Using pairwise comparisons in the online social moderation of performance assessment

Assessing the performance of a student involves some form of judgement, and where more than one assessor is involved this usually requires some form of moderation to ensure consistent and fair results. Often this involves meetings or communication between assessors, which is referred to as social moderation. This paper reports on a study that investigated the use of online technologies to support a form of social moderation of artworks submitted for assessment in a senior secondary school course in Western Australia. Online systems were used to facilitate communications and provide access to digital representations of the submissions along with assessment tools. In particular a pairwise comparison judging online tool was used. This approach to social moderation was tested in a realistic context involving a sample of 12 teachers from rural schools for whom face-to-face meetings would be difficult. The aim was to investigate whether the use of these online systems would support good moderation outcomes and valuable professional learning for those involved. The study found that this approach to online social moderation was feasible, and participants perceived that it had improved the consistency of their judgements because they had developed an improved understanding of the assessment criteria and standard of work. However, analysis of scores and reliability data suggested some were not adequately consistent, and it was likely that this was due to their inexperience in assessing such work. Therefore some changes to the processes of this form of online social moderation were recommended

A Probiotic-Based Sanitation System for the Reduction of Healthcare Associated Infections and Antimicrobial Resistances: A Budget Impact Analysis

Healthcare Associated Infections (HAIs) and antibiotic resistance have high social and economic burdens. Healthcare environments play an important role in the transmission of HAIs. The Probiotic Cleaning Hygiene System (PCHS) showed to decrease hospital surface pathogens up to 90% vs. conventional chemical cleaning (CCC). This study compares PCHS to CCC as to reduction of HAIs and their severity, related antibiotic resistances, and costs. Incidence rates of HAIs/antibiotic resistances were estimated from a multicenter pre-post (6 months CCC + 6 months PCHS) intervention study after applying propensity score matching technique. A budget impact analysis compared the current scenario of use of CCC with future scenarios considering increasing utilization of PCHS, from 5% to 50% in the next five years, from the hospital perspective in Italy. The cumulative incidence of HAI was 4.6% and 2.4% (p <0.0001) for CCC (N=4,160) and PCHS (N=4,160) (OR = 0.47, CI 95% 0.37-0.60), with severe HAIs of 1.57% vs 1% and antibiotic resistances of 1.13% vs 0.53%, respectively. Increased use of PCHS over CCC in Italian internal medicine/geriatrics and neurology departments in the next 5 years is expected to avert at least about 31,000 HAIs and 8,500 antibiotic resistances, and save at least 14 million Euros, of which 11.6 for the treatment of resistant HAIs. Innovative, environmentally sustainable sanitation systems, like PCHS, might substantially reduce antibiotic resistance and increase protection of health worldwide

MicroRNA-Mediated Direct Reprogramming of Human Adult Fibroblasts Toward Cardiac Phenotype

open6Modulation of microRNA expression holds the promise to achieve direct reprogramming of fibroblasts into cardiomyocyte-like cells as a new strategy for myocardial regeneration after ischemic heart disease. Previous reports have shown that murine fibroblasts can be directly reprogrammed into induced cardiomyocytes (iCMs) by transient transfection with four microRNA mimics (miR-1, 133, 208, and 499, termed "miRcombo"). Hence, study on the effect of miRcombo transfection on adult human cardiac fibroblasts (AHCFs) deserves attention in the perspective of a future clinical translation of the approach. In this brief report, we studied for the first time whether miRcombo transient transfection of AHCFs by non-viral vectors might trigger direct reprogramming of AHCFs into cardiomyocyte-like cells. Initially, efficient miRNA delivery to cells was demonstrated through the use of a commercially available transfection agent (DharmaFECT1). Transient transfection of AHCFs with miRcombo was found to upregulate early cardiac transcription factors after 7 days post-transfection and cardiomyocyte specific marker cTnT after 15 days post-transfection, and to downregulate the expression of fibroblast markers at 15 days post-transfection. The percentage of cTnT-positive cells after 15 days from miRcombo transfection was ∼11%, as evaluated by flow cytometry. Furthermore, a relevant percentage of miRcombo-transfected AHCFs (∼38%) displayed spontaneous calcium transients at 30 days post-transfection. Results evidenced the role of miRcombo transfection on triggering the trans differentiation of AHCFs into iCMs. Although further investigations are needed to achieve iCM maturation, early findings from this study pave the way toward new advanced therapies for human cardiac regeneration.openPaoletti C; Divieto C; Tarricone G; Di Meglio F; Nurzynska D; Chiono VPaoletti, C; Divieto, C; Tarricone, G; Di Meglio, F; Nurzynska, D; Chiono,

Meat quality and lipid fatty acid profile from wild thrush (Turdus philomelos), woodcock (Scolopax rusticola) and starling (Sturnus vulgaris): A preliminary comparative study

Background: The present study aimed to evaluate the nutritional proximate composition, some qualitative traits and fatty acid profile of meat from wild thrush, woodcock and starling hunted in Southern Italy in 2017 and 2018. Methods: Nutritive composition and physical traits of meat and lipid fatty acid profile were evaluated in breast muscle (Pectoralis major) of gamebirds. Results: From findings, the meat pH was significantly (P < 0.001) higher in starling when compared to the other two species. Thrush meat was significantly (P = 0.002) darker and had higher redness (P < 0.001) and yellowness (P = 0.004) in comparison to starling and woodcock. Thrush breast muscle showed the highest (P < 0.001) level of lipids and lowest (P < 0.001) protein content. Meat from thrush showed the best lipid fatty acid profile based on the higher (P < 0.001) monounsaturated fatty acids (MUFA) and lower (P < 0.001) saturated fatty acids (SFA) concentrations. Starling breast muscle reported the highest (P = 0.002) polyunsaturated fatty acids (PUFA) level compared to both thrush and woodcock, whereas no differences were detected on total n-3. The ratio n-6/n-3 was higher (P = 0.001) in starling muscle. Thrush breast muscle had the lowest (P < 0.001) atherogenic and thrombogenic indices compared to the other gamebirds. Conclusions: The findings indicated that meat from the three investigated gamebirds species may represent a healthily lipid food source for human consumption in relation to the prevention of cardiovascular diseases

Market Access for Medical Devices: Adapting to Change

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When a probiotic-based sanitizing method may halve healthcare-associated infections and reduce associated costs

No abstract availabl

Incentivizing research into the effectiveness of medical devices

Introduction Medical devices (MDs) often obtain market authorization with much less clinical evidence than other health technologies, especially pharmaceuticals. This is due to a number of reasons. First, in contrast to pharmaceuticals, there is no legal requirement to conduct adequately controlled clinical studies, other than for ‘high-risk’ devices in some jurisdictions. In the US for example, high-risk devices and innovative lower-risk devices are required to demonstrate ‘reasonable assurance of safety and effectiveness’, which may imply clinical evidence based on randomized studies in many instances. In contrast, in the EU the requirement is to demonstrate adequate performance and safety, which can often be achieved by conducting observational studies such as registries [1, 2]. Secondly, the devices industry comprises many small and medium-size enterprises (SMEs), which would find the cost of conducting clinical studies, especially randomized controlled trials, prohibitive. However, although some larger manufacturers do undertake clinical studies of some of their products, manufacturers with similar products (called ‘fast-followers’) can often claim ‘substantial equivalence’ to a product that already has market authorization, thus avoiding the need to conduct costly and timeconsuming clinical studies. Since regulatory agencies often accept these claims of equivalence, for example under the 510(k) process in the US [3], this further reduces the incentives for manufacturers to conduct expensive clinical studies. Therefore, although device manufacturers have patent protection, they are often not granted data exclusivity in the same way as pharmaceutical manufacturers. Finally, unlike pharmaceuticals, devices are often modified once on the market, meaning that even if clinical evidence was available for the original version of the product, it may not necessarily be available for the version currently being marketed. For example in the US, one analysis showed that for 77 original market authorization applications for cardiac implantable electronic devices (e.g., pacemakers, implantable cardioverter-defibrillators) since 1979, the FDA approved 5829 ‘supplements’ reflecting product modifications in the period up until 2012. Of course, many of these product modifications were minor and unlikely to affect the performance of the device, but 37 % involved a change to the device’s design. In the vast majority of these cases the FDA deemed that new clinical data were not necessary for approval [4]. The lack of clinical evidence prior to product launch, especially evidence of comparative effectiveness, limits the possibilities for health technology assessment [2]. However, it should be remembered that clinical evidence can be gathered both pre-market (i.e., through conducting controlled clinical trials in an experimental setting), and postmarket, through clinical studies undertaken in regular clinical practice. Post-market effectiveness research may be more important for MDs than pharmaceuticals, as the performance of the device often depends on the interaction with the user (the so-called learning curve) [5]. This suggests that solutions to the problem of inadequate clinical evidence should address the issue of conducting clinical research in both the pre- and post-market phase. In this editorial we consider ways in which MD manufacturers could be incentivized to produce more clinical evidence to facilitate health technology assessments, including economic evaluations

Sustainable rearing for kid meat production in Southern Italy marginal areas: A comparison among three genotypes

