Enhancing reflective learning experiences in museums through interactive installations

In this study we examine the effect that several technological affordances have upon the experiences of children while visiting a museum, focusing upon engagement, discussion and reflection. The museum is the Baba Nyonya Heritage Museum in Malacca, Malaysia. We created a number of public interactive installations designed to facilitate inter-cultural and inter-generational dialogues about cultural identity. The technology employed mixed and augmented reality techniques and gesture recognition to enable visitors to have a multisensory experience with the artefacts on display. Analysis of pre- to post-test knowledge based surveys showed significant learning gains as a result of interacting with the exhibits. Surveys of visitors’ attitudes showed that they felt they had benefitted from the physical interactivity. Qualitative analysis of observational and video data showed that the different interaction techniques provided both benefits and challenges for interaction, which we reflect upon in the paper

The agency role of simulation models in model-building groups

Simulation models, in particular System Dynamics (SD) models, can be used in a group modelling setting to communicate, integrate, learn, collaborate, organize knowledge and derive new insights. Such models can play the roles of conceptual integrators, representations, learning or predictive tools. In this ethnographic study of two in-depth SD group modelling projects we discovered that SD models can be active agents in the group-model building process by initiating cognitive transition on participants’ (model and case based) modes of reasoning. We found that the cognitive transition was achieved through a series of surprises or shocks that refuted participants’ prior conceptions and forced them to switch between case-based and model-based reasoning during the model-building process. Based on these insights, we present a framework that describes how simulation models change the mode of reasoning in group modelling project and explains the model’s agency role. The study addresses the calls from earlier OR articles to contribute with more case studies using an ethnographic method looking into simulation artefact agency

Variation in dissolved organic matter (DOM) stoichiometry in UK freshwaters:Assessing the influence of land cover and soil C:N ratio on DOM composition

Dissolved organic matter (DOM) plays an important role in freshwater biogeochemistry. To investigate the influence of catchment character on the quality and quantity of DOM in freshwaters, forty-five sampling sites draining subcatchments of contrasting soil type, hydrology and land cover within one large upland-dominated and one large lowland-dominated catchment, were sampled over a one-year period. Dominant land cover in each subcatchment included: arable and horticultural, blanket peatland, coniferous woodland, improved-, unimproved-, acid- and calcareous-grasslands. The composition of the C, N, and P pool was determined as a function of the inorganic nutrient species (NO3-, NO2-, NH4+, PO43-) and dissolved organic nutrient (DOC, DON and DOP) concentrations. DOM quality was assessed by calculation of the molar DOC:DON and DOC:DOP ratios and specific ultraviolet absorbance (SUVA254). In catchments with little anthropogenic nutrient inputs, DON and DOP typically comprised >80% of the TDN and TDP concentrations. By contrast, in heavily impacted agricultural catchments DON and DOP typically comprised 5-15% of TDN and 10-25% of TDP concentrations. Significant differences in DOC:DON and DOC:DOP ratios were observed between land cover class with significant correlations observed between both the DOC:DON and DOC:DOP molar ratios and SUVA254 (rs = 0.88 and 0.84, respectively). Analysis also demonstrated a significant correlation between soil C:N ratio and instream DOC:DON/DOP (rs = 0.79 and 0.71 respectively). We infer from this that soil properties, specifically the C:N ratio of the soil organic matter pool, has a significant influence on the composition of DOM in streams draining through these landscapes

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570