Search

Online course instruction remains one of the fastest growing sectors in the higher education industry but has been historically stigmatized with poor quality and low standards. Early distance education programs were heavily teacher-centric in design and were used as a means to disseminate information to students at a distance. However, institutions have worked to re-envision distance education through a student-centered learning approach to improve the modality quality. In light of the rapid shift to online teaching as a result of the COVID-19 pandemic response, there is a need to improve practices for preparing quality courses to support student learning in hybrid and online learning formats. There are a variety of quality assurance frameworks and evaluation instruments, such as the Quality Matters Higher Education Rubric, that are utilized to measure the quality of course design. The purpose of this case study is to analyze the faculty and student perceptions of the impact of course design on student learning at a small public college in Central Florida.

Abstract Background A cluster randomised trial is a randomised controlled trial in which groups of individuals (clusters) are randomised to treatment arms. Stepped wedge cluster randomised trials are a type of cluster randomised trial where clusters are randomised to sequences. These trial designs are important for impacting decision-making, and it is therefore important that they be well-conducted and reported. Main body In November 2018, we created a new website dedicated to cluster randomised trials, including stepped wedge designs: https://clusterrandomisedtrials.qmul.ac.uk/ . The idea for the website emerged from the conference on Current Developments in Cluster Randomised Trials and Stepped Wedge Designs held in November 2016 at Queen Mary University of London, with the aim to provide an online resource to facilitate quality trials and methodological research on these types of trial. The website is divided into sections covering Design, Analysis and Reporting for traditional (i.e. parallel two-arm) cluster randomised trials and stepped wedge designs and contains resources in the form of hyperlinks to relevant papers along with brief explanations. A noticeboard page provides details on announcements, events, and past events. Conclusion We aim to keep the site updated with the latest publications and events related to cluster randomised trials, and welcome suggestions from the research community on further resources or events to add. We hope that the site will facilitate high-quality traditional and stepped wedge cluster randomised trials.

Abstract Background Diarrheal disease is a significant cause of morbidity and mortality in under-fives in many low- and middle-income countries. Changes in food safety, hygiene practices, and nutrition around the weaning period may reduce the risk of disease and improve infant development. The MaaCiwara study aims to evaluate the effectiveness of a community-based educational intervention designed to improve food safety and hygiene behaviours, as well as child nutrition. This update article describes the statistical analysis plan for the MaaCiwara study in detail. Methods and design The MaaCiwara study is a parallel group, two-arm, superiority cluster randomised controlled trial with baseline measures, involving 120 clusters of rural and urban communities. These clusters are randomised to either receive the community-based behaviour change intervention or to the control group. The study participants will be mother–child pairs, with children aged between 6 and 36 months. Data collection involves a day of observation and interviews with each participating mother–child pair, conducted at baseline, 4 months, and 15 months post-intervention. The primary analysis aims to estimate the effectiveness of the intervention on changes to complementary food safety and preparation behaviours, food and water contamination, and diarrhoea. The primary outcomes will be analysed generalised linear mixed models, at individual level, accounting for clusters and rural/urban status to estimate the difference in outcomes between the intervention and control groups. Secondary outcomes include maternal autonomy, enteric infection, nutrition, child anthropometry, and development scores. In addition, structural equation analysis will be conducted to examine the causal relationships between the different outcomes. Trial registration International Standard Randomised Controlled Trial Number (ISRCTN) register: ISRCTN14390796 . Registered on 13 December 2021.

