Problem-based learning spanning real and virtual words: a case study in Second Life

There is a growing use of immersive virtual environments for educational purposes. However, much of this activity is not yet documented in the public domain, or is descriptive rather than analytical. This paper presents a case study in which university students were tasked with building an interactive learning experience using Second Life as a platform. Both problem‐based learning and constructionism acted as framing pedagogies for the task, with students working in teams to design and build a learning experience which could potentially meet the needs of a real client in innovative ways which might not be possible in real life. A process account of the experience is provided, which examines how the pedagogies and contexts (real and virtual) influence and enhance each other. The use of a virtual environment, combined with problem‐based learning and constructionism, subtly changed the nature of the instructor–student relationship, allowed students to explore ‘problematic problems’ in a motivating and relevant manner, provided students with greater ownership over their work, and allowed problems to be set which were flexible, but at the same time allowed for ease of assessment

The meanings of the 'struggle/fight metaphor' in the special needs domain: the experiences of practitioners and parents of children with high functioning autism spectrum conditions

The special needs domain has long been recognised as problematic and adversarial. Much research has focused on areas of contention, such as the relationships between parents and practitioners, especially in educational settings, or on problems within the structure and operation of the domain. This study adopts a whole system approach in combining discussion of the structural basis of tension within the domain with an investigation of how both parents and practitioners describe, experience and respond to tensions within the special needs domain; such tensions being viewed as facets of the 'struggle' and 'fight' metaphor. Whole systems approaches are derived from the systems discipline, which developed initially out of the nineteenth century interest in organic and engineering systems, but more recently has focused on organisational and inter-organisational arrangements, including the part people play in enabling or disabling such arrangements. It is a strongly interdisciplinary approach more commonly found in organisational studies than in the social sciences more generally. Fifteen practitioners, from health and education settings, and twelve parents of children and young people with diagnoses of high functioning autism spectrum conditions participated in the study. The participants' stories of their experiences of the special needs domain were collected using a narrative inquiry approach. The data was analysed using concepts and theoretical frameworks derived from the work of Pierre Bourdieu, Uri Bronfenbrenner and Charles Wright Mills. An exploration of the influences shaping the special needs domain revealed a number of areas of unresolved tension, some of which result in tensions for those involved in the domain such as can be described as 'fight', and some of which might be addressed by structural changes to the systems comprising the special needs domain such as those envisaged in forthcoming legislation. However importantly the empirical study found that many tensions and struggles experienced by both parents and practitioners did not emanate from the structures of the domain and therefore were unlikely to be amenable to structural changes. Parents 'struggle' to maintain their identity as 'good' parents, to acquire information and to navigate the system in order to access services and resources. Practitioners experience conflict as they seek to access information and training, engage in the complex choreography of cooperating and collaborating in interagency and interprofessional working and endeavour to harmonise their professional practice with agency and public policy priorities. The thesis concludes with a brief discussion of the relationship between whole system approaches and other interdisciplinary approaches to investigating complex problems in the human sciences. It is suggested that systems diagramming techniques such as systems mapping and rich pictures are useful additions to the sociologist's toolkit

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Problem-based learning spanning real and virtual words: a case study in Second Life

There is a growing use of immersive virtual environments for educational purposes. However, much of this activity is not yet documented in the public domain, or is descriptive rather than analytical. This paper presents a case study in which university students were tasked with building an interactive learning experience using Second Life as a platform. Both problem-based learning and constructionism acted as framing pedagogies for the task, with students working in teams to design and build a learning experience which could potentially meet the needs of a real client in innovative ways which might not be possible in real life. A process account of the experience is provided, which examines how the pedagogies and contexts (real and virtual) influence and enhance each other. The use of a virtual environment, combined with problem-based learning and constructionism, subtly changed the nature of the instructor–student relationship, allowed students to explore ‘problematic problems' in a motivating and relevant manner, provided students with greater ownership over their work, and allowed problems to be set which were flexible, but at the same time allowed for ease of assessment

Effect of Noninvasive Respiratory Strategies on Intubation or Mortality Among Patients With Acute Hypoxemic Respiratory Failure and COVID-19: The RECOVERY-RS Randomized Clinical Trial.

Importance Continuous positive airway pressure (CPAP) and high-flow nasal oxygen (HFNO) have been recommended for acute hypoxemic respiratory failure in patients with COVID-19. Uncertainty exists regarding the effectiveness and safety of these noninvasive respiratory strategies. Objective To determine whether either CPAP or HFNO, compared with conventional oxygen therapy, improves clinical outcomes in hospitalized patients with COVID-19-related acute hypoxemic respiratory failure. Design, Setting, and Participants A parallel group, adaptive, randomized clinical trial of 1273 hospitalized adults with COVID-19-related acute hypoxemic respiratory failure. The trial was conducted between April 6, 2020, and May 3, 2021, across 48 acute care hospitals in the UK and Jersey. Final follow-up occurred on June 20, 2021. Interventions Adult patients were randomized to receive CPAP (n = 380), HFNO (n = 418), or conventional oxygen therapy (n = 475). Main Outcomes and Measures The primary outcome was a composite of tracheal intubation or mortality within 30 days. Results The trial was stopped prematurely due to declining COVID-19 case numbers in the UK and the end of the funded recruitment period. Of the 1273 randomized patients (mean age, 57.4 [95% CI, 56.7 to 58.1] years; 66% male; 65% White race), primary outcome data were available for 1260. Crossover between interventions occurred in 17.1% of participants (15.3% in the CPAP group, 11.5% in the HFNO group, and 23.6% in the conventional oxygen therapy group). The requirement for tracheal intubation or mortality within 30 days was significantly lower with CPAP (36.3%; 137 of 377 participants) vs conventional oxygen therapy (44.4%; 158 of 356 participants) (absolute difference, -8% [95% CI, -15% to -1%], P = .03), but was not significantly different with HFNO (44.3%; 184 of 415 participants) vs conventional oxygen therapy (45.1%; 166 of 368 participants) (absolute difference, -1% [95% CI, -8% to 6%], P = .83). Adverse events occurred in 34.2% (130/380) of participants in the CPAP group, 20.6% (86/418) in the HFNO group, and 13.9% (66/475) in the conventional oxygen therapy group. Conclusions and Relevance Among patients with acute hypoxemic respiratory failure due to COVID-19, an initial strategy of CPAP significantly reduced the risk of tracheal intubation or mortality compared with conventional oxygen therapy, but there was no significant difference between an initial strategy of HFNO compared with conventional oxygen therapy. The study may have been underpowered for the comparison of HFNO vs conventional oxygen therapy, and early study termination and crossover among the groups should be considered when interpreting the findings. Trial Registration isrctn.org Identifier: ISRCTN16912075