Do teaching staff trust stakeholders and tools in learning analytics? A mixed methods study.

Learning analytics (LA) has gained increasing attention for its potential to improve different educational aspects (e.g., students' performance and teaching practice). The existing literature identified some factors that are associated with the adoption of LA in higher education, such as stakeholder engagement and transparency in data use. The broad literature on information systems also emphasizes the importance of trust as a critical predictor of technology adoption. However, the extent to which trust plays a role in the adoption of LA in higher education has not been examined in detail in previous research. To fill this literature gap, we conducted a mixed method (survey and interviews) study aimed to explore how much teaching staff trust LA stakeholders (e.g., higher education institutions or third-parties) and LA technology, as well as the trust factors that could hinder or enable adoption of LA. The findings show that the teaching staff had a high level of trust in the competence of higher education institutions and the usefulness of LA; however, the teaching staff had a low level of trust in third parties that are involved in LA (e.g., external technology vendors) in terms of handling privacy and ethics-related issues. They also had a low level of trust in data accuracy due to issues such as outdated data and lack of data governance. The findings have strategic implications for institutional leaders and third parties in the adoption of LA by providing recommendations to increase trust, such as, improving data accuracy, developing policies for data sharing and ownership, enhancing the consent-seeking process, and establishing data governance guidelines. Therefore, this study contributes to the literature on the adoption of LA in HEIs by integrating trust factors.

Thought Leader Perspectives on the Benefits, Barriers, and Enablers for Routinely Collected Electronic Health Data to Support Professional Development: Qualitative Study.

BACKGROUND: Hospitals routinely collect large amounts of administrative data such as length of stay, 28-day readmissions, and hospital-acquired complications; yet, these data are underused for continuing professional development (CPD). First, these clinical indicators are rarely reviewed outside of existing quality and safety reporting. Second, many medical specialists view their CPD requirements as time-consuming, having minimal impact on practice change and improving patient outcomes. There is an opportunity to build new user interfaces based on these data, designed to support individual and group reflection. Data-informed reflective practice has the potential to generate new insights about performance, bridging the gap between CPD and clinical practice. OBJECTIVE: This study aims to understand why routinely collected administrative data have not yet become widely used to support reflective practice and lifelong learning. METHODS: We conducted semistructured interviews (N=19) with thought leaders from a range of backgrounds, including clinicians, surgeons, chief medical officers, information and communications technology professionals, informaticians, researchers, and leaders from related industries. Interviews were thematically analyzed by 2 independent coders. RESULTS: Respondents identified visibility of outcomes, peer comparison, group reflective discussions, and practice change as potential benefits. The key barriers included legacy technology, distrust with data quality, privacy, data misinterpretation, and team culture. Respondents suggested recruiting local champions for co-design, presenting data for understanding rather than information, coaching by specialty group leaders, and timely reflection linked to CPD as enablers to successful implementation. CONCLUSIONS: Overall, there was consensus among thought leaders, bringing together insights from diverse backgrounds and medical jurisdictions. We found that clinicians are interested in repurposing administrative data for professional development despite concerns with underlying data quality, privacy, legacy technology, and visual presentation. They prefer group reflection led by supportive specialty group leaders, rather than individual reflection. Our findings provide novel insights into the specific benefits, barriers, and benefits of potential reflective practice interfaces based on these data sets. They can inform the design of new models of in-hospital reflection linked to the annual CPD planning-recording-reflection cycle.

Quality Indicators in the Clinical Specialty of Urology: A Systematic Review.

CONTEXT: In health care, monitoring of quality indicators (QIs) in general urology remains underdeveloped in comparison to other clinical specialties. OBJECTIVE: To identify, synthesise, and appraise QIs that monitor in-hospital care for urology patients. EVIDENCE ACQUISITION: This systematic review included peer-reviewed articles identified via Embase, MEDLINE, Web of Science, CINAHL, Global Health, Google Scholar, and grey literature from 2000 to February 19, 2021. The review was carried out under the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines and used the Appraisal of Indicators through Research and Evaluation (AIRE) tool for quality assessment. EVIDENCE SYNTHESIS: A total of 5111 articles and 62 government agencies were screened for QI sets. There were a total of 57 QI sets included for analysis. Most QIs focused on uro-oncology, with prostate, bladder, and testicular cancers the most represented. The most common QIs were surgical QIs in uro-oncology (positive surgical margin, surgical volume), whereas in non-oncology the QIs most frequently reported were for treatment and diagnosis. Out of 61 articles, only four scored a total of ≥50% on the AIRE tool across four domains. Aside from QIs developed in uro-oncology, general urological QIs are underdeveloped and of poor methodological quality and most lack testing for both content validity and reliability. CONCLUSIONS: There is an urgent need for the development of methodologically robust QIs in the clinical specialty of general urology for patients to enable standardised quality of care monitoring and to improve patient outcomes. PATIENT SUMMARY: We investigated a range of quality indicators (QIs) that provide health care professionals with feedback on the quality of their care for patients with general urological diseases. We found that aside from urological cancers, there is a lack of QIs for general urology. Hence, there is an urgent need for the development of robust and disease-specific QIs in general urology.

