The recent interest in the use of Immersive Virtual Reality (IVR) in education seems to correspond with the increased affordability, accessibility and functionality of IVR hardware and software. IVR ...has the potential to enhance
immersion, improve spatial capabilities, promote empathy, increase motivation and possibly improve learning outcomes. However, the extent to which teachers capitalise on these potentials in the future depends their perceptions of IVR and
their behavioural intentions to use it. Accordingly, this study aimed to identify relevant factors and influences relating to preservice teachers' behavioural intention to use IVR, using the Unified Theory of Acceptance and Use of
Technology 2 (UTAUT2) model. Confirmatory factor analysis revealed that UTAUT2 provided a suitable model to describe preservice teachers' perceptions of IVR on all dimensions (performance expectancy, effort expectancy, social influence,
facilitating conditions, hedonic motivation, price value, habit and behavioural intention), with hedonic motivation receiving the highest scores and habit scoring the lowest. Interview responses revealed the reasons for the substantial
variation in preservice teacher perceptions, which depended on a range of external- ("first-order"), internal- ("second-order") and design ("third-order")-related issues. Implications for schools, educational leaders and teacher
education are discussed. Author abstract
It is important to find better treatments for diabetic nephropathy (DN), a debilitating renal complication. Targeting early features of DN, including renal extracellular matrix accumulation (ECM) and ...glomerular hypertrophy, can prevent disease progression. Here we show that a megacluster of nearly 40 microRNAs and their host long non-coding RNA transcript (lnc-MGC) are coordinately increased in the glomeruli of mouse models of DN, and mesangial cells treated with transforming growth factor-β1 (TGF- β1) or high glucose. Lnc-MGC is regulated by an endoplasmic reticulum (ER) stress-related transcription factor, CHOP. Cluster microRNAs and lnc-MGC are decreased in diabetic Chop
mice that showed protection from DN. Target genes of megacluster microRNAs have functions related to protein synthesis and ER stress. A chemically modified oligonucleotide targeting lnc-MGC inhibits cluster microRNAs, glomerular ECM and hypertrophy in diabetic mice. Relevance to human DN is also demonstrated. These results demonstrate the translational implications of targeting lnc-MGC for controlling DN progression.
There are a large variety of methodologies, contexts and perspectives that have been used to evaluate the use of technology in education. The vast array of literature involving learning technology ...evaluation makes it challenging to acquire an accurate sense of the different aspects of learning that are evaluated, and the possible approaches that can be used to evaluate them. This study conducted a systematic review of how technology use in education has been evaluated, based on 365 papers published in Computers and Education between 2015 and 2017. The papers analyzed encompassed a diverse range of education levels, disciplines and technologies, that were broadly commensurate with characterizations of the learning technology field from other studies. The analysis found that the evaluation of learning technology use tended to focus on eight themes: learning outcomes, affective elements, behaviors, design, technology elements, pedagogy, presence, and institutional environment. In the majority of studies (66.6%) at least one established instrument was used to evaluate the effectiveness of learning technology usage, however, a wide variety of instruments were observed within sub-themes of evaluation. The 22 instruments used to evaluate an aspect of learning technology usage in more than one study are identified. Evaluation trends for different disciplines, technologies and educational levels are also established. The findings provide an analytical framework that educators and researchers can utilize when evaluating the use of technology in education, and could potentially inform the development of new, more holistic and more robust evaluation methods.
•Eight foci of learning technology evaluations emerged from a systematic review.•The main foci were learning outcomes, affective elements, behaviors and design.•Of the 365 papers analyzed, 66.6% used at least one instrument from a prior study.•The 22 instruments used in multiple studies to evaluate sub-categories are reported.•The results assist learning technology evaluation and characterize the field.
Sarcopenia and frailty in decompensated cirrhosis Tandon, Puneeta; Montano-Loza, Aldo J.; Lai, Jennifer C. ...
