Do MOOCs encourage corporate social responsibility or are they simply a marketing opportunity?

This paper explores institutional drivers for developing MOOCs by juxtaposing them against the original drivers for generating MOOCs: to offer open access education. However, the original impetus for MOOC development may be shifting towards a business oriented model. Therefore, instead of contributing to corporate social responsibility and inclusivity agendas facilitating open access to education, MOOCs are akin to an institution's shop window allowing the pseudo 'purchaser' the opportunity to glimpse behind the scenes. Hence, we ask: are MOOCs merely a sophisticated form of window dressing, showing pseudo 'purchasers' what institutions want them to see enticing them to purchase more lucrative products? Notwithstanding the motivation for developing MOOCs participants must first access them. Therefore the paper examines what MOOCs actually offer participants who are likely to access them and concludes by examining how MOOCs can be developed to facilitate better completion rates and encourage wider participation from hard to access groups.

Changes in benthic community structure and sediment characteristics after natural recolonisation of the seagrass Zostera muelleri.

Macrofauna are important contributors to estuarine ecosystem services within and outside of seagrass beds. Here we documented the natural recolonisation of a temperate seagrass (Zostera muelleri) community over 15 years in an urban estuary (Waitemata Harbour, North Island, New Zealand). We also investigated the change in macrofaunal communities in relation to seagrass cover over time, from transition from bare sandflat to seagrass. Colonisation by seagrass was associated with an increase in macrofaunal species diversity (from an average of 32 species per core in 2001 to 46 species per core in 2015) and abundance (from 482 to 2273 individuals per core), as well as an increase in sediment mud (from 4.09% to 12.37%) and organic matter content (from 0.90% to 1.41%). The most abundant species within both seagrass and adjacent unvegetated sandflat were similar, the polychaetes Heteromastus filiformis, Aricidea sp., and Prionospio aucklandica, and the amphipod Paracalliope novizealandiae. The difference in macrofaunal community structure between seagrass and unvegetated sandflat was primarily associated with higher abundance of P. novizealandiae and lower abundance of Pseudopolydora sp. in seagrass. A successional effect was observed in macrofaunal communities over the 15 years following seagrass expansion, primarily associated with an increase in the abundance of Aricidea sp., H. filiformis, and P. novizealandiae, and a reduction in the abundance of the bivalve Linucula hartvigiana. This study is the first to document long-term changes in seagrass and their associated communities during a natural recolonisation event, providing insight into timeframes required both for the regrowth of a seagrass meadow from initial colonisation of individual patches, as well as the trajectories and timeframes of change from a sandflat to a seagrass-associated macrofaunal community. This research enhances our understanding of how changes in seagrass distributions due to seagrass loss or restoration may affect macrofaunal community composition and ultimately ecosystem function.

Medical device classification: focus on vascular access.

Developments in the medical device industry are driven by a rapidly changing healthcare arena in combination with advances in technological fields such as materials science, bio-engineering and electronics. Subsequently, it is now estimated that over 500 000 different types of medical devices are produced globally. This article aims to give a simple explanation of device classification as it relates to vascular access devices. It aims to provide the reader with information to increase their knowledge and understanding of this topic.

The effect of curing hepatitis C with direct-acting antiviral treatment on endothelial function.

BACKGROUND: Epidemiological data suggest that chronic HCV infection (CHC) is associated with increased cardiovascular risk, but it is unknown if it is associated with endothelial dysfunction. We aimed to assess the effect of antiviral treatment on endothelial function in non-cirrhotic adults with CHC. METHODS: Self-controlled before and after study. All patients had genotype-1 CHC and were treated with 12 weeks of paritaprevir/ritonavir, ombitasvir and dasabuvir (PrOD), with ribavirin added for those with genotype-1a infection. Endothelial function was assessed at three time points before antiviral treatment, at treatment weeks 1, 4, 8 and 12, and 12 weeks after the end of treatment. The main assessment tools were reactive hyperaemia peripheral arterial tonometry (RHPAT) and serum concentrations of angiopoietin-2 (Ang-2) and E-selectin. RESULTS: A total of 16 patients were enrolled. Mean (sd) age was 51.4 (6.9) years and 11 participants (69%) were male. All 16 patients achieved a sustained virological response. The mean (sd) baseline RHPAT index was 2.05 (0.48), and there was no significant change during treatment (mean within-patient change from baseline to end of treatment =-0.23 [0.45]; P= not significant). There was a significant improvement in both mean Ang-2 (baseline 2.44 [0.79] ng/ml, within-patient change -0.60 [0.44]; P<0.001) and E-selectin (baseline 48.7 [21.5] ng/ml, within-patient change -14.4 [13.0]; P<0.001). CONCLUSIONS: Removing HCV viraemia is associated with a significant improvement in endothelial function as measured by serum markers, but not in bedside microvascular reactivity. Chronic HCV viraemia may be associated with endothelial cell dysfunction and therefore long-term cardiovascular risk.

