A framework to facilitate effective e-learning in engineering development environments: executive summary

The demands of the continually changing and developing workplace require individuals to be adaptable, multi-disciplined and with the ability to work collaboratively, often in virtual environments. Professional engineers of today must meet these demands and have appropriate business and communication skills to operate in today's competitive, fast-moving, global environment. Yet these engineers still need to remain productive and routinely keep abreast of technological advances for their day-to-day working requirements. Thus, a range of continually renewable competencies is essential, which in turn puts pressure on both industry and academia to consider alternative ways to inform and educate their engineers and students. To help address these requirements, electronic learning (e-leaming) has been researched as a possible solution to facilitate a more flexible, distributed, collaborative, self-directed, virtual learning environment for both work-based professional engineers and engineering students. This research revealed gaps in both the existing literature and working practices regarding the elearning needs of engineers and in current approaches to meet these needs. Consequently, the main objective of the research was to develop a mechanism to assist providers of e-leaming to construct effective e-leaming activities in engineering development environments. In this context, 'development' environments refer to the engineer's product-development environment and the engineering student's study environment, with the increasing responsibility for selfdevelopment in an engineering career. The research identified and investigated factors that affect learning in these engineering environments, and examined current Web-based technologies to support and enhance learning experiences. A framework was developed as the mechanism to group the different and non-comparable learning factors together into philosophy, delivery, management and technology categories. These learning factors can be connected and sequenced differently in the categories, depending on the learning requirements. Hence, the main research innovation has been the creation of this framework to structure, link and order key learning factors, which offers guidance to e-leaming providers developing e-leaming environments. A predominant action research methodology was adopted for the research, as the author was involved with engineering environments and their e-leaming practices, decisions, developments and implementations in varying degrees. The main areas investigated for the research were: 1) Exploring learning methods & preferred learning styles in the engineering environment. Important findings here identified that engineers have a strong visual learning style preference and practise experiential learning in their engineering environments. 2) Examining technologies to support and enhance learning. This provided an understanding of 'hard' computer and Web capabilities, and 'soft' non-tangible technologies. Web technologies were of particular interest to this research due to their wide reach and interactive impact on the modem working and learning environments. 3) Investigating marketing considerations from the Web-based learning (WBL) providers' viewpoint. Marketing issues, products and services of WBL providers were investigated. This compared what and how the market offered and identified the business aspects of WBL. 4) Developing an e-learning framework. The research was consolidated to create a novel framework that grouped disparate learning factors for effective e-leaming development. 5) Studying practical engineering e-learning applications. Areas of the proposed framework were validated and refined from the case study data and experiences. Critical success factors (CSF) were derived to provide a business perspective for e-leaming developments, and these complemented the framework's learning factors. The above areas have been addressed in detail and documented in separate Engineering Doctorate submissions. This Executive Summary outlines and consolidates these areas, and describes, exemplifies and verifies the various factors within the e-leaming framework and the CSFs. The rationale, applications and guidelines for the e-leaming framework are also discussed. The framework provides a toolkit for building effective e-leaming activities in engineering development environments. Thus, the research shows that e-leaming can provide the solution to facilitate a flexible, continuous learning environment for engineers

A framework to facilitate effective e-learning in engineering development environments : executive summary

