What works?: the culture of evidence in university teaching

This article analyses the culture of evidence in university teaching and its implications in the professional training of teachers in higher educa tion. The new culture of organisati on and assessment introduced into university teaching has brought about the configuration of a management model geared towards results and accountability based on solid evidence. Its implementation means that both administrators and teachers are asking themselves: what works? This study shows that the implementation of a culture of evidence requires the adoption of a pluralist vision of evidence, as well as cl ear criteria for determining the validity of evidence. In addition, teachers should be trained to mobilise systematic pedagogic know ledge and transform their practice, using available institutional support, the systematic analysis of their own experience, and the promotion of best practic

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Criteria for reporting incidental findings in clinical exome sequencing : a focus group study on professional practices and perspectives in Belgian genetic centres

Background: Incidental and secondary findings (IFs and SFs) are subject to ongoing discussion as potential consequences of clinical exome sequencing (ES). International policy documents vary on the reporting of these findings. Discussion points include the practice of unintentionally identified IFs versus deliberately pursued SFs, patient opt-out possibilities and the spectrum of reportable findings. The heterogeneity of advice permits a non-standardised disclosure but research is lacking on actual reporting practices. Therefore, this study assessed national reporting practices for IFs and SFs in clinical ES and the underlying professional perspectives. Methods: A qualitative focus group study has been undertaken, including professionals from Belgian centres for medical genetics (CMGs). Data were analysed thematically. Results: All Belgian CMGs participated in this study. Data analysis resulted in six main themes, including one regarding the reporting criteria used for IFs. All CMGs currently use ES-based panel testing. They have limited experience with IFs in clinical ES and are cautious about the pursuit of SFs. Two main reporting criteria for IFs were referred to by all CMGs: the clinical significance of the IF (including pathogenicity and medical actionability) and patient-related factors (including the patient's preference to know and patient characteristics). The consensus over the importance of these criteria contrasted with their challenging interpretation and application. Points of concern included IFs' pathogenicity in non-symptomatic persons, IFs concerning variants of uncertain significance, the requirement and definition of medical actionability and patient opt-out possibilities. Finally, reporting decisions were guided by the interaction between the clinical significance of the IF and patient characteristics. This interaction questions the possible disclosure of findings with context-dependent and personal utility, such as IFs concerning a carrier status. To evaluate the IF's final relevance, a professional and case-by-case deliberation was considered essential. Conclusions: The challenging application of reporting criteria for IFs results in diversified practices and policy perspectives within Belgian CMGs. This echoes international concerns and may have consequences for effective policy recommendations

Ethical values supporting the disclosure of incidental and secondary findings in clinical genomic testing : a qualitative study

Background: Incidental findings (IFs) and secondary findings (SFs), being results that are unrelated to the diagnostic question, are the subject of an important debate in the practice of clinical genomic medicine. Arguments for reporting these results or not doing so typically relate to the principles of autonomy, nonmaleficence and beneficence. However, these principles frequently conflict and are insufficient by themselves to come to a conclusion. This study investigates empirically how ethical principles are considered when actually reporting IFs or SFs and how value conflicts are weighed. Methods: A qualitative focus group study has been undertaken, including a multidisciplinary group of professionals from Belgian centres for medical genetics. The data were analysed thematically. Results: All eight Belgian centres participated in this study. Ethical values were frequently referred to for disclosure policies on IFs and SFs. Participants invoked respect for patient autonomy to support the disclosure of IFs and optout options for IFs and SFs, non-maleficence for the professional delineation of reportable IFs and opt-out options for IFs and SFs and (the particular scope of) beneficence for the mandatory reporting of actionable IFs, the delineation of reportable IFs and a current decline of actively pursued SFs. Professional assumptions about patients’ genetic literacy were an important factor in the weighing of values. Conclusions: In line with the traditional bioethical discourse, the mandatory reporting of actionable IFs might be interpreted as a “technological, soft paternalism”. Restricting patients’ choices might be acceptable, but then its motives should be valid and its beneficent outcomes highly plausible. Hence, the presuppositions of technological, soft paternalism - patients’ inability to make informed decisions, normative rationality, the efficacy of beneficent outcomes and the delineated spectrum of beneficence - should be approached critically. Moreover, distributive justice should be considered an important value in the delineation of the current scope of the ethical debate on IFs and SFs. This study of guiding values may stimulate the debate on the ethical grounds for a solid policy on IFs and SFs internationally

