Meta-analysis of the clinical performance of commercial SARS-CoV-2 nucleic acid and antibody tests up to 22 August 2020

Background: Reliable testing for SARS-CoV-2 is key for the management of the COVID-19 pandemic. Aim: We estimate diagnostic accuracy for nucleic acid and antibody tests 5 months into the COVID-19 pandemic, and compare with manufacturer-reported accuracy. Methods: We reviewed the clinical performance of SARS-CoV-2 nucleic acid and antibody tests based on 93,757 test results from 151 published studies and 20,205 new test results from 12 countries in the European Union and European Economic Area (EU/ EEA). Results: Pooling the results and considering only results with 95% confidence interval width ≤ 5%, we found four nucleic acid tests, including one pointof- care test and three antibody tests, with a clinical sensitivity ≥ 95% for at least one target population (hospitalised, mild or asymptomatic, or unknown). Nine nucleic acid tests and 25 antibody tests, 12 of them point-of-care tests, had a clinical specificity of ≥ 98%. Three antibody tests achieved both thresholds. Evidence for nucleic acid point-of-care tests remains scarce at present, and sensitivity varied substantially. Study heterogeneity was low for eight of 14 sensitivity and 68 of 84 specificity results with confidence interval width ≤ 5%, and lower for nucleic acid tests than antibody tests. Manufacturer-reported clinical performance was significantly higher than independently assessed in 11 of 32 and four of 34 cases, respectively, for sensitivity and specificity, indicating a need for improvement in this area. Conclusion: Continuous monitoring of clinical performance within more clearly defined target populations is needed.</p

A scoping review of the use of e-learning and e-consultation for healthcare workers in low- and middle-income countries and their potential complementarity

Objective: Although the provision of e-learning (EL) training for healthcare workers (HCWs) and provider-to-HCW e-consultation (EC) is considered useful for health outcomes, research on their joint use is limited. This scoping review aimed to create an overview of what is currently known in the literature about the use and implementation of EC and EL by HCWs in LMICs and to answer the question of whether there is evidence of complementarity. Materials and Methods: Scientific databases were searched and peer-reviewed papers were reviewed systematically according to predefined inclusion/exclusion criteria. Data were extracted including the study focus (EC/EL), year of publication, geographical location, target population, target disease(s) under study, type(s) of study outcomes, and article type. Results: A total of 3051 articles were retrieved and screened for eligibility, of which 96 were kept for analysis. Of these, only 3 addressed both EL and EC; 54 studies addressed EL; and 39 addressed EC. Most studies looked at gain in knowledge/skills usability, efficiency, competence, and satisfaction of HCW, or barriers/challenges to implementation. Descriptive studies focused on the application of EL or EC for targeting specific health conditions. Factors contributing to the success of EC or EL networks were institutional anchoring, multiple partnership, and capacity building of local experts. Conclusions: Our review found an important gap in the literature in relation to the complementary role of EL and EC for HCWs in LMICs evidenced by outcome measures. There is an important role for national and international academic institutions, learned medical societies, and networks to support regional experts in providing EL and EC for added value that will help the clinical performance of HCWs and improve health outcomes

Motivation for learning in campus-integrated MOOCs: Self-determined students, grade hunters and teacher trusters

Massive Open Online Course (MOOC) integration into campus education is rising, in many different forms. When integrating MOOCs, motivation to learn demands consideration as it is related to academic achievement and well-being. Student motivation in formal integrated MOOC learning is understudied. This study aimed to characterize the shape of motivation to learn in integrated MOOC learning. Motivation profiles of undergraduate students that learn in three different MOOC integration designs were explored, as was the distribution of profiles among integration designs. Finally, factors that underpin motivation were compared between integration designs. Six motivation profiles were recovered through a two-step cluster analysis: Self-determined students, highly self-determined students, grade hunters, and teacher trusters who are moderately, highly, or extremely trusting. Proportions of motivation profiles differed significantly between MOOC integration designs, and psychological needs were satisfied and frustrated significantly different between designs. Implications for future MOOC integration research and practice are discussed

Development and application of a massive open online course to deliver innovative transplant education

Massive Open Online Courses (MOOCs) offer an entirely new course concept for delivering content and engaging learners. This method of teaching has huge potential for the field of transplant education. In this study we describe the development and implementation of the MOOC “Clinical Kidney, Pancreas and Islet Transplantation”. Three and a half years after the introduction of the course, the learning demographics have been analyzed. The majority of learners were from Europe, North America and Asia. The course has been offered at several different stages of education at Leiden University Medical Center from undergraduate to continuous medical education. The level of engagement with the content was associated with the background and motivations of the learners. 74% had a bachelor's degree or higher. 48% of the undergraduate students participated in other content than instructed. Learners reported having liked the design of the course. Personal growth was the main motivation for 93% of worldwide learners. 69% considered the content of the MOOC to be relevant to their job. In general student's intentions focused more on reasons of personal growth, general interest, and relevance to school or degree program. Overall the integration of the MOOC in different settings of formal transplant education offered an added value to the on-campus program

User experiences of medical students with 360-degree virtual reality applications to prepare them for the clerkships