The current gold standard grafting material is autologous bone due to its osteoinductive and osteoconductive properties. Autograft harvesting results in donors site morbidity. Coral scaffolds offer a natural autograft alternative, sharing the density and porosity of human bone. This study investigated the biocompatibility and osteogenic potential of a novel, sustainably grown Pocillopora scaffold with human bone marrow-derived mesenchymal stromal cells (MSCs). The coral-derived scaffold displays a highly textured topography, with concavities of uniform size and a high calcium carbonate content. Large scaffold samples exhibit compressive and diametral tensile strengths in the range of trabecular bone, with strengths likely increasing for smaller particulate samples. Following the in vitro seeding of MSCs adjacent to the scaffold, the MSCs remained viable, continued proliferating and metabolising, demonstrating biocompatibility. The seeded MSCs densely covered the coral scaffold with organized, aligned cultures with a fibroblastic morphology. In vivo coral scaffolds with MSCs supported earlier bone and blood vessel formation as compared to control constructs containing TCP-HA and MSCs. This work characterized a novel, sustainably grown coral scaffold that was biocompatible with MSCs and supports their in vivo osteogenic differentiation, advancing the current repertoire of biomaterials for bone grafting.

Aims: There is ambiguity surrounding the degree of scaphoid union required to safely allow mobilization following scaphoid waist fracture. Premature mobilization could lead to refracture, but late mobilization may cause stiffness and delay return to normal function. This study aims to explore the risk of refracture at different stages of scaphoid waist fracture union in three common fracture patterns, using a novel finite element method. Methods: The most common anatomical variant of the scaphoid was modelled from a CT scan of a healthy hand and wrist using 3D Slicer freeware. This model was uploaded into COMSOL Multiphysics software to enable the application of physiological enhancements. Three common waist fracture patterns were produced following the Russe classification. Each fracture had differing stages of healing, ranging from 10% to 90% partial union, with increments of 10% union assessed. A physiological force of 100 N acting on the distal pole was applied, with the risk of refracture assessed using the Von Mises stress. Results: Overall, 90% to 30% fracture unions demonstrated a small, gradual increase in the Von Mises stress of all fracture patterns (16.0 MPa to 240.5 MPa). All fracture patterns showed a greater increase in Von Mises stress from 30% to 10% partial union (680.8 MPa to 6,288.6 MPa). Conclusion: Previous studies have suggested 25%, 50%, and 75% partial union as sufficient for resuming hand and wrist mobilization. This study shows that 30% union is sufficient to return to normal hand and wrist function in all three fracture patterns. Both 50% and 75% union are unnecessary and increase the risk of post-fracture stiffness. This study has also demonstrated the feasibility of finite element analysis (FEA) in scaphoid waist fracture research. FEA is a sustainable method which does not require the use of finite scaphoid cadavers, hence increasing accessibility into future scaphoid waist fracture-related research. Cite this article: Bone Jt Open 2023;4(8):612–620.

Objectives. Flavonoids comprise a huge class of phenolic compounds widely distributed throughout the plant kingdom. Although quercetin and rutin have been studied individually for their therapeutic value, the synergistic effect of combining the two has previously not been measured. The objective of this trial was to evaluate the anti-inflammatory and antioxidant properties of both quercetin and rutin when combined in the form of SophorOx™ (a proprietary preparation of quercetin–rutin) in exercised rats. Methods. Sprague–Dawley rats were orally administered SophorOx™ at 500 mg·kg−1·b.w. and subjected to daily exercise on a fabricated treadmill for 4 weeks. A total of 24 animals were randomly divided into four groups. All the animals were examined for body weight, feed consumption, signs of clinical abnormalities, and morbidity. In addition, serum collected on days 8, 15, 22, and 29 were measured for the liver function test (LFT), random blood sugar (RBS), inflammatory markers C-reactive protein (CRP), oxidative stress markers (8-isoprostane (8-iso-PGF2α), malondialdehyde (MDA), 8-hydroxydeoxyguanosine (8-OHdG), and cytokine levels interleukin-1β (IL-1β), interleukin 6 (IL-6), and tumor necrosis factor-α (TNF-α)) by the ELISA method. Results. Rats that received SophorOx™ showed no signs of adverse effects, and no significant changes were observed in body weight, feed consumption, liver enzymes, and blood glucose levels. The exercise-treated rats administered with SophorOx™ exhibited a significant reduction in oxidative and inflammatory marker levels, viz., CRP (113.32 ng·mL−1) and oxidative stress markers 8-OHdG (19.32 pg·mL−1), MDA (1.06 nmol·mL−1), 8-iso-PGF2α (1.29 ng·mL−1), IL-1β (0.77 pg·mL−1), and IL-6 (317.14 pg·mL−1) in comparison to those rodents that were exercised without SophorOx™. Conclusion. Oral administration of SophorOx™ significantly reduced oxidative stress and inflammatory marker levels when measured in the rodents subjected to high-intensity exercise.

