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Virtual and augmented (VAR) technology is in the early stages of being adopted as a teaching platform in higher education. The technology can facilitate immersive learning in environments that are not usually physically accessible to students via 3D models and interactive 360° videos. To date, adoption rates of VAR technology for teaching have not been well described across a higher education institution. Further, there is an absence of information on the optimal VAR laboratory designs and cost per student. In this study, a purpose designed virtual reality laboratory was formed in 2017 at The University of Sydney, housing 26 Oculus Rift headset units. An evaluation was conducted on the design, costs, rates of teaching adoption and student experiences over five teaching periods (2.5 years). Over this period, 4833 students were taught in the laboratory across 7952 student visits. The laboratory was used most by the Faculty of Engineering (53%), followed by the Faculty of Arts & Social Science (23.8%) and Faculty of Science (23.2%). For engineering, the units of study using the laboratory represented only 1.4% of annual faculty subjects offered. This confirms that adoption was in the initial stage of innovation diffusion. The laboratory saw a 250% increase in student numbers over the period of evaluation and 71.5% of students surveyed ( n  = 295) reported enhanced learning outcomes. The cost per visit was only AU$ 19.50. These findings give confidence to higher education institutions that the right VAR technology infrastructure is a sound educational investment for the future., Supplementary Information: The online version contains supplementary material available at 10.1007/s10639-021-10653-6., Competing Interests: Conflicts of interestThe authors have no conflict of interests to declare that are relevant to the content of this article. The funding groups had no role; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.)

Objective: This quality improvement (QI) initiative was designed to identify gaps between evidence-based or hospital recommendations for trial of labour after cesarean delivery (TOLAC) labour management and clinical practice., Methods: Viable, singleton pregnancies from January 1, 2016, to December 31, 2018, undergoing TOLAC were extracted from the electronic medical record. Sixty randomly selected charts were reviewed for (1) consent, (2) induction methods, (3) oxytocin use, (4) continuous fetal monitoring, (5) admission indication, (6) examination regularity, (7) duration of dystocia before decision to perform cesarean delivery (CD), and (8) maternal complications., Results: The institutional vaginal birth after cesarean rate was 71%. Documented consent to TOLAC on admission was present in 50% of cases. Oxytocin augmentation was used in 38% of cases, and the median maximum dose was 4 mU/min (interquartile range [IQR] 3-7.5 mU/min). Delays in initiating oxytocin were identified in 47% of those patients. Decisions to deliver by cesarean were made after a median time of 5 hours and 40 minutes (IQR 3 hours and 30 minutes to 6 hours and 35 minutes) of failure to progress despite adequate contractions. After this decision, median time to delivery was 1 hour and 11 minutes (IQR 57 minutes to 2 hours and 16 minutes). Complications included postpartum hemorrhage (5%) and chorioamnionitis (6.7%). Surgical injury occurred in 10% of intrapartum CD. Peripartum complications were associated with delay in oxytocin implementation (χ 2 (1) = 9.80; P < 0.001) in secondary analysis., Conclusion: Areas for QI were identified in (1) consent, (2) duration of dystocia before decision to proceed with CD and delay to CD, and (3) peripartum complications. We recognize the potential use of this as a tool to identify areas for QI and prospective study., (Copyright © 2020 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)

We present novel data on the composition-, pH-, and salt-dependent zero shear viscosity of the commercially important mixture of anionic sodium dodecyl sulfate (SDS) and zwitterionic lauramidopropyl betaine (LAPB). We show via proton NMR experiments that the notionally zwitterionic LAPB exhibits a large p K a shift in the presence of SDS and can become partially cationic at formulation-relevant pH ranges of 4.5-6.0-that is, the binary system is effectively a ternary system. This has a pronounced effect on the viscosity of the system at low pH, especially if the fraction of LAPB is high. We use theoretical arguments to motivate a semiempirical but practical approach to model the viscosity of the mixtures using thermodynamic parameters such as the excess chemical potentials or activity coefficients of the surfactants. We demonstrate this using an augmented regular solution theory-based mixed micelle thermodynamic model and develop robust regression models using Bayesian approaches. We also show how the p K a shift from NMR experiments can be used to parameterize the thermodynamic model. This framework should be extensible to other arbitrary surfactant mixtures in the future and hence will be of broad interest for the development of surfactant formulations for household, personal care, and other applications.