For medical students, the transition from the preclinical to the clinical phase of their curriculum (clerkships) can result in increased levels of stress and anxiety. This is partly caused by low self-perception of preparedness. By using 360° video-based virtual reality it is possible to provide learners virtual access to clinical situations ahead of time. This technique can provide active and contextual user experiences and offers opportunities to demonstrate both behavioral skills and subject knowledge. We developed two 360° video-based virtual reality applications for medical students transitioning to the clerkships. In this study, we describe the development and evaluated the user experiences. Two virtual reality applications were developed for use in a small group learning session. One of the applications is an interactive virtual tour of a hospital ward, in which learners explore the Internal Medicine ward and learn about the roles of different health care professionals and their mutual interactions. In each room, the learners listen to a voice-over and look at hotspots to gather additional information. The other application has been developed to train students in observing (un)professional behavior of healthcare providers in their daily activities. An evaluation was performed by an anonymous explorative questionnaire with open and closed questions (Likert scales) regarding the user experience and cybersickness symptoms. In our study, 171 students used the applications and completed the questionnaire. For 63% of the respondents, this was their first experience with a virtual reality headset. Qualitative analysis showed that students evaluated the learning method as realistic, informative and enjoyable. Most students evaluated virtual reality as a good (59%) or excellent (26%) tool for learning. Forty-five percent of the students experienced physical discomfort, such as nausea, dizziness, headache and disorientation. In most cases, these complaints were mild, although a small number experienced severe nausea (n = 6) or severe headache (n = 2). Students suggested several areas of improvement including increase of display resolution and decrease of ambient noise causing distraction. 360° video-based virtual reality can successfully be implemented in the medical curriculum to create a realistic learning experience to prepare students for the clerkships

Tunneling anisotropic magnetoresistance in Co/AIOx/Al tunnel junctions with fcc Co (111) electrodes

Tunneling anisotropic magnetoresistance (TAMR) has been characterized in junctions comprised of face-centered cubic (fcc) Co (111) ferromagnetic electrodes grown epitaxially on sapphire substrates, amorphous AlOx tunnel barriers, and nonmagnetic Al counterelectrodes. Large TAMR ratios have been found, up to similar to 7.5% and similar to 11% (at 5 K), for the in-plane and out-of-plane magnetization geometry, respectively. Such large TAMR values were not expected a priori, given the weak anisotropy of the (bulk) Co bands due to spin-orbit interaction, and the absence of Co (111) surface states that cross the Fermi energy. Both the in-plane and out-of-plane TAMR effects exhibit a predominantly twofold symmetry, and a strong bias dependence. The in-plane TAMR shows a maximum along the (twofold) magnetic hard axis, suggesting a relation between magnetic anisotropy and TAMR. We propose that uniaxial strain in combination with Bychkov-Rashba spin-orbit interaction, producing an interfacial tunneling DOS that depends on the magnetization direction, is responsible for the TAMR effect. The importance of the interfacial Co/AlOx (electronic) structure for the TAMR effect is underlined by measurements on junctions with overoxidized AlOx barriers, which show markedly different bias and angle dependence

Didactical characteristics of Dutch websites about kidney transplantation targeted for kidney patients and living donors: An exploratory study

Objective: The aim was to explore the origin, content topics, teaching modes (instruction, interaction, and assessment), and corresponding social-epistemological dimensions (choices in knowledge transfer vs. knowledge building, and individual vs. group learning) of web-based information on kidney transplantation targeted for patients and living donors. Methods: Dutch websites on kidney transplantation were retrieved using the search engine Google.nl. From 24 websites, 250 webpages were examined on origin, content topics, teaching modes, and corresponding social-epistemological dimensions. Results: The majority of the websites had a professional organization as origin (20/24). The number and distribution of content topics varied among the websites. Of the 16 different teaching modes found, 11 were instructional, 4 were interactional, and 1 assessment mode was found. The websites offered almost exclusively teaching modes on individual and passive learning, whereas group learning and interactive knowledge building was hardly encountered. Conclusion: The diversity in teaching modes and social-epistemological dimensions of Dutch websites on kidney transplantation targeted for patients and living donors is limited. The websites only provided a partial view on kidney transplantation; information regarding contact with others, e.g. support, was limited. A more balanced availability of teaching approaches and content topics is desirable to fit with the didactical goals to make well-considered health decisions

Microvascular changes in estrogen-α sensitive brainstem structures of aging female hamsters

Structural neuronal plasticity is present in the nucleus para-retroambiguus (NPRA) and the commissural nucleus of the solitary tract/A2 group (NTScom/A2) in female hamsters. Both brainstem nuclei play a role in estrous cycle related autonomic adaptations. We investigated how aging affects the capillary condition in these adaptive brainstem regions. Senescent female hamsters (±95 weeks) were tested weekly for their 4-day estrous cycle. Subsequently morphological changes of NPRA and NTScom/A2 were compared with those of young (±20 weeks) females in an ultrastructural study. The medial tegmental field served as control area. In 841 capillaries (n = 319 capillaries, young females (N = 3); n = 522 capillaries, aged females (N = 4)) vascular aberrations were classified into 3 categories: endothelial and tight junction, basement membrane and pericyte aberrations. In old animals, capillaries showed marked endothelial changes, disrupted tight junctions, and thickening and splitting of basement membranes. Aberrations were found in 40–60% of all capillaries. About 70% of the pericytes contained degenerative inclusions. Despite this generalized vascular degeneration, the reproductive cycle of female hamsters was unaffected by vascular senescence. Perivascular fibrosis as reported in aging rats was never observed, which suggests the existence of species differences.