BackgroundThere has been extensive research on the relationship between hearing and cognitive impairment in older adults but little examination of the role of mediating factors. Social isolation is a potential mediator, occurring because of hearing loss, and contributing to accelerated cognitive decline. Previous systematic reviews on this topic area have not considered the temporal nature of hearing loss and cognitive impairment exclusively or examined potential mediators within a longitudinal study design.MethodsA systematic review was conducted. Electronic searches were performed in Web of Science, PubMed (Medline), Scopus, EMBASE, PsychInfo, and ProQuest (PsychArticles and ProQuest Dissertation and Theses) based on a search string of keywords relating to hearing loss, social isolation, and cognitive impairment/dementia in June 2023. Papers were critically appraised using the CASP checklists for cohort studies. Risk of bias in the selected studies was assessed using the Item Bank for Assessment of Risk of Bias and Precision for Observational Studies of Interventions or Exposures.ResultsEleven of the 15 included studies provide evidence of a dose-dependent association between hearing threshold (40 dB HL or greater) and later cognitive impairment or incident dementia. Only one study included social isolation as a mediator, which was found to not be a significant contributing factor. The meta-analysis of 5 studies pooled hazard ratio for cognitive impairment due to hearing loss is 1.11 (95% CI: 1.06 to 1.15, p

Summary: Background: SCORE is the first randomised controlled trial (RCT) to examine shared oncologist and general practitioner (GP) follow-up for survivors of colorectal cancer (CRC). SCORE aimed to show that shared care (SC) was non-inferior to usual care (UC) on the EORTC QLQ-C30 Global Health Status/Quality of Life (GHQ-QoL) scale to 12 months. Methods: The study recruited patients from five public hospitals in Melbourne, Australia between February 2017 and May 2021. Patients post curative intent treatment for stage I–III CRC underwent 1:1 randomisation to SC and UC. SC replaced two oncologist visits with GP visits and included a survivorship care plan and primary care management guidelines. Assessments were at baseline, 6 and 12 months. Difference between groups on GHQ-QoL to 12 months was estimated from a mixed model for repeated measures (MMRM), with a non-inferiority margin (NIM) of −10 points. Secondary endpoints included quality of life (QoL); patient perceptions of care; costs and clinical care processes (CEA tests, recurrences). Registration ACTRN12617000004369p. Findings: 150 consenting patients were randomised to SC (N = 74) or UC (N = 76); 11 GPs declined. The mean (SD) GHQ-QoL scores at 12 months were 72 (20.2) for SC versus 73 (17.2) for UC. The MMRM mean estimate of GHQ-QoL across the 6 month and 12 month follow-up was 69 for SC and 73 for UC, mean difference −4.0 (95% CI: −9.0 to 0.9). The lower limit of the 95% CI did not cross the NIM. There was no clear evidence of differences on other QoL, unmet needs or satisfaction scales. At 12 months, the majority preferred SC (40/63; 63%) in the SC group, with equal preference for SC (22/62; 35%) and specialist care (22/62; 35%) in UC group. CEA completion was higher in SC. Recurrences similar between arms. Patients in SC on average incurred USD314 less in health costs versus UC patients. Interpretation: SC seems to be an appropriate and cost-effective model of follow-up for CRC survivors. Funding: Victorian Cancer Agency and Cancer Australia.

