24,206 research outputs found
Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study
No full textThe identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135–15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359–5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138–5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184–5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598–9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090–6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286–5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912–7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138–0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143–0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)
Intelligent support for group work in collaborative learning environments
No full textThe delivery of intelligent support for group work is a complex issue in
collaborative learning environments. This particularly pertains to the construction
of effective groups and assessment of collaboration problems. This is because the
composition of groups can be affected by several variables, and various methods
are desirable for ascertaining the existence of different collaboration problems.
Literature has shown that current collaborative learning environments provide
limited or no support for teachers to cope with these tasks. Considering this and the
increasing use of online collaboration, this research aims to explore solutions for
improving the delivery of support for group work in collaborative learning
environments, and thus to simplify how teachers manage collaborative group work.
In this thesis, three aspects were investigated to achieve this goal. The first
aspect emphasises on proposing a novel approach for group formation based on
students‘ learning styles. The novelty and importance of this approach is the
provision of an automatic grouping method that can tailor to individual students‘
characteristics and fit well into the existing collaborative learning environments.
The evaluation activities comprise the development of an add-on tool and an
undergraduate student experiment, which indicate the feasibility and strength of the
proposed approach — being capable of forming diverse groups that tend to perform
more effectively and efficiently than similar groups for conducting group
discussion tasks.
The second focus of this research relates to the identification of major
group collaboration problems and their causes. A nationwide survey was conducted
that reveals a student perspective on the issue, which current literature fails to
adequately address. Based on the findings from the survey, an XML-based
representation was created that provides a unique perspective on the linkages
between the problems and causes identified.
Finally, the focus was then shifted to the proposal of a novel approach for
diagnosing the major collaboration problems identified. The originality and
significance of this approach lies in the provision of various methods for ascertaining the existence of different collaboration problems identified, based on
student interaction data that result from the group work examined. The evaluation
procedure focused on the development of a supporting tool and several
experiments with a test dataset. The results of the evaluation show that the
feasibility and effectiveness are sustained, to a great extent, for the diagnostic
methods addressed.
Besides these main proposals, this research has explored a multi-agent
architecture to unify all the components derived for intelligently managing online
collaborative learning, which suggests an overarching framework providing
context for other parts of this thesis
The influence of socioeconomic inequity and guidelines compliance on clinical outcomes of patients with acute biliary pancreatitis. An international multicentric cohort study
No full textBACKGROUND: There is lack of data on the association between
socioeconomic factors, guidelines compliance and clinical
outcomes among patients with acute biliary pancreatitis (ABP).
METHODS: Post-hoc analysis of the international MANCTRA-1
registry evaluating the impact of regional disparities as
indicated by the Human Development Index (HDI), and guideline
compliance on ABP clinical outcomes. Multivariable logistic
regression models were employed to identify prognostic factors
associated with mortality and readmission. RESULTS: Among 5313
individuals from 151 centres across 42 countries marked
disparities in comorbid conditions, ABP severity, and medical
procedure usage were observed. Patients from lower HDI countries
had higher guideline non-compliance (p < 0.001) and mortality
(5.0\% vs. 3.2\%, p = 0.019) in comparison with very high HDI
countries. On adjusted analysis, ASA score (OR 1.810, p =
0.037), severe ABP (OR 2.735, p < 0.001), infected necrosis (OR
2.225, p = 0.006), organ failure (OR 4.511, p = 0.001) and
guideline non-compliance (OR 2.554, p = 0.002 and OR 2.178, p =
0.015) were associated with increased mortality. HDI was a
critical socio-economic factor affecting both mortality (OR
2.452, p = 0.007) and readmission (OR 1.542, p = 0.046).
CONCLUSION: These data highlight the importance of collaborative
research to characterise challenges and disparities in global
ABP management. Less developed regions with lower HDI scores
showed lower adherence to clinical guidelines and higher rates
of mortality and recurrence
SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study
No full textSARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (>= 7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3-6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly
A Framework for collaborative writing with recording and post-meeting retrieval capabilities
No full textFrom a HCI perspective, elucidating and supporting the context in which collaboration takes place is key to implementing successful collaborative systems. Synchronous collaborative writing usually takes place in contexts involving a “meeting” of some sort. Collaborative writing meetings can be face-to-face or, increasingly, remote Internet-based meetings. The latter presents software developers with the possibility of incorporating multimedia recording and information retrieval capabilities into the collaborative environment. The collaborative writing that ensues can be seen as an activity encompassing asynchronous as well as synchronous aspects. In order for revisions, information retrieval and other forms of post-meeting, asynchronous work to be effectively supported, the synchronous collaborative editor must be able to appropriately detect and record meeting metadata. This paper presents a collaborative editor that supports recording of user actions and explicit metadata production. Design and technical implications of introducing such capabilities are discussed with respect to document segmentation, consistency control, and awareness mechanisms
Exploratory talk within collaborative small groups in mathematics
No full textThis report describes one aspect of a wider research study on exploratory talk within collaborative small groups in secondary mathematics lessons. It outlines students’ views of using collaborative activity to learn mathematics. The fuller research study explores the extent to which exploratory talk occurs in collaborative peer groups in secondary mathematics classrooms