Development of a paediatric short-stay observation and assessment unit.

In recent years children's emergency admissions have risen by 18%. In 2011 a team at a city district general hospital in England recognised that children were being admitted to the general children's ward and often only staying for short periods of time. After a review of the service a plan was put forward for the development of a paediatric short-stay observation and assessment unit. The unit has led to a reduction in ward admissions and offered opportunities for children's nurses to extend their roles in assessment and treatment. This article explores the planning, delivery and audit of this unit and offers an exemplar for other trusts considering a similar change to service delivery.

Interdisciplinary care of a neonate with haemophagocytic lymphohistiocytosis.

Haemophagocytic lymphohistiocytosis (HLH) is a rare condition not commonly observed in neonatal units. It poses a challenge to neonatal staff to source expertise and information when diagnosing and treating patients with this condition. This article uses a case study of a neonate with HLH to analyse interdisciplinary team dynamics in hospital and explore how teams can effectively share knowledge and learn from each other when treating patients with rare and complex conditions.

Real-world efficacy and safety of ritonavir-boosted paritaprevir, ombitasvir, dasabuvir ± ribavirin for hepatitis C genotype 1 - final results of the REV1TAL study.

BACKGROUND: Limited data exist on the outcomes of ritonavir-boosted paritaprevir with ombitasvir and dasabuvir (PrOD) ± ribavirin in a real-world setting. The aim of this study was to compare the efficacy and safety of PrOD-based therapy in hepatitis C genotype 1 patients with and without cirrhosis, and to explore pre-treatment factors predictive of sustained viral response (SVR) and serious adverse events (SAEs) on treatment. METHODS: 451 patients with hepatitis C genotype 1 treated in 20 centres across Australia were included. Baseline demographic, clinical and laboratory information, on-treatment biochemical, virological and haematological indices and details on serious adverse events were collected locally. RESULTS: Cirrhosis was present in 340 patients (75.4%). Overall SVR was 95.1% with no differences in SVR between the cirrhosis and non-cirrhosis groups (94.7% versus 96.4%). SVR in subgenotypes 1a and 1b was 93.1% and 99.2%, respectively. On multivariate analysis, baseline bilirubin level and early treatment cessation predicted SVR. SAEs occurred in 10.9% of patients including hepatic decompensation (2.7%) and hepatocellular carcinoma (1.8%). On multivariate analysis of factors predictive of SAEs in the overall group, Child-Turcotte-Pugh (CTP) B was the only significant factor, while in those with cirrhosis, baseline albumin and creatinine levels were significant. CONCLUSIONS: In this large real-world cohort of HCV genotype 1 subjects, treatment with PrOD was highly effective and similar to clinical trials. Important determinants of reduced SVR include early cessation of therapy and baseline bilirubin concentration. SAEs were not infrequent with CTP B patients being at greatest risk.

Needle-free devices: keeping the system closed.

Health professionals are under increasing pressure to reduce costs while ensuring patient safety. As the number of vascular access devices (VADs) used in health care continues to increase, there is a need to reduce the complications of infection and occlusion associated with them. Needle-free devices (NFDs), also known as needleless connectors, have been available since the early 1990s and the type and variety of these devices has continued to develop. As well as the original aim of NFDs to maintain a closed system and to reduce the risk of needlestick injuries and blood spillage, NFDs are now designed with the aim of improving clinical outcomes by reducing the common complications of infection and catheter occlusion. As there are a number of NFDs available with specific designs, it is imperative that health professionals have an understanding of the different types and functions. This article provides an explanation of NFD design and functions and guidance and information about their benefits, as well as advice on preventing complications associated with their use.