Introduction Knife-enabled crime is a UK public health issue leading to substantial impacts on society, victims and their families, as well as additional strain on the healthcare system. Despite the increase in knife-enabled crime and the overwhelming consequences, there is a lack of comprehensive studies exploring the long-term health outcomes of knife crime victims in the UK. The research gap hinders the development of more targeted secondary preventative interventions, resource allocation and public awareness campaigns. This systematic review aims to identify the long-term health outcomes of knife crime victims, therefore providing valuable knowledge for stakeholders, health practitioners and policymakers for a more effective public health response.Methods and analysis A comprehensive search strategy was developed, focusing on four key concepts: study design, knife-related offences, outcomes and risk. Databases being searched include MEDLINE, EMBASE, PsycINFO, ProQuest Criminology Collection, Web of Science Core Collection, Google Scholar and OpenGrey. Reference lists and forward citations will be inspected for further suitable literature. The study selection will involve two independent reviewers screening the studies from the search, with disagreements resolved by a third reviewer. All UK quantitative research on long-term health outcomes of knife crime victims will be included in the review. Covidence will be used to efficiently manage data. A data extraction form has been developed which will summarise key aspects of each study that will be included in the review. Methodological Index for Non-Randomised Studies quality assessment checklist will be used to assess the studies and the Newcastle-Ottawa Scale will assess the risk of bias in each study. Findings will be narratively synthesised, and if heterogeneity is sufficient, a meta-analysis will be conducted.Ethics and dissemination Ethics approval is not required for this study as no original data will be collected. The results will be disseminated through a peer-reviewed publication and conference presentation.

IntroductionDuring the COVID-19 pandemic in the UK, those considered most vulnerable to adverse outcomes from infection were designated “clinically extremely vulnerable” and advised to “shield.” This involved prolonged confinement at home with strict limits on face-to-face contact, beyond national restrictions. Shielding ended in September 2021 and was considered likely to have harmed mental health and wellbeing. As the UK moved toward a new phase of “living with COVID-19” the mental health and wellbeing experiences of those advised to shield may have diverged from the general population.MethodsThis study is a secondary analysis of nine “COVID-19 Survey” waves of Understanding Society, a longitudinal study of UK participants covering April 2020 to September 2021 alongside pre-pandemic baseline data. The prevalence of clinically significant psychological distress (General Health Questionnaire 12) and low life satisfaction were examined at each wave for participants with longitudinal responses across all waves, stratified by receipt of shielding guidance (Received n = 410, Not received n = 6,878). Mixed effects regression modeling examined associations between shielding guidance receipt and mental health and life satisfaction when adjusting for potential confounders including age and sex, pre-pandemic mental health/life satisfaction, and loneliness.ResultsThose who received shielding guidance were more likely to experience poor mental health and low life satisfaction during the pandemic. However, this largely reflected differences in pre-pandemic baselines. Variation between waves broadly coincided with the changing burden of COVID-19 and associated restrictions, with similar patterns regardless of shielding guidance receipt. Regression modeling combining data across all waves indicated that receipt of shielding guidance did not independently predict adverse outcomes. However, poor pre-pandemic mental health and low life satisfaction, and frequent loneliness, as well as demographic factors including sex and age, consistently predicted adverse pandemic mental health and wellbeing.DiscussionWhile those who received shielding guidance did on average experience poorer mental health and life satisfaction during the pandemic, this study suggests this largely reflects existing inequalities. Drawing on data throughout the shielding program, it addresses an existing evidence gap. These findings reinforce the importance of addressing existing mental health inequalities in the recovery from the current pandemic and for future preparedness.