An exploration into physician and surgeon data sensemaking: a qualitative systematic review using thematic synthesis.

Providing electronic health data to medical practitioners to reflect on their performance can lead to improved clinical performance and quality of care. Understanding the sensemaking process that is enacted when practitioners are presented with such data is vital to ensure an improvement in performance. Thus, the primary objective of this research was to explore physician and surgeon sensemaking when presented with electronic health data associated with their clinical performance. A systematic literature review was conducted to analyse qualitative research that explored physicians and surgeons experiences with electronic health data associated with their clinical performance published between January 2010 and March 2022. Included articles were assessed for quality, thematically synthesised, and discussed from the perspective of sensemaking. The initial search strategy for this review returned 8,829 articles that were screened at title and abstract level. Subsequent screening found 11 articles that met the eligibility criteria and were retained for analyses. Two articles met all of the standards within the chosen quality assessment (Standards for Reporting Qualitative Research, SRQR). Thematic synthesis generated five overarching themes: data communication, performance reflection, infrastructure, data quality, and risks. The confidence of such findings is reported using CERQual (Confidence in the Evidence from Reviews of Qualitative research). The way the data is communicated can impact sensemaking which has implications on what is learned and has impact on future performance. Many factors including data accuracy, validity, infrastructure, culture can also impact sensemaking and have ramifications on future practice. Providing data in order to support performance reflection is not without risks, both behavioural and affective. The latter of which can impact the practitioner's ability to effectively make sense of the data. An important consideration when data is presented with the intent to improve performance.Registration This systematic review was registered with Prospero, registration number: CRD42020197392.

Learning professional touch: an exploration of pre-registration Physiotherapy students' experiences.

Physical touch is considered a core competency in Physiotherapy, central to clinical reasoning and communication. Nevertheless, there is a dearth of research into how the skill is learned and the experiences of students in that process. The aim of this paper is to explore that learning experience among pre-registration physiotherapy students. An approach underpinned by phenomenology and ethnographic methods was undertaken over an 8-month period in one Higher Education Institution in the UK. Data came from a series of observations and focus groups, complemented by personal reflective learning diaries with first- and second-year undergraduate students. Focus group data were analyzed thematically and triangulated with other data sources. Three themes were developed: 1) 'Uncertainty, self-awareness and anxiety' explores the discomfort experienced in the early stages; 2) 'Emerging familiarity and awareness of inter-action' demonstrates developing confidence in bodily capability and communicative capacity; and 3) 'Realities of touch in a clinical environment' focuses on the shift from the pre-clinical to clinical context and highlights the cyclical processes of embodied learning. This study highlights the complexity and immediacy of the embodied learning of touch and its interactions with the development of professional identity. Negotiation of boundaries, both seen and unseen, creates jeopardy in that process through the first two years of the course.

The body-space relations of research(ed) on bodies: The experiences of becoming participant researchers.

This paper heeds calls for reflections on how the research field is defined through embodied socio-spatial presence and immediacy. Focusing on classroom "body-training" observations that were part of a larger qualitative research project, and on the field notes and reflections of three researchers, we explore the transition from observer-researchers to participant-researchers. That is, we explore how, by researching others, we unexpectedly became researched on as our own bodies became instruments in the research process and were used to elicit knowledge on embodied learning, body-mapping and corporeal trace. As a methodological intervention, conducting research through the body, the positioning of bodies and body-to-body interaction, can tell us much about the often ignored embodied and emotional dimensions of the research field. But, in addition, it can elucidate the power relations between, and the fluidity of, researcher and researched positions in the jolting of secured researcher identity. Here we detail how different researchers performed different embodied and emotional subjectivities in different training research spaces. We explore how ontological anxieties of our own placed bodies, based around constructed notions of femininity, religion and researcher professionalism, shape this immediate body-to-body encounter and the subsequent research process.

HIV-1-Related Cardiovascular Disease Is Associated With Chronic Inflammation, Frequent Pericardial Effusions, and Probable Myocardial Edema.