Engaging male university student leaders in the adaptation process of the one man can intervention (OMCI) to inform sexual violence prevention strategies in student residences: a case study

Sexual violence is a human rights violation, which affects physical, sexual, reproductive, mental and social well-being. The overwhelming burden of sexual violence is borne mostly by women and children at the hands of men. The university environment is no exception, and the impacts of sexual violence on students are multiple and complex. The extent of sexual violence in universities in South Africa is largely unknown, but local media allude to its common occurrence. University residences have been identified as communities at risk for sexual violence globally, and recent developments in primary prevention interventions for sexual violence globally and in South Africa provide opportunities to address this issue among university students. The focus of this thesis was on primary prevention, recognising that men are part of the solution. Male university student leaders residing in residences were engaged in a participatory process of adapting the One Man Can Intervention, which is a South African community-based primary prevention intervention to address Gender Based Violence and spread of HIV infection. The One Man Can Intervention has never been adapted for use with university students and although numerous sexual violence prevention interventions have been implemented and found to be effective in higher education institutions in other developed countries, no primary prevention interventions have yet been reported within South African university residences. The aim of this study was to identify and describe the process of adaptation and implementation of the One Man Can Intervention with male university students to inform primary prevention strategies against sexual violence within university residences. A qualitative research methodology was used to conduct this study, using a case study design. Process evaluation was used to understand the case. Participants included 15 student leaders from five male university residences who participated in the series of workshops, which evolved into the adapted intervention. The study used focus groups, direct observations, participants' reflections and semi-structured interviews. Thematic data analysis was used to analyse the data. The adaptation process led to development of a new intervention of six workshops, named by the participants 'Men With Conscience', which indicated ownership of the adapted intervention. The findings suggest that through participation in a series of six workshops, which addressed issues around gender norms and values, societal pressures for men's behaviour, understanding rape, bystander intervention and fostering healthy relationships, change was shown to be happening in the young men over the period of participation. Participants were challenged to think critically about sexual violence; they reflected on their role as men in prevention of sexual violence; they reached a turning point after they understood what rape meant and they called upon themselves to become accountable for prevention of sexual violence within the university structures and beyond. This case study and qualitative data provide some evidence of how men can engage in discussions to prevent sexual violence. The study concludes with seven recommendations: sexual violence prevention policies for the university setting; dedicated resources and funding for prevention of sexual violence interventions; incorporation of a public health approach to prevention of sexual violence; testing and implementation of the Men With Conscience model at universities in South Africa; curriculum development; and engagement of male students in prevention and training of student leaders on sexual violence

Futures of Responsible and Inclusive AI: How Might We Foster an Inclusive, Responsible and Foresight-Informed AI Governance Approach?

This paper seeks to investigate how we might foster an inclusive, foresight-informed responsible AI governance framework. This paper discusses the gaps and opportunities in current AI initiatives across various stakeholders and acknowledges the importance of anticipation and agility. This paper also posits that it is important for legal, policy, industry and academia to understand the specificities of each other’s domains better to build an inclusive governance framework

Monoclonal antibodies in type 2 asthma : a systematic review and network meta-analysis