Rapid shallow landslides are a significant hillslope erosion mechanism and limited understanding of their initiation and development results in persistent risk to infrastructure. Here, we analyse the slope above the strategic A83 Rest and be Thankful road in the west of Scotland. An inventory of 70 landslides (2003–2020) shows three types of shallow landslide, debris flows, creep deformation, and debris falls. Debris flows dominate and account for 5,350 m3 (98%) of shallow-landslide source volume across the site. We use novel time-lapse vector tracking to detect and quantify slope instabilities, whilst seismometers demonstrate the potential for live detection and location of debris flows. Using on-slope rainfall data, we show that shallow-landslides are typically triggered by abrupt changes in the rainfall trend, characterised by high-intensity, long duration rainstorms, sometimes part of larger seasonal rainfall changes. We derive empirical antecedent precipitation (>62 mm) and intensity-duration (>10 h) thresholds over which shallow-landslides occur. Analysis shows the new thresholds are more effective at raising hazard alerts than the current management plan. The low-cost sensors provide vital notification of increasing hazard, the initiation of movement, and final failure. This approach offers considerable advances to support operational decision-making for infrastructure threatened by complex slope hazards.

Abstract Background Doctors, including junior doctors, are vulnerable to greater levels of distress and mental health difficulties than the public. This is exacerbated by their working conditions and cultures. While this vulnerability has been known for many years, little action has been taken to protect and support junior doctors working in the NHS. As such, we present a series of recommendations from the perspective of junior doctors and other relevant stakeholders, designed to improve junior doctors’ working conditions and, thus, their mental health. Methods We interviewed 36 junior doctors, asking them for recommendations for improving their working conditions and culture. Additionally, we held an online stakeholder meeting with a variety of healthcare professionals (including junior doctors), undergraduate medical school leads, postgraduate speciality school leads and NHS policymakers where we asked what could be done to improve junior doctors’ working conditions. We combined interview data with notes from the stakeholder discussions to produce this set of recommendations. Results Junior doctor participants and stakeholders made organisational and interpersonal recommendations. Organisational recommendations include the need for more environmental, staff and educational resources as well as changes to rotas. Interpersonal recommendations include changes to communication and recommendations for better support and teamwork. Conclusion We suggest that NHS policymakers, employers and managers consider and hopefully implement the recommendations set out by the study participants and stakeholders as reported in this paper and that the gold standards of practice which are reported here (such as examples of positive learning environments and supportive supervision) are showcased so that others can learn from them.

Abstract Background There is increasing focus on moving populations towards healthier and more environmentally sustainable dietary patterns. The Australian Dietary Guidelines provide dietary patterns that promote health and wellbeing. It is unclear how these guidelines align with the more recently published global recommendations of the EAT-Lancet Planetary Health Reference Diet, and how Australian diets compare to both sets of recommendations. Methods Data from one 24-h recall collected for the 2011–13 National Nutrition and Physical Activity Survey were analysed for 5,920 adults aged 19–50 years. Subgroups of this population were identified by diet quality and lower or higher consumption of foods often considered to be environmentally intensive (higher animal meat and dairy foods) or associated with healthiness (higher vegetables and lower discretionary choices). Food group and nutrient composition of Australian diets were compared to diets modelled on the Australian Dietary Guidelines and Planetary Health Reference Diet. The environmental impacts of diets were estimated using an index of combined metrics. Results Compared with the Planetary Health Reference Diet, the Australian Dietary Guidelines contained more servings of the vegetable, dairy and alternatives, fruit, and discretionary choices. The amount of meat and alternatives was higher in the Planetary Health Reference Diet than Australian Dietary Guidelines due to the inclusion of more plant-based meat alternatives. The average Australian diet contained two to almost four times the Australian Dietary Guidelines and Planetary Health Reference Diet maximum recommended intake of discretionary choices, and provided inadequate amounts of the vegetables, cereals, unsaturated fats and meats and alternatives food groups, primarily due to lower intakes of plant-based alternatives. The average Australian diet also contained less dairy and alternatives than the Australian Dietary Guidelines. In the average Australian diet, red meat and poultry contributed 73% to the total servings of meat and alternatives compared to 33% and 10% for the Australian Dietary Guidelines and Planetary Health Reference Diet respectively. The modelled Australian Dietary Guidelines diet met the relevant nutrient reference value for all 22 nutrients examined, whereas the Planetary Health Reference Diet contained an inadequate amount of calcium. The environmental impact scores of the Planetary Health Reference Diet and Australian Dietary Guidelines were 31% and 46% lower than the average Australian diet. Conclusions Significant changes are required for Australians’ dietary intake to align more closely with national and global dietary recommendations for health and environmental sustainability.

