With more programmes being taught through English in non-Anglophone contexts, higher education lecturers are faced with new challenges. This article briefly presents a professional development ...initiative carried out at departmental level as an intervention for all English Medium Instruction lecturers. In order to assess the effect of such an intervention, a mix of different data sets are used, moving from self-assessment by participants to observations of individual teaching practices in the classrooms. It is shown how corroboration of surveys and observation reports in an explicit feedback template can be used to evidence the value of the intervention in context.
The cinchona-alkaloid-catalyzed cycloaddition reactions of 2-cyclohexenone with tropone and various heptafulvenes give 8+2 or 4+2 cycloadducts, depending on the substituents present on the ...heptafulvene. We report the results of new experiments with heptafulvenes, containing diester and barbiturate substituents, which in combination with computational studies were performed to elucidate the factors controlling 8+2 vs 4+2 cycloaddition pathways, including chemo-, regio-, and stereoselectivities of these higher-order cycloadditions. The protonated cinchona alkaloid primary amine catalyst reacts with 2-cyclohexenone to form a linear dienamine intermediate that subsequently undergoes a stepwise 8+2 or 4+2 cycloaddition. Both tropone and the different heptafulvenes initially form 8+2 cycloadducts. The final product is ultimately decided by the reversibility of the 8+2 cycloaddition and the relative thermal stability of the 4+2 products. The stereoisomeric transition states are distinguished by the steric interactions between the protonated catalyst and tropone/heptafulvenes. The 8+2 cycloaddition of barbiturate-heptafulvene afforded products with an unprecedented trans-fusion of the five- and six-membered rings, while the 8+2 cycloadducts obtained from cyanoester-heptafulvene and diester-heptafulvene were formed with a cis-relationship. The mechanism, thermodynamics, and origins of stereoselectivity were explained through DFT calculations using the ωB97X-D density functional.
Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial.
To bring together a large ...multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management.
A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts prior to voting during a consensus conference.
Online Delphi survey and consensus conference.
The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management.
Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), and 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus).
Overall, 116 statements were included in the Delphi survey. Of these statements, 33 (28%) achieved level 1 consensus and 49 (42%) achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease, and the evolving role of checkpoint inhibitor therapy in metastatic disease.
These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time when further evidence is available to guide our approach.
This report summarises findings from an international, multistakeholder project organised by the EAU and ESMO. In this project, a steering committee identified areas of bladder cancer management where there is currently no good-quality evidence to guide treatment decisions. From this, they developed a series of proposed statements, 71 of which achieved consensus by a large group of experts in the field of bladder cancer. It is anticipated that these statements will provide further guidance to health care professionals and could help improve patient outcomes until a time when good-quality evidence is available.
Children with congenital heart defects (CHDs) have increased risk of cognitive disabilities for reasons not fully understood. Previous studies have indicated signs of disrupted fetal brain growth ...from mid-gestation measured with ultrasound and magnetic resonance imaging (MRI) and infants with CHDs have decreased brain volumes at birth. We measured the total and regional brain volumes of infants with and without CHDs using MRI to investigate, if certain areas of the brain are at particular risk of disrupted growth. MRI brain volumetry analyses were performed on 20 infants; 10 with- (postmenstrual age 39-54 weeks, mean 44 weeks + 5 days) and 10 without CHDs (postmenstrual age 39-52 weeks, mean 43 weeks + 5 days). In six infants with- and eight infants without CHDs grey and white matter were also differentiated. Infants with CHDs had smaller brains (48 ml smaller; 95% CI, 6.1-90; p = 0.03), cerebrums (37.8 ml smaller; 95% CI, 0.8-74.8; p = 0.04), and cerebral grey matter (25.8 ml smaller; 95% CI, 3.5-48; p = 0.03) than infants without CHD. Brain volume differences observed within weeks after birth in children with CHDs confirm that the brain impact, which increase the risk of cognitive disabilities, may begin during pregnancy.
The importance and awareness of accurate online water quality measurements increase every year in the oil and gas sector, whether it is for reducing oil discharge, preparing produced water for ...reinjection, or improving operational performance. For online measurement techniques to yield valuable analytical information, an understanding of their outputs must be established. Produced water reinjection has gained increasing attention in the last decade, as it can minimize negative environmental impacts by reducing oil discharge and has the potential to extend the economic life of reservoirs. To increase the amount of produced water that can be reinjected, the water must be maintained at a sufficient quality to prevent unintended formation damage. This review paper thoroughly describes different water quality issues related to suspended solids that can occur in an injection water treatment system and how the issues are often interlinked. A case study of measuring the total suspended solids concentration of seawater sampled from the Danish sector of the North Sea has been carried out to effectively quantify water quality in an injection water treatment facility. Furthermore, numerous on- and in-line techniques have been evaluated as candidates for measuring suspended solids. The last part of the paper discusses considerations regarding future microscopy analyzers based on five promising online microscopy technologies.
Advanced life support courses have a clear educational impact; however, it is important to determine whether participation of one or more members of the resuscitation team in an accredited advanced ...life support course improves in-hospital cardiac arrest patient survival outcomes.