The demands of the continually changing and developing workplace require individuals to be adaptable, multi-disciplined and with the ability to work collaboratively, often in virtual environments. Professional engineers of today must meet these demands and have appropriate business and communication skills to operate in today's competitive, fast-moving, global environment. Yet these engineers still need to remain productive and routinely keep abreast of technological advances for their day-to-day working requirements. Thus, a range of continually renewable competencies is essential, which in turn puts pressure on both industry and academia to consider alternative ways to inform and educate their engineers and students. To help address these requirements, electronic learning (e-leaming) has been researched as a possible solution to facilitate a more flexible, distributed, collaborative, self-directed, virtual learning environment for both work-based professional engineers and engineering students. This research revealed gaps in both the existing literature and working practices regarding the elearning needs of engineers and in current approaches to meet these needs. Consequently, the main objective of the research was to develop a mechanism to assist providers of e-leaming to construct effective e-leaming activities in engineering development environments. In this context, 'development' environments refer to the engineer's product-development environment and the engineering student's study environment, with the increasing responsibility for selfdevelopment in an engineering career. The research identified and investigated factors that affect learning in these engineering environments, and examined current Web-based technologies to support and enhance learning experiences. A framework was developed as the mechanism to group the different and non-comparable learning factors together into philosophy, delivery, management and technology categories. These learning factors can be connected and sequenced differently in the categories, depending on the learning requirements. Hence, the main research innovation has been the creation of this framework to structure, link and order key learning factors, which offers guidance to e-leaming providers developing e-leaming environments. A predominant action research methodology was adopted for the research, as the author was involved with engineering environments and their e-leaming practices, decisions, developments and implementations in varying degrees. The main areas investigated for the research were: 1) Exploring learning methods ;preferred learning styles in the engineering environment. Important findings here identified that engineers have a strong visual learning style preference and practise experiential learning in their engineering environments. 2) Examining technologies to support and enhance learning. This provided an understanding of 'hard' computer and Web capabilities, and 'soft' non-tangible technologies. Web technologies were of particular interest to this research due to their wide reach and interactive impact on the modem working and learning environments. 3) Investigating marketing considerations from the Web-based learning (WBL) providers' viewpoint. Marketing issues, products and services of WBL providers were investigated. This compared what and how the market offered and identified the business aspects of WBL. 4) Developing an e-learning framework. The research was consolidated to create a novel framework that grouped disparate learning factors for effective e-leaming development. 5) Studying practical engineering e-learning applications. Areas of the proposed framework were validated and refined from the case study data and experiences. Critical success factors (CSF) were derived to provide a business perspective for e-leaming developments, and these complemented the framework's learning factors. The above areas have been addressed in detail and documented in separate Engineering Doctorate submissions. This Executive Summary outlines and consolidates these areas, and describes, exemplifies and verifies the various factors within the e-leaming framework and the CSFs. The rationale, applications and guidelines for the e-leaming framework are also discussed. The framework provides a toolkit for building effective e-leaming activities in engineering development environments. Thus, the research shows that e-leaming can provide the solution to facilitate a flexible, continuous learning environment for engineers.EThOS - Electronic Theses Online ServiceEngineering and Physical Science Research Council (Great Britain) (EPSRC)GBUnited Kingdo

Colectomy is a risk factor for venous thromboembolism in ulcerative colitis

AIM: To compare venous thromboembolism (VTE) in hospitalized ulcerative colitis (UC) patients who respond to medical management to patients requiring colectomy.METHODS: Population-based surveillance from 1997 to 2009 was used to identify all adults admitted to hospital for a flare of UC and those patients who underwent colectomy. All medical charts were reviewed to confirm the diagnosis and extract clinically relevant information. UC patients were stratified by: (1) responsive to inpatient medical therapy (n = 382); (2) medically refractory requiring emergent colectomy (n = 309); and (3) elective colectomy (n = 329). The primary outcome was the development of VTE during hospitalization or within 6 mo of discharge. Heparin prophylaxis to prevent VTE was assessed. Logistic regression analysis determined the effect of disease course (i.e., responsive to medical therapy, medically refractory, and elective colectomy) on VTE after adjusting for confounders including age, sex, smoking, disease activity, comorbidities, extent of disease, and IBD medications (i.e., corticosteroids, mesalamine, azathioprine, and infliximab). Point estimates were presented as odds ratios (OR) with 95%CI.RESULTS: The prevalence of VTE among patients with UC who responded to medical therapy was 1.3% and only 16% of these patients received heparin prophylaxis. In contrast, VTE was higher among patients who underwent an emergent (8.7%) and elective (4.9%) colectomy, despite greater than 90% of patients receiving postoperative heparin prophylaxis. The most common site of VTE was intra-abdominal (45.8%) followed by lower extremity (19.6%). VTE was diagnosed after discharge from hospital in 16.7% of cases. Elective (adjusted OR = 3.69; 95%CI: 1.30-10.44) and emergent colectomy (adjusted OR = 5.28; 95%CI: 1.93-14.45) were significant risk factors for VTE as compared to medically responsive UC patients. Furthermore, the odds of a VTE significantly increased across time (adjusted OR = 1.10; 95%CI: 1.01-1.20). Age, sex, comorbidities, disease extent, disease activity, smoking, corticosteroids, mesalamine, azathioprine, and infliximab were not independently associated with the development of VTE.CONCLUSION: VTE was associated with colectomy, particularly, among UC patients who failed medical management. VTE prophylaxis may not be sufficient to prevent VTE in patients undergoing colectom

