Computer Science Students' Perceptions of Emergency Remote Teaching: An Experience Report

In the first 6 months of 2020, the COVID-19 pandemic forced numerous universities across the globe to quickly transfer all their courses online, a response known as Emergency Remote Teaching. Courses initially designed for face to face delivery had to be quickly adapted to a new online format. In this paper, we study the perception of the transition to remote teaching in a group of computer science students. Despite the advantage given by an average higher computer literacy, the results of this study suggest that students found the transition challenging, especially regarding tasks such as asking questions during video lectures and interacting with instructors. The transition seems to have had a greater impact on students of lower level courses. Differences were found also across race and residence status (but not gender). The initial format of the course was also relevant: students fared better if their course relied on online tools before the transition.

PD-1 suppresses the maintenance of cell couples between cytotoxic T cells and target tumor cells within the tumor

The killing of tumor cells by CD8⁺ T cells is suppressed by the tumor microenvironment, and increased expression of inhibitory receptors, including programmed cell death protein-1 (PD-1), is associated with tumor-mediated suppression of T cells. To find cellular defects triggered by tumor exposure and associated PD-1 signaling, we established an ex vivo imaging approach to investigate the response of antigen-specific, activated effector CD8⁺ tumor-infiltrating lymphocytes (TILs) after interaction with target tumor cells. Although TIL-tumor cell couples readily formed, couple stability deteriorated within minutes. This was associated with impaired F-actin clearing from the center of the cellular interface, reduced Ca²⁺ signaling, increased TIL locomotion, and impaired tumor cell killing. The interaction of CD8⁺ T lymphocytes with tumor cell spheroids in vitro induced a similar phenotype, supporting a critical role of direct T cell-tumor cell contact. Diminished engagement of PD-1 within the tumor, but not acute ex vivo blockade, partially restored cell couple maintenance and killing. PD-1 thus contributes to the suppression of TIL function by inducing a state of impaired subcellular organization.

SemEHR: A general-purpose semantic search system to surface semantic data from clinical notes for tailored care, trial recruitment, and clinical research

Objective

Unlocking the data contained within both structured and unstructured components of electronic health records (EHRs) has the potential to provide a step change in data available for secondary research use, generation of actionable medical insights, hospital management, and trial recruitment. To achieve this, we implemented SemEHR, an open source semantic search and analytics tool for EHRs.

Methods

SemEHR implements a generic information extraction (IE) and retrieval infrastructure by identifying contextualized mentions of a wide range of biomedical concepts within EHRs. Natural language processing annotations are further assembled at the patient level and extended with EHR-specific knowledge to generate a timeline for each patient. The semantic data are serviced via ontology-based search and analytics interfaces.

Results

SemEHR has been deployed at a number of UK hospitals, including the Clinical Record Interactive Search, an anonymized replica of the EHR of the UK South London and Maudsley National Health Service Foundation Trust, one of Europe’s largest providers of mental health services. In 2 Clinical Record Interactive Search–based studies, SemEHR achieved 93% (hepatitis C) and 99% (HIV) F-measure results in identifying true positive patients. At King’s College Hospital in London, as part of the CogStack program (github.com/cogstack), SemEHR is being used to recruit patients into the UK Department of Health 100 000 Genomes Project (genomicsengland.co.uk). The validation study suggests that the tool can validate previously recruited cases and is very fast at searching phenotypes; time for recruitment criteria checking was reduced from days to minutes. Validated on open intensive care EHR data, Medical Information Mart for Intensive Care III, the vital signs extracted by SemEHR can achieve around 97% accuracy.

Conclusion

Results from the multiple case studies demonstrate SemEHR’s efficiency: weeks or months of work can be done within hours or minutes in some cases. SemEHR provides a more comprehensive view of patients, bringing in more and unexpected insight compared to study-oriented bespoke IE systems. SemEHR is open source, available at https://github.com/CogStack/SemEHR.

Analysis of correlation between pediatric asthma exacerbation and exposure to pollutant mixtures with association rule mining

OBJECTIVES

Traditional studies on effects of outdoor pollution on asthma have been criticized for questionable statistical validity and inefficacy in exploring the effects of multiple air pollutants, alone and in combination. Association rule mining (ARM), a method easily interpretable and suitable for the analysis of the effects of multiple exposures, could be of use, but the traditional interest metrics of support and confidence need to be substituted with metrics that focus on risk variations caused by different exposures.

METHODS

We present an ARM-based methodology that produces rules associated with relevant odds ratios and limits the number of final rules even at very low support levels (0.5%), thanks to post-pruning criteria that limit rule redundancy and control for statistical significance. The methodology has been applied to a case-crossover study to explore the effects of multiple air pollutants on risk of asthma in pediatric subjects.

RESULTS

We identified 27 rules with interesting odds ratio among more than 10,000 having the required support. The only rule including only one chemical is exposure to ozone on the previous day of the reported asthma attack (OR=1.14). 26 combinatory rules highlight the limitations of air quality policies based on single pollutant thresholds and suggest that exposure to mixtures of chemicals is more harmful, with odds ratio as high as 1.54 (associated with the combination day0 SO₂, day0 NO, day0 NO₂, day1 PM).

CONCLUSIONS

The proposed method can be used to analyze risk variations caused by single and multiple exposures. The method is reliable and requires fewer assumptions on the data than parametric approaches. Rules including more than one pollutant highlight interactions that deserve further investigation, while helping to limit the search field.

Neuropsychological benefits of a narrative cognitive training program for people living with dementia: A pilot study

Many areas in the cortex are active during reading of narrative material, and these activations in the brain produce significant changes in connectivity. Following previous results showing cognitive benefits in memory domains of a narrative training program in nursing home patients living with dementia, the aim of the present study was to perform a more in depth investigation of the effects of this training on memory domains and other cognitive areas.

A smart trocar for automatic tool recognition in laparoscopic surgery

BACKGROUND

Operating rooms have become increasingly complex environments and more prone to errors because of loss of situation awareness. Adding computer intelligence to the operating room may help overcome these limitations particularly if the system can automatically track which step of an operation a surgeon is performing. To develop such a platform, it is necessary to track which laparoscopic instruments are being used and in which port they are inserted. This article describes the development and validation of a "Smart Trocar" that can automatically perform this function.

METHODS

A Smart Trocar system prototype was developed that uses a wireless camera attached to a standard laparoscopic port and custom software algorithms. The system recognizes color wheels attached to the handle of a laparoscopic instrument and compares the unique color pattern to an instrument library for proper tool identification. The system was tested for reliability in a box trainer environment using a variety of tool positions and levels of room light illumination.

RESULTS

Correct color classification was achieved in 96.7% of trials. There were no errors in detection of the color wheel in space. In addition, the distance of the color wheel from the camera did not influence results and correct classifications were evenly distributed among the 12 laparoscopic tool positions tested.

CONCLUSION

This work describes a Smart Trocar system that identifies which laparoscopic tool is being used and in which port and proves its reliability. The system is an important element of a more comprehensive program being developed to automatically understand what step of an operation a surgeon is performing and use these data to improve situation awareness in the operating room.

Complications of diagnostic and therapeutic ERCP: a prospective multicenter study

OBJECTIVES

Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP/ES) can be associated with unforeseeable complications, especially when involving postprocedural pancreatitis. The aim of the study was to investigate risk factors for complications of ERCP/ES in a prospective multicentric study.

METHODS

One hundred fifty variables were prospectively collected at time of ERCP/ES and before hospital discharge over 2 years, in consecutive patients undergoing the procedure in nine endoscopic units in the Lombardy region of Italy. More than 150 ERCPs were performed in each center per year by a single operator or by a team of no more than three endoscopists.

RESULTS

Two thousand four hundred sixty-two procedures were performed; 18 patients were discharged because the papilla of Vater was not reached (duodenal obstruction, previous gastrectomy, etc.). Two thousand four hundred forty-four procedures were considered in 2103 patients. Overall complications occurred in 121 patients (4.95% of cases): pancreatitis in 44 patients (1.8%), hemorrhage in 30 (1.13%), cholangitis in 14 (0.57%), perforation during ES in 14 (0.57%), and others in 14 (0.57%); deaths occurred in three patients (0.12%). In multivariate analysis, the following were significant risk factors: a) for pancreatitis, age (< or = 60 yr), use of precutting technique, and failed clearing of biliary stones, and b) for hemorrhage, precut sphincterotomy and obstruction of the orifice of the papilla of Vater.

CONCLUSIONS

The results of our study further contribute to the assessment of risk factors for complications related to ERCP/ES. It is crucial to identify high risk patients to reduce complications of the procedures.

Complications of diagnostic and therapeutic ERCP: a prospective multicenter study

OBJECTIVES

Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP/ES) can be associated with unforeseeable complications, especially when involving postprocedural pancreatitis. The aim of the study was to investigate risk factors for complications of ERCP/ES in a prospective multicentric study.

METHODS

One hundred fifty variables were prospectively collected at time of ERCP/ES and before hospital discharge over 2 years, in consecutive patients undergoing the procedure in nine endoscopic units in the Lombardy region of Italy. More than 150 ERCPs were performed in each center per year by a single operator or by a team of no more than three endoscopists.

RESULTS

Two thousand four hundred sixty-two procedures were performed; 18 patients were discharged because the papilla of Vater was not reached (duodenal obstruction, previous gastrectomy, etc.). Two thousand four hundred forty-four procedures were considered in 2103 patients. Overall complications occurred in 121 patients (4.95% of cases): pancreatitis in 44 patients (1.8%), hemorrhage in 30 (1.13%), cholangitis in 14 (0.57%), perforation during ES in 14 (0.57%), and others in 14 (0.57%); deaths occurred in three patients (0.12%). In multivariate analysis, the following were significant risk factors: a) for pancreatitis, age (< or = 60 yr), use of precutting technique, and failed clearing of biliary stones, and b) for hemorrhage, precut sphincterotomy and obstruction of the orifice of the papilla of Vater.

CONCLUSIONS

The results of our study further contribute to the assessment of risk factors for complications related to ERCP/ES. It is crucial to identify high risk patients to reduce complications of the procedures.

Mycophenolate mofetil (MMF) in the treatment of chronic renal rejection

BACKGROUND

Experimental studies suggest the efficacy of MMF in the treatment of chronic renal rejection in rats. Studies on the efficacy of MMF in chronic renal rejection in man are scarce and controversial.

AIM

The aim of this study was to verify in a prospective non-randomized study the efficacy of MMF given at the dose of 2 g/day in substitution of azathioprine (AZA) in the chronic rejection of cadaveric kidney transplantation.

PATIENTS AND METHODS

Twelve patients with histologically proven chronic renal rejection were enrolled. The patients were 5 males and 7 females. Mean age 38.3 +/- 13.8 years, with a mean duration of transplant of 39 +/- 19 months. Mean serum creatinine values at -6, -3, 0, +3, +6, +12 months were respectively 1.72 +/- 0.33, 1.84 +/- 0.36, 2.15 +/- 0.50, 1.88 +/- 0.54, 1.81 +/- 0.71, 1.73 +/- 0.58 mg/dl. Mean creatinine clearance values were 58.85 +/- 10.06,48.8 +/- 13.3,45.8 +/- 10.2, 54.7 +/- 13.3, 51 +/- 12.7, 57.7 +/- 18.5 ml/min. Mean deltaGFR before MMF was -2.15 ml/month.