Objective: To provide an evidence-based algorithm to guide the diagnosis and management of pregnancy of unknown location and tubal and nontubal ectopic pregnancy., Target Population: All patients of reproductive age., Benefits, Harms, and Costs: The implementation of this guideline aims to benefit patients with positive β-human chorionic gonadotropin results and provide physicians with a standard algorithm for expectant, medical, and surgical treatment of pregnancy of unknown location and tubal pregnancy and nontubal ectopic pregnancies., Evidence: The following search terms were entered into PubMed/Medline and Cochrane in 2018: cesarean section, chorionic gonadotropin, beta subunit, human/blood, fallopian tubes/surgery, female, fertility, humans, infertility, laparoscopy, methotrexate, methotrexate/administration & dosage, methotrexate/therapeutic use, pregnancy (abdominal, angular, cervix, cornual, ectopic, ectopic/diagnosis, ectopic/diagnostic imaging, ectopic/drug therapy, ectopic/epidemiology, ectopic/mortality, ectopic/surgery, heterotopic, interstitial, isthmo-cervical, ovarian, tubal, unknown location), recurrence, risk factors, salpingectomy, salpingostomy, tubal pregnancy, ultrasonography, doppler ultrasonography, and prenatal. Articles included were randomized controlled trials, meta-analyses, systematic reviews, observational studies, and case reports. Additional publications were identified from the bibliographies of these articles. Only English-language articles were reviewed., Validation Methods: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations)., Intended Audience: Obstetrician-gynaecologists, family physicians, emergency physicians, midwives, registered nurses, nurse practitioners, medical students, and residents and fellows., Summary Statements (grade Ratings in Parentheses): RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES)., (Copyright © 2021. Published by Elsevier Inc.)

Climate change is expected to increase the prevalence of water-borne diseases especially in developing countries. Climate-resilient drinking water supplies are critical to protect communities from faecal contamination and thus against increasing disease risks. However, no quantitative assessment exists for the impacts of short-term climate variability on faecal contamination at different drinking water sources in developing countries, while existing understanding remains largely conceptual. This critical gap limits the ability to predict drinking water quality under climate change or to recommend climate-resilient water sources for vulnerable communities. This study aims to provide such quantitative understanding by investigating the relationships between faecal contamination and short-term climate variability across different types of water sources. We collected a novel dataset with over 20 months' monitoring of weather, Escherichia coli (E. coli) and total coliforms, at 233 different water sources in three climatically different regions in Tanzania. We then took a rigorous statistical analysis with Bayesian hierarchical models, to relate both contamination occurrence and amount to climate variability. The model results explained the temporal variability in drinking water faecal contamination using climate predictors, and also revealed the climate sensitivity of faecal contamination for individual water sources. We found that: a) short-term climate variability and baseline contamination levels can explain about half the observed variability in faecal contamination (R 2  ≥ 0.44); b) increased contamination was most consistently related to recent heavy rainfall and high temperature across different water sources; c) unimproved water sources such as the unprotected dug wells have substantially higher climate sensitivity. Based on these results, we can expect substantial increases in drinking water contamination risks across tropical Sub-Saharan Africa and South-East Asian developing countries under a warmer climate, which highlight the urgent need of protecting vulnerable communities from the severe climate impacts., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This work was supported by the UK Department for International Development (DFID) and implemented by the World Health Organization (WHO). Ifakara Health Institute was awarded a technical services agreement from WHO to implement the project in Tanzania (Grant ID #2016/632163-0). WHO had some input into the initial study design but at no other stages of research synthesis or writing of this publication., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Climate change is expected to increase waterborne diseases especially in developing countries. However, we lack understanding of how different types of water sources (both improved and unimproved) are affected by climate change, and thus, where to prioritize future investments and improvements to maximize health outcomes. This is due to limited knowledge of the relationships between source water quality and the observed variability in climate conditions. To address this gap, a 20-month observational study was conducted in Tanzania, aiming to understand how water quality changes at various types of sources due to short-term climate variability. Nine rounds of microbiological water quality sampling were conducted for Escherichia coli and total coliforms, at three study sites within different climatic regions. Each round included approximately 233 samples from water sources and 632 samples from households. To identify relationships between water quality and short-term climate variability, Bayesian hierarchical modeling was adopted, allowing these relationships to vary with source types and sampling regions to account for potentially different physical processes. Across water sources, increases in E. coli/ total coliform levels were most closely related to increases in recent heavy rainfall. Our key recommendations to future longitudinal studies are (a) demonstrated value of high sampling frequency and temporal coverage (a minimum of 3 years) especially during wet seasons; (b) utility of the Bayesian hierarchical models to pool data from multiple sites while allowing for variations across space and water sources; and (c) importance of a multidisciplinary team approach with consistent commitment and sharing of knowledge., (©2019. The Authors.)