High engagement, high quality: A guiding framework for developing empirically informed asynchronous e-learning programs for health professional educators.

E-learning involves the transfer of skills and knowledge via technology so that learners can access meaningful and authentic educational materials. While learner engagement is important, in the context of healthcare education, pedagogy must not be sacrificed for edu-tainment style instructional design. Consequently, health professional educators need to be competent in the use of current web-based educational technologies so that learners are able to access relevant and engaging e-learning materials without restriction. The increasing popularity of asynchronous e-learning programs developed for use outside of formal education institutions has made this need more relevant. In these contexts, educators must balance design and functionality to deliver relevant, cost-effective, sustainable, and accessible programs that overcome scheduling and geographic barriers for learners. This paper presents 10 guiding design principles and their application in the development of an e-learning program for general practice nurses focused on behavior change. Consideration of these principles will assist educators to develop high quality, pedagogically sound, engaging, and interactive e-learning resources.

Assessment and delivery of treatment for hepatitis C virus infection in an opioid substitution treatment clinic with integrated peer-based support in Newcastle, Australia.

BACKGROUND: Among people who inject drugs (PWID), the prevalence of hepatitis C virus (HCV) infection is high; however HCV treatment uptake remains low. New models of care are needed to address the growing burden of HCV-related disease in PWID and to understand the barriers to assessment and treatment of HCV. This study evaluated assessment and treatment for HCV infection among PWID attending an opioid substitution treatment (OST) clinic with an integrated peer support worker model. METHODS: Clients with a history of IDU and chronic HCV infection, attending the Newcastle Pharmacotherapy Service, Newcastle Australia, were recruited as part of a multisite prospective observational study (the ETHOS Cohort). Additional chart review was conducted for clients not enrolled in the ETHOS Cohort. A peer support worker was introduced to complement and extend services offered by the clinical team. Client contacts and assessments with a nurse and/or peer worker were evaluated, including those who commenced HCV treatment. RESULTS: A total of 1447 clients attended the OST service during February 2009 and June 2014. Of these, 378 (26%) were assessed by a nurse and 242 (17%) by a clinician. HCV treatment was commenced by 20 (5%) participants and 15 (75%) achieved a sustained virological response (SVR). During May 2009 and July 2011, 332 nurse contacts and 726 peer worker contacts were evaluated. The nurse-led contacts were related to HCV treatment (50%) and review of pathology tests (34%), whereas peer worker contacts included discussion about HCV treatment (75%), education, counselling and/or support (53%) and general discussion about HCV infection (59%). CONCLUSION: These data demonstrate that peer support workers facilitate broader discussion about HCV treatment, education and/or support, allowing nurses to focus on HCV-related assessment and treatment. HCV treatment uptake was very low in this cohort, but SVR was high. The integration of peer support workers in treatment programs within OST clinics may address barriers to HCV care, but further studies are needed to assess their impact on assessment and treatment outcomes.

Boceprevir early-access for advanced-fibrosis/cirrhosis in Asia-Pacific hepatitis C virus genotype 1 non-responders/relapsers.

AIM: To examined the efficacy and safety of treatment with boceprevir, PEGylated-interferon and ribavirin (PR) in hepatitis C virus genotype 1 (HCVGT1) PR treatment-failures in Asia. METHODS: The Boceprevir Named-Patient Program provided boceprevir to HCVGT1 PR treatment-failures. Participating physicians were invited to contribute data from their patients: baseline characteristics, on-treatment responses, sustained virological response at week 12 (SVR12), and safety were collected and analysed. Multivariate analysis was performed to determine predictors of response. RESULTS: 150 patients were enrolled from Australia, Malaysia, Singapore and Thailand (Asians = 86, Caucasians = 63). Overall SVR12 was 61% (Asians = 59.3%, Caucasians = 63.5%). SVR12 was higher in relapsers (78%) compared with non-responders (34%). On-treatment responses predicted SVR, with undetectable HCVRNA at week 4, 8 and 12 leading to SVR12s of 100%, 87%, and 82% respectively, and detectable HCVRNA at week 4, 8 and 12, leading to SVR12s of 58%, 22% and 6% respectively. Asian patients were similar to Caucasian patients with regards to on-treatment responses. Patients with cirrhosis (n = 69) also behaved in the same manner with regards to on-treatment responses. Those with the IL28B CC genotype (80%) had higher SVRs than those with the CT/TT (56%) genotype (P = 0.010). Multivariate analysis showed that TW8 and TW12 responses were independent predictors of SVR. Serious adverse events occurred in 18.6%: sepsis (2%), decompensation (2.7%) and blood transfusion (14%). Discontinuations occurred in 30.7%, with 18.6% fulfilling stopping rules. CONCLUSION: Boceprevir can be used successfully in PR treatment failures with a SVR12 > 80% if they have good on-treatment responses; however, discontinuations occurred in 30% because of virological failure or adverse events.

