Reusing adaptation strategies in adaptive educational hypermedia systems

Due to the difficulty and thus effort and expenses involved in creating them, personalization strategies in learning environments have to demonstrate a higher return-on-investment (ROI), if they are to be a viable component of the learning setting of the future. One feature that can increase this ROI is the reusability of adaptation strategies in Adaptive Educational Hypermedia Systems. This research looks into various ways of enhancing this reusability. Using multiple modular adaptation strategies (MAS) with a controlling meta-strategy is proposed as a more efficient way of authoring adaptation strategies. This renders the reuse of adaptation strategies faster and easier for course authors. A method for semi-automatically breaking down complex adaptation strategies into smaller modular adaptation strategies is described. Potential problems with using multiple strategies are described and ways to solve them are discussed. Finally, some evaluation points are illustrated, conclusions are drawn and further research areas are identified

Supporting delivery of adaptive hypermedia

Although Adaptive Hypermedia (AH) can improve upon the traditional one-size-fitsall learning approach through Adaptive Educational Hypermedia (AEH), it still has problems with the authoring and delivery processes that are holding back the widespread usage of AEH. In this thesis we present the development of the Adaptive Delivery Environment (ADE) delivery system and use the lessons learnt during its development along with feedback from adaptation specification authors, researchers and other evaluations to formalise a list of essential and recommended optional features for AEH delivery engines. In addition to this we also investigate how the powerful adaptation techniques recommended in the above list and described in Brusilovsky and Knutov’s taxonomies can be implemented in a way that minimises the technical knowledge of adaptation authors needed to use these techniques. As the adaptation functionality increases, we research how a modular framework for adaptation strategies can be created to increase the reusability of parts of an AH system’s overall adaptation specification. Following on from this, we investigate how reusing these modular strategies via a pedagogically based visual editor can enable adaptation authors without programming experience to use these powerful adaptation techniques

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Merging strategies for authoring QoE-based adaptive hypermedia

Personalization is desirable, but writing the adaptation behaviour description to go with it is taxing. Even more challenging is the application of multiple adaptation strategies over the same static content. This paper focuses on recent work on strategy modularisation and merger development in the authoring process ofadaptive hypermedia. The reason for the modularisation of strategies is to break a complex adaptation decision into a number of simpler ones, which may be reused more easily and applied in different orders. The rationale for strategy merger is to be able to apply multiple adaptation strategies over the same content - a challenge which is not yet fully addressed in current adaptive hypermedia systems. To demonstrate the proposed method we present an example case study and sample strategies written in the LAG adaptation language. The case study is based on a recently proposed model for Quality of Experience in e-learning. This model exposes the complex interaction between a number of factors affecting QoE and hence presents a good candidate for the application of a strategy merger, as well as modularisation. We have then evaluated this approach via structured questionnaires used with a number of design experts of hypermedia content creation, especially in the domain of education. This allows us to draw generic conclusions for both our own further research, as well as for the community at large, interested in the area of reuse and modularisation of adaptation

Delaying surgery for patients with a previous SARS-CoV-2 infection

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Outcomes from elective colorectal cancer surgery during the SARS‐CoV‐2 pandemic

Aim This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic. Method This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data. Results From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58–14.06), postoperative SARS-CoV-2 (16.90, 7.86–36.38), male sex (2.46, 1.01–5.93), age >70 years (2.87, 1.32–6.20) and advanced cancer stage (3.43, 1.16–10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%). Conclusion Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease