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Lecturers in higher education often consider the incorporation of web technologies into their teaching practice. Partially structured and populated course site templates could aid them in getting started with creating and deploying webbased materials and activities to enrich the teaching and learning experience. Discussions among instructional technology support staff and lecturers reveal a paucity of robust specifications for possible course site features that could comprise a template. An attempted mapping from the teaching task as understood by the instructor to the envisaged course website properties proves elusive. We conclude that the idea of an initial state for a course site, embodied in a template, remains useful and should be developed not according to a formula but with careful attention to the context and existing pedagogical practice. Any course template provided for the use of lecturers should be enhanced with supporting instructions and examples of how it may be adapted for their particular purposes.Keywords: course template; learning platform; pedagogical dimensions; course site properties(Published: 17 December 2012)Citation: Research in Learning Technology 2012, 20: 18665 - http://dx.doi.org/10.3402/rlt.v20i0.18665

Using a repetitive-sequence-based (rep)-PCR (DiversiLab), we have molecularly typed Acinetobacter nosocomial bloodstream isolates ( Acinetobacter baumannii [ n = 187], Acinetobacter pittii [ n = 23], and Acinetobacter nosocomialis [ n = 61]) obtained from patients hospitalized in U.S. hospitals over a 10-year period (1995-2004) during a nationwide surveillance study (Surveillance and Control of Pathogens of Epidemiological Importance [SCOPE]). Patterns of A. baumannii rep-PCR were compared to those of previously identified international clonal lineages (ICs) and were further investigated by multilocus sequence typing (MLST) to compare the two typing methods. Forty-seven of the A. baumannii isolates clustered with the previously defined IC 2. ICs 1, 3, 6, and 7 were also detected. The remaining 81 isolates were unrelated to the described ICs. In contrast, A. pittii and A. nosocomialis isolates were more heterogeneous, as determined by rep-PCR. Our MLST results were in good correlation with the rep-PCR clusters. Our study confirms previous data indicating the predominance of a few major clonal A. baumannii lineages in the United States, particularly IC 2. The presence in the United States of A. baumannii ICs 1, 2, and 3 from as early as 1995 suggests that global dissemination of these lineages was an early event.

High-dose chemotherapy followed by autologous stem cell transplantation (SCT) represents the standard of care in relapsed or refractory Hodgkin lymphoma (HD) and non-Hodgkin lymphoma (NHL). It is also an important therapeutic step in the therapy of multiple myeloma (MM) to improve progression-free survival. Application of high-dose chemotherapy is depending on the collection of a sufficient amount of CD34+ stem cells. Most investigators describe a minimum harvest of 2.0 × 106 CD34+ cells/kg bodyweight (BW) for patients with lymphoma and of 4.0 × 106 cells/kg BW for patients with MM undergoing tandem transplantation. Unfortunately, up to 45% of patients fail to mobilize the minimum amount for this important therapeutic approach, being considered as “poor mobilizers” [1–5]. Factors predisposing poor mobilization are age >60 years, progressive disease, severe bone marrow involvement, previous chemo- and/or radiotherapy, type of chemotherapy, previously failed mobilization attempts, platelet counts 5 × 106 CD34+ cells/kg body weight (BW) in patients with NHL and >6 × 106 CD34+ cells/kg BW in patients with MM. The percentage of patients who successfully met the primary endpoint was significantly higher in the plerixafor group than in the placebo group: 59 versus 20% in patients with NHL and 71.6 versus 34.4% in patients with MM, respectively. These trials for the novel CXCR4-inhibitor plerixafor excluded patients who failed prior conventional mobilization. However, these transplant candidates were in need of novel mobilization regimens and strategies allowing them to proceed to the life-saving therapeutic approach of autologous SCT.

Studies assessing the timing of percutaneous coronary interventions (PCI) in patients with Non-ST segment elevation Acute Coronary Syndromes (NSTE-ACS) have failed to generate a consensus on how early PCI should be performed in such patients.This meta-analysis compares clinical outcomes at 30 days in NSTE-ACS patients undergoing PCI within 24 hours of presentation (early PCI) with those receiving PCI more than 24 hours after presentation (delayed PCI).Data were extracted from searches of MEDLINE (1990-2010) and Google scholar and from scrutiny of abstract booklets from major cardiology meetings (1990-2010).Randomized clinical trials (RCTs) that included the composite endpoint of death and non-fatal myocardial infarction (MI) at 30 days after PCI were considered.Two independent reviewers extracted data using standard forms. The effects of early and delayed PCI were analyzed by calculating pooled estimates for death, non-fatal MI, bleeding, repeat revascularization and the composite endpoint of death or non-fatal MI at 30 days. Univariate analysis of each of these variables was used to create odds ratios.Seven studies with a total of 13,762 patients met the inclusion criteria. There was no significant difference in the odds of the composite endpoint of death or non-fatal MI at 30 days between patients undergoing early PCI and those receiving delayed PCI (OR-0.83, 95%CI 0.62-1.10). Patients receiving delayed PCI experienced a 33% reduction in the odds of repeat revascularization at 30 days compared to those undergoing early PCI (OR-1.33, 95%CI 1.14-1.56, P=0.0004).Conversely, patients undergoing early PCI experienced lower odds of bleeding than those receiving delayed PCI (OR-0.76, 95%CI 0.63-0.91, P = 0.0003).In NSTE-ACS patients early PCI doesn't reduce the odds of the composite endpoint of death or non-fatal MI at 30 day. This strategy is associated with lower odds of bleeding and higher odds of repeat revascularization at 30 days than a strategy of delayed PCI.

In patients with acute myelogenous leukemia, published guidelines and treatment recommendations are usually the basis for starting the work-up process for allogeneic transplant. However, only consistent recommendations would allow a standardized clinical practice. We conducted a comprehensive systematic literature search to identify and evaluate the best available evidence from controlled clinical trials. In addition, recommendations given by leading organizations in the USA and Europe were analyzed. The following aspects were selected for systematic comparison: factors for risk assessment and categorization, role of type of donor, significance of allogeneic transplant in first or second complete remission and in relapse/progressive disease; and role of reduced intensity conditioning regimens. In conclusion, the recommendations for the use of allogeneic transplant given by the literature and by published guidelines are inconsistent and will need clarification.

The CXCR4-inhibitor plerixafor mobilizes hematopoietic stem cells amplifying the effects of granulocyte-CSF (G-CSF). Before approval plerixafor was used in a compassionate use program (CUP) for patients who failed a previous mobilization. In the German CUP 60 patients from 23 centers (median age 56.5 years (2-75)) were given 240 μg/kg plerixafor SC 9-11 h before apheresis. A total of 78.3% (47/60) received G-CSF for 4 days before plerixafor administration; 76.6% of those (36/47) yielded at least 2.0 × 10(6) CD34(+) cells/μL. The median cell yield was 3.35 × 10(6) CD34+ cells/kg (0-29.53). Nine patients received plerixafor alone or with G-CSF for less than 4 days mobilizing a median of 3.30 × 10(6) CD34+ cells/kg (1.6-5.6). There was no significant difference between G-CSF application for 4 days and for a shorter period of time (P=0.157). A total of 47 patients received plerixafor plus G-CSF combined with chemotherapy yielding a median of 3.28 × 10(6) CD34+ cells/kg (0-24.79). In all, 40 of 60 patients (66.7%) proceeded to transplantation, and achieved a timely and stable engraftment. Side effects were rare and manageable. In conclusion, mobilization with plerixafor in poor mobilizers is safe and results in a sufficient stem cell harvest in the majority of patients.

Physicianepatient email communication is gaining popularity. However, a formal assessment of physicians’ email communication skills has not been described. We hypothesized that the email communication skills of rheumatology fellows can be measured in an objective structured clinical examination (OSCE) setting using a novel email content analysis instrument which has 18 items. During an OSCE, we asked 50 rheumatology fellows to respond to a simulated patient email. The content of the responses was assessed using our instrument. The majority of rheumatology fellows wrote appropriate responses scoring a mean (6SD) of 10.6 (62.6) points (maximum score 18), with high inter-rater reliability (0.86). Most fellows were concise (74%) and courteous (68%) but not formal (22%). Ninety-two percent of fellows acknowledged that the patient’s condition required urgent medical attention, but only 30% took active measures to contact the patient. No one encrypted their messages. The objective assessment of email communication skills is possible using simulated emails in an OSCE setting. The variable email communication scores and incidental patient safety gaps identified, suggest a need for further training and defined proficiency standards for physicians’ email communication skills.

Actinobacillus pleuropneumoniae is an important pathogen of the porcine respiratory tract. Subclinically and chronically infected pigs may enter a permanent carrier state, harboring A. pleuropneumoniae in lungs or tonsils. Despite the enormous role of A. pleuropneumoniae in domestic swine production, no published data about prevalence and distribution of A. pleuropneumoniae infections in wild boars (Sus scrofa) are available. Antibodies against A. pleuropneumoniae have been detected in serum of wild boars from Slovenia. The aim of the present study was to evaluate A. pleuropneumoniae infection status in wild boars in Germany. Tissue samples from lungs and tonsils of 531 wild boars from 52 hunts during the hunting seasons 2004-05 to 2006-07 were examined for A. pleuropneumoniae by polymerase chain reaction (PCR). Although gross pathologic lesions typical for pleuropneumonia were not detected, 35.8% of the wild boars were PCR-positive. Tonsils were involved in 94.3% and lungs in 15.5%. Actinobacillus pleuropneumoniae infection prevalence increased with age and body weight. Further research is needed to understand the involvement of different A. pleuropneumoniae serotypes and to understand the interrelationship of A. pleuropneumoniae infection between wild boars and domestic pigs.

This paper reports on the re-design of the Advanced Certificate in Education (ACE) programme, which is offered by the University of Pretoria through distance education (DE) to teachers in rural South Africa. In 2007, a team re-designed the programme with the goal of promoting access, quality, and student support. The team included an independent body, the South African Institute of Distance Education (SAIDE), and various education specialists. Training workshops for academics and a comprehensive internal and external review process contributed to the quality of the re-designed programme. Interactive web-based technologies were not included because of poor Internet connectivity; however, the authors note the use and potential of cell phone technology for DE programmes. Student support was enhanced by an additional short contact session, a capping assignment, a CD-ROM, and decentralised tutoring at contact venues. The programme was re-evaluated and approved in 2008, and the re-design methodology now guides similar projects.

In Hinblick auf Infektionskrankheiten des Respirationstraktes bei Schweinen fand in den letzten Jahren, v.a. durch die Zunahme des Tierhandels und die regional zum Teil erheblich gestiegene Schweinedichte, eine weite Erregerverbreitung statt. Häufig handelt es sich um Mischinfektionen mit verschiedenen viralen und/oder bakteriellen pneumopathogenen Erregern, deren Interaktionen eine erhebliche Bedeutung bei der Entstehung respiratorischer Erkrankungen zugemessen wird. Serologische Untersuchungen bei Wildschweinen konnten zwar Antikörper gegen einige respiratorischen Krankheitserreger nachweisen, Berichte über direkte Erregerisolierungen oder gar klinische Erkrankungen sind hingegen auf Einzelfälle und einzelne Erreger beschränkt. Die Rolle des Wildschweins als Erregerreservoir für Erkrankungen wie z.B. die Aujeszkysche Krankheit oder Klassische Schweinepest ist sehr gut belegt. Ziel der vorliegenden Arbeit war, das Vorkommen verschiedener respiratorischer Krankheitserreger bei Wildschweinen bundesweit in einzelnen Revieren zu untersuchen und darüber hinaus Erkenntnisse über mögliche Erregerinteraktionen, die Rolle des Wildschweins als Erregerreservoir sowie über die Ausbreitungsrichtung und Übertragungswegen respiratorischer Krankheitserreger zwischen Haus- und Wildschweinen zu erlangen. Insgesamt 361 Wildschweine aus 33 Revieren wurden deutschlandweit auf das Vorkommen respiratorischer Krankheitserreger untersucht. Der Nachweis spezifischer Nukleinsäuren von PRRSV, Influenzavirus A, M. hyopneumoniae, A. pleuropneumoniae und H. parasuis erfolgte an 361 Lungen- und Tonsillenproben mittels PCR, während für α-hämolysierende Streptokokken, P. multocida und B. bronchiseptica an 302 Tonsillenproben ein kultureller Erregernachweis durchgeführt wurde. Eine Überprüfung der angezüchteten P. multocida-Stämme auf die Fähigkeit der Toxinbildung wurde ebenfalls mittels PCR durchgeführt. Ein europäisches und ein amerikanisches PRRSV-Amplifikat wurden sequenziert und auf der Basis der ORF 1 -Sequenz des Lelystadvirus und des MLV Impfvirus ´Ingelvac PRRS´ verglichen. Zusammenfassend wurden für die Jagdsaison 2004/2005 und 2005/2006 folgende Nachweishäufigkeiten in Deutschland ermittelt: europäisches PRRSV 5,5 %, amerikanisches PRRSV 3,6 %, Influenzavirus A 6,4 %, M. hyopneumoniae 44,0 %, A. pleuropneumoniae 42,7 %, H. parasuis 73,7 %, α-hämolysierende Streptokokken 57,9 %, P. multocida 32,2 % und B. bronchiseptica 0,3 %. Dabei zeigte sich eine ausgeprägte räumliche und zeitliche (d.h. saisonale) Inhomogenität der Ergebnisse. Prävalenzen für das europäische und das amerikanische PRRSV ergaben sich lediglich in der Jagdsaison 2004/2005, mit höheren Werten für die nördlichen Bundesländer Schleswig-Holstein, Mecklenburg-Vorpommern, Niedersachsen und Brandenburg und niedrigeren Werten für die südlichen Bundesländer Baden-Württemberg und das Saarland. Interessanterweise zeigte sich bezüglich der Influenzavirus A-positiven Reviere ein ähnliches Verbreitungsmuster wie für das PRRSV. Die viralen Krankheitserreger ausgeschlossen, zeichneten sich die Bundesländer Thüringen, Bayern, Schleswig-Holstein, Sachsen-Anhalt, Sachsen und Nordrhein-Westfalen durch insgesamt hohe Erregerprävalenzen aus, während die Prävalenzen im Saarland, in Hessen und Brandenburg für die Mehrzahl der untersuchten Bakterien auffällig niedrig ausfielen. RNA des europäischen PRRSV wurde in 95,2 %, die des amerikanischen PRRSV in 100% der positiven Fälle aus Lungenproben nachgewiesen. Auch bezüglich des Schweineinfluenzavirus erfolgte die Isolierung der Erreger-RNA mit 81,8 % hauptsächlich aus Lungenproben. Dabei konnte bei keinem der PRRSV bzw. Influenzavirus A positiven Wildschweine in Lungen- und Tonsillengewebe gleichzeitig Nukleinsäure nachgewiesen werden. M. hyopneumoniae-DNA fand sich in ausgeglichenen Anteilen in Tonsillen- und Lungengewebe. In 53,5 % wurde MHP-DNA aus beiden Geweben gleichzeitig isoliert. Der Nachweis von A. pleuropneumoniae-DNA