Piloting Multimodal Learning Analytics using Mobile Mixed Reality in Health Education

© 2019 IEEE. Mobile mixed reality has been shown to increase higher achievement and lower cognitive load within spatial disciplines. However, traditional methods of assessment restrict examiners ability to holistically assess spatial understanding. Multimodal learning analytics seeks to investigate how combinations of data types such as spatial data and traditional assessment can be combined to better understand both the learner and learning environment. This paper explores the pedagogical possibilities of a smartphone enabled mixed reality multimodal learning analytics case study for health education, focused on learning the anatomy of the heart. The context for this study is the first loop of a design based research study exploring the acquisition and retention of knowledge by piloting the proposed system with practicing health experts. Outcomes from the pilot study showed engagement and enthusiasm of the method among the experts, but also demonstrated problems to overcome in the pedagogical method before deployment with learners

Developmental asynchrony and antagonism of sex determination pathways in a lizard with temperature-induced sex reversal

Abstract Vertebrate sex differentiation follows a conserved suite of developmental events: the bipotential gonads differentiate and shortly thereafter sex specific traits become dimorphic. However, this may not apply to squamates, a diverse vertebrate lineage comprising of many species with thermosensitive sexual development. Of the three species with data on the relative timing of gonad differentiation and genital dimorphism, the females of two (Niveoscincus ocellatus and Barisia imbricata) exhibit a phase of temporary pseudohermaphroditism or TPH (gonads have differentiated well before genital dimorphism). We report a third example of TPH in Pogona vitticeps, an agamid with temperature-induced male to female sex reversal. These findings suggest that for female squamates, genital and gonad development may not be closely synchronised, so that TPH may be common. We further observed a high frequency of ovotestes, a usually rare gonadal phenotype characterised by a mix of male and female structures, exclusively associated with temperature-induced sex reversal. We propose that ovotestes are evidence of a period of antagonism between male and female sex-determining pathways during sex reversal. Female sexual development in squamates is considerably more complex than has been appreciated, providing numerous avenues for future exploration of the genetic and hormonal cues that govern sexual development

Effect of a Perioperative, Cardiac Output-Guided Hemodynamic Therapy Algorithm on Outcomes Following Major Gastrointestinal Surgery A Randomized Clinical Trial and Systematic Review

Importance: small trials suggest that postoperative outcomes may be improved by the use of cardiac output monitoring to guide administration of intravenous fluid and inotropic drugs as part of a hemodynamic therapy algorithm.Objective: to evaluate the clinical effectiveness of a perioperative, cardiac output–guided hemodynamic therapy algorithm.Design, setting, and participants: OPTIMISE was a pragmatic, multicenter, randomized, observer-blinded trial of 734 high-risk patients aged 50 years or older undergoing major gastrointestinal surgery at 17 acute care hospitals in the United Kingdom. An updated systematic review and meta-analysis were also conducted including randomized trials published from 1966 to February 2014.Interventions: patients were randomly assigned to a cardiac output–guided hemodynamic therapy algorithm for intravenous fluid and inotrope (dopexamine) infusion during and 6 hours following surgery (n=368) or to usual care (n=366).Main outcomes and measures: the primary outcome was a composite of predefined 30-day moderate or major complications and mortality. Secondary outcomes were morbidity on day 7; infection, critical care–free days, and all-cause mortality at 30 days; all-cause mortality at 180 days; and length of hospital stay.Results: baseline patient characteristics, clinical care, and volumes of intravenous fluid were similar between groups. Care was nonadherent to the allocated treatment for less than 10% of patients in each group. The primary outcome occurred in 36.6% of intervention and 43.4% of usual care participants (relative risk [RR], 0.84 [95% CI, 0.71-1.01]; absolute risk reduction, 6.8% [95% CI, ?0.3% to 13.9%]; P?=?.07). There was no significant difference between groups for any secondary outcomes. Five intervention patients (1.4%) experienced cardiovascular serious adverse events within 24 hours compared with none in the usual care group. Findings of the meta-analysis of 38 trials, including data from this study, suggest that the intervention is associated with fewer complications (intervention, 488/1548 [31.5%] vs control, 614/1476 [41.6%]; RR, 0.77 [95% CI, 0.71-0.83]) and a nonsignificant reduction in hospital, 28-day, or 30-day mortality (intervention, 159/3215 deaths [4.9%] vs control, 206/3160 deaths [6.5%]; RR, 0.82 [95% CI, 0.67-1.01]) and mortality at longest follow-up (intervention, 267/3215 deaths [8.3%] vs control, 327/3160 deaths [10.3%]; RR, 0.86 [95% CI, 0.74-1.00]).Conclusions and relevance: in a randomized trial of high-risk patients undergoing major gastrointestinal surgery, use of a cardiac output–guided hemodynamic therapy algorithm compared with usual care did not reduce a composite outcome of complications and 30-day mortality. However, inclusion of these data in an updated meta-analysis indicates that the intervention was associated with a reduction in complication rate