Nodal metastasis is an independent prognostic factor in patients with melanoma. Sentinel lymph node biopsy (SNB) is a recommended component of the management of patients with AJCC stage T1b or above. The dermal scar is injected with a Technetium-99 m (99MTc) Nanocolloid, a radiotracer that drains into sentinel nodes to be identified on a preoperative SPECT/CT scan. Intraoperatively the sentinel nodes are located using a gamma probe and patent blue dye. A 79-year-old male was referred to the Plastics Outpatient Department for management of a biopsy proven pT4b melanoma on the right flank and a suspicious lesion on the right shoulder. He was scheduled for a SNB and wide local excision of the flank melanoma and excisional biopsy of the shoulder lesion. He received injections of 99MTc Nanocolloid around the flank biopsy scar, however, preoperative, and intraoperative attempts to locate a node using radiological and surgical techniques were unsuccessful. The biopsy of the shoulder lesion sent for histopathology revealed a pT1b melanoma. A subsequent second SNB on the shoulder melanoma was unsuccessful, as 99MTc Nanocolloid failed to drain into a sentinel node for a second time. The drainage function of lymphatic vessels declines with age however the complete failure of nodal uptake is exceptionally rare. Novel radiotracers such as 99MTc Tilmanocept have shown superior lymph node tracking in recent tracers.

Biofouling is the buildup of marine organisms on a submerged material. This research tests the efficacy of phosphonium ion gels comprising phosphonium monomers ([P444VB][AOT] and [P888VB][AOT]) and free ionic liquid ([P4448][AOT], [P88814][AOT]) (10 to 50 wt%), varying copper(II) oxide biocide concentrations (0 to 2 wt%), and the docusate anion [AOT]− for added hydrophobicity. The efficacy of these formulations was tested using a seachest simulator protected from light and tidal currents in New Zealand coastal waters over the summer and autumn periods. Anti-fouling performance was correlated with the hydrophobicity of the surface (water contact angle: 14–131°) and biocide concentration. Formulations with higher hydrophobicity (i.e., less free ionic liquid and longer alkyl chain substituents) displayed superior anti-fouling performance. The presence of the copper(II) biocide negatively affected anti-fouling performance via significant increases to hydrophilicity. No correlation was observed between antimicrobial activity and anti-fouling performance. Overall, phosphonium ion gels show potential for combining anti-fouling and foul release properties.

Many workplaces offer health and wellbeing initiatives to their staff as recommended by international and national health organisations. Despite their potential, the influence of these initiatives on health behaviour appears limited and evaluations of their effectiveness are rare. In this research, we propose evaluating the effectiveness of an established behaviour change intervention in a new workplace context. The intervention, 'mental contrasting plus implementation intentions', supports staff in achieving their health and wellbeing goals by encouraging them to compare the future with the present and to develop a plan for overcoming anticipated obstacles. We conducted a systematic review that identified only three trials of this intervention in workplaces and all of them were conducted within healthcare organisations. Our research will be the first to evaluate the effectiveness of mental contrasting outside a solely healthcare context. We propose including staff from 60 organisations, 30 in the intervention and 30 in a waitlisted control group. The findings will contribute to a better understanding of how to empower and support staff to improve their health and wellbeing. Trial registration: ISRCTN17828539.