein Telescope

Understanding the health-related quality of life and treatment-related side-effects in patients who have been in remission from testicular cancer for 12–24 months

IntroductionDespite the excellent long-term prognosis after treatment for testicular cancer (TCa), therapy-related side effects can be persistent and severe. The aim of this study was to determine the nature and prevalence of post-treatment symptoms and their impact on health-related quality of life (HRQoL) in TCa patients 12 to 24 months after treatment.Materials and methodsCross-sectional, single-center study. All patients who were aged 18 and over, had completed TCa treatment 12–24 months previously and had no evidence of disease recurrence were considered eligible. Participants were stratified into four groups: 1) orchidectomy only; 2) orchidectomy and single dose adjuvant carboplatin; 3) multi-agent induction chemotherapy (CBOP-BEP, BEPx3 or x4, or Epx4 regimens); and 4) post-chemo retroperitoneal lymph node dissection (PC-RPLND). Eligible patients were asked to complete the EQ-5D-5L questionnaire and the EORTC QLQ-TC26 questionnaire. We performed a thematic analysis of free-text commentary to evaluate the sensitivity of PROMs used across the treatment groups. Descriptive results were reported. For categorical variables, numbers and percentages were used, and for continuous variables median and IQR values were used.ResultsThe EQ-5D-5L questionnaire showed that patients treated with orchidectomy only and orchidectomy and adjuvant carboplatin experienced only minor physical medium- to long-term side-effects. In contrast, more intensive treatment regimens, such as multi-agent chemotherapy or PC-RPLND, were associated with a higher burden of medium- to long-term side-effects. Similar results were obtained with the EORTC QLQ-TC26 questionnaire.ConclusionsThis study reports the medium- to long-term HRQoL and side effects of TCa treatments, using both EQ-5D-5L and EORTC QLQ-TC26 questionnaires, and identifies possibly “unasked” questions from a patient perspective in relation to supportive care needs following TCa treatment. This information will help clinicians to better understand the consequences of treatment and in turn provide better patient counseling before treatment

Physical function endpoints in cancer cachexia clinical trials: Systematic Review 1 of the cachexia endpoints series

In cancer cachexia trials, measures of physical function are commonly used as endpoints. For drug trials to obtain regulatory approval, efficacy in physical function endpoints may be needed alongside other measures. However, it is not clear which physical function endpoints should be used. The aim of this systematic review was to assess the frequency and diversity of physical function endpoints in cancer cachexia trials. Following a comprehensive electronic literature search of MEDLINE, Embase and Cochrane (1990-2021), records were retrieved. Eligible trials met the following criteria: adults (≥18 years), controlled design, more than 40 participants, use of a cachexia intervention for more than 14 days and use of a physical function endpoint. Physical function measures were classified as an objective measure (hand grip strength [HGS], stair climb power [SCP], timed up and go [TUG] test, 6-min walking test [6MWT] and short physical performance battery [SPPB]), clinician assessment of function (Karnofsky Performance Status [KPS] or Eastern Cooperative Oncology Group-Performance Status [ECOG-PS]) or patient-reported outcomes (physical function subscale of the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaires [EORTC QLQ-C30 or C15]). Data extraction was performed using Covidence and followed PRISMA guidance (PROSPERO registration: CRD42022276710). A total of 5975 potential studies were examined and 71 were eligible. Pharmacological interventions were assessed in 38 trials (54%). Of these, 11 (29%, n = 1184) examined megestrol and 5 (13%, n = 1928) examined anamorelin; nutritional interventions were assessed in 21 trials (30%); and exercise-based interventions were assessed in 6 trials (8%). The remaining six trials (8%) assessed multimodal interventions. Among the objective measures of physical function (assessed as primary or secondary endpoints), HGS was most commonly examined (33 trials, n = 5081) and demonstrated a statistically significant finding in 12 (36%) trials (n = 2091). The 6MWT was assessed in 12 trials (n = 1074) and was statistically significant in 4 (33%) trials (n = 403), whereas SCP, TUG and SPPB were each assessed in 3 trials. KPS was more commonly assessed than the newer ECOG-PS (16 vs. 9 trials), and patient-reported EORTC QLQ-C30 physical function was reported in 25 trials. HGS is the most commonly used physical function endpoint in cancer cachexia clinical trials. However, heterogeneity in study design, populations, intervention and endpoint selection make it difficult to comment on the optimal endpoint and how to measure this. We offer several recommendations/considerations to improve the design of future clinical trials in cancer cachexia