BACKGROUND: Patients with treated HIV infection have clear survival benefits although with increased cardiac morbidity and mortality. Mechanisms of heart disease may be partly related to untreated chronic inflammation. Cardiovascular magnetic resonance imaging allows a comprehensive assessment of myocardial structure, function, and tissue characterization. We investigated, using cardiovascular magnetic resonance, subclinical inflammation and myocardial disease in asymptomatic HIV-infected individuals. METHODS AND RESULTS: Myocardial structure and function were assessed using cardiovascular magnetic resonance at 1.5-T in treated HIV-infected individuals without known cardiovascular disease (n=103; mean age, 45±10 years) compared with healthy controls (n=92; mean age, 44±10 years). Assessments included left ventricular volumes, ejection fraction, strain, regional systolic, diastolic function, native T1 mapping, edema, and gadolinium enhancement. Compared with controls, subjects with HIV infection had 6% lower left ventricular ejection fraction (P<0.001), 7% higher myocardial mass (P=0.02), 29% lower peak diastolic strain rate (P<0.001), 4% higher short-tau inversion recovery values (P=0.02), and higher native T1 values (969 versus 956 ms in controls; P=0.01). Pericardial effusions and myocardial fibrosis were 3 and 4× more common, respectively, in subjects with HIV infection (both P<0.001). CONCLUSIONS: Treated HIV infection is associated with changes in myocardial structure and function in addition to higher rates of subclinical myocardial edema and fibrosis and frequent pericardial effusions. Chronic systemic inflammation in HIV, which involves the myocardium and pericardium, may explain the high rate of myocardial fibrosis and increased cardiac dysfunction in people living with HIV.

Identification of effective subdominant anti-HIV-1 CD8+ T cells within entire post-infection and post-vaccination immune responses.

Defining the components of an HIV immunogen that could induce effective CD8+ T cell responses is critical to vaccine development. We addressed this question by investigating the viral targets of CD8+ T cells that potently inhibit HIV replication in vitro, as this is highly predictive of virus control in vivo. We observed broad and potent ex vivo CD8+ T cell-mediated viral inhibitory activity against a panel of HIV isolates among viremic controllers (VC, viral loads <5000 copies/ml), in contrast to unselected HIV-infected HIV Vaccine trials Network (HVTN) participants. Viral inhibition of clade-matched HIV isolates was strongly correlated with the frequency of CD8+ T cells targeting vulnerable regions within Gag, Pol, Nef and Vif that had been identified in an independent study of nearly 1000 chronically infected individuals. These vulnerable and so-called "beneficial" regions were of low entropy overall, yet several were not predicted by stringent conservation algorithms. Consistent with this, stronger inhibition of clade-matched than mismatched viruses was observed in the majority of subjects, indicating better targeting of clade-specific than conserved epitopes. The magnitude of CD8+ T cell responses to beneficial regions, together with viral entropy and HLA class I genotype, explained up to 59% of the variation in viral inhibitory activity, with magnitude of the T cell response making the strongest unique contribution. However, beneficial regions were infrequently targeted by CD8+ T cells elicited by vaccines encoding full-length HIV proteins, when the latter were administered to healthy volunteers and HIV-positive ART-treated subjects, suggesting that immunodominance hierarchies undermine effective anti-HIV CD8+ T cell responses. Taken together, our data support HIV immunogen design that is based on systematic selection of empirically defined vulnerable regions within the viral proteome, with exclusion of immunodominant decoy epitopes that are irrelevant for HIV control.

HIV is an independent predictor of aortic stiffness.

BACKGROUND: Patients with treated Human Immunodeficiency Virus-1 (HIV) infection are at increased risk of cardiovascular events. Traditionally much of this risk has been attributed to metabolic and anthropometric abnormalities associated with HIV, which are similar to the metabolic syndrome (MS), an established risk factor for cardiovascular mortality. It remains unclear whether treated HIV infection is itself associated with increased risk, via increase vascular stiffness. METHODS: 226 subjects (90 with HIV) were divided into 4 groups based on HIV and MS status: 1) HIV-ve/MS-ve, 2) HIV-ve/MS + ve, 3) HIV + ve/MS-ve and 4)HIV + ve/MS + ve. CMR was used to determine aortic pulse wave velocity (PWV) and regional aortic distensibility (AD). RESULTS: PWV was 11% higher and regional AD up to 14% lower in the HIV + ve/MS-ve group when compared to HIV-ve/MS-ve (p < 0.01 all analyses). PWV and AD in the HIV + ve/MS-ve group was similar to that observed in the HIV-ve/MS + ve group (p > 0.99 all analyses). The HIV + ve/MS + ve group had 32% higher PWV and 30-34% lower AD than the HIV-ve/MS-ve group (all p < 0.001), and 19% higher PWV and up to 31% lower AD than HIV + ve/MS-ve subjects (all p < 0.05). On multivariable regression, age, systolic blood pressure and treated HIV infection were all independent predictors of both PWV and regional AD. CONCLUSION: Across multiple measures, treated HIV infection is associated with increased aortic stiffness and is also an independent predictor of both PWV and regional AD. The magnitude of the effect of treated HIV and MS are similar, with additive detrimental effects on central vascular elasticity.

