An Adaptive Visual Learning Approach for Waterborne Disease Prevention in Rural West Africa

Depleted water supplies, along with industrial and human waste, are driving a world water crisis that poses a growing risk to food markets, energy production, political stability, and human health (Global Water Security 2012). One obvious example of the this crisis is the more than 1 billion people who obtain their drinking water from contaminated sources (WHO/UNICEF 2006; Clasen et al. 2008). With a projected increase of 1.3 billion people between now and 2050, Africa will add more to the global population than any other world region (Haub and Kaneda 2013). For this research, visual learning design factors were incorporated into water literacy materials in order to study ways in which cultural and societal barriers can be overcome through culture- and gender-appropriate graphics designed to foster visual storytelling in the West African country of Niger. Women were targeted as the study population since they are the primary water fetchers and handlers in sub-Saharan Africa. Eye-tracking technology and GIS tools were used for quantification of the visual design characteristics. Research was conducted in 23 villages along the Niger River, and included 510 interviews, 693 focus group participants, 9 different cultural groups, over 30 hours of audio interviews, and 464 eye-tracking trials. Tobii X2-60 eye-tracking equipment was used in bush maternity wards, medicinal depositories, and mud-brick homes. Eye-tracking data were imported into an ArcGIS platform, where kernel density estimation (KDE) analyses were performed in an effort to compare and contrast the KDE of varying education levels, age groups, ethnic groups, and village types. Spatial autocorrelation analyses were used to evaluate whether the spatial pattern of attribute values (fixation time) was clustered, dispersed, or random. Results from this research suggest that visual communication can be used to overcome low education and cultural barriers for waterborne disease prevention. Using an adaptive visual-learning approach for the research method provided a creative alternative to conventional water-education materials, as most do not consider mother tongue and low literacy. Through visual communication, a novel way has been developed to understand how disadvantaged populations in sub-Saharan Africa visually process water literacy materials

Blending Learning: The Evolution of Online and Face-to-Face Education from 20082015

In 2008, iNACOL produced a series of papers documenting promising practices identified throughout the field of K–12 online learning. Since then, we have witnessed a tremendous acceleration of transformative policy and practice driving personalized learning in the K–12 education space. State, district, school, and classroom leaders recognize that the ultimate potential for blended and online learning lies in the opportunity to transform the education system and enable higher levels of learning through competency-based approaches.iNACOL's core work adds significant value to the field by providing a powerful practitioner voice in policy advocacy, communications, and in the creation of resources and best practices to enable transformational change in K–12 education.We worked with leaders throughout the field to update these resources for a new generation of pioneers working towards the creation of student-centered learning environments.This refreshed series, Promising Practices in Blended and Online Learning, explores some of the approaches developed by practitioners and policymakers in response to key issues in K–12 education, including:Blended Learning: The Evolution of Online and Face-to-Face Education from 2008-2015;Using Blended and Online Learning for Credit Recovery and At-Risk Students;Oversight and Management of Blended and Online Programs: Ensuring Quality and Accountability; andFunding and Legislation for Blended and Online Education.Personalized learning environments provide the very best educational opportunities and personalized pathways for all students, with highly qualified teachers delivering world-class instruction using innovative digital resources and content. Through this series of white papers, we are pleased to share the promising practices in K–12 blended, online, and competency education transforming teaching and learning today

Thiopurine monotherapy is effective in ulcerative colitis but significantly less so in Crohn’s disease: long-term outcomes for 11 928 patients in the UK inflammatory bowel disease bioresource

Objective: Thiopurines are widely used as maintenance therapy in inflammatory bowel disease (IBD) but the evidence base for their use is sparse and their role increasingly questioned. Using the largest series reported to date, we assessed the long-term effectiveness of thiopurines in ulcerative colitis (UC) and Crohn’s disease (CD), including their impact on need for surgery. Design: Outcomes were assessed in 11 928 patients (4968 UC, 6960 CD) in the UK IBD BioResource initiated on thiopurine monotherapy with the intention of maintaining medically induced remission. Effectiveness was assessed retrospectively using patient-level data and a definition that required avoidance of escalation to biological therapy or surgery while on thiopurines. Analyses included overall effectiveness, time-to-event analysis for treatment escalation and comparison of surgery rates in patients tolerant or intolerant of thiopurines. Results: Using 68 132 patient-years of exposure, thiopurine monotherapy appeared effective for the duration of treatment in 2617/4968 (52.7%) patients with UC compared with 2378/6960 (34.2%) patients with CD (p<0.0001). This difference was corroborated in a multivariable analysis: after adjusting for variables including treatment era, thiopurine monotherapy was less effective in CD than UC (OR 0.47, 95% CI 0.43 to 0.51, p<0.0001). Thiopurine intolerance was associated with increased risk of surgery in UC (HR 2.44, p<0.0001); with a more modest impact on need for surgery in CD (HR=1.23, p=0.0015). Conclusion: Thiopurine monotherapy is an effective long-term treatment for UC but significantly less effective in CD