The free scission energy is the thermodynamic parameter that governs the contour length of wormlike micelles (WLMs). It is the contour length and the propensity to coil and entangle that determine the viscoelastic properties of this commercially important substance class. The free scission energy Δ F sc and the associated change in enthalpy Δ H sc and entropy Δ S sc on scission have been determined for a mixed anionic/zwitterionic surfactant system (sodium laureth sulfate and cocamidopropyl betaine) at various salt concentrations (3-5 wt % NaCl). Both enthalpy Δ H sc and entropy Δ S sc changes decrease linearly with increasing NaCl concentration. At NaCl concentrations above 4 wt %, Δ S sc even adopts negative values. The term TΔ S sc decreases more rapidly than Δ H sc around room temperature and causes the observed elongation of WLMs upon addition of NaCl. It is suggested that Δ S sc is initially positive due to fewer bound counterions per surfactant molecule at end caps compared to the intact, cylindrical parts before scission, leading to a net release of ions upon scission. Negative values of Δ S sc are attributed to hydrophobic hydration occurring at the end caps at high salt concentrations. 23 Na NMR measurements indicate the presence of immobilized ions, supporting a previously proposed ion-cloud model based on neutron scattering results.

In developing countries, rural water sources have the highest levels of faecal contamination but are the least monitored. Affordable field-based water quality tests are needed. The presence of faecal indicator bacteria can be determined with hydrogen sulphide (H 2 S) detecting tests, that are inexpensive and simple to make locally. In rural Tanzania, a non-governmental organisation (NGO) designed, produced and evaluated a new H 2 S water quality test kit. The H 2 S test results correlated with log 10 Escherichia coli densities from conventional water quality tests. The production cost was US$ 1.10 and the test retailed for US$ 1.37. In total, 433 tests were sold through local pharmacies and NGOs. Additionally, 165 WaSH education meetings, reaching 3,408 community members, were conducted with the H 2 S test demonstrated in over half the meetings. Pre- and post-surveys of 294 meeting participants saw an increased reporting of household level water treatment by 24%. The H 2 S test was widely accepted, with 94% of those surveyed willing to buy the test in the future. International and national guidelines for drinking water monitoring need to be amended to include locally produced H 2 S water quality tests. This will enable households to monitor their own water sources and make informed choices about water safety and treatment.

Generating mitochondrial genome (mitogenome) data from reference samples in a rapid and efficient manner is critical to harnessing the greater power of discrimination of the entire mitochondrial DNA (mtDNA) marker. The method of long-range target enrichment, Nextera XT library preparation, and Illumina sequencing on the MiSeq is a well-established technique for generating mitogenome data from high-quality samples. To this end, a validation was conducted for this mitogenome method processing up to 24 samples simultaneously along with analysis in the CLC Genomics Workbench and utilizing the AQME (AFDIL-QIAGEN mtDNA Expert) tool to generate forensic profiles. This validation followed the Federal Bureau of Investigation's Quality Assurance Standards (QAS) for forensic DNA testing laboratories and the Scientific Working Group on DNA Analysis Methods (SWGDAM) validation guidelines. The evaluation of control DNA, non-probative samples, blank controls, mixtures, and nonhuman samples demonstrated the validity of this method. Specifically, the sensitivity was established at ≥25 pg of nuclear DNA input for accurate mitogenome profile generation. Unreproducible low-level variants were observed in samples with low amplicon yields. Further, variant quality was shown to be a useful metric for identifying sequencing error and crosstalk. Success of this method was demonstrated with a variety of reference sample substrates and extract types. These studies further demonstrate the advantages of using NGS techniques by highlighting the quantitative nature of heteroplasmy detection. The results presented herein from more than 175 samples processed in ten sequencing runs, show this mitogenome sequencing method and analysis strategy to be valid for the generation of reference data., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Purpose: To compare the biomechanical performance of medial row suture placement relative to the musculotendinous junction (MTJ) in a cadaveric transosseous equivalent suture bridge (TOE-SB) double-row (DR) rotator cuff repair (RCR) model., Methods: A TOE-SB DR technique was used to reattach experimentally created supraspinatus tendon tears in 9 pairs of human cadaveric shoulders. The medial row sutures were passed either near the MTJ (MTJ group) or 10 mm lateral to the MTJ (rotator cuff tendon [RCT] group). After the supraspinatus repair, the specimens underwent cyclic loading and load to failure tests. The localized displacement of the markers affixed to the tendon surface was measured with an optical tracking system., Results: The MTJ group showed a significantly higher (P = .03) medial row failure (5/9; 3 during cyclic testing and 2 during load to failure testing) compared with the RCT group (0/9). The mean number of cycles completed during cyclic testing was lower in the MTJ group (77) compared with the RCT group (100; P = .07) because 3 specimens failed in the MTJ group during cyclic loading. There were no significant differences between the 2 study groups with respect to biomechanical properties during the load to failure testing., Conclusions: In a cadaveric TOE-SB DR RCR model, medial row sutures through the MTJ results in a significantly higher rate of medial row failure., Clinical Relevance: In rotator cuff tears with tendon tissue loss, passage of medial row sutures through the MTJ should be avoided in a TOE-SB RCR technique because of the risk of medial row failure., (Copyright © 2016. Published by Elsevier Inc.)