Sustainable goat breeding plays an important role in the economy of marginal areas. The present study aimed to compare performances and meat quality traits in kids of a native Apulian genotype (Garganica) in comparison with two Mediterranean breeds (Maltese and Derivata di Siria). Kids suckled dam milk until they were 21 (±2) days old, hence three groups of 12 male kids per each genotype were made. The kids received a pelleted feed ad libitum in addition to dam milk and were slaughtered at 60 days of age. The Maltese kids showed the lowest net cold-dressing percentage, with statistical differences compared to Garganica and Derivata di Siria. Meat obtained from Garganica kids showed a rosy color due to a significantly lower a* index and were also more tender since a lower WBS was recorded in comparison with the other two genotypes. As for the nutritional value of meat, the best n-6/n-3 ratio was found for the Derivata di Siria breed. In conclusion, Garganica kid meat showed the lowest content of SFA and atherogenic index, with potential beneficial effects for human health

Trans-arterial radioembolization in intermediate-advanced hepatocellular carcinoma: systematic review and meta-analyses.

Published onlineJournal ArticleThis is the final version of the article. Available from Impact Journals via the DOI in this record.Trans-arterial radioembolization (TARE) is a recognized, although not explicitly recommended, experimental therapy for unresectable hepatocellular carcinoma (HCC).A systematic literature review was performed to identify published studies on the use of TARE in intermediate and advanced stages HCC exploring the efficacy and safety of this innovative treatment.Twenty-one studies reporting data on overall survival (OS) and time to progression (TTP), were included in a meta-analysis. The pooled post-TARE OS was 63% (95% CI: 56-70%) and 27% (95% CI: 21-33%) at 1- and 3-years respectively in intermediate stage HCC, whereas OS was 37% (95% CI: 26-50%) and 13% (95% CI: 9-18%) at the same time intervals in patients with sufficient liver function (Child-Pugh A-B7) but with an advanced HCC because of the presence of portal vein thrombosis. When an intermediate and advanced case-mix was considered, OS was 58% (95% CI: 48-67%) and 17% (95% CI: 12-23%) at 1- and 3-years respectively. As for TTP, only four studies reported data: the observed progression probability was 56% (95% CI: 41-70%) and 73% (95% CI: 56-87%) at 1 and 2 years respectively. The safety analysis, focused on the risk of liver decompensation after TARE, revealed a great variability, from 0-1% to more than 36% events, influenced by the number of procedures, patient Child-Pugh stage and treatment duration.Evidence supporting the use of radioembolization in HCC is mainly based on retrospective and prospective cohort studies. Based on this evidence, until the results of the ongoing randomized trials become available, radioembolization appears to be a viable treatment option for intermediate-advanced stage HCC.The present study was funded by ASBM Srl through an unrestricted grant to CERGAS, Bocconi University, Via Roentgen 1, 20136 Milan, Italy

Mobile health divide between clinicians and patients in cancer care: results from a cross-sectional international survey

Background: Mobile technologies are increasingly being used to manage chronic diseases, including cancer, with the promise of improving the efficiency and effectiveness of care. Among the myriad of mobile technologies in health care, we have seen an explosion of mobile apps. The rapid increase in digital health apps is not paralleled by a similar trend in usage statistics by clinicians and patients. Little is known about how much and in what ways mobile health (mHealth) apps are used by clinicians and patients for cancer care, what variables affect their use of mHealth, and what patients’ and clinicians’ expectations of mHealth apps are. Objective: This study aimed to describe the patient and clinician population that uses mHealth in cancer care and to provide recommendations to app developers and regulators to generally increase the use and efficacy of mHealth apps. Methods: Through a cross-sectional Web-based survey, we explored the current utilization rates of mHealth in cancer care and factors that explain the differences in utilization by patients and clinicians across the United States and 5 different countries in Europe. In addition, we conducted an international workshop with more than 100 stakeholders and a roundtable with key representatives of international organizations of clinicians and patients to solicit feedback on the survey results and develop insights into mHealth app development practices. Results: A total of 1033 patients and 1116 clinicians participated in the survey. The proportion of cancer patients using mHealth (294/1033, 28.46%) was far lower than that of clinicians (859/1116, 76.97%). Accounting for age and salary level, the marginal probabilities of use at means are still significantly different between the 2 groups and were 69.8% for clinicians and 38.7% for patients using the propensity score–based regression adjustment with weighting technique. Moreover, our analysis identified a gap between basic and advanced users, with a prevalent use for activities related to the automation of processes and the interaction with other individuals and a limited adoption for side-effect management and compliance monitoring in both groups. Conclusions: mHealth apps can provide access to clinical and economic data that are low cost, easy to access, and personalized. The benefits can go as far as increasing patients’ chances of overall survival. However, despite its potential, evidence on the actual use of mobile technologies in cancer care is not promising. If the promise of mHealth is to be fulfilled, clinician and patient usage rates will need to converge. Ideally, cancer apps should be designed in ways that strengthen the patient-physician relationship, ease physicians’ workload, be tested for validity and effectiveness, and fit the criteria for reimbursement