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Your Wait Time From This Point Will Be...: Practices For Designing Amusement Park Queues

Amusement park developers have begun designing queue systems to make the wait for service less cumbersome for guests. Maister introduced a theoretical framework with eight guidelines for improving customer satisfaction and minimizing the perception of wait duration. These guide- lines were designed to be generalizable to a wide range of settings but do not fully take into account the unique characteristics of theme park queues. The following proposed guidelines offer a taxonomy for reducing the negative impact of subjective perception of time and provide a specific framework for designing these queued environments in an amusement park setting. © 2013 Human Factors and Ergonomics Society

Understanding And Managing Karst Water Resources In Belize: Case Studies Of Both Past And Present In A Changing Climate

Belize is a developing country that faces water resource issues in the forms of both quality and quantity, stemming from a long history of environmental stress and population threats, from the ancient Maya to present. Belize’s karst landscape, which comprises a large part of the country from the coast to the Maya Mountains, is characterized by springs, caves, sinkholes, and aquifers systems formed from the dissolution of carbonate (limestone, dolomite) rock. This research presents several different case studies, spanning from the ancient Maya and issues with drought to modern communities that rely on groundwater resources quickly being depleted. Past drought patterns may recur, and their effects on population and the environment in areas like Orange Walk in the north to Gales Point in the south, where villages and towns surrounded by karst remnants have limited access to fresh, clean water. Part of this research used cave sediments to examine past vegetation change and the impacts of the Maya on the landscape on the Vaca Plateau to provide a history of socio-environmental interactions. We also examined the modern water resource issues for Belize, and have several pilot projects underway throughout the region to study and resolve these issues and compare the modern population to that of the Maya to better understand issues from future drought and climate change

Age-related changes in platelet function are more profound in women than in men

Age is a risk factor for cardiovascular disease (CVD), however the effect of age on platelet function remains unclear. Ideally, platelet function should be assayed under flow and shear conditions that occur in vivo. Our study aimed to characterise the effect of age on platelet translocation behaviour using a novel flow-based assay that measures platelet function in less than 200 mu l of blood under conditions of arterial shear. Blood from males (n = 53) and females (n = 56), ranging in age from 19-82 and 21-70 respectively were perfused through custom-made parallel plate flow chambers coated with immobilised human von Willebrand Factor (VWF) under arterial shear (1,500s(-1)). Platelet translocation behaviour on VWF was recorded by digital-image microscopy and analysed. The study showed that aging resulted in a significant decrease in the number of platelet tracks, translocating platelets and unstable platelet interactions with VWF. These age related changes in platelet function were more profound in women than in men indicating that age and gender significantly impacts on platelet interactions with VWF

Age-related changes in platelet function are more profound in women than in men

Age is a risk factor for cardiovascular disease (CVD), however the effect of age on platelet function remains unclear. Ideally, platelet function should be assayed under flow and shear conditions that occur in vivo. Our study aimed to characterise the effect of age on platelet translocation behaviour using a novel flow-based assay that measures platelet function in less than 200 mu l of blood under conditions of arterial shear. Blood from males (n = 53) and females (n = 56), ranging in age from 19-82 and 21-70 respectively were perfused through custom-made parallel plate flow chambers coated with immobilised human von Willebrand Factor (VWF) under arterial shear (1,500s(-1)). Platelet translocation behaviour on VWF was recorded by digital-image microscopy and analysed. The study showed that aging resulted in a significant decrease in the number of platelet tracks, translocating platelets and unstable platelet interactions with VWF. These age related changes in platelet function were more profound in women than in men indicating that age and gender significantly impacts on platelet interactions with VWF