Snx3 Regulates Recycling of the Transferrin Receptor and Iron Assimilation

Sorting of endocytic ligands and receptors is critical for diverse cellular processes. The physiological significance of endosomal sorting proteins in vertebrates, however, remains largely unknown. Here we report that sorting nexin 3 (Snx3) facilitates the recycling of transferrin receptor (Tfrc) and thus is required for the proper delivery of iron to erythroid progenitors. Snx3 is highly expressed in vertebrate hematopoietic tissues. Silencing of Snx3 results in anemia and hemoglobin defects in vertebrates due to impaired transferrin (Tf)-mediated iron uptake and its accumulation in early endosomes. This impaired iron assimilation can be complemented with non-Tf iron chelates. We show that Snx3 and Vps35, a component of the retromer, interact with Tfrc to sort it to the recycling endosomes. Our findings uncover a role of Snx3 in regulating Tfrc recycling, iron homeostasis, and erythropoiesis. Thus, the identification of Snx3 provides a genetic tool for exploring erythropoiesis and disorders of iron metabolism

Snx3 Regulates Recycling of the Transferrin Receptor and Iron Assimilation

Sorting of endocytic ligands and receptors is critical for diverse cellular processes. The physiological significance of endosomal sorting proteins in vertebrates, however, remains largely unknown. Here we report that sorting nexin 3 (Snx3) facilitates the recycling of transferrin receptor (Tfrc) and thus is required for the proper delivery of iron to erythroid progenitors. Snx3 is highly expressed in vertebrate hematopoietic tissues. Silencing of Snx3 results in anemia and hemoglobin defects in vertebrates due to impaired transferrin (Tf)-mediated iron uptake and its accumulation in early endosomes. This impaired iron assimilation can be complemented with non-Tf iron chelates. We show that Snx3 and Vps35, a component of the retromer, interact with Tfrc to sort it to the recycling endosomes. Our findings uncover a role of Snx3 in regulating Tfrc recycling, iron homeostasis, and erythropoiesis. Thus, the identification of Snx3 provides a genetic tool for exploring erythropoiesis and disorders of iron metabolism.National Institutes of Health (U.S.) (P01 HL032262

Global respiratory syncytial virus–related infant community deaths

Background Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% of mortality occurring in low- and lower middle-income countries. At least half of RSV-related deaths are estimated to occur in the community, but clinical characteristics of this group of children remain poorly characterized. Methods The RSV Global Online Mortality Database (RSV GOLD), a global registry of under-5 children who have died with RSV-related illness, describes clinical characteristics of children dying of RSV through global data sharing. RSV GOLD acts as a collaborative platform for global deaths, including community mortality studies described in this supplement. We aimed to compare the age distribution of infant deaths <6 months occurring in the community with in-hospital. Results We studied 829 RSV-related deaths <1 year of age from 38 developing countries, including 166 community deaths from 12 countries. There were 629 deaths that occurred <6 months, of which 156 (25%) occurred in the community. Among infants who died before 6 months of age, median age at death in the community (1.5 months; IQR: 0.8−3.3) was lower than in-hospital (2.4 months; IQR: 1.5−4.0; P < .0001). The proportion of neonatal deaths was higher in the community (29%, 46/156) than in-hospital (12%, 57/473, P < 0.0001). Conclusions We observed that children in the community die at a younger age. We expect that maternal vaccination or immunoprophylaxis against RSV will have a larger impact on RSV-related mortality in the community than in-hospital. This case series of RSV-related community deaths, made possible through global data sharing, allowed us to assess the potential impact of future RSV vaccines

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

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century