United Kingdom National Guideline on the Management of Trichomonas vaginalis 2014.

The main objective is to assist practitioners in managing men and women diagnosed withTrichomonas vaginalis(TV) infection. This guideline offers recommendations on the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of TV, covering the management of the initial presentation, as well as how to prevent transmission and future infection.

Comprehensive cardiac magnetic resonance imaging and spectroscopy reveal a high burden of myocardial disease in HIV patients.

BACKGROUND: HIV infection continues to be endemic worldwide. Although treatments are successful, it remains controversial whether patients receiving optimal therapy have structural, functional, or biochemical cardiac abnormalities that may underlie their increased cardiac morbidity and mortality. The purpose of this study was to characterize myocardial abnormalities in a contemporary group of HIV-infected individuals undergoing combination antiretroviral therapy. METHODS AND RESULTS: Volunteers with HIV who were undergoing combination antiretroviral therapy and age-matched control subjects without a history of cardiovascular disease underwent cardiac magnetic resonance imaging and spectroscopy for the determination of cardiac function, myocardial fibrosis, and myocardial lipid content. A total of 129 participants were included in this analysis. Compared with age-matched control subjects (n=39; 30.23%), HIV-infected subjects undergoing combination antiretroviral therapy (n=90; 69.77%) had 47% higher median myocardial lipid levels (P <0.003) and 74% higher median plasma triglyceride levels (both P<0.001). Myocardial fibrosis, predominantly in the basal inferolateral wall of the left ventricle, was observed in 76% of HIV-infected subjects compared with 13% of control subjects (P<0.001). Peak myocardial systolic and diastolic longitudinal strain were also lower in HIV-infected individuals than in control subjects and remained statistically significant after adjustment for available confounders. CONCLUSIONS: Comprehensive cardiac imaging revealed cardiac steatosis, alterations in cardiac function, and a high prevalence of myocardial fibrosis in a contemporary group of asymptomatic HIV-infected subjects undergoing combination antiretroviral therapy. Cardiac steatosis and fibrosis may underlie cardiac dysfunction and increased cardiovascular morbidity and mortality in subjects with HIV.

The means of correct training: embodied regulation in training for body work among mothers.

In the main, the literature on body work has focused on the workplace, overlooking the spaces and places of training for work. Drawing on tutors' understandings of teaching and mothers' varied experiences of training for body work in areas of health, beauty and social care, this paper explores the learning environment as a liminal space. For many mothers, it is a space that sits at the nexus of home, work and leisure and is where the individual moves from student to practitioner/worker. These transitions require gender and maternal identities, among others, to be negotiated and regulated. By conceptualising body work as the interaction between bodies and the (self)disciplining of one's own body, this paper discusses various regulatory processes of learning, from embedding and embodying of 'professional' knowledge and identities to the repressing of cultural norms and behaviour. In so doing, the paper also considers how students struggle with, and occasionally resist and subvert, regulatory norms, imbuing the learning environment with their own meaning and sense of self. With this focus, we highlight the resonance of the body work concept for drawing together a wide range of subject areas, and suggest the closer the work with the body the more urgent the need for regulation of one's own body and the more fine-tuned the embodied discipline.

"Constant Medical Supervision": locating reproductive bodies in Victorian and Edwardian Dundee.

The literature on infant mortality has remained largely detached from the burgeoning literature on the body and embodiment. This paper reconsiders these two literatures in relation to the dynamics of industrialisation, social reform, and struggles over women's bodies in late 19th and early 20th century Dundee. During this period, Dundee was dominated by the jute industry which employed a largely female workforce. This industrial nexus was articulated within a broader environment of social improvement that was preoccupied with population growth and national power. As the need for healthy 'future citizens' became imperative, Dundee's infant mortality rate became a crucial marker in assessing working women's role and care of self. This paper pays specific attention to the strategies of reform that tracked, monitored and disciplined these working women and their 'reproductive' bodies. It focuses on the forms of knowledge and systems of knowledge production that characterised these projects, and how the conjunctures between power and knowledge were grounded in material spatial practices, transforming women's social and physical place in Dundee, and forming an urban geography of 'health reform'.