erfolgt mit 81,2 % fast ausschließlich aus den Tonsillen und unterstreicht die Bedeutung des Wildschweins als APP-Reservoir. Auch für H. parasuis konnte mit 41,6 % HPS-DNA positiven Tonsillenproben und 6,3 % HPS-DNA positiven Lungenproben eine stärkere Erreger-Präsenz in den Tonsillen festgestellt werden. Anders als bei APP wies jedoch über die Hälfte der positiven Wildschweine (52,2 %) HPS-DNA sowohl in Tonsillen als auch in der Lunge auf. Der direkte Homologie-Vergleich von 193 Basen des europäischen Wildschweinisolates mit der Sequenz des Lelystadvirus zeigte im Bereich von zwei Basen des ORF 1 eine Sequenzabweichung im Sinne einer Punktmutation auf, was einer genetischen Übereinstimmung von 98,96 % entspricht. Eine ähnlich hohe Übereinstimmung von 96 % ergab sich aus dem Vergleich des MLV Impfvirus ´Ingelvac PRRS´ mit dem beim Wildschwein nachgewiesenen amerikanischen PRRSV auf der Grundlage von 50 Basen des ORF 1. Die Abweichung beruhte auf zwei Punktmutationen. Beide Vergleiche dienten dazu, die Amplifikate als PRRSV-Sequenzen zu bestätigen und vergleichend einzuordnen. Der Nachweis des amerikanischen PRRSV bei Wildschweinen in Europa ist bislang einzigartig und wirft die Frage nach der Herkunft des Virus auf. Als mögliche Erklärung kommt neben der Übertragung von Lebendimpfvirus von Haus- auf Wildschweine auch die Existenz eines dem amerikanischen Genotyp ähnlichen PRRSV-Wildtypstammes innerhalb der Wildschweinpopulation in Frage. With regard to respiratory tract infections in swine there has been a wide distribution of pathogens over the last years, in particular because of the increase of animal trade and local pig density. Frequently, respiratory diseases are caused by a mixed infection of different viral and/or bacterial agents, with pathogen interactions playing a significant role in the development of these diseases. Former serological studies on wild boars detected antibodies against some respiratory agents in these species, but reports on direct bacterial or viral isolation or even on clinical disease are restricted to individual cases and singular pathogens. The role of the wild boar as reservoir for certain pathogens e.g. for the causative agents of Aujeszky´s disease or classical swine fever is well known. The aim of this study was to evaluate the occurrence of different respiratory pathogens in wild boars in Germany and to obtain more information about possible pathogen interactions, the role of the wild boar as a pathogen reservoir and the way and direction of pathogen transmission between wild boars and domestic pigs. In total, 361 wild boar from 33 hunting grounds all over Germany were examined for the occurrence of respiratory pathogens. The detection of specific nucleic acids from PRRSV, Influenzavirus A, M. hyopneumoniae, A. pleuropneumoniae and H. parasuis was carried out on 361 lung and tonsillar samples using PCR, whereas 302 tonsillar samples were tested for α-haemolytic Streptococci, P. multocida and B. bronchiseptica by microbiological investigation. Furthermore cultured P. multocida isolates were checked for the ability of producing dermonecrotoxin by PCR as well. Both an American and European PRRSV-amplicon was sequenced and compared on basis of the ORF 1 sequence of the Lelystadvirus and the MLV vaccine strain ´Ingelvac PRRS´. In summary, the following prevalences were determined in the hunting seasons 2004/2005 and 2005/2006 in Germany: European PRRSV 5.5 %, American PRRSV 3.6 %, Influenzavirus A 6.4 %, M. hyopneumoniae 44.0 %, A. pleuropneumoniae 42.7 %, H. parasuis 73.7 %, α-haemolytic Streptococci 57.9 %, P. multocida 32.2 % und B. bronchiseptica 0.3 %. At the same time there was a distinct spatial and temporal inhomogeneity of results. Prevalences of the European and American PRRSV were only detected in the hunting season 2004/2005, with high values for the northern states Schleswig-Holstein, Mecklenburg-Western Pomerania, Lower Saxony and Brandenburg and low