Learning in Online Continuing Professional Development: An Institutionalist View on the Personal Learning Environment

The nature of institutions is an important question for the Personal Learning Environment (PLE). Whilst the PLE has tended to focus on what is considered to be “non-institutional” technology like social software, most online tools today have a corporate/institutional foundation. How should educators position themselves with learners who have to negotiate different institutional and discursive contexts – whether within corporate social software, formal education, work or the family? Drawing on previous work focusing on how learners maintain personal coherence in organising learning between different contexts, institutional theory is used to revise the model of the learner as a ‘viable system’, which focuses on the dynamics of transactions that learners make with different institutional entities. Data from an online Continuing Professional Development (CPD) course in acute cancer care is analysed to show how learner transactions indicate constraints bearing upon learners both from their professional context and from their formal educational study. The pattern of learner engagement suggests that the interaction of constraints creates the conditions to motivate in-depth contribution to the course forums.  This finding leads us to suggest a rethink of pedagogy within the PLE, and a broader consideration of institutional and other constraints in educational dynamics

A Novel Unsupervised Method to Identify Genes Important in the Anti-viral Response: Application to Interferon/Ribavirin in Hepatitis C Patients

Background: Treating hepatitis C with interferon/ribavirin results in a varied response in terms of decrease in viral titer and ultimate outcome. Marked responders have a sharp decline in viral titer within a few days of treatment initiation, whereas in other patients there is no effect on the virus (poor responders). Previous studies have shown that combination therapy modifies expression of hundreds of genes in vitro and in vivo. However, identifying which, if any, of these genes have a role in viral clearance remains challenging. Aims: The goal of this paper is to link viral levels with gene expression and thereby identify genes that may be responsible for early decrease in viral titer. Methods: Microarrays were performed on RNA isolated from PBMC of patients undergoing interferon/ribavirin therapy. Samples were collected at pre-treatment (day 0), and 1, 2, 7, 14 and 28 days after initiating treatment. A novel method was applied to identify genes that are linked to a decrease in viral titer during interferon/ribavirin treatment. The method uses the relationship between inter-patient gene expression based proximities and inter-patient viral titer based proximities to define the association between microarray gene expression measurements of each gene and viral-titer measurements. Results: We detected 36 unique genes whose expressions provide a clustering of patients that resembles viral titer based clustering of patients. These genes include IRF7, MX1, OASL and OAS2, viperin and many ISG's of unknown function. Conclusion: The genes identified by this method appear to play a major role in the reduction of hepatitis C virus during the early phase of treatment. The method has broad utility and can be used to analyze response to any group of factors influencing biological outcome such as antiviral drugs or anti-cancer agents where microarray data are available. © 2007 Brodsky et al

Utility of palliative EUS-guided biliary drainage using lumen-apposing metal stents: a prospective multicenter feasibility study (with video)

BACKGROUND AND AIMS: Biliary drainage with ERCP is successful in only 80% to 90% of extrahepatic cholangiocarcinoma and pancreatic cancer. We present the results of a multicenter prospective study assessing the safety, feasibility, and quality of life of patients after EUS-guided biliary drainage (EUS-BD) with lumen-apposing metal stents (LAMSs), after failed ERCP. METHODS: All consecutive adults with a dilated common bile duct (CBD) ≥14 mm secondary to inoperable malignant distal common bile duct (CBD) stricture and failed ERCP biliary drainage were screened and recruited from 3 tertiary U.K. centers. Technical success of EUS-BD using LAMSs was the primary endpoint. Improvement in serum bilirubin, 30-day mortality, procedure-related adverse events, and quality of life were secondary endpoints. The quality of life improvement was measured using a validated questionnaire (EORTC QLQ-BIL21). RESULTS: Twenty patients were included in analysis. EUS-BD was technically successful in all patients and the clinical success was 95% (19/20) at day 7 (>50% reduction in bilirubin) and 92.3% (12/13) at day 30 (bilirubin <50 μmol/L). There were significant improvements in overall quality of life score (49 vs 42, p=0.03) at day 30. All cause 30-day mortality was 20% and the moderate adverse event rate was 10% (1 cholangitis and 1 stent migration). CONCLUSION: EUS-BD has acceptable technical success and safety as a second line palliative treatment for inoperable malignant distal CBD strictures. Randomized controlled studies comparing EUS-BD with percutaneous transhepatic biliary drainage (PTBD) are needed to determine their effectiveness in clinical practice

Business models in servitization

This chapter sheds light on the different business models of manufacturing companies that have servitized their business operations. This chapter presents four distinctive yet simultaneously pursued business models for servitized manufacturers: (1) the product business model, (2) the service-agreement business model (3) the process-oriented business model, and (4) the performance-oriented business model. Depending on the direction taken, dedicated customer needs targeted, value propositions adopted, and services and solutions provided, a servitized manufacturer should decide which business model(s) the firm will adopt with different customers.fi=vertaisarvioitu|en=peerReviewed

In-street wind direction variability in the vicinity of a busy intersection in central London