Objective: To evaluate the safety and effectiveness of conservative management for cervical ectopic pregnancies., Methods: We conducted a retrospective review of all cases of cervical ectopic pregnancy diagnosed at our tertiary care academic centre between January 2002 and July 2014. The diagnosis of cervical ectopic pregnancy was made using transvaginal ultrasound according to published criteria. Management decisions were made by individual clinicians., Results: Cervical ectopic pregnancy was diagnosed in 27 women with a median age of 34 years. Two thirds of them were nulliparous, and 44% (12/27) reported infertility. The mean gestational age at diagnosis was seven weeks. The median serum human chorionic gonadotropin level was 11 300 IU/L (range 610 to 163 700). Fetal cardiac activity was present in 19 pregnancies (70%). Vaginal bleeding was the most common presentation, occurring in 23 cases (85%). Three women presented with acute life-threatening hemorrhage. All cases were successfully managed conservatively, allowing uterine preservation. Systemic methotrexate (single or multi-dose protocol) was the mainstay of therapy. Other minimally invasive interventions included ultrasound-guided injection of potassium chloride into the pregnancy, uterine artery embolization, vaginal ligation of cervical branches of the uterine arteries, and dilatation and curettage, with or without dilute vasopressin cervical infiltration and Foley catheter tamponade., Conclusion: Systemic methotrexate alone or in combination with other minimally invasive techniques can be effective conservative treatment for cervical pregnancies. A fertility-sparing approach is the optimal treatment for this patient population, which has high rates of infertility and nulliparity. We present a management algorithm based on our results to aid in standardizing the management of cervical ectopic pregnancies.

Qiagen's Investigator™ Quantiplex kit, a total human DNA quantitation kit, has a 200-base pair internal control, fast cycling time, and scorpion molecules containing a covalently linked primer, probe, fluorophore, and quencher. The Investigator™ Quantiplex kit was evaluated to investigate a value under which complete short tandem repeat (STR) failure was consistently obtained. Buccal swabs were extracted using the Qiagen QIAamp(®) DNA Blood Mini Kit, quantified with the Investigator™ Quantiplex kit using a tested half-volume reaction, amplified with the ABI AmpFlSTR(®) Identifiler kit, separated on the 3100Avant Genetic Analyzer, and data analyzed with GeneMapper(®) ID v.3.2. While undetected samples were unlikely to produce sufficient data for statistical calculations or CODIS upload (2.00 alleles and 0.82 complete loci on average), data may be useful for exclusionary purposes. Thus, the Investigator™ Quantiplex kit may be useful for predicting STR success. These findings are comparable with previously reported data from the Quantifiler™ Human kit., (© 2013 American Academy of Forensic Sciences.)