values for the southern states Baden-Wuerttemberg and Saarland. Interestingly, the Influenzavirus A positive hunting grounds showed a similar distribution pattern as seen for PRRSV. With disregard of the viral pathogens, overall prevalences in Thuringia, Bavaria, Schleswig-Holstein, Saxony-Anhalt, Saxony and North Rhine-Westphalia were higher-than-average, whereas Saarland, Hesse and Brandenburg were characterised by noticeable low prevalences for most of the examined bacteria. Ribonucleic acid of European PRRSV was detected in 95.2 % and American PRRSV in 100 % of lung samples derived from positive wild boars. Also in the case of Influenzavirus A the RNA was primary detected in lung samples. In this case the prevalence was 81.8 %. Thereby none of the positive wild boars with European PRRSV, American PRRSV or Influenzavirus A simultaneously harboured RNA in lung and tonsillar tissue. M. hyopneumoniae DNA was found in balanced rates in lung and tonsillar samples. In 53.5 % MHP DNA was isolated from both tissues at the same time. The evidence of A. pleuropneumoniae DNA was almost solely restricted to tonsillar samples with a prevalence of 81.2 %, which confirms the meaning of the wild boar as a reservoir for this agent. With regard to H. parasuis there was also a much higher pathogen presence in tonsillar tissue (41.6 % HPS DNA) than in lung tissue (6.3 % HPS DNA). In contrast to A. pleuropneumoniae half of the positive wild boars (52.2 %) harboured H. parasuis DNA in tonsillar samples as well as in lung samples. The direct comparison of 193 bases of the European wild boar isolate with the sequence of Lelystadvirus showed a point mutation in the range of two bases belonging to the ORF 1 region. This correlates with a homology of 98.96 %. A similar high homology of 96 % was found through comparison of the American wild boar strain with the MLV vaccine strain ´Ingelvac PRRS´ examining 50 bases of the ORF 1. The divergence was due to two point mutations. Both comparisons were undertaken to confirm the PCR products as PRRSV sequences and to classify them in relation to other isolates. The detection of the American PRRSV strain among wild boar populations in Europe is unique and raises the question of its origin. Besides the transmission of a vaccine virus strain from domestic pigs to wild boars, the existence of an American-like wild typ PRRSV strain among wild boars is a possible alternative explanation.

The Porcine Reproductive and Respiratory Syndrome (PRRS) is one of the economically most important swine diseases worldwide. The virus can be spread by viraemic and persistent infected pigs. Spread and infection are advanced in areas with high herd and population densities. As wild boars have been found seropositive for PRRSV in Germany, France, and the USA, exchange between wild and domestic pig populations may exist. However, comprehensive information on PRRSV infection in wild boars is presently not available. The aim of the current study was thus, to systematically study PRRSV infection in wild boars to provide information on spatiotemporal, host and viral effects. The study was based on 531 wild boars from 52 hunts in Germany (2004-2007). PRRSV infection was determined and strains (US/EU) were classified by PCR. A total of 15.9% of the wild boars were PRRSV-positive (US: 14.2%; EU: 6.2%), with remarkable effects of state (US: 5.1-46.2%; EU: 0-17.6%), season (0-36.5%) and tissue (lungs: 89%; tonsils: 11%). Prevalences did neither correlate with age or weight, nor with density of production units, domestic pigs or wild boars. Open reading frame (ORF) 1-sequences within EU- and US-strains did not differ among wild boar samples. Homologies between EU-samples/Lelystad-virus and US-samples/PRRSV-MLV virus were 99.3 and 97%, respectively. This is the first comprehensive evidence of PRRSV infection in wild boars. We conclude that there is only a weak relation between wild boar and domestic PRRSV infection.