Opportunities and challenges in personalized MOOC experience

To provide MOOC participants with efficient learning resources and feedback according to the unique needs of each learner is obvious a greater challenge. In this paper, we describe the top five challenges that have the power to hinder the overall personalize MOOC experience. In addition to that, we suggest new opportunities considering individual differences in order to support personalized MOOC experienc

Análisis de clúster de perspectivas de participantes en MOOC

Els cursos en línia massius i oberts (Massive Open Online Courses, MOOC) proporcionen oportunitats il·limitades per a la participació de milers d’estudiants en cursos d’ensenyament superior en línia. Els MOOC tenen característiques úniques que els converteixen en un mètode efectiu de l’aprenentatge electrònic, en concret l’aprenentatge millorat per tecnologia (Technology-Enhanced Learning, TEL). Nombroses institucions ofereixen una creixent varietat de MOOC. No obstant això, existeixen múltiples reptes que han ser considerats en desenvolupar MOOC, per exemple, la taxa d’abandonament de participants en els cursos és del 95%. Una de les possibles raons és la complexitat i la diversitat dels participants en els MOOC. Aquesta diversitat no està només relacionada amb el perfil demogràfic i cultural, sinó també amb els diversos motius i perspectives que els usuaris tenen en inscriure’s en MOOC. La intenció d’aquest article és agrupar en clústers els objectius dels participants en MOOC i analitzar-los per aconseguir una millor comprensió dels seus comportaments. El principal resultat és el descobriment de vuit clústers: aprenentatge mesclat (blended learning), flexibilitat (flexibility), contingut d’alta qualitat (high quality content), disseny instruccional i metodologies d’aprenentatge (instructional design & learning methodologies), aprenentatge al llarg de la vida (lifelong learning), aprenentatge en xarxa (network learning), obertura (openness) i aprenentatge centrat en l’estudiant (student-centered learning). Aquest esquema d’agrupament en clústers crea una visió significativa per a la comunitat de participants en MOOC.Massive Open Online Courses (MOOCs) are providing opportunities for thousands of learners to participate in free higher education courses online. MOOCs have unique features that make them an effective Technology-Enhanced Learning (TEL) approach. Institutions are offering a growing variety of MOOCs. Nevertheless, there are several crucial challenges that should be considered in the development of MOOCs, e.g., the drop-out rate of over 95% of course participants. One of the potential reasons for that is the complexity and diversity of MOOC participants. This diversity is not only related to the cultural and demographic profile, but also considers the diverse motives and perspectives when enrolled in MOOCs. This paper aims to cluster and analyze the different objectives of MOOC stakeholders to build a deeper and better understanding of their behaviors. Our main finding was a set of eight clusters, i.e., blended learning, flexibility, high quality content, instructional design and learning methodologies, lifelong learning, network learning, openness, and student-centered learning. This cluster schema creates a meaningful picture for the MOOC community.Los cursos en línea masivos y abiertos (Massive Open Online Courses, MOOC) proporcionan oportunidades ilimitadas para la participación de miles de estudiantes en cursos de enseñanza superior en línea. Los MOOC tienen características únicas que los convierten en un método efectivo del aprendizaje electrónico, en concreto el aprendizaje mejorado por tecnología (Technology-Enhanced Learning, TEL). Numerosas instituciones ofrecen una creciente variedad de MOOC. Sin embargo, existen múltiples retos que deben ser considerados al desarrollar MOOC, por ejemplo, la tasa de abandono de participantes en los cursos es del 95%. Una de las posible razones para ello es la complejidad y la diversidad de los participantes en los MOOC. Esta diversidad no está solamente relacionada con el perfil demográfico y cultural, sino también con los diversos motivos y perspectivas que los usuarios tienen al inscribirse en MOOC. La intención de este artículo es agrupar en clústeres los objetivos de los participantes en MOOC y analizarlos para lograr una mayor comprensión de sus comportamientos. El principal resultado es el descubrimiento de ocho clústeres: aprendizaje mezclado (blended learning), flexibilidad (flexibility), contenido de alta calidad (high quality content), diseño instruccional y metodologías de aprendizaje (instructional design & learning methodologies), aprendizaje a lo largo de la vida (lifelong learning), aprendizaje en red (network learning), apertura (openness) y aprendizaje centrado en el estudiante (student-centered learning). Este esquema de agrupamiento en clústeres crea una visión significativa para la comunidad de participantes en MOOC

Application of Bifidobacteria as Starter Culture in Whole Wheat Sourdough Breadmaking