We searched EMBASE.com, Medline, Cochrane and CINAHL from inception to 1 November 2022. Included studies were randomised or non-randomised interventional studies assessing the impact of attendance at accredited life support courses on patient outcomes. Accredited life support courses were classified into 3 contexts: Advanced Life Support (ALS), Neonatal Resuscitation Training (NRT), and Helping Babies Breathe (HBB). Existing systematic reviews were identified for each of the contexts and an adolopment process was pursued. Appropriate risk of bias assessment tools were used across all outcomes. When meta-analysis was appropriate a random-effects model was used to produce a summary of effect sizes for each outcome.
Of 2714 citations screened, 19 studies (1 ALS; 7 NRT; 11 HBB) were eligible for inclusion. Three systematic reviews which satisfied AMSTAR-2 criteria for methodological quality, included 16 of the studies we identified in our search. Among adult patients all outcomes including return of spontaneous circulation, survival to discharge and survival to 30 days were consistently better with accredited ALS training. Among neonatal patients there were reductions in stillbirths and early neonatal mortality.
These results support the recommendation that accredited advanced life support courses, specifically Advanced Life Support, Neonatal Resuscitation Training, and Helping Babies Breathe improve patient outcomes.
The aim of this study was to systematically review the performance of deep learning technology in detecting and classifying pulmonary nodules on computed tomography (CT) scans that were not from the ...Lung Image Database Consortium and Image Database Resource Initiative (LIDC-IDRI) database. Furthermore, we explored the difference in performance when the deep learning technology was applied to test datasets different from the training datasets. Only peer-reviewed, original research articles utilizing deep learning technology were included in this study, and only results from testing on datasets other than the LIDC-IDRI were included. We searched a total of six databases: EMBASE, PubMed, Cochrane Library, the Institute of Electrical and Electronics Engineers, Inc. (IEEE), Scopus, and Web of Science. This resulted in 1782 studies after duplicates were removed, and a total of 26 studies were included in this systematic review. Three studies explored the performance of pulmonary nodule detection only, 16 studies explored the performance of pulmonary nodule classification only, and 7 studies had reports of both pulmonary nodule detection and classification. Three different deep learning architectures were mentioned amongst the included studies: convolutional neural network (CNN), massive training artificial neural network (MTANN), and deep stacked denoising autoencoder extreme learning machine (SDAE-ELM). The studies reached a classification accuracy between 68-99.6% and a detection accuracy between 80.6-94%. Performance of deep learning technology in studies using different test and training datasets was comparable to studies using same type of test and training datasets. In conclusion, deep learning was able to achieve high levels of accuracy, sensitivity, and/or specificity in detecting and/or classifying nodules when applied to pulmonary CT scans not from the LIDC-IDRI database.
This paper offers a new and closer look into the strength anisotropy of concrete by presenting the so far largest experimental programme (290 tests) and by presenting an advanced statistical analysis ...of the results. The experimental investigation sheds light on the influence of several important design parameters and conditions on the anisotropy. This includes the influence of reinforcement, w/c-ratio, curing time, load history and structural geometry. For this purpose, cores were drilled out at different angles from beam- and slab specimens for compressive testing. The main findings include: a) the reference cylinder strength (i.e. w/c-ratio) does not have a significant influence on the anisotropy when the anisotropy is quantified as an absolute difference between the strength of cores drilled in the two directions; b) the anisotropy in structural members without load history is <5 MPa; c) the anisotropy amounts to 5–10 MPa for members with load history.
Seasonal and annual dynamics of the zooplankton community in lakes are affected by changes in abiotic drivers, trophic interactions (e.g., changes in phytoplankton and fish communities and ...abundances) and habitat characteristics (e.g. macrophyte abundance and composition). However, little is known about the temporal responses of the zooplankton community to abiotic and biotic drivers across lakes at the regional scale. Using a comprehensive 20-year dataset from 20 Danish lakes in recovery from eutrophication, we assessed the seasonal and annual trends in the spatial heterogeneity of zooplankton community across lakes and related it to abiotic and biotic drivers. We found significant seasonality and inter-annual decreases in spatial zooplankton heterogeneity in both shallow and deep lakes, with the decrease in the spatial turnover dominating the temporal dynamics of the beta diversity. For the inter-annual changes, decreased spatial heterogeneity of phytoplankton, macrophytes and fish were important biotic drivers at the regional scale. Using a series of ordinary least squares regressions and model selection with model averaging approaches, we revealed that both local (e.g., total phosphorus, total nitrogen, pH, Secchi depth, alkalinity, Schmidt stability, water temperature) and regional drivers (e.g., air temperature, solar irradiance) were important variables influencing the spatial zooplankton heterogeneity, although the directions depended on the beta diversity measures and water depth. Our results highlight an important role of bottom-up forces through phytoplankton community as well as macrophytes and top-down forces via fishes in driving the temporal changes in zooplankton community composition patterns at the regional scale.
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•Temporal trends in spatial zooplankton heterogeneity across lakes are quantified.•Heterogeneity of zooplankton exhibits strong seasonality.•Spatial turnover dominate the temporal dynamic of zooplankton beta diversity.•Restoration measures cause spatial homogenisation of macrophyte, fish and plankton.•Bottom-up, top-down forces and macrophytes drive spatial zooplankton heterogeneity.
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