We present results from fast-response wind measurements within and above a busy intersection between two street canyons (Marylebone Road and Gloucester Place) in Westminster, London taken as part of the DAPPLE (Dispersion of Air Pollution and Penetration into the Local Environment; www.dapple.org.uk) 2007 field campaign. The data reported here were collected using ultrasonic anemometers on the roof-top of a building adjacent to the intersection and at two heights on a pair of lamp-posts on opposite sides of the intersection. Site characteristics, data analysis and the variation of intersection flow with the above-roof wind direction (θref) are discussed. Evidence of both flow channelling and recirculation was identified within the canyon, only a few metres from the intersection for along-street and across-street roof-top winds respectively. Results also indicate that for oblique rooftop flows, the intersection flow is a complex combination of bifurcated channelled flows, recirculation and corner vortices. Asymmetries in local building geometry around the intersection and small changes in the background wind direction (changes in 15-min mean θref of 5–10 degrees) were also observed to have profound influences on the behaviour of intersection flow patterns. Consequently, short time-scale variability in the background flow direction can lead to highly scattered in-street mean flow angles masking the true multi-modal features of the flow and thus further complicating modelling challenges

Veränderungen der Ertragsmodelle durch digitale Produkt-Service- Systeme am Beispiel dormakaba

Dormakaba ist ein globaler Anbieter von smarten und sicheren Zutrittslösungen und ein Beispiel für Digitalisierung von produzierenden Unternehmen. Die Digitalisierung betrifft nicht nur dormakaba selber, sondern verändert Abläufe und Geschäftsmodelle in der gesamten Gebäude- & Sicherheitsbranche. Zum einen werden Räume flexibler genutzt. Zum anderen kommen digitale Lösungen bereits bei der Planung und Realisierung sowie bei der Verwaltung von Gebäuden zum Einsatz. Mit der digitalen Plattform „dormakaba exivo“ ermöglicht dormakaba die elektronische Verwaltung von Zutrittsberechtigungen. Dies ist die Grundlage für vielfältige neue Geschäftsmodelle rund um den Zugang zu und die Nutzung von Räumen. Im Business Model Profit Schema wird für einige dieser neuen Geschäftsmodelle dargestellt, welche physischen Komponenten oder Dienstleistungen kostenfrei oder zu sehr niedrigen Kosten zur Verfügung gestellt werden und mit welchen Dienstleistungen Deckungsbeiträge erwirtschaftet werden

Long Term Planetary Habitability and the Carbonate-Silicate Cycle

The potential habitability of an exoplanet is traditionally assessed by determining whether its orbit falls within the circumstellar “habitable zone” of its star, defined as the distance at which water could be liquid on the surface of a planet (Kopparapu et al.,2013). Traditionally, these limits are determined by radiative-convective climate models, which are used to predict surface temperatures at user-specified levels of greenhouse gases. This approach ignores the vital question of the (bio)geochemical plausibility of the proposed chemical abundances. Carbon dioxide is the most important greenhouse gas in Earth's atmosphere in terms of regulating planetary temperature, with the long-term concentration controlled by the balance between volcanic outgassing and the sequestration of CO2 via chemical weathering and sedimentation, as modulated by ocean chemistry, circulation, and biological (microbial) productivity. We developed a model that incorporates key aspects of Earth's short- and long-term biogeochemical carbon cycle to explore the potential changes in the CO2 greenhouse due to variance in planet size and stellar insolation. We find that proposed changes in global topography, tectonics, and the hydrological cycle on larger planets result in proportionally greater surface temperatures for a given incident flux. For planets between 0.5 and 2 R⊕, the effect of these changes results in average global surface temperature deviations of up to 20 K, which suggests that these relationships must be considered in future studies of planetary habitability

Decoherence induced deformation of the ground state in adiabatic quantum computation

Despite more than a decade of research on adiabatic quantum computation (AQC), its decoherence properties are still poorly understood. Many theoretical works have suggested that AQC is more robust against decoherence, but a quantitative relation between its performance and the qubits' coherence properties, such as decoherence time, is still lacking. While the thermal excitations are known to be important sources of errors, they are predominantly dependent on temperature but rather insensitive to the qubits' coherence. Less understood is the role of virtual excitations, which can also reduce the ground state probability even at zero temperature. Here, we introduce normalized ground state fidelity as a measure of the decoherence-induced deformation of the ground state due to virtual transitions. We calculate the normalized fidelity perturbatively at finite temperatures and discuss its relation to the qubits' relaxation and dephasing times, as well as its projected scaling properties.Comment: 10 pages, 3 figure

A rare case of abnormal uterine bleeding caused by cavernous hemangioma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cavernous hemangiomas of the uterus are extremely rare, benign lesions. A survey of the current literature identified fewer than 50 cases of hemangioma of the uterus.</p> <p>Case presentation</p> <p>We report a case of cavernous hemangioma of the uterus in a 27-year-old Malay, para 1 woman who presented at our hospital with torrential vaginal bleeding having been transferred by land ambulance from a district hospital 30 minutes away. 11 weeks previously she had an urgent cesarean section at our hospital. She had to undergo a hysterectomy to control her bleeding after other measures were unsuccessful. A histopathological report confirmed a diffuse ramifying hemangioma of the cervix and uterus with left hematosalpinx.</p> <p>Conclusion</p> <p>Most ramifying hemangioma lesions are asymptomatic and are found incidentally, but sometimes they may cause abnormal vaginal bleeding and hence should be included in the differential diagnosis of patients with vaginal bleeding. Hysterectomy is the primary mode of treatment in most symptomatic cases.</p