RESULTS

After MMF introduction, the overall GFR decrease attenuated. In particular in seven patients after MMF administration, we obtained a significant reduction of mean serum creatinine value (1.84 +/- 0.55 vs. 1.38 +/- 0.41mg/dl; p = 0.004). In three patients, we obtained a stabilization in GFR. Two patients were slowly progressing even after MMF introduction. After a switch to MMF in almost all patients, we obtained an improvement of renal function. In three patients, we obtained a stabilization of renal function without regression. In particular, seven patients showed a remarkable improvement of renal function.

CONCLUSIONS

In conclusion our data even if concerning a small number of patients, confirm the efficacy of MMF in the treatment of renal allograft chronic dysfunction.

Universal precautions and dedicated machines as cheap and effective measures to control HCV spread

Haemodialysis patients are at great risk for HCV infection, and a strict relationship is clear between anti-HCV positivity and dialysis age or hospital dialysis, irrespective of previous blood transfusions. Notwithstanding that, the precise root of its nosocomial nontransfusional diffusion among haemodialysis patients is not clear yet. As isolation is a very expensive policy, we evaluated whether simpler measures such as the observance of the Universal Precautions (UP), and the use of anti-HCV positive patient dedicated monitors can stop the diffusion of HCV infection in a hospital haemodialysis centre. Since January 1990 to December 1991 (1st phase), the patients shared the monitors irrespective of their serological status for HCV, and training of the dialysis care staff was not performed with regard to the UP. Since January 1991 to June 1996 (2nd phase), according to the UP, strictly personal dialysis-tools were used for all patients, anti-HCV positive patients were assigned to dedicated monitors in defined (not separated) areas of the dialysis rooms and the dialysis care staff was trained to the strict observance of the UP. In the first phase of the follow-up 5 seroconversions occurred; none occurred in the second one. Our study shows that isolation is not required for such patients. We believe that measures such as the application of UP, dedicated machines and continuous training of the care staff, instead of the isolation of positive patients, result in the same efficacy and are cheaper than isolation of positive patients. Therefore they are mandatory for all haemodialysis centres.

Accelerated (malignant) hypertension: a study of 121 cases between 1974 and 1996

A series of 121 consecutive cases with accelerated hypertension is presented. Forty-seven patients had essential hypertension. This diagnosis was confirmed during the follow-up, which lasted from 3 to 255 months (mean 63.1 +/- 58.1). The relationship between the effects of pharmacological treatment on high blood pressure (BP) and disease course were analyzed in accelerated essential hypertensive patients only, to avoid the imponderable influence of basic disease in secondary hypertension. In most cases, therapeutical effect on BP was monitored by multiple daily BP self-measurements. Since 1974, when this study was initiated, plasma creatinine concentration at admission showed a clear-cut decrease, especially after the introduction in the eighties of new hypotensive drugs. A sustained BP decrease assured a long-lasting preservation of renal function, if the initial functional loss was limited (plasma creatinine concentration of 2 mg/dl (176.8 mumol/l) or less). Renal function was preserved even if the BP decrease was not optimal and signs of relapsing malignant retinopathy were observed in the course of disease. Although the whole series showed a 12-year survival rate of about 69%, patients enrolled after 1980 had a 100% survival rate.

[Acute cholecystitis associated with calculosis of the biliary tract in a high-risk patient. Combined emergency surgical and peroperative endoscopic treatment]

Patient age (over 65), and lithiasis of the common bile duct are two factors which increase the morbidity and mortality rate in emergency surgery for biliary lithiasis. Normally, calculi in the CBD can be cleared by means of supraduodenal or transduodenal access. In both cases, however, complications are frequent in high risk patients. Treatment of gallstones can be modified to achieve a reduction in the morbidity and mortality rate. This study presents an initial survey of 4 elderly patients, presenting with acute gallbladder disease and CBD stones, treated with surgical cholecystectomy and contemporary perioperative endoscopic papillotomy and CBD clearance. The underlying rationale and the good initial results support this combined surgical and endoscopic approach.