Technologies to enhance self-directed learning from hypertext

With the growing popularity of the World Wide Web, materials presented to learners in the form of hypertext have become a major instructional resource. Despite the potential of hypertext to facilitate access to learning materials, self-directed learning from hypertext is often associated with many concerns. Self-directed learners, due to their different viewpoints, may follow different navigation paths, and thus they will have different interactions with knowledge. Therefore, learners can end up being disoriented or cognitively-overloaded due to the potential gap between what they need and what actually exists on the Web. In addition, while a lot of research has gone into supporting the task of finding web resources, less attention has been paid to the task of supporting the interpretation of Web pages. The inability to interpret the content of pages leads learners to interrupt their current browsing activities to seek help from other human resources or explanatory learning materials. Such activity can weaken learner engagement and lower their motivation to learn. This thesis aims to promote self-directed learning from hypertext resources by proposing solutions to the above problems. It first presents Knowledge Puzzle, a tool that proposes a constructivist approach to learn from the Web. Its main contribution to Web-based learning is that self-directed learners will be able to adapt the path of instruction and the structure of hypertext to their way of thinking, regardless of how the Web content is delivered. This can effectively reduce the gap between what they need and what exists on the Web. SWLinker is another system proposed in this thesis with the aim of supporting the interpretation of Web pages using ontology based semantic annotation. It is an extension to the Internet Explorer Web browser that automatically creates a semantic layer of explanatory information and instructional guidance over Web pages. It also aims to break the conventional view of Web browsing as an individual activity by leveraging the notion of ontology-based collaborative browsing. Both of the tools presented in this thesis were evaluated by students within the context of particular learning tasks. The results show that they effectively fulfilled the intended goals by facilitating learning from hypertext without introducing high overheads in terms of usability or browsing efforts

An Ontology Based Approach to Enhance Information Retrieval from Al-Shamelah Digital Librar

With the huge number of Islamic resources that emerged over hundreds of years, several difficulties were introduced when searching in this huge heritage. This has challenged developers to build computer applications to facilitate information retrieval from Islamic Resources. One of these applications is Al-Shamelah Digital Library (ADL), Al-maktabah Al-Shamelah, which is a huge database containing thousands of books in different disciplines. The search facility offered by ADL is mainly based on keyword matching, and does not provide semantic interpretations of Islamic texts. It also does not handle complex queries or extract implicit relations and meanings from text. Driven by these challenges, this work presents OntoADL, a system that supports semantic search over a section of Al-Shamelah digital library. At the core of OntoADL is our approach that leverages ontology-based annotations to produce highly relevant search results and to offer recommendations of related topics. The design and architecture of OntoADL is discussed, focusing on how ontology-based reasoning can result in intelligent results that meet the user’s interests. The search service in OntoADL was evaluated by being compared with the search service in the conventional ADL. The OntoADL achieved 83% recall and 66% precision while the ADL system achieved 70% recall and 36% precision

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research