11 pages, 4 tables, 2 figures.-- Published online: 3 March 2011.-- The original publication is available at www.springerlink.comThis investigation is aimed at developing a new cereal-based product, with increased nutritional quality, by using Bifidobacterium pseudocatenulatum ATCC 27919 as starter in whole wheat sourdough fermentation and evaluating its performance. Four different sourdough levels (5%, 10%, 15%, and 20% on flour basis) in bread dough formulation were analysed. The effects of the use of bifidobacteria in sourdough bread were comparatively evaluated with controls (yeast and/or chemically acidified sourdough with antibiotics). The sourdough and dough fermentative parameters analysed were pH, total titratable acidity, d/l-lactic and acetic acids. Bread performance was evaluated by specific volume, slice shape, crumb structure and firmness, crust and crumb colour, pH, total titratable acidity, and d/l-lactic and acetic acids, phytate, and lower myo-inositol phosphate contents. The sourdough breads showed similar technological quality to the control sample, with the exception of specific bread volume (decreased from 2.46 to 2.22 mL/g) and crumb firmness (increased from 2.61 to 3.18 N). Sourdough inoculated with bifidobacteria significantly increased the levels of organic acids in fermented dough and bread. The Bifidobacterium strain contributed to the fermentation process, increasing phytate hydrolysis during fermentation owing to the activation of endogenous cereal phytase and its own phytase, resulting in bread with significantly lower phytate levels (from 7.62 to 1.45 μmol/g of bread in dry matter). The inclusion of sourdough inoculated with bifidobacteria made possible the formulation of whole wheat bread with positive changes in starch thermal properties and a delay and decrease in amylopectin retrogradation.This work was financially supported by grants AGL2006-09613/ALI, CSIC-200870I229, and Consolider Fun-C-Food CSD2007-00063 from the Ministry of Science and Innovation, Spain (MICINN). The scholarship of J.M. Sanz Penella and the contract of J.A. Tamayo Ramos from MICINN are greatly acknowledged.Peer reviewe

MAT-725: SELF LEVELING MORTAR: WHY AND HOW?

Concrete floors can develop faults over time which can cause damage thus hindering smooth transportation, industrial aspects and some residential drawbacks. In addition, flaws and cracks are known to progress into more serious damage with time and use. Self leveling mortar has been used on a relatively limited scale worldwide to allow for more even, higher performance and easy-to-apply flooring. However, there has been little information available with respect to their use and best practices. The primary focus of this work is to prepare mortar that possesses self-levelling flow characteristics. Hence, several mixtures have been designed using various constituents with moderate 28-day strength of 35 MPa. Chemical and mineral admixtures have been incorporated together with limestone to enhance the flow and cohesiveness as well as improve performance. The results reveal that self-levelling mortar can be successfully produced with comparable properties to ready-to-use market product. These mixtures were evaluated to have both performance and economic merits

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Effective design of blended MOOC environments in higher education

Over the past five years, Massive Open Online Courses (MOOCs) have a remarkable ability to expand access to a large scale of participants worldwide to attend free online courses, beyond the formality of the higher education systems. MOOCs have unique features that support a movement toward a vision of lifelong and on-demand learning for those who are working full time or have taken a break from formal education. Despite their popularity and the large scale participation, a variety of concerns and criticism in the use of MOOCs have been raised. The original concept of MOOCs that aims at breaking down obstacles to education for anyone, anywhere and at any time is far away from the reality. In fact, most MOOC implementations so far still follow a top-down, controlled, teacher-centered, and centralized learning model. Endeavors to implement bottom-up, student-centered, truly open, decentralized, and distributed forms of MOOCs are exceptions rather than the rule. Moreover, the lack of human interaction is the major limitation of the existing MOOCs. Other limitations of MOOCs include pedagogical problems concerning assessment and feedback, the lack of interactivity around the video content, as well as the complexity and diversity of MOOC participants. Furthermore, a major problem with MOOCs is the ignorance of the importance and benefits of face-to-face communication. These limitations raise some serious concerns on what role MOOCs should play, or how they should fit into the higher education landscape as an alternative model of teaching and learning and a substantial supplement.Therefore, the aim of this dissertation is to shine new light to address these limitations. The new design paradigm of blended MOOCs (bMOOCs) that aim at bringing in-class (i.e. face-to-face) interactions and online learning components together as a blended environment can resolve some of the hurdles facing standalone MOOCs. In fact, the bMOOCs model has the potential to foster student-centered learning, provide effective assessment and feedback, support the interactive design of the video lectures, consider the different patterns of participants in the MOOC, as well as bring the benefits of face-to-face interactions into the MOOC environment.This dissertation followed the case study research methodology and the user-centered design approach, in order to design, implement, and evaluate the L²P-bMOOC platform. The main contributions are: a theoretical framework that compile and analyze the accumulated literature that has been conducted on Video-Based Learning and MOOCs between 2008 and 2015, a cluster of different patterns of MOOC stakeholders to build a deeper and better understanding of their behaviors, a design dimension and criteria catalogue for effective bMOOC environments, the conceptualization and implementation of the L²P-bMOOC platform, an evaluation procedure for usability and effectiveness of bMOOCs, and opportunities for future work in the area of bMOOCs