THE ABSENCE OF THYROID DISEASE IN AN AUSTRALIAN HEPATITIS C COHORT TREATED WITH TRIPLE COMBINATION THERAPY: A PARADIGM SHIFT.

OBJECTIVE: To assess the prevalence of thyroid disease in triple combination therapy with interferon (IFN)-α, ribavirin (RBV), and protease inhibitors (boceprevir and telaprevir) for the treatment of chronic hepatitis C virus (HCV) infection in an Australian hepatitis C cohort. Also, to compare with those who received dual RBV and IFN in the past. METHODS: A preliminary, retrospective, and nested case control study of thyroid disease in patients who underwent triple combination therapy for chronic HCV infection compared with dual therapy at a major tertiary referral hospital center. Fifty-nine patients were treated with such therapy at the Hunter New England Area Hepatitis C Treatment Center. Of these, 38 were treated with boceprevir and 21 with telaprevir. All had genotype 1 HCV infection. The main outcome measures included (1) the prevalence of thyroid disease (TD), including hyperthyroidism and hypothyroidism, and (2) thyroid outcome comparison with patients who had received dual therapy. RESULTS: There was no case of TD detected for the entire duration of therapy with triple anti-HCV therapy. There was a significant absence of TD in the protease inhibitor-treated group. CONCLUSION: No case of TD was detected during the treatment of HCV patients with protease inhibitor-based triple therapy. The reasons for this are unclear. Larger studies are necessary to confirm this finding.

The impact of peer-led simulations on student nurses.

BACKGROUND: Simulation within nurse education has been widely accepted as an educational approach. However, this is mainly led by the facilitator with the student maintaining a passive role in the learning. OBJECTIVES: This paper describes a study that was undertaken to analyse the effectiveness of peer-led simulations in the undergraduate nursing programme. DESIGN: A mixed-method approach was used for this study design. SETTINGS: This study took place in a simulation suite within a university in the Midlands. PARTICIPANTS: Twenty four second-year child branch students were purposively selected to take part. METHODS: Students designed and facilitated a simulation based on the care of a critically ill child. Formal assessment of the learning was collected via the use of a structured clinical examination. Students completed an evaluation of their perceived confidence and competence levels. RESULTS: There was 100% pass rate in the assessment of students' clinical competence following the simulation. Thematic analysis of the evaluation highlighted the learning achieved by the students, not only of their clinical skills but also their personal development. CONCLUSIONS: The use of peer-led simulation promotes new learning and is a valuable educational approach.

Thyroid disease in chronic hepatitis C infection treated with combination interferon-α and ribavirin: management strategies and future perspective.

OBJECTIVE: Hepatitis C virus (HCV) infection is one of the major epidemics afflicting young people in both developed and developing countries. The most common endocrine disorder associated with this infection, especially in conjunction with interferon-α (IFN-α)-based therapy, is thyroid disease (TD). This review examines the development of TD before, during, and after the completion of treatment with combination IFN-α and ribavirin (RBV) for chronic HCV infection. We also summarize the current understanding of the natural history of the condition and propose management and follow-up guidelines. METHODS: PubMed was searched up to June 30, 2011 for English-language publications that contained the search terms "hepatitis C virus," "chronic hepatitis C," "HCV," "thyroid disease," "thyroiditis," "autoimmunity," "interferon-alpha," and "ribavirin." Additional publications were identified from the reference lists of identified papers. The included studies were original research publications and included combination IFN-α and RBV use in patients that developed TD. RESULTS: The prevalence of TD before combination IFN-α and RBV therapy ranges from 4.6 to 21.3%; during therapy, 1.1 to 21.3%; and after therapy, 6.7 to 21.3%. The most common TD is thyroiditis. Thyroid function testing (TFT) frequency and diagnostic criteria for various thyroid conditions are not standardized, and many of the existing studies are retrospective. CONCLUSION: Patients undergoing this therapy should be assessed with a standardized protocol to appropriately detect and manage developed TD. Based on the currently available literature, we recommend that patients receiving combination interferon-α and RBV therapy undergo monthly thyrotropin (TSH) level testing.