Journal of hepatology,
July 2021, 2021-07-00, 20210701, Letnik:
75, Številka:
Suppl 1
Journal Article
Recenzirano
Odprti dostop
In patients with decompensated cirrhosis, sarcopenia and frailty are prevalent. Although several definitions exist for these terms, in the field of hepatology, sarcopenia has commonly been defined as ...loss of muscle mass, and frailty has been broadly defined as the phenotypic manifestation of the loss of muscle function. Prompt recognition and accurate assessment of these conditions are critical as they are both strongly associated with morbidity, mortality, poor quality of life and worse post-liver transplant outcomes in patients with cirrhosis. In this review, we describe the complex pathophysiology that underlies the clinical phenotypes of sarcopenia and frailty, their association with decompensation, and provide an overview of tools to assess these conditions in patients with cirrhosis. When available, we highlight data focusing on patients with acutely decompensated cirrhosis, such as inpatients, as this is an area of unmet clinical need. Finally, we discuss management strategies to reverse and/or prevent the development of sarcopenia and frailty, which include adequate nutritional intake of calories and protein, as well as regular exercise of at least moderate intensity, with a mix of aerobic and resistance training. Key knowledge gaps in our understanding of sarcopenia and frailty in decompensated cirrhosis remain, including best methods to measure muscle mass and function in the inpatient setting, racial/ethnic variation in the development and presentation of sarcopenia and frailty, and optimal clinical metrics to assess response to therapeutic interventions that translate into a reduction in adverse outcomes associated with these conditions.
Because the educational technology research literature is so broad, it is difficult for researchers to acquire an accurate sense of the issues and trends across the entire field. There has not been ...any recent effort to synthesize or critically analyse the systematic reviews in the area of educational technology. This study analysed 73 systematic literature reviews, including meta‐analyses, focused on the evaluation of technology in educational contexts, in order to holistically understand the impact of learning technology use across different aspects of evaluation. Among these reviews, the most common theme examined was learning outcomes (89%), followed by affective elements (45%), behaviours (25%), technological elements (21%) and teaching/pedagogical aspects (19%). Most of the reviews found that the use of technology improved learning outcomes and affective perceptions. Approaches involving interaction, gamification, constructivism, student‐centred learning and feedback were most effective. The analysis highlighted the need for more reviews focusing on multiple aspects of learning technology evaluation, on school level education and on the use of technology in naturalistic (non‐interventional) settings. Critical reflections are also cast on the methods used to conduct systematic reviews in the educational technology field.
Lay Description
What is already known about this topic
Systematic literature reviews are often used to understand trends in specific areas of educational technology research and evaluation.
There has not been any recent effort to synthesis or critically analyse the reviews in areas of educational technology research.
What this paper adds
A critical analysis of 73 systematic reviews to understand trends in learning technology evaluation.
Technology use consistently improves outcomes across reviews of different learning domains, technologies, and levels.
Approaches involving interaction, gamification, constructivism, student‐centred learning and feedback were most effective.
The majority of systematic reviews did not evaluate the quality of the primary papers which they examined.
Implications of study findings for practitioners
Educators should preference approaches that are constructivist, social, gamified, student‐centred and involving feedback.
Educators should strive to evaluate the quality of the papers they review as well as multiple aspects of learning.
The more detailed findings of this paper will enable educators to adopt a more nuanced approach to their practice.
Women with cirrhosis awaiting liver transplantation (LT) experience higher rates of waitlist mortality than men; it is unknown whether practices surrounding delisting for being “too sick” for LT ...contribute to this disparity beyond death alone. We conducted an analysis of patients listed for LT in the United Network for Organ Sharing/Organ Procurement and Transplantation Network not receiving exception points from May 1, 2007 to July 1, 2014 with a primary outcome of delisting with removal codes of “too sick” or “medically unsuitable.” A total of 44 388 patients were included; 4458 were delisted for being “too sick” for LT. Delisting was more frequent in women (11% vs 9%, P < .001). Compared to delisted men, delisted women differed in age (58 vs 57), non–hepatitis C virus listing diagnoses (69% vs 56%), hepatic encephalopathy (36% vs 31%), height (161.9 vs 177.0 cm), private insurance (47% vs 52%), and Karnofsky performance status (60 vs 70) (P < .001 for all). There were no differences in Model for End‐Stage Liver Disease including serum sodium and Child Pugh Scores. A competing risk analysis demonstrated that female sex was independently associated with a 10% (confidence interval 2%‐18%) higher risk of delisting when accounting for rates of death and transplantation and adjusting for confounders. This study demonstrates a significant disparity in delisting practices by sex, highlighting the need for better assessments of sickness, particularly in women.
In this analysis of all waitlist candidates in the United States from 2007 to 2014, the investigators demonstrate significant disparities in delisting practices by sex, highlighting the need for better assessments of sickness, particularly in women.