Objective: The purpose of the study is to review the surgical technique, complication rate and obstetric outcome associated with the laparoscopic approach to the placement of the cervico-isthmic cerclage., Study Design: A prospective cohort study was conducted from 2003-2008 and compared with previously reported cases of cervico-isthmic cerclage by laparotomy and laparoscopy., Results: Thirty-one patients underwent cerclage placement during pregnancy and 34 patients were not pregnant at the time of the surgery. Seven cases were converted to laparotomy due to complications arising from uterine vessel bleeding or impaired surgical visibility; 2 pregnancies were lost perioperatively. No other complications occurred. The fetal salvage rate (n = 67 pregnancies) was 89% with a mean gestational age of 35.8 +/- 2.9 weeks. Six pregnancies were lost in the second trimester due to the consequences of acute or subacute chorioamnionitis., Conclusion: Our findings suggest that the cervico-isthmic cerclage placed laparoscopically compares favorably with the traditional laparotomy approach.

How do people report the contents of short-term memory when information about order must be retained but items can be retrieved in any order? We report an experiment using an unconstrained reconstruction task in which people can report list items in any order but must place them in their correct serial positions. We found (1) a tendency to report recent items first in immediate but not in delayed reconstruction, (2) a tendency to recall temporally isolated items first, (3) a preference for forward recall order, and (4) a preference for output orders that minimize the length of the path that must be traversed through memory space during retrieval. The results constrain most current models of short-term memory in which retrieval is ballistic and is assumed to run to completion autonomously once initiated.

The mechanism and the nature of the dynamically determined product selectivity in Diels-Alder cycloadditions of 3-methoxycarbonylcyclopentadienone (2) with 1,3-dienes was studied by a combination of product studies, experimental kinetic isotope effects, standard theoretical calculations, and quasiclassical trajectory calculations. The low-energy transition structures in these reactions are structurally balanced between [4pi(diene) + 2pi(dienone)] and the [2pi(diene) + 4pi(dienone)] modes of cycloaddition. The accuracy of these structures and their bispericyclic nature is supported by the experimental isotope effects. Trajectories passing through these transition structures can lead to both [4pi(diene) + 2pi(dienone)] and [2pi(diene) + 4pi(dienone)] cycloadducts, and the mixture of products obtained varies with the structure of the diene. The factors affecting this selectivity are analyzed. The geometry of the transition structure is a useful predictor of the major product, but the selectivity is also guided by the shape of the energy surface as trajectories approach the products and by how trajectories cross the transition state ridge.

Objective: To assess the perceived learning outcomes from the various roles involved in the development and implementation of an objective structured clinical examination (OSCE) by residents for residents., Methods: Final-year residents in Obstetrics and Gynaecology at the University of Toronto created OSCE stations in preparation for their certification examination. They evaluated their experience using a survey designed to assess the learning effectiveness of the roles played in an OSCE. Residents were asked to compare resident-created stations with faculty-created stations., Results: The students found every aspect of OSCE development to be of educational benefit. Residents rated the candidate role as more beneficial than other roles. Residents perceived the benefits of the OSCE sessions to be greater than equivalent lengths of time spent in traditional group study sessions., Conclusions: A self-directed learning approach, based on OSCE development and implementation, shows promise as a learning aid at the senior residency level. We suggest a controlled trial designed to objectively measure outcomes of this learner-centred approach.

Objective: To determine the current practice patterns of Canadian obstetricians towards pregnant women at term, with intact membranes, who have had a previous Caesarean delivery., Study Design: A questionnaire was developed in French and English, pretested, and mailed to all obstetricians registered with the Canadian Medical Directory. Two reminders were sent out at 3-week intervals. Respondents identities were kept anonymous., Results: Of 1497 questionnaires sent out, 750 (50%) were returned. Of these 750 respondents, 102 were no longer working in obstetrics and 47 did not manage women with prior uterine incisions in labour, thus leaving 601 respondents (80% of all respondents) who did manage pregnant women in labour with previous Caesarean scars eligible for the analysis. Whereas 91% of these 601 respondents always counsel prospective vaginal birth after Caesarean (VBAC) candidates regarding the risk of uterine rupture, 9% never, or only occasionally, do so. Of these 601 respondents, 16% would use ultrasound assessment of lower uterine segment thickness to consider patients for VBAC, and 25% percent would use prostaglandins to induce labour in women who have had a previous Caesarean., Conclusion: There is considerable disparity in the approach of Canadian obstetricians to the management of women with a previous Caesarean delivery scar who come to term without the spontaneous onset of labour, including appropriateness of inducing labour. A large, multicentre, prospective, randomized controlled trial of large numbers of women would help to determine the safety of VBAC and induction of labour in the setting of a uterine scar.