The reduced predictive value of interleukin 28b gene polymorphisms in a cohort of patients with thyroiditis developed during antiviral therapy for chronic hepatitis C: a preliminary study.

BACKGROUND: Single nucleotide polymorphism in the interleukin28B (IL28B) gene was recently shown to be associated with a significant increase in response to interferon-α and ribavirin treatment in patients with chronic hepatitis C. Similarly, thyroid disease (TD) occurring during treatment confer an improved sustained virologic response (SVR). OBJECTIVES: To determine the role of IL28B genotypes in a cohort of hepatitis C patients who develop TD during treatment and its relationship to SVR. PATIENTS AND METHODS: IL28B gene profiles including rs12979860, rs12980275 and rs 8099917 and their genotypes were determined in a cohort of 23 hepatitis C patients who developed TD during treatment and their relationship to SVR. RESULTS: Out of 23 studies cases, 19 has one or more favorable genotypes, of which 15 (78.9%) achieved SVR. Eleven has all three unfavorable genotypes and yet achieved 72.7 % SVR. The presence of more than one favorable genotype only correctly predicts SVR vs. non- SVR in ~50 % of cases, i.e. by chance. CONCLUSIONS: Despite the small number of subjects, the presence of one or more unfavorable IL28B genotype does not portend a poor SVR prognostic outcome. This suggests that TD in this clinical context may be a critical factor in the achievement of SVR, probably above that of the genetic predisposition.

Isolation and characterization of microsatellites in the lichen Buellia frigida (Physciaceae), an Antarctic endemic.

PREMISE OF THE STUDY: Microsatellite markers were characterized for an Antarctic endemic, Buellia frigida, to investigate population structure and origin of Antarctic lichens. METHODS AND RESULTS: Five primer sets were characterized. All loci were polymorphic with eight to 16 alleles per locus in a sample of 59 lichens. CONCLUSIONS: The microsatellite markers potentially provide insight into population structure and gene flow of B. frigida.

Do medicines OSCEs improve drug administration ability?

AIM: To examine the efficacy of the early introduction of a medicines management 'objective structured clinical examination' (OSCE) into an undergraduate adult nursing students' programme of education and to determine if the acquisition of applied drug/pharmacology knowledge and drug administration of medicines had improved prior to qualification. METHOD: A longitudinal comparative design was selected for this study. A convenience random samples method of three cohorts of adult nursing students (N=90) undertaking a pre-registration nursing programme was used to identify participants. Participants were assessed at the following points during their preparatory educational programmes. Cohort one (N=30) had completed 8 months of their programme, cohort two (N=30) had completed 20 months of their programme and cohort three (N=30) had completed 30 months of education. Students were asked to undertake a drug administration simulated activity (DASA) to generate the data for this study and differences between the students' performance was compared against the criteria of the DASA. RESULTS/FINDINGS: There were statistical differences observed on almost every criteria of the DASA between the three groups of students. Students who had been previously exposed to medicines management OSCEs as an assessment method demonstrated superior medicines management skills and pharmacology knowledge than the control group (group three). CONCLUSION: The authors of this study conclude that early introduction of clinical examinations, namely OSCEs with an integrated approach to pharmacology and medicines management teaching, does facilitate and improve students drug administration and applied pharmacology ability.

Simulated practice--a panacea for health education?

A variety of approaches to teaching and learning are required to encompass the complexity of nursing. Simulated practice involves computer-based simulated environments, human patient simulation and role play, enabling multiple learning objectives to be taught in a realistic clinical environment without harming patients. The Nursing and Midwifery Council recognizes the use of simulated practice and has enabled higher education pre-registration nurse programme providers to incorporate a maximum of 300 hours of simulated practice as part of the 2300-hour practice hours component. However, not all students respond positively to simulated activity, which should be used to augment clinical practice and not replace it. It is important to ensure the quality of the simulation enables the educational experience to be positive for students.