AIM To investigate the impact of physical frailty on risk of hospitalisation in cirrhotic patients on the liver transplant waitlist.METHODS Cirrhotics listed for liver transplantation at a single ...centre underwent frailty assessments using the Fried Frailty Index, consisting of grip strength, gait speed, exhaustion, weight loss, and physical activity. Clinical and biochemical data including MELD score as collected at the time of assessment. The primary outcome was number of hospitalised days per year; secondary outcomes included incidence of infection. Univariable and multivariable analysis was performed using negative binomial regression to associate baseline parameters including frailty with clinical outcomes and estimated incidence rate ratios(IRR). RESULTS Of 587 cirrhotics, 64% were male, median age(interquartile range) was 60(53-64) years and MELD score was 15(12-18). Median Fried Frailty Index was 2(1-3); 31.6% were classified as frail(fried frailty ≥ 3). During 12 mo of follow-up, 43% required at least 1hospitalisation; 38% of which involved major infection.107/184(58%) frail and 142/399(36%) non-frail patients were hospitalised at least once(P < 0.001). In univariable analysis, Fried Frailty Index was associated with total hospitalisation days per year(IRR = 1.51,95%CI: 1.28-1.77; P ≤ 0.001), which remained significant on multivariable analysis after adjustment for MELD, albumin, and gender(IRR for frailty of 1.21,95%CI: 1.02-1.44; P = 0.03). Incidence of infection was not influenced by frailty.CONCLUSION In cirrhotics on the liver transplant waitlist, physical frailty is a significant predictor of hospitalisation and total hospitalised days per year, independent of liver disease severity.
Cirrhosis is characterized by sarcopenia and malnutrition, leading to progressive functional decline. We aimed to objectively measure functional decline in patients with cirrhosis awaiting liver ...transplantation and its association with waiting list mortality. Consecutive adults listed for liver transplantation with laboratory Model for End‐Stage Liver Disease (MELD) ≥12 at a single center underwent functional status assessments at every outpatient visit using the Short Physical Performance Battery (0 = impaired to 12 = robust), consisting of gait, chair stands, and balance tests. Joint linear time‐to‐event analyses modeled the simultaneous impact of the longitudinal trajectory of physical function on waiting list mortality (=death or delisted for being too sick for liver transplantation). Included were 309 liver transplantation candidates. Median laboratory MELD was 15, serum albumin was 3.0 g/dL, 28% had ascites, 18% had hepatic encephalopathy, and 83% were Child class B or C. At a median follow‐up of 14 months, 15% died or were delisted and 28% underwent liver transplantation. Average physical function worsened per 3 months on the waiting list: −0.38 kg in grip strength, −0.05 meters/second in gait, 0.03 seconds in chair stands, and −0.16 Short Physical Performance Battery points. In joint models of longitudinal trajectories of physical function and waiting list mortality adjusted for MELD‐Na, albumin, hepatocellular carcinoma, and baseline physical function, the longitudinal trajectories of each physical function measure were significantly associated with waiting list mortality: grip (hazard ratio = 0.89, 95% confidence interval 0.83‐0.95), gait (hazard ratio = 0.72, 95% confidence interval 0.62‐0.84), chair stands (hazard ratio = 1.17, 95% confidence interval 1.09‐1.25), and Short Physical Performance Battery <10 (hazard ratio = 1.45, 95% confidence interval 1.15‐2.20). Conclusion: Liver transplantation candidates experience significant functional decline on the waiting list, despite modest wait time and low baseline MELD; decline in physical function is associated with an increased risk of death or delisting, independent of liver disease severity. (Hepatology 2016;63:574–580)
Colibactin is an assumed human gut bacterial genotoxin, whose biosynthesis is linked to the clb genomic island that has a widespread distribution in pathogenic and commensal human enterobacteria. ...Colibactin-producing gut microbes promote colon tumour formation and enhance the progression of colorectal cancer via cellular senescence and death induced by DNA double-strand breaks (DSBs); however, the chemical basis that contributes to the pathogenesis at the molecular level has not been fully characterized. Here, we report the discovery of colibactin-645, a macrocyclic colibactin metabolite that recapitulates the previously assumed genotoxicity and cytotoxicity. Colibactin-645 shows strong DNA DSB activity in vitro and in human cell cultures via a unique copper-mediated oxidative mechanism. We also delineate a complete biosynthetic model for colibactin-645, which highlights a unique fate of the aminomalonate-building monomer in forming the C-terminal 5-hydroxy-4-oxazolecarboxylic acid moiety through the activities of both the polyketide synthase ClbO and the amidase ClbL. This work thus provides a molecular basis for colibactin's DNA DSB activity and facilitates further mechanistic study of colibactin-related colorectal cancer incidence and prevention.
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