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Piloting multimodal learning analytics using mobile mixed reality in health education

© 2019 IEEE. Mobile mixed reality has been shown to increase higher achievement and lower cognitive load within spatial disciplines. However, traditional methods of assessment restrict examiners ability to holistically assess spatial understanding. Multimodal learning analytics seeks to investigate how combinations of data types such as spatial data and traditional assessment can be combined to better understand both the learner and learning environment. This paper explores the pedagogical possibilities of a smartphone enabled mixed reality multimodal learning analytics case study for health education, focused on learning the anatomy of the heart. The context for this study is the first loop of a design based research study exploring the acquisition and retention of knowledge by piloting the proposed system with practicing health experts. Outcomes from the pilot study showed engagement and enthusiasm of the method among the experts, but also demonstrated problems to overcome in the pedagogical method before deployment with learners

The lived experience of facioscapulohumeral muscular dystrophy : a systematic review and synthesis of the qualitative literature

To enable clinicians to orient their services to the needs of people living with FSHD (pwFSHD) this review sought to characterise the lived experience of pwFSHD. Five electronic databases were systematically searched for qualitative research studies containing quotations from pwFSHD. Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines informed the methodology. Study quality was assessed using the Critical Appraisal Skills Programme Checklist (CASP) tool which measures the methodological quality of qualitative research. Data extracted from included studies were analysed using thematic synthesis. 99 pwFSHD took part in 6 studies included in this review, from research teams based in two countries. Five descriptive themes emerged: "engaging with life as symptoms progress", "the emotional journey", "a family burden to bear", "social connection and disconnection", and "tension between visibility and invisibility". From these, two analytical themes were derived: "the emotional challenge of continuing and intensifying adaptation" and "the relational burden of rare disease". The lived experience of pwFSHD is characterised by physical, emotional, and social challenges that impact on engagement with life, particularly as symptoms progress. Further research is needed to provide a fuller understanding of the experience of pain in FSHD and of the lived experience of FSHD across cultures

Adaptive Virtual Reality Games for Rehabilitation of Motor Disorders

This paper describes the development of a Virtual Reality (VR) based therapeutic training system aimed at encourage stroke patients with upper limb motor disorders to practice physical exercises. The system contains a series of physically-based VR games. Physically-based simulation provides realistic motion of virtual objects by modelling the behaviour of virtual objects and their responses to external force and torque based on physics laws. We present opportunities for applying physics simulation techniques in VR therapy and discuss their potential therapeutic benefits to motor rehabilitation. A framework for physically-based VR rehabilitation systems is described which consists of functional tasks and game scenarios designed to encourage patients’ physical activity in highly motivating, physics-enriched virtual environments where factors such as gravity can be scaled to adapt to individual patient’s abilities and in-game performance

The macro-economic determinants of health and health inequalities—umbrella review protocol

Background The economic determinants of health have been widely recognised as crucial factors affecting health; however, to date, no comprehensive review has been undertaken to summarise these factors and the ways in which they can influence health. We conceptualise the economy as a complex system made up of underlying approaches, regulation from institutions, markets, finance, labour, the public-private balance as well as production and distributional effects, which collectively impact on health through the effect of moderators. This protocol details the methods for an umbrella review to explore the macro-economic factors, strategies, policies and interventions that affect health outcomes and health inequalities. Methods We will identify relevant systematic reviews using search terms derived from the Journal of Economic Literature classification. Reviews will be included if they meet the Database of Abstracts and Reviews of Effects criteria for systematic reviews. Reviews of studies with and without controls will be included; both association and intervention studies will be included. Primary outcomes will include but are not limited to morbidity, mortality, prevalence and incidence of conditions and life expectancy. Secondary outcomes will include health inequalities by gender, ethnicity or socio-economic status. Six databases will be searched using tailored versions of our piloted search strategy to locate relevant reviews. Data will be extracted using a standardized pro forma, and the findings will be synthesized into a conceptual framework to address our review aim. Discussion Our umbrella review protocol provides a robust method to systematically appraise the evidence in this field, using new conceptual models derived specifically to address the study question. This will yield important information for policymakers, practitioners and researchers at the local, national and international level. It will also help set the future research agenda in this field and guide the development of interventions. Systematic review registration This umbrella review protocol has been registered with PROSPERO CRD42017068357