The SvO2 Study: General design and results of the feasibility phase of a multicenter, randomized trial of three different hemodynamic approaches and two monitoring techniques in the treatment of critically ill patients
No full textAlthough the attainment of normal hemodynamic values has always been assumed to be the therapeutic target for critically ill patients, recent studies reported increased values in oxygen transport variables in survivors of high-risk surgery. It has been supposed that the higher values observed in survivors might indicate a physiological compensation for the increased metabolic requirements due to disease. We designed a randomized, multicentric trial to evaluate the effect of high values of cardiac index (CI) and oxygen delivery (DO2) in critically ill patients. Patients enrolled in the study are randomized to three different hemodynamic targets: normal values of CI (2.5 or = 4.5 L min-1 m-2), and mixed venous oxygen saturation (SvO2) > or = 70% or (Sat a--Sat v) < or = 20%. Two different monitoring systems are used to maintain the target: conventional Swan-Ganz catheter with scheduled samples of mixed venous O2 saturation, and optical catheter with continuous SvO2 evaluation. The aim of the study is to answer three questions regarding the hypothesis reported above: (1) Are results in postoperative patients applicable to other pathological groups? (2) Does continuous monitoring of SvO2 provide advantages over conventional hemodynamic monitoring? (3) Is a normal SvO2 rather than a supranormal CI a good and predictable therapeutic goal? We report herein the protocol of the study and the results of the pilot phase, which was conducted in 98 critically ill patients enrolled by 56 participating centers to evaluate the safety and feasibility of the proposed trial
An Exploration of Communication Strategies for Effectively Organizing and Managing Collaborative Grant Writing Groups
No full textThe present research explored approaches to collaborative grant writing, as little is known about the details or range of variation in the processes that are currently deployed by professionals working within this context. Findings were used to build a typology of the roles specific to collaborative grant writing groups, provide a discussion of ideal group composition and leadership, and to identify and suggest ten best practice strategies for organizing and managing group dynamics and tasks during the phases of the collaborative writing process
Investigations of collaborative design environments: A framework for real-time collaborative 3D CAD
No full textThis thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.This research investigates computer-based collaborative design environments, in particular issues of real-time collaborative 3D CAD. The thesis first presents a broad perspective of collaborative design environments with a preliminary case study of team design activities in a conventional and a computer mediated setting. This study identifies the impact and the feasibility of computer support for collaborative design and suggests four kinds of essential technologies for a successful collaborative design environment: information-sharing systems, synchronous and asynchronous co- working tools, project management systems, and communication systems. A new conceptual framework for a real-time collaborative 3D design tool, Shared Stage, is proposed based upon the preliminary study. The Shared Stage is defined as a shared 3D design workspace aiming to smoothly incorporate shared 3D workspaces into existing individual 3D workspaces. The addition of a Shared Stage allows collaborating designers to interact in real-time and to have a dynamic and interactive exchange of intermediate 3D design data. The acceptability of collaborative features is maximised by maintaining consistency of the user interface between 3D CAD systems. The framework is subsequently implemented as a software prototype using a new software development environment, customised by integrating related real-time and 3D graphic software development tools. Two main components of the Shared Stage module in the prototype, the Synchronised Stage View (SSV) and the Data Structure Diagram (DSD), provide essential collaborative features for real-time collaborative 3D CAD. These features include synchronised shared 3D representation, dynamic data exchange and awareness support in 3D workspaces. The software prototype is subsequently evaluated to examine the usefulness and usability. A range of quantitative and qualitative methods is used to evaluate the impact of the Shared Stage. The results, including the analysis of collaborative interactions and user perception, illustrate that the Shared Stage is a feasible and valuable addition for real-time collaborative 3D CAD. This research identifies the issues to be addressed for collaborative design environments and also provides a new framework and development strategy of a novel real-time collaborative 3D CAD system. The framework is successfully demonstrated through prototype implementation and an analytical usability evaluation.Financial support from the Department and from the UK government through the Overseas Research Studentship Awards
Opioid PrEscRiptions and usage After Surgery (OPERAS): protocol for a prospective multicentre observational cohort study of opioid use after surgery
No full textIntroductionPostoperative pain is common and frequently addressed through opioid analgesia. This practice must balance the benefits of achieving adequate pain relief against the harms of adverse effects such as opioid-induced ventilatory impairment and opioid use disorder. This student and trainee-led collaborative study aims to investigate and compare the prescription versus consumption of opioids at 7 days postdischarge after common surgical procedures and their impact on patient-reported outcomes regarding postoperative pain.Methods and analysisThis is a prospective multicentre observational cohort study of surgical patients in Australia, Aotearoa New Zealand and select international sites, conducted by networks of students, trainees and consultants. Consecutive adult patients undergoing common elective and emergency general, orthopaedic, gynaecological and urological surgical procedures are eligible for inclusion, with follow-up 7 days after hospital discharge. The primary outcome will be the proportion of prescribed opioids consumed by patients at 7 days postdischarge. Secondary outcomes will include patient-reported quality of life and satisfaction scores, rate of non-opioid analgesic use, rate of continuing use of opioids at follow-up, rates of opioid prescription from other sources and hospital readmissions at 7 days postdischarge for opioid related side-effects or surgery-related pain. Descriptive and multivariate analyses will be conducted to investigate factors associated with opioid requirements and prescription-consumption discrepancies.Ethics and disseminationOPERAS has been approved in Australia by the Hunter New England Human Research Ethics Committee (Protocol 2021/ETH11508) and by the Southern Health and Disability Ethics Committee (2021 EXP 11199) in Aotearoa New Zealand. Results will be submitted for conference presentation and peer-reviewed publication. Centre-level data will be distributed to participating sites for internal audit
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