Since novel treatments to target eosinophilic inflammation in Type 2 asthma are emerging, we aimed to evaluate and meta-analyze the efficacy of monoclonal antibodies to reduce exacerbation rate. PubMed and Web of Science were searched for phase II and phase III randomized clinical trials with monoclonal antibodies targeting key mediators of type 2-associated asthma. Thirty trials were selected involving biologics that target the IL-5 pathway, IL-13, the common IL-4 and IL-13 receptor, IL-9, IL-2 and TSLP. As no head-to-head trials were retrieved from literature, we performed an arm-based network meta-analysis to compare effects on exacerbation rate between the different treatments. Mepolizumab, reslizumab and benralizumab significantly reduced the risk of exacerbations compared to placebo (by 47-52%, 50-60%, and 28-51% respectively). Reslizumab and benralizumab also improved lung function. Dupilumab and tezepelumab improved lung function in frequent exacerbators. Lebrikizumab had no significant effect on the number of exacerbations, symptom control or health-related quality of life. Tralokinumab improved lung function compared to placebo. Network meta-analysis of all treatment and placebo arms, showed no superiority of one biologic over the others. Large reductions in exacerbation rates were observed compared to placebo, though only benralizumab was sufficiently powered (n = 2051) to demonstrate significantly decreased exacerbation rates in the subgroup analysis of IL-5 acting agents compared to placebo. Monoclonal antibodies such as mepolizumab, reslizumab and benralizumab have proven their benefit to reduce exacerbation rates in severe persistent eosinophilic asthma in the published trials. However, no statistically significant superiority was observed of one biologic over the other in the network meta-analysis. More studies with direct head to head comparisons and better defined endotypes are required

Emergence of Equilibria from Individual Strategies in Online Content Diffusion

Social scientists have observed that human behavior in society can often be modeled as corresponding to a threshold type policy. A new behavior would propagate by a procedure in which an individual adopts the new behavior if the fraction of his neighbors or friends having adopted the new behavior exceeds some threshold. In this paper we study the question of whether the emergence of threshold policies may be modeled as a result of some rational process which would describe the behavior of non-cooperative rational members of some social network. We focus on situations in which individuals take the decision whether to access or not some content, based on the number of views that the content has. Our analysis aims at understanding not only the behavior of individuals, but also the way in which information about the quality of a given content can be deduced from view counts when only part of the viewers that access the content are informed about its quality. In this paper we present a game formulation for the behavior of individuals using a meanfield model: the number of individuals is approximated by a continuum of atomless players and for which the Wardrop equilibrium is the solution concept. We derive conditions on the problem's parameters that result indeed in the emergence of threshold equilibria policies. But we also identify some parameters in which other structures are obtained for the equilibrium behavior of individuals

Infrared thermography-calorimetric quantitation of energy expenditure in biomechanically different types of jūdō throwing techniques: a pilot study

It was the purpose of this pilot study to assess the energy expenditure (EE) of two biome-chanically different jūdō throws, namely, the simple mechanical couple-based uchi-mata vs. the lever-based throw ippon-seoi-nage, using infrared thermal calorimetry (ITC). Testing subjects included one Caucasian female elite athlete (age: 26.4 years) and one male veteran jūdōka (age: 50.8 years). ITC images were captured by an Avio NEC InfRec R300 camera and thermal data obtained were plotted into a proprietary equation for estimation of EE. Data were compared to respiratory data obtained by a Cosmed K4 b2 portable gas analyzer. Oxy-gen consumption as estimated by ITC capture during practice of uchi-mata was markedly lower than during performance ippon-seoi-nage in the female (457 mL•min-1 vs. 540 mL•min-1, P<0.05) and male subject (1,078 mL•min-1 vs. 1,088 mL•min-1, NS), with the difference in values between both genders subject being significant (P<0.01). The metabolic cost of the exercise (uchi-mata vs. ippon-seoi-nage) itself was 1.26 kcal•min-1 (88 W) vs. 1.68 kcal•min-1 (117 W) (P<0.05) in the female subject, and 2.97 kcal•min-1 (207 W) (P<0.01) vs. 3.02 kcal•min-1 (211 W) (NS) in the male subject. Values for the female were significantly differ-ent (P<0.01) from those of the male subject. The results support the initial hypothesis that the couple-based jūdō throws (in this case, uchi-mata) are energetically more efficient than lever-based throws, such as ippon-seoi-nage. Application of this approach may be of practical use for coaches in optimizing energy-saving strategies